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ASD Diagnosis Disclosure with Children

By | NESCA Notes 2022

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

All brains are different. Thus, there is no “one way” to disclose a diagnosis of an Autism Spectrum Disorder (ASD) to a child. The when, where, and how of diagnosis disclosure depends on the child and family’s preferences, values, and experiences. In addition, families do not have to feel alone in this process. Many families find it helpful to consult with parent support groups and professionals (e.g., therapist, neuropsychologist, speech and language pathologist, in-home ABA provider) to collaborate and discuss how to best approach diagnosis disclosure based on an individual child’s needs.

In my experience, I have found that disclosing a diagnosis of ASD to a young child is helpful when a child’s support network is integrated and involved in the process. As a family therapist, I see diagnosis disclosure as a family process and a potential to create and develop a conversation for the child and family that does not focus on identification and labeling of deficits but rather a conversation that is focused on understanding how each individual in the family thinks, feels, regulates, and relates to the world. The narratives we tell ourselves influence our well-being, and it is thus very important that children and families have a narrative or story to help guide their personal understanding and meaning of an ASD diagnosis.

Following a neuropsychological evaluation, I often provide child and family feedbacks to children and their caregivers to discuss the diagnosis. These meetings are designed to be “therapeutic feedbacks.” Here are key components of my “therapeutic feedback” sessions for “making meaning” of the diagnosis of ASD which may be helpful for some parents and providers:

  1. Normalize that all family members have unique learning styles and brains. Encourage parents and siblings to share what they know about their own learning styles of strengths and challenges. For example, a caregiver might say, “All brains are different, and I can’t wait to learn about how your brain works, how your sister’s brain works, and how my brain works.”
  2. Create a story about how the child thinks, feels, regulates, and relates to the world. Assist your child in developing a strength-based individualized narrative or story of their diagnosis, a narrative which also validates and acknowledges challenges. This can help the child and family see and understand how strengths can be used to meet challenges. The diagnosis of ASD becomes secondary to the process of describing the child’s perspective and experience – or describing their learning style. This idea stems from narrative therapy – a therapeutic treatment which helps individuals and families “edit and re-author” the stories we tell about ourselves, others, and our environment to increase well-being. It is important to remember that all stories are unique to the child and depend on the child’s experience and learning style. Examples that children and families have developed include, understanding ASD as “superpower,” “awesome awe-sism,” “data brain,” “legomaster,” “detective,” and “Ms. Feel Big.”
  3. Recognize the child as the “expert” of their experience. Many children with ASD experience heightened feelings of “being misunderstood” which can produce stress and significant emotional difficulties. It is thus very important to connect with the child’s own point of view, language, play themes, and description of their experience. Therefore, think developmentally – use play, videos/movies, books, art, or a written/visual outline (e.g., one column of “superpower” strengths and one column of “superpower” challenges). Here is an example of a book, which has been used in therapeutic feedbacks for diagnosis disclosure for some children depending on the child’s learning profile and special interests.
  4. Externalize the challenges that children experience and identify themselves. Do this by separating “problems” from the child. For example, a child I was working with identified that their “superpower” (ASD) makes them “just do it,” which in diagnostic terms reflects “impulsivity.” The family and I talked about “just do it” to create a story in which the child had a “jumpy monkey” (this child loved monkeys). This “jumpy monkey” needed “help” from the child’s “superpower” to “stop and think,” which in clinical terms means developing the child’s “impulse control.” This is a good example of how a child and family identified an ASD strength that could be used to meet a challenge.
  5. Review and revisit the conversation. Keep the conversation open and accessible to the child in every-day life. Practice normalizing and discussing every family member’s story of strengths and challenges at dinnertime, in the car, and during therapies (speech therapy, occupational therapy, psychotherapy, etc.).

These therapeutic feedback tips are just some of many. For an additional list of tips, please visit the University of Washington Autism Center’s Dr. Sarah Woods’ “Tips for Talking to Your Child About Their Autism Diagnosis.”

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Ring in the New Year with SMART Goals

By | NESCA Notes 2022

By: Tabitha Monahan, M.A., CRC
NESCA Transition Specialist/Counselor

Happy New Year! 2021 was another chaotic and challenging year. Many folks have big plans to start the year strong and make hefty goals for their new year resolutions. French writer, Antoine de Saint-Exupéry, wrote: “a goal without a plan is just a wish.” This is true for resolutions, just as it is for any goal. How can we help our young people change their wishes, visions, and dreams into goals? We teach them (and maybe ourselves while we’re at it) how to plan. One of my favorite strategies for both teaching and reaching goals is by creating SMART Goals. What is a Smart Goal?

Specific – The goal should be specific. I’ll increase the distance I run is vague. Will you increase the distance by 20 feet, 2 miles? Are you planning for a marathon? Instead, let’s take a look at step 2, making it measurable.

Measurable – There’s a good chance that if your goal is not specific enough, it will be hard to measure if you have succeeded in that goal. So, let’s make our exercise goal both specific and measurable. I’ll increase the distance I run from 1mile to 3.2 miles (5k).

Attainable – Attainable is the hard one for many students who are still building awareness of their strengths and challenges. Let’s say a person who has never run wants to run in the Boston Marathon. This is likely not an attainable goal, even if it is specific and measurable. While Couch to 5k training exists, I have not personally seen the couch to marathon training program. Having measurable steps also helps break down the goal into smaller pieces, which will be further discussed later.

Relevant – If I am trying to increase my social circle and group leisure skills, running is unlikely to get me there. However, if, like many people, we’re trying to improve our health in 2021 (or take off some of those quarantine pounds), increasing the distance we run certainly will help get us there. Many young adults may need to bounce ideas off someone to ensure the goal is relevant to the area at hand.

Time-bound – Attainable and time-based work tightly together. If you do not give yourself a deadline, the goal may still be there come December 2022. Humans work best with deadlines. We need the motivation to complete a plan, and often motivation needs a sense of urgency.

When students begin working on developing SMART goals, the hardest area for students to understand and develop is creating an ATTAINABLE goal. The goals are often too hefty and need to be broken into much smaller pieces. My clients who are meeting with me in person are greeted by a quote in my office from Dr. Glenn Doyle, offering my favorite way of looking at creating that attainable goal.

When in doubt, set the goal small.

Then chop it in half (½)

Then take the first part of that goal….

Figure out just what you’d need to do

to GET STARTED on it.

THAT’s your NEW GOAL.

~Dr. Glenn Doyle~

(emphasis mine)

Okay, so what does our SMART goal look like for increased health and wellness? I will increase the distance I run from 1 mile to 3.2 miles (5k) in ¼ mile increments by June 30, 2022.

We have all the pieces. It is specific, and we know precisely what the end goal will be and how we will get there. It’s measurable; there is something we can check off as complete, like a to-do list. It’s attainable and seems realistic. We are not trying to run the Boston Marathon course after only running a mile. We will start as a beginning runner and work towards a 5k, and we are not trying to do it tomorrow with no steps in between. It’s relevant; we are working on bettering our health in 2022. And it is time-based. We want to meet our goal by the end of June.

Now that we’ve refreshed our minds on SMART goals, how do we build these skills in transition-aged youth? Ask them. Ask your child, your students, your clients what they want for themselves in education, employment, and independent living. We already have the starting points. We have their vision. We have the IEP TEAM’s goals and objectives.

The youth may have a far-reaching (and maybe seemingly unattainable) goal. Help them break that big goal down into smaller parts and work backward. Do they want to be an engineer? Engineers need a college degree. What does the student need to do to graduate college? They need to get into college. How do they get into college? They need to apply and graduate from high school. What do they need to do to graduate high school? They need to pass their science class. That seems like a reasonable starting place, and it is still related to the vision. What might a SMART goal look like for that student? I will receive a passing grade on my final exam by answering the end of chapter questions each week and asking for clarification from my teacher for any questions I got wrong by the end of the spring semester.

But how do we support them when they aren’t making progress? Many people have a hard time adjusting once they have made a plan. Whenever we set a goal, we need to look at our progress periodically. We need to check that the goal is still attainable by the deadline we gave ourselves. Are we making progress? If we are still running only a mile and it’s March, what adjustments do we need to make? Suppose a student is not finding answering the end of chapter questions helpful in confirming their knowledge of the material. What changes can they make to increase their understanding of the material? Maybe the student asks the teacher if they can work one on one twice a week to increase understanding? Frustration, when the plan doesn’t work, makes many give up on the goal. Learning how to adapt is just as essential as learning how to make a goal.

A person who has practiced SMART goals is a person who will have an increased understanding of the objectives and smaller steps they need to reach their vision. They will have more confidence in their abilities and more awareness of their challenges. A person who has goal-setting skills is a person who has control of their own life. What are your SMART goals for 2022?

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Social Skill Concerns in a Time of Reduced Social Opportunities

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

Even in pre-pandemic times, we saw many children and adolescents where social difficulties were the primary concern. Now, almost two years into the life-altering changes brought on by COVID-19, it is rare that I see a young person whose parents do not raise social concerns. Some common concerns include:

My child does not know how to play with peers.

My child is anxious/fearful around peers.

My child avoids peers and/or would rather play alone.

My child does well with 1-2 peers but cannot handle a group.

My child does not have friends and/or does not seem to know how to make friends.

These are all important, valid concerns. Social development is critical to evaluate and understand when we look at a child’s overall functioning, and early social skills lay an important foundation for later independent functioning, fulfilling interpersonal relationships, and vocational/academic success. Concerns about social presentation (i.e., how your child “looks” or behaves socially) can have many varied causes. Sometimes the cause is clear and relatively straightforward to determine with a neuropsychological evaluation. For example, an evaluation may lead to an autism diagnosis, explaining why a child is struggling socially. Other times, the exact cause is unclear, and probably related to many different factors all coming together. For example, children with ADHD very often present with social challenges, though the path from ADHD to social problems is not always “cut and dry.”

For children coming in to testing now (and over the past 18 months), some of the biggest complicating factors are the social isolation, online learning, and reduced social opportunities related to the pandemic. This is not to say that there are no longer clear cases where a child has autism at the root of their social difficulties – there certainly are. However, for each child now, we must consider the impact that COVID has had on their specific social development. This will depend on the child’s age (and age at the onset of the pandemic), school placement and educational environment, family structure (e.g., siblings and/or other children in the home), and community policies. For example, young children who are attending daycare/private preschool may actually not have missed as much socialization time, as many daycares re-opened after only a few months of closure. This is not to minimize the disruption or extreme challenge of such closures to families; for young children, however, it is likely that their social development is not radically impacted by a few months of reduced social opportunities. In contrast, an elementary-age child may have experienced well over a year of reduced socialization, with remote learning in place for many communities until the fall of 2021.

In all cases, pre-existing and/or co-occurring areas of difficulty are extremely important in our conceptualization of why a child is struggling socially. If your child will have an evaluation soon and you have social concerns, you can prepare by thinking about:

  • What was my child like socially before COVID?
    • Did they have strong friendships? Did they have conflict or “drama” with peers often? Were they invited to playdates and/or birthday parties?
  • What was my child like emotionally before COVID?
    • Happy? Easy-going? Quiet and shy? Sensitive? Irritable?
  • What were the practical, observable things that changed from March 2020 through the present?
    • How much time did they spend doing online learning? Did someone in their family become very ill? Lose a job? How isolated were they?
  • What was my child’s response to the things that happened above?
    • Did they enjoy online learning? Were they fearful about becoming sick? Did they miss spending time with friends or family?
  • What other areas seem to be challenging for them?
    • Communicating? Reading? Managing feelings? Paying attention?

All of these are helpful pieces of information that you can communicate to an evaluator. This will build context for the concerns that you see now, and help us move through the web of complex possibilities that may be contributing to your child’s social challenges. Remember that it is always good to be watchful and thoughtful when your child is struggling. At the same time, keep in mind that many individuals (children, adolescents, and adults alike) will require long periods of time to rebuild their skills, stamina, strength, and sense of safety. It is still OK not to be OK quite yet.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Getting Back in the Swing of Things

By | NESCA Notes 2021

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

The past 22 months have brought more transitions and changes to our daily lives than ever before. Whether children and parents have had to transition from routine school breaks, or to unprecedented remote learning environments, we have all dealt with our fair share of the unexpected since the COVID-19 pandemic began. As we prepare to enter yet another transition with winter break ending (and February break not too far away), these changes in schedule and routine can be difficult adjustments for entire families. Not to mention the seemingly never-ending worries wondering whether virtual learning will resume once again. In order to help ease these times of transition, try utilizing the following tips:

Consider sticking to similar routines when possible. Sleeping in, unusual mealtimes, and later bedtimes are all tempting (and sometimes unavoidable!) when we don’t have our regular school or work routines during breaks and vacations. Try to implement some sort of routine whenever possible if routine is what works best for you and your family. It might mean that you can still sleep in, but mornings start consistently at 7am instead of 5am. Maybe dinner is no longer eaten at 7pm but at 6pm. Whatever the changes may be, consistency is key.

Schedule time for fun! As much as routine and schedules can be important, don’t forget to leave time for enjoyable activities! The holiday season can bring numerous obligations between holiday parties, visiting with family/friends, and previously scheduled extracurricular activities. Take some time to plan preferred family activities as well! After all, a break is supposed to be just that…a break!

Don’t wait to start transitioning back to school day routines until the morning of. Going back to work or school after extended time off can be really challenging. There is often a sense of dread and “Sunday Scaries” that accompany a return back to our daily responsibilities. Don’t wait until the night before or morning of to resume a typical bedtime and wakeup call. Instead, gradually shift the nighttime and early morning routine over a few days so that the night before/morning of doesn’t feel so daunting and overwhelming! By pushing back bedtime and setting the alarm 15 minutes earlier over the course of several days, the difference won’t seem as insurmountable.

Create visual calendars and talk about the transition ahead of time. Creating visuals can be crucial in helping children to prepare for what is to come. For younger children who do not yet have an appropriate conceptualization of time, a visual can be a particularly useful resource in preparing them for what to expect and when. Make reviewing the visual calendar a part of the nighttime or morning routine.

Provide validation and have patience with yourself. No matter how hard we try to prepare, seeing an increase in problematic behaviors, temper tantrums, and emotional outbursts is to be expected throughout times of change. Helpful strategies during times of dysregulation include naming the emotion, validating it, and creating space for safe and appropriate expression. Try using statements such as:

  • Labeling the emotion: “It looks like an earlier bedtime is really frustrating for you.”
  • Validating the feeling: “It’s okay to feel this way.”
  • Normalize the feeling: “Sometimes I feel overwhelmed when I have to do things I don’t like.”
  • Modeling appropriate strategies: “Something that can be helpful for me is deep breathing. Do you want to try and see if this is helpful for you, too?

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

To book an appointment with Dr. Miranda Milana, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Boredom: The Good, the Bad, and the Ugly

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

According to the APA Dictionary of Psychology, boredom is defined as:

A state of weariness or ennui resulting from a lack of engagement with stimuli in the environment. It is generally considered to be one of the least desirable conditions of daily life and is often identified by individuals as a cause of feeling depressed. It can be seen as the opposite of interest and surprise

In an APA podcast called Speaking of Psychology, Erin Westgate, PhD, a psychologist who studies boredom, suggests that boredom is an unpleasant emotion similar to anger, sadness, fear, and pain. In her efforts to understand and define boredom, Dr. Westgate explored the ways in which attention and meaning affect emotions and explain boredom. She opines that boredom may result from one’s inability to sustain attention, which may occur either when a task is too easy or too hard. It may help to understand why students describe a less preferred subject (e.g., math) as boring. Boredom may also be due to a sense that what we are doing lacks meaning. In both instances, the mind wanders and we are faced with that sense of being alone with our thoughts. Dr. Westgate notes that some thoughts are more engaging than others, and there are certain conditions under which people enjoy or do not enjoy their own thoughts. It has become increasingly difficult for people to sit and think, and consequently they search for ways to escape or avoid the boredom that results. However, boredom is not all bad. Like many things in life, it depends on how we manage it.

Similar to other negative emotions, boredom alerts us that something is wrong in our body, and it is human nature to want to escape or avoid it. When escape and avoidance become the only method to cope with boredom, individuals may begin experiencing chronic boredom, which can be detrimental to emotional and physical wellbeing. When boredom becomes chronic, it no longer works as a useful signal. Boredom can be more impactful than loneliness and is often mistaken for loneliness. When boredom is not well managed, it can lead to depression and self-destructive behaviors, such as self-harm and addiction. As alluded to above, the ability to sit with our thoughts and feelings without trying to avoid or escape them has become increasingly difficult. Perhaps related to the ease with which they can be avoided; for example, when our body sends out the first signal of discomfort, we can distract ourselves by reaching for our phone. An article in TIME magazine stated:

We’re trying to swipe and scroll the boredom away, but in doing that, we’re actually making ourselves more prone to boredom, because every time we get our phone out we’re not allowing our mind to wander and to solve our own boredom problems, Mann says, adding that people can become addicted to the constant dopamine hit of new and novel content that phones provide. Our tolerance for boredom just changes completely, and we need more and more to stop being bored.

Relying on electronics is only one example of a way to avoid and escape the discomfort of boredom. It is highly reinforcing because, in the short-term, it works. However, when it is one’s only tool in the toolbox, it may quickly undermine their ability for learning to manage uncomfortable thoughts and feelings and use them for creating positive change. Therefore, it is necessary to find a positive, opposite behavior to replace the maladaptive behavior. This often leads to an increased sense of purpose and agency, and improved self-esteem and self-concept.

Children and adolescents often complain about being bored, and while boredom is uncomfortable, it can also help to develop skills, creativity, and boost self-esteem. Once boredom sets in, it can be difficult for children to shift their attention to find meaning when confronted with the discomfort of boredom. According to an article published by the Child Mind Institute, boredom can be a great way to teach children how to manage frustration and regulate emotions when things are boring or not going their way. It is not that boredom teaches the skills, but rather it is what they do when faced with boredom. There are many strategies outlined in the article to help parents nurture skills when their children are bored. In general, be aware that behaviors may be attention-seeking, and therefore, should not be reinforced. Otherwise, boredom offers an opportunity for children to do something meaningful that benefits them and those around them. When properly managed, it spurs creativity and innovation. Along the way, it is important to be realistic and recognize that there will be failure, and learning to manage the discomfort of failure is an added bonus.

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Assessing Work Motivation and Values

By | NESCA Notes 2021

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

Over the past few months, my colleague Tabitha Monahan and I have dedicated several of our blog entries to vocational assessment as a critical tool for helping students learn about employment and set career goals for themselves. Previous blogs have provided an overview of vocational assessment as well as an in depth look at career interest inventories, vocational aptitude testing, and real-life experiences, such as informational interviews and job shadows. However, there is another type of vocational assessment that we have not yet discussed that can be an invaluable tool for helping students to learn about their “vocational selves” and ultimately choosing occupations that are a good fit—a work motivation or work value assessment.

Work motivations or values are the qualities, principles, or standards that really matter to a person as a worker. Essentially, if you are going to get out of bed every day and go to a job, what are the characteristics that your job needs to have in order for you to feel that going to work is worthwhile? Certainly, money can be an important characteristic of a job, but is that more important to you than helping others, creativity, or recognition? Each of us has a different set of values that will drive us to make choices and take action in our lives, and having an occupation that satisfies those values is just as important as having a job that aligns with our interests and skills.

Similar to career interest inventories, work motivation and value assessments come in many shapes and sizes, some formal (e.g., lengthy and standardized) and some informal (e.g., short checklists or rating scales). Also, similar to career interest inventories, it can be helpful to administer or self-administer more than one of these assessment tools to get a sense of how clear one’s work motivations and values are (i.e., how often an individual responds to assessments with a similar pattern of expressed values). Additionally, it is recommended that students not just take assessments, but that educators and career counselors engage students in qualitative conversations about their results so that students have the opportunity to clarify their values as well as more quantitative exercises, such as comparing work values with career interests.

While there are many different work motivation and value classification systems, I’m choosing to highlight the four work motive categories and eight value constructs from one of my favorite assessment tools, the Work Motivation Scale below.

Fulfillment Motives: The need for work that provides the individual with opportunities to reach their maximum potential. Creativity, curiosity, foresight, and competence are attributes that are often observed in individuals with high fulfillment motives. Fulfillment motives are comprised of the following work value constructs:

  • Success Orientation: Individuals scoring high on this construct are motivated toward accomplishing career goals and reaching their full potential through their work. Passionate about their work, they are willing to endure periods of hardship to be successful.
  • Mission Orientation: Individuals scoring high on this construct are oriented toward seeing the big picture and tend to be less concerned with details. Goal directed, they recognize how their current work fits into and contributes to the overall direction of the organization.

Self-Esteem Motives: The need for achievement, responsibility, and challenging and meaningful work tasks. Links between leadership and achievement are usually present for individuals with high self-esteem motives. Self-esteem motives are comprised of the following work value constructs:

  • Managing Others: Individuals scoring high on this construct value opportunities to direct and supervise the work of others. They willingly take responsibility for worker  performance and the productivity of a work unit, department, or work function.
  • Task Orientation: Individuals scoring high on this construct are oriented toward completing tasks. Planning their work, making the most of resources, and maintaining their focus are important to them. They may hesitate to perform functions outside of those tied to a specific job description.

Affiliation Motives: The need for the acceptance and support of coworkers and supervisors. Cooperation and collaboration toward meeting work goals are sought by individuals with high affiliation motives. Affiliation motives are comprised of the following work value constructs:

  • Supervisor Relations: Individuals scoring high on this construct feel that cooperating with and relating to their supervisor are important. They strive to meet their supervisor’s expectations and highly appreciate their supervisor’s recognition and support.
  • Coworker Relations: Individuals scoring high on this construct feel that relating to peers is important. They prefer to be actively involved in employee related organizations at work and outside of work. They highly value collaboration and teamwork.

Survival and Safety Motives: The need for employment with an adequate livable wage and a safe and secure work environment. The need for favorable benefits packages is also valued by individuals with high survival and safety motives. Survival and safety motives are comprised of the following work value constructs:

  • Working Conditions: Individuals scoring high on this construct believe that a good work environment and creature comforts (climate control, privacy, adequate lighting) are important. They value having the materials, equipment, and resources to do their work effectively and efficiently.
  • Earnings and Benefits: Individuals scoring high on this construct value salary, raises, health insurance plans, pensions, and retirement planning. Vacation, sick leave, personal days, and family leave policy are important considerations in their employment choices as well.

Definitions provided by/taken from the Work Motivation Scale Administrator’s Guide.

Understanding which of these constructs and categories matter most to a student, and a student understanding this about themselves, can have a huge impact on helping a young person to find fulfilling work.

To read more about vocational assessment, check out the following blog entries:

For more information about vocation assessment and transition assessment at NESCA, visit our transition services page and our transition FAQs.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com, call 617-658-9800 or complete our online Intake Form.

A Social Life – What is it Exactly?

By | NESCA Notes 2021

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Many parents want their children to have friends and a social life, yet are concerned about the quality of their child’s social life. They often describe their child’s afterschool hours as being occupied with screen time, which may actually include others. Other children may be engaged in structured activities, such as scouts, sports, school-based clubs (i.e., robotics), music lessons, gaming clubs, and more. Then there are the children that tire easily when around many people and prefer alone time or being around one or two friends. When children are asked if they have friends, they often say yes and that they are online friends. These children who are engaged in structured social activities, online gaming, and other online activities say they have satisfying social lives. So, who’s to judge? A person’s definition of a satisfying social life is for each of us to decide (so long as they are doing so safely and responsibly).

When it comes to defining friends and a social life, there is often a disconnect between a child or teen’s definition and that of their parents. Today, there are so many more ways to have friends, a social life and socialize than there were “when we were kids.” Having a social life is now defined more broadly, such as online friends, gaming friends, the number of followers on Instagram/Twitter, and so much more.

A “virtual friend” or “online friend” is someone who one connects with online. These virtual friends are often very connected to others and can even become BFVs (best friends virtually). In the “old days” before the internet, these friends would have been called “pen pals,” whereby letters were written and exchanged. These pen pals of old sometimes heard all the trials and tribulations of one’s life. Virtual friends (VF) may stay as that – you may or may not ever meet them, which doesn’t diminish the relationship or make it less important and meaningful. IRLs (in real life friends) are people who one connects with in-person or in real-time. Many times, children and teens have better and stronger VFs than IRL friends. And sometimes they do meet up at different events, such as: E3 Expo, PAX, gaming clubs, Comic-Con and many more.

Socializing is different for each of us. How do we respect our children’s personalities and choices regarding socializing while encouraging them to explore more and different friendships and experiences? There are “introverts” and “extroverts” amongst us. Many extroverts love socializing both in real life and virtually and have many friends. They get energized by being around others. They’ll text a friend(s) and invite them over with no plan on what to do other than hang out. They care little about planning, predictability, and are okay going with the flow, handling ambiguity and uncertainty. Introverts are more comfortable with alone time, structure, predictability, clear boundaries, and rules/guidelines when engaging with others. Often times these kids are more comfortable with VFs and the online world with its structured platforms, anonymity, and being able to participate/not participate on their terms. Many of these kids are often the leaders and moderators on virtual platforms – something you may not suspect given their presentation in real-time/real life.

In this new world of online social connection, it is best to not try to force your child into being an “in real life socializer,” and involved in many social activities but instead make sure they have the social skills and knowledge to be successful in the real world of school, work, and community. Be aware of what and whom your children are connecting with online and accept who they are as a person. Trying to force them to be someone they are not may lead to more mental health challenges than them only having VFs or only engaging with IRL friends occasionally or on their terms. A satisfying social life is a personal choice and one that can’t be forced. There are many adults who are happy with one or two IRL friends and have structured activities they participate in (i.e., book club, trivia night, etc.); yet have many more VFs in their online platforms.

There has been much written about introverts in an extroverted world and how trying to force them to be someone they are not can backfire. Being happy with one’s social experiences and friends – whether virtual or in real life – is what it’s all about.

References

https://www.parents.com/kids/development/shy/raising-an-introvert-in-an-extrovert-world/

https://www.pewresearch.org/internet/2015/08/06/chapter-4-social-media-and-friendships/

https://www.pewresearch.org/internet/2018/11/28/teens-friendships-and-online-groups/

 

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Building Skills over the Holidays

By | NESCA Notes 2021

By: Becki Lauzon, M.A., CRC
Transition Specialist and Consultant

The holidays tend to come with more time off for students and families wondering what they can do to keep up with skills and activities. On the plus side, the holidays also lend themselves to activities that typically don’t occur year-round. Below are some helpful suggestions for students and their families to fight boredom and work on building skills:

Learning about different cultures and traditions

Giving back to the community

  • Building a sense of community has always been a big part of transition work with my students. Many communities offer opportunities to give back during the holiday season, such as giving gifts to those who are less fortunate, helping out at a food pantry, serving meals, etc. Using the internet to search for opportunities within your community can be very rewarding during this time of year.

Seasonal work

  • Many places are hiring seasonal employees this time of year. For individuals who are unsure of making a long-term commitment to a job or want to sample something, this can be the perfect time of year for that!

Plan and prepare a meal

Giving gifts

  • If your child needs to purchase gifts for friends or family members, this can be a great opportunity to turn it into a learning opportunity. Start by having them identify the person they are buying for and a few things that the person likes. Next, give your child a budget for the gift and spend some time searching online to identify items they may want to purchase. By preparing in advance, it allows for an easier shopping experience in the store!

Holiday cards/thank you notes

 

About the Author

Becki Lauzon, M.A., CRC, works with teens, young adults and their families out of the Newton, MA and Plainville, MA offices. Lauzon has unparalleled experience as a Transition Specialist, Transition Consultant and Vocational Program Coordinator. Lauzon will be providing transition assessment (including testing, functional evaluations and observations) consultation, case management, training and professional development for schools; and transition planning, consultation and coaching for transition-aged students and their parents.

 

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Career Counseling at NESCA

By | NESCA Notes 2021

By: Tabitha Monahan, M.A., CRC
NESCA Transition Specialist/Counselor

Career Counseling is a fluid process that typically occurs throughout a person’s lifetime. It begins when children are young and learning about different jobs that their family members have and what they see on television. As children get older, more pieces get added to that initial exploration.

What does Career Counseling through NESCA look like? It can be broken down into three distinct categories. Still, students and young adults frequently jump back and forth between the categories several times throughout the process. Today’s blog focuses on discussing these categories in a little more detail.

Who am I?

Each case begins with an initial interview with the client to learn more about them, their interests, goals for the future, and goals they wish to achieve in counseling. Often formal assessment measures are given to discover the client’s areas of interest and aptitude. We will then explore those results and connect them to their stated goal. Sometimes the results align well with the person’s initially stated goal; frequently, this is an eye-opening experience. Depending on the client’s needs and goals, additional formal and informal exploration activities will be completed to allow the client to build further understanding about who they are as a learner, worker, and what motivates them.

Exploration

Career Counseling at NESCA is a data-driven process. Whether the data is from formal or informal measures, the client is guided through and assisted in understanding who they are and how that can connect to a happy and successful career. At this stage, clients will be assisted in exploring careers of interest that they have identified and learn about the careers in more detail, such as learning education requirements, typical job tasks, and how their strengths and areas of challenge will affect their potential success in the identified jobs. Additional skills worked on will include writing resumes and cover letters, interview preparation, and identifying possible reasonable accommodations and disclosure. If appropriate, informational interviews and job shadowing opportunities will be explored.

Moving forward

Once a client has learned the type of work they would like and understands foundational work skills, the next step they will take with the career counselor is to start the job search. In a systematic fashion, clients will be supported in finding available openings, applying for specific jobs, customizing cover letters and resumes for individual jobs, and pre-interview preparation. Additionally, goal setting, time and task management, and other employment success skills are explored during this process.

Continued success

Once a client has successfully been hired for a position, many continue their work with a career counselor. Typically, sessions decrease after a person becomes employed, but it is recommended that follow-up meetings occur at 1-week, 1-month, and 3-months post-employment to check in and problem solve any areas of concern that arise. Clients are encouraged to reach out before these times if an issue occurs to assist in finding a solution before the problem affects their employment.

Who is a good fit for Career Counseling at NESCA?

  • High school students who are not sure of what they want to do after high school and have a hard time developing their vision for their future (whether in creating their IEP vision or in general).
  • High school or college students who do not know what major to pick as they do not know the type of work they want to do after college.
  • Recent college graduates who need support in their job search and interview preparation.
  • Young adults who are looking to figure out their next employment steps or have had difficulty remaining employed once hired.

While the above is a general idea of what a Career Counseling client can expect, each person’s journey through the process is unique. For an in-depth conversation on how Career Counseling at NESCA may support you or your child in meeting their career goals, please fill out our intake form or call our main office at 617.658.9800. Services are currently being offered remotely, with limited in-person services starting this fall.

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Anxiety Reducers for Children and Teens with ASD

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Research indicates that children and teens with Autism Spectrum Disorders (ASD) are more sensitive to heightened physiological sympathetic arousal (the “fight or flight” response), including increased heart rate, breathing rate, feeling “on edge” and body-based tenseness. Heightened physiological arousal is neurologically connected to sensory processing and emotional responses. This is why some children with ASD have “high startle responses” or sensitivities to specific sensations, such as touch or sounds. This is also why some children and teens with ASD are vulnerable to feelings of anxiety, particularly within social situations and settings.

There is growing research focusing on possible strategies and interventions that reduce anxiety and “buffer” the “fight or flight” response that can be activated for many children and teens with ASD.

5 Research-driven Anxiety Reducers:

Animals: Include companion or therapy animals in social groups or social outings (particularly new social events). In one study, children with ASD showed a 43% decrease in skin conductance responses during free play with peers in the presence of animals, as compared to toys (O’Haire, McKenzie, Beck, & Slaughter, 2015).

Exercise: Make a plan to engage in a “warm up” body-based activity right before a social event when anxiety levels are increasing (e.g., jumping jacks, burpees, squats). Research indicates that exercise calms the amygdala and decreases physiological arousal.

Relax or Distract: Practice progressive muscle relaxation (PMR). Recent research has indicated that regular and routine engagement in PMR sessions can be a useful strategy for individuals with ASD. Distract yourself from the anxiety-producing situation for the short term (e.g., count by 3s, name three things you can see and hear in the room, repeat words from your favorite song in your head).

Plan to Take a Break: Children and teens can benefit from having a healthy “escape plan” to take a break from socially-demanding and sensory-demanding settings (e.g., a large event like a play or concert, a college lecture, an interview for a job). Research indicates that “rest breaks” during mentally demanding tasks result in increased alertness, decreased fatigue and heightened relaxation.

Social Stories: Social stories provide the opportunity to practice and prepare for stressful situations, decreasing “fight or flight” responses. Read more about examples and applications of social stories in my colleague, Dr. Erin Gibbons’ previous blog post.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Click here to learn more about NESCA’s ASD Diagnostic Clinic.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.