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16

Working to Make Traffic Stops for Autistic Drivers Less Stressful

By | NESCA Notes 2024

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

Any driver who has ever cruised down a highway and suddenly sees flashing blue lights and hears the siren of a police car pulling up behind them knows that feeling of panic and dread – that immediate stress response that runs through your body. The internal questioning begins…What did I do wrong?, Was I speeding?, Did I not use my turn signal?, etc. The flight and fight response courses through our body. We pull over and wait while the officer gets out of their car and approaches. We know to keep our hands visible, wait patiently, and wait to be spoken to. These “unwritten rules” may not be specifically taught, but we just know to do them. Now, imagine for a moment that you are autistic and unwritten rules are difficult for you in general – never mind in this stressful situation. This situation is exacerbated in intensity by the very nature of their Autism Spectrum Disorder (ASD) diagnosis, which may lead to the driver experiencing difficulty with communicating, their ability to manage the stress of the situation, interacting as expected socially, and managing the total flooding of their sensory systems. If the driver is a minority and autistic, the stress may be further compounded.

Recently in Massachusetts, The Blue Envelope initiative was unanimously passed by both the House and Senate. This initiative assists autistic drivers in auto accident situations and traffic stops. While it is voluntary for police departments and autistic individuals to participate, the hope is that both groups will avail themselves of this potential to support and be supported in driving situations that arise. It is designed to make experiences like the one outlined above safer, and to ease communication between autistic drivers and police officers. The program began through a collaborative effort among autistic individuals, their parents, and multiple agencies and organizations, including the Massachusetts Chiefs of Police Association, Massachusetts State Police, Advocates for Autism of Massachusetts, and The Arc of Massachusetts.

The Blue Envelope Program is literally based on a blue envelope that autistic drivers keep in their vehicle with their important papers inside (i.e., driver’s license, registration, insurance card, and a contact card). The Blue Envelope isn’t just an ordinary envelope to keep things organized. Rather, it’s meant to be a “life saver and game changer,” as it is specially designed to provide critical communication guidelines and support as well as other important information about ASD. The communication information is printed on the outside of the envelope, thus alerting the officer that they are interacting with an autistic person. Along with general information about ASD, the information in the envelope can be personalized –  since we know that each person’s strengths and challenges are never the same from one individual with autism to the next. Also included on the outside of the envelope are “instructions/guidelines” for the individual. The intent of this program, by alerting officers that they are interacting with an autistic individual, is so they may potentially modify their interaction approach and style; possibly averting the individual becoming escalated, leading to more serious encounter. The Blue Envelope Program is available in many states, including RI, CT, ME, NJ, PA, AZ, and CA. It is currently in use by the Massachusetts State Police and some local communities. The program also includes training for law enforcement officers on how to approach and interact with individuals should they have a Blue Envelope.

The Blue Envelope Program hopes to, “enhance understanding, reduce anxiety, streamline communication and encourage preparedness,” and create a “positive outcome” for all. There are tips for officers that include things like, “use simple, direct language, avoid idioms, be observant, allow drivers longer time to respond, and clearly tell the driver when the stop is done.” If signs of distress are visible, try to reduce sensory inputs (turning off flashlights, sirens, etc.). Tips for drivers include handing the officers the Blue Envelope and telling them you’re autistic, following instructions, and asking for clarification if they do not understand something the officer is saying. The general guidance remains to always keep your hands visible – on the steering wheel; and if you need to reach for anything, tell the officer what you are doing before doing it.

The goal of the Blue Envelope Program is to create an outcome that is safe, respectful, and positive for all parties involved in a traffic stop, whether it be an accident or a traffic violation. Its aim is that autistic drivers will feel safer, calmer, more secure, and less stressed during traffic stops and that the officer training will help them be more aware of whom they are interacting with, be more prepared, exhibit greater empathy, and be more patient when interacting with an autistic driver. It has the potential to be a win-win program for all involved.

If you would like to apply for a Blue Envelope in Massachusetts, visit: https://www.mass.gov/info-details/blue-envelope-program#tips-for-a-safe-traffic-stop-

Additional Resources:

 

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 clinicians, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant/service in the referral line.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

47

If My Child Attends a Residential School, Will the State Pay for Housing When They Graduate?

By | NESCA Notes 2024

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

The goal of transition services is to help students who are on IEPs to progress toward their measurable postsecondary goals. This includes planning for future learning and work situations, and also planning for future living—as independently as possible. An enormous challenge that comes up in this planning process is that families (and sometimes the professionals supporting them) do not fully understand the realities of housing for adults who have exited public education.

There is a common misconception that if your child has qualified for residential special education programming, that will mean that your child will qualify for residential support as an adult. However, adult human service supports are not an entitlement like special education—these services are voted on by state legislature. The truth is that adult services and benefits are built to fill in the gaps of what you cannot physically or financially do to support your child. If you are alive and you can reasonably take care of your child, even with support, that is what you will be expected to do. If, instead, you want your child to be able to live in their own home or a shared home, then you and your child will be responsible for figuring out how to find and fund that living situation.

Hopefully, this data, shared by Cathy Boyle of Autism Housing Pathways in a January presentation, titled “Thinking About Housing,” will help to hammer home this point. Cathy shared numbers from fiscal year 2021 which quantified some of the residential supports awarded to young adults in Massachusetts who turned 22 during that fiscal year. Specifically, there were 1,233 students turning 22 who were served by the Department of Developmental Services (DDS) in Massachusetts. Of that number, only 263 received “residential supports.” However, the majority of those “residential supports” were provided in shared living situations where the housing was not being funded by DDS. It was only about 100 individuals statewide who turned 22 and entered into brick-and-mortar homes funded by DDS.

Regarding who is able to secure DDS housing in Massachusetts, it is typically only available to individuals who have an intellectual disability that was diagnosed before age 18 and (1) are a danger to themselves, and/or (2) are a danger to others, and/or (3) have pica (a condition in which a person eats items not usually considered food). There are some other criteria considered, including whether the caregiver can keep the individual healthy and safe (based on caregiver criteria, such as age, health, employment) and the judgment of the evaluator from the state. But, as previously described, housing is reserved for individuals with the most significant needs. Also, while there is funding through DDS for day services for adults with autism in Massachusetts, this budget explicitly does not cover residential services or housing. Only individuals with autism who also meet the intellectual disability criteria are eligible for housing under standard criteria.

If your child has a mental health condition, you may wonder about housing through Department of Mental Health (DMH). While it’s difficult to find current statistics on the number of young adults turning 22 and receiving group home services, there is a limited number of beds, and eligibility criteria for DMH services specifies that you can only be eligible for services if they are actually available. Also, the criterion for housing is quite similar to DDS in that an individual has to be entirely unable to live at home even with intensive in-home support. This often equates to the same variable of whether your child is actively at risk of harming themselves or another person.

While I’m providing data from Massachusetts in order to exemplify these housing challenges, the struggles are similar, if not more difficult, across the United States. The reality is that if you have a child with a disability, you and your child are more than likely going to have to plan for and figure out how to pay for their housing in adulthood. This is one of the ways that our children are treated 100% similarly to nondisabled adults. Although having a disability may help your child to qualify for accommodations in adulthood, living accommodations are most often not part of that right.

Resources:

NESCA offers many services designed to help students bridge the transition from high school to college including executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our transition planning services, visit https://nesca-newton.com/transition/. To learn about other coaching services, visit: https://nesca-newton.com/coaching-services/. To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/.

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

46

Preparing for a College Visit

By | NESCA Notes 2024

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

With vacation weeks coming up in Massachusetts and New Hampshire, many local families—especially those with juniors in high school—are contemplating visits to college campuses. School vacation weeks in the spring are a great time to visit colleges because you can tour the campus at a point in time when students are engaged in a typical flurry of academic and extracurricular activities. Summer may allow for more convenient or peaceful tours, but it is not a time of year when the happenings on campus accurately reflect student life (unless there is a very active summer session). Instead, spring and fall are often considered the optimal seasons for campus visits. For those of you planning upcoming visits, here are a few tips to consider—especially if you are a student with a learning disability, autism, or a mental health diagnosis.

  • Sign up ahead of time for the tour through the college’s web site. Even if a college does not require registration, potential students should go ahead and register for the college tour so that they get “credit” for their visit. There are lots of metrics that count as part of the college admissions process, and one of these important variables is literally the number of times that a potential student makes contact with the college. Things like registering for a tour, emailing admissions, following the college on social media, visiting with college representatives at college fairs, and signing up to receive materials by mail or email can all be considered “points of contact” with the college and may help students to ultimately be accepted.
  • Be prepared to answer a few questions about yourself. Most college information sessions or tours will start with the admissions staff and/or tour guide introducing themself and asking a few questions about the students in the group. Students should be prepared to share things like their name, hometown, grade, potential major, and clubs or activities they might want to participate in during college. Not all of this information will be requested outright, but some will typically be part of introductions and more may be asked during a presentation or tour. For students who have a hard time answering questions on the spot, they will feel much more comfortable if they have thought about—and practiced—answering these questions before the tour. They can also be more actively involved. Terms like undergraduate, graduate, first-year, and transfer may also come up when visiting colleges, and it can be helpful to review some college vocabulary ahead of time so that students are not flustered in the moment.
  • Ask questions of your own! (But make sure you are asking the right people your questions.) Information sessions and college tours are typically facilitated by admissions staff and college students. These are the times when you are learning about the college in general and getting a sense of campus culture, facilities, and services available to all students on the campus. For legal reasons, college admissions and college disability supports are notably separate entities. This means that college information sessions and tours are not typically the time and place for accommodation- and disability-specific questions. So, what questions should you ask? Well, there are plenty of web-based resources that you can look to in order to create your own personal list of tour questions. Here are just a few you might find interesting:

Even if you have done online research about a college, it’s a good idea to ask a few questions about items that are important to you to see if things on campus are really as described. Also, if you are a student with a disability, you might ask some of the questions that get at culture and inclusion: What’s it like to be a new student on campus? How do you see the college demonstrate commitment to diversity and inclusion? What controversial issues have come up on campus?

  • Don’t panic if you don’t see yourself or your student in the tour guide. College tour guides are typically some of the highest performing, actively involved students at the college and are usually representative of an extreme rather than the “average” student. While these students are certainly a part of the campus and culture, it is important to get a sense of who else is on the campus. Take time to observe and talk with other students you see walking around on campus. If you can, circle back to an academic building in an area of interest and find a student to talk to there. Or just stop a few students around campus and ask informal questions (e.g., Why did you pick this college? What do you wish you could change? What do you do like about being a student here? What do you wish you knew before you started college here?).
  • Take time to eat on campus. Make time before or after your tour to eat in a main cafeteria or campus center. If you are going to be eating three meals a day on campus, its important to know what that experience will be like. Certainly, the food is important. You need to know if there are a variety of food options and that there is something you would be comfortable eating for all meals. Also, you want to get a sense of the atmosphere, including how crowded it is and how easy it is to find a table.
  • If you are just getting started on your college search process and do not have a set list of schools yet, don’t worry. You can still get out and visit schools. I often suggest starting with different college archetypes (e.g., big school, little school, school spread out in a city, school with more defined campus, private, public, community, etc.). It can be good to just pick a few different school types, visit the colleges, and then do some real downloading of information and preferences immediately after the visits. I often ask students to do some ratings of colleges as they leave the schools so that they can quantify their “gut feeling” about a school and use that for comparison even if they aren’t sure exactly what it was that they liked or disliked. Even a bad college visit can help to determine some of the things that are most important about the college search process!

Embarking on college campus visits is a bit of a house hunting process—you are looking at potential academic homes. It can definitely be overwhelming, especially when it’s a process that you have not been through before and you may not know exactly what you want or what’s worth looking at. But you have to start somewhere. Following these suggestions should allow you to get a true sense of campus life and culture while also learning about yourself and your own preferences and values. Be prepared, but also trust yourself, and let each experience help you learn who you want to be as a future college student.

 

NESCA offers many services designed to help students bridge the transition from high school to college, work, and more independent adult life. Such services include executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our coaching services, visit: https://nesca-newton.com/coaching-services/ . NESCA also offers postsecondary transition consultation to families who want support identifying whether students are ready for college transition, or they may need a step in between or a scaffolded transition: https://nesca-newton.com/transition/#planning. To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/.

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

11

Is My Child Neurodivergent, and What Does That Mean?

By | NESCA Notes 2024

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

One of society’s leading sources of information is social media, which can be an excellent source of information and support. Parents may turn to social media when they notice their child struggling, trying to find others with similar concerns or answers about why their child seems “different.” Additionally, many children, adolescents, and young adults who feel different or out of place seek and find people or ideas that resonate with them online. While it may put them at ease, it often leads parents and their children to question if there is a diagnosis that will help them understand their child or themselves. Increasingly, people are asking if it is autism or another neurodivergent condition.

Neurodivergence is a term used to describe individuals whose brains function differently from what is considered typical. Neurodivergence is a broad term describing neurodevelopmental disorders present at birth and lasting throughout one’s life. Identifying if your child is neurodivergent can be the first step in understanding their unique strengths and challenges. There are numerous neurodivergent conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), dyslexia, and others, each with their own characteristics and support needs.

Recognizing signs of neurodivergence in children can vary depending on the specific condition, but some common indicators include:

  • Difficulty with social interactions and communication
  • Repetitive behaviors or intense interests
  • Sensory sensitivities or aversions
  • Challenges with attention and focus
  • Delayed speech or language development
  • Difficulties with organization and planning
  • Impulsivity or hyperactivity
  • Unusual reactions to sensory stimuli
  • Emotional regulation difficulties
  • Learning and academic challenges

Observing patterns of behavior, communication, and sensory processing in your child can help indicate if they may be neurodivergent. Seeking a professional evaluation from a psychologist or developmental specialist can provide a more accurate diagnosis and guidance on supporting your child effectively. It is essential to remember that neurodivergence is not a label or limitation but a spectrum of diverse traits and abilities that contribute to the richness of human experience. By recognizing and embracing neurodiversity, society can benefit from the unique perspectives, talents, and contributions of individuals with diverse neurological profiles. Proper diagnosis, support, understanding, and accommodation are essential in helping neurodivergent individuals thrive and succeed in their lives.

About the Author

Dr. Cynthia (Cindy) Hess conducts neuropsychological evaluations as a pediatric neuropsychologist at NESCA. Dr. Hess enjoys working with children and young adults with complex emotional and behavioral profiles. She is skilled at evaluating social and emotional challenges as well as a range of learning profiles. Her experience allows her to guide families in understanding the supports and services their child requires to be successful in school.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

13

The Intersection of Mental Health and Executive Function

By | NESCA Notes 2024

By: Carly Edelstein, MSW, LCSW
Licensed Clinical Social Worker and Executive Function Coach

Mental Health challenges and executive function (EF) deficits are often intertwined, as one can easily impact the severity of the other. As a psychotherapist and executive function coach, I find myself regularly assessing my clients with comorbid EF and mental health challenges in order to identify which presented first.

Why does this matter?
Emotional regulation and executive control both live in the frontal lobe of the brain. They operate close together and impact one another. Because of this, mental health challenges, such as depression and anxiety, can be overlooked and mislabeled as an executive function deficit. Identifying the root cause of a student’s EF struggles is critical for properly planning appropriate next steps and necessary supports. For example, if a student’s depression is causing them not to initiate and/or complete work, the depression usually needs to be addressed before they receive EF coaching. If the student is already working with a mental health professional, such as a therapist, it is important for them to be cleared by the therapist to add in an EF coach. Working on too many new skills at once can be overwhelming, so it is important that enough foundational coping skills are learned first.

An example of anxiety causing an EF deficit:
Clara gets extremely anxious in social situations due to a lack of self-esteem. She had a negative experience in middle school where other students made fun of her lisp whenever she read out loud in class. Now, in high school, Clara is afraid to ask questions, even when she is confused. She is left not fully understanding the material, class assignment expectations, or how to approach studying for quizzes and tests. Rather than asking for help, Clara keeps to herself. Even when teachers offer to help her, she responds with, “Thank you, but I’m all set.”

Clara’s parents can see that she struggles to initiate homework assignments, rarely studies for upcoming tests, and that her grades are declining. They don’t fully understand why, because when they ask her, she is quick to deflect and change the subject.

By checking in with Clara’s teachers, her parents may receive feedback that she often shies away from their support. With a lack of understanding why, her teachers aren’t sure how else to approach the situation other than continuing to check in. Jumping into EF coaching to address her task initiation and study skills may help, but it doesn’t address the root of the problem. A more appropriate action plan would be for Clara to first receive psychotherapy, addressing the bullying that led to her social anxiety and self-esteem issues and then shifting to EF skill building.

An example of an EF deficit causing anxiety/depression:
Gabriel is a seventh grade student diagnosed with ADHD. He has a difficult time advocating for himself and asking for help due to some additional communication challenges. His ADHD also makes it challenging to stay on task and pay attention to details. This results in Gabriel constantly forgetting what his homework assignments are and when they are due, creating a lot of missing work. Gabriel’s teachers are often redirecting him and reminding him of incomplete work. They have tried to help him develop plans to make it up, but he struggles to follow through with these plans. At home, Gabriel’s parents often share their frustrations with him and try to help him get back on track. With adults constantly reminding him he’s behind, Gabriel has developed internalized anxiety, often wondering why he can’t be like everyone else. He tries so hard to remember what his homework is and when it is due, but can never seem to get it right. Over time, he begins to experience symptoms of depression as his self-esteem declines.

In this situation, Gabriel’s lack of EF skills is the root cause of his negative thinking patterns. By receiving EF coaching, he can learn ways to regularly track his assignments. He can be taught how to break them down into smaller, more manageable tasks in a way that helps him overcome procrastination. Additionally, he is able to become proactive and communicate with his teachers so that they are kept on the same page. As these skills get stronger, Gabriel becomes more responsible, and gets praise from his teachers and parents in return. Given the impact of this situation, he may also benefit from short-term counseling to better understand the connection between his EF and anxiety. Increased self-awareness helps students learn how to advocate for themselves the next time they encounter a similar situation.

Does this sound familiar?
These scenarios are common and can be difficult to navigate without proper assessment and guidance from professionals. If you or your child struggles with mental health and EF-related challenges and you are not sure where to start, book a free introductory call with me or one of our other wonderful and experienced EF coaches. NESCA also offers comprehensive neuropsychological evaluation services and neuropsychological consultation for families who are wondering about possible missed learning, attention, mental health, or other diagnoses. We look forward to working with you!

 

About the Author

Carly Edelstein is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Ms. Edelstein provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

45

Summer Planning for Teenagers

By | NESCA Notes 2024

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

March is an incredibly busy time in my household. Three out of four of our family members celebrate birthdays, winter sports turn into playoffs, and school events seem to pop up every week. March is also the time when we finalize our “summer camp plan” and manage lengthy online registration processes. If you have a teenager in the household, particularly a teen with a disability, you may also be thinking about summer and feeling particular pressure to “make the most” of the time while your child is still in high school. In case you are still scrambling for your own summer plan, I wanted to offer up several activities that are worth considering as part of your teen’s summer plan.

Get a paid summer job! Time and time again, research indicates that individuals who have paid employment in high school are more successful college students and more successful in obtaining employment as adults. If your child is college bound, having a paid work experience among their high school activities is a huge boost to their college applications. And, if not, paid work experiences teach soft skills for employment, help students figure out more about their career interests and preferences, and help to build meaningful resumes. Being able to do work that meets someone else’s standards is a vital life skill, and summer is an optimal time to build that skill.

Gain overnight experience. Students who plan to go to college but have never spent a night away from home need to know how they are going to handle that experience. There are all sorts of summer programs where students can spend time overnight, away from home, among peers. Overnight programs vary in length. Students who are just venturing out for the first time may feel most comfortable in a program that lasts a week or less, whereas other students may want a 3-week or 6-week experience. For college-bound students, I often recommend taking advantage of programs that happen right on college campuses in dorms. But there are also great programs outdoors or even travel programs in the United States or overseas. Knowing that you can spend the night away from family (and knowing what it’s like to “live” among a whole group of young people) is often a critical step in setting post-high school goals.

Use the time to build new executive functioning or emotional regulation skills. Students who struggle with executive functioning or emotional regulation often need coaching or therapy during the school year, just to keep up with school activities. However, students and families often reach out for these resources because they are already in crisis. A student will seek out an executive function coach when a student is already behind with assigned work or grades. Families often seek out therapy when an emotional crisis has occurred. School provides a number of executive functioning and emotional demands, so it can be hard for a coach or therapist to build new skills with a student while the student is also meeting those demands. Summer can be an optimal time to work more intensively to build new skills, strategies, and systems because it is a time when other demands are reduced. If your teen has a therapist, tutor, executive function coach, social pragmatic coach, or other support person who is helping them to tread water during the school year, it’s definitely worth asking whether intensive services over the summer might help the student to build skills that will last long-term and help the student be better prepared for the following school year.

Summer can also be a great time to tackle time-consuming activities, like completing the college application, drafting a college essay or two, cleaning out a bedroom or reorganizing study space, or building a new life skill, like driving, cooking, or mastering a laundry routine.

March is a great time to take stock of what your teenager wants to do after high school, what challenges might impede them smoothly transitioning to those activities, and thinking about how summer might be the perfect time to eliminate some of those challenges!

NESCA offers many services designed to help students bridge the transition from high school to college, work, and more independent adult life. Such services include executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our coaching services, visit: https://nesca-newton.com/coaching-services/. NESCA also offers postsecondary transition consultation to families who want support identifying the most meaningful ways for their student to spend the summer: https://nesca-newton.com/transition/#planning. To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/.

 

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

46

Why is it so hard to develop Executive Function skills for college as a high school student?

By | NESCA Notes 2024

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

Students with disabilities often have challenges with executive function skills. These may include difficulties with organization, planning and prioritization, time management, task initiation, attention and effort, working memory, self-regulation, self-monitoring, and mental flexibility. Being successful as a college student often depends on using and integrating these skills. Therefore, it’s no surprise that most of the IEPs I read when working with teenage and young adult students have goals or objectives aimed at remediating executive function (EF) skills. However, many students on IEPs have these “EF” goals for years and still don’t effectively develop the skills they need to successfully manage executive functioning tasks as college students.

One of the reasons for the remaining skill gap when students matriculate to college is because high school student responsibilities are pretty radically different from college student responsibilities. While research indicates that individuals can continue developing executive function skills throughout the lifespan, this requires a very particular set of activities. Executive function skills develop through a combination of direct instruction and opportunities to practice using the learned skills with and without support. But there often are not opportunities for practicing the skills needed for college as a high school student.

Below is a list of executive function supports that exist in high school, but often disappear in college:

  • Classes are small and always taught by teachers
  • Class material is centralized in books or on the board in the classroom
  • Time is structured by the school
  • Students are told what they need to learn from homework
  • Students are reminded of assignments and due dates
  • Completed homework is checked by teachers
  • Reading is discussed in classes
  • Studying is limited to a few hours per week
  • Testing is frequent and covers small amounts of material
  • Teachers approach students who need help
  • Schools are required to find students with disabilities who need specialized instruction and accommodations
  • Parents and teachers will remind students of their responsibilities
  • Parents and teachers will help to set priorities (or simply set them for the student)
  • Parents and teachers will correct students when behavior is unexpected

In college, students may have large classes taught by other students or experts in their fields who aren’t experts on teaching. They have to use syllabi, manage their own schedules (with large swaths of unscheduled time), integrate academic materials from a wide range of sources, and self-direct long hours of reading and studying. They also have to be responsible for advocating for themselves, knowing when they need help, and knowing what they are responsible for (academically, socially, and in their dorms) and getting those things done without parent and teacher reminders. For students who have strengths with executive functioning, often the transition to college still presents a steep learning curve. But for those who have vulnerabilities in these areas, it can be critical to recognize that the gaps are large between these two learning environments, and sometimes additional support and instruction is necessary while students are taking college classes. Some students will still need to build effective academic and executive function skills, and practice and master those executive function skills, while they are in college and managing this new set of demands.

NESCA offers many services designed to help students bridge the transition from high school to college, including executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our coaching services, visit: https://nesca-newton.com/coaching-services/ . To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/ .

Reference:

Many of the bulleted items of executive function supports that exist in high school are adapted from this high school versus college comparison by King’s College: https://www.kings.edu/admissions/high_school_vs_college

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

18

Transition Goals: What are they and why do they matter in the IEP process?

By | NESCA Notes 2024

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

As an evaluator and consultant, I spend a lot of time in team meetings. Usually, I expect to be invited to more of these at the beginning of the school year when teams meet to review assessments or important changes that have occurred during summer months. But May and June are also times when teams cram in meetings, especially for high school students who may be close to exiting public education. Therefore, it seems timely to write my blog on transition goals and their role in the IEP process.

For all students with individualized educational programs (IEPs), teams are accustomed to writing and implementing annual goals. But, for students 16 and older (or students who live in states where transition planning starts earlier such as students 14 and above in Massachusetts), their IEP process also needs to include transition goals. What is confusing about transition goals is that we commonly used this verbiage to describe a few different components of the IEP for transition-aged students.

In my opinion, the most important transition goals, are the measurable postsecondary goals, that are included in the IEP. These describe the outcomes that a team expects for the student to achieve after exiting public education and are based on the student’s own strengths, preferences, interests and vision. Every IEP across the country must include measurable postsecondary goals. In Massachusetts, postsecondary goals are documented in the student’s vision statement at the start of the IEP. For transition-aged students, the vision statement needs to include explicit statements about the outcomes that are expected for the student in transition planning areas. Postsecondary goals for education and/or training as well as employment are required for all students on IEPs, and many students will also have independent living and community participation goals. However, postsecondary goals and transition services are document differently in many states and it is important to familiarize yourself with the location of a student’s postsecondary goals in your own state’s IEP.

Below is a formula for writing a postsecondary goal that is adapted from the National Technical Assistance Center on Transition: The Collaborative (NTACT:C):


Within 2 months of graduation, Joseph will participate in supported employment training and community-based training with assistance from MA Department of Developmental Services. A few examples of measurable postsecondary goals are included below:

  • After earning her diploma, Sarah will attend a four-year college in Massachusetts or New Hampshire (and major in education or child development).
  • After graduation, Tom will work part-time at TJ Maxx with support from his coworkers and supervisor.
  • After high school, Joseph will use public transportation (e.g., subway, bus) to get to and from his apprenticeship.

Unlike annual goals, measurable postsecondary goals are not goals that will be achieved in the calendar year or even while the student is on an IEP. However, there is another type of “transition goal” that is closely related. Once an IEP team has clearly defined a student’s postsecondary goals, they are required to identify transition services that the student will need to make progress toward these goals. When the IEP is developed, the IEP must include annual IEP goals that clearly and directly relate to the student’s postsecondary goals and transition service needs. For example, a student who wants to attend college may need annual goals related to building executive functioning, self-advocacy and college-level academic skills; while a student who wants to use human service supports for community-based employment may need to build communication, self-regulation and work readiness skills. Annual IEP goals should be based on the student’s disability-related needs and also their postsecondary goals—Given the student’s disabilities, what skills does the student need to build this year to be able to attain their postsecondary goals in the future?

Special education is about preparing students for future education, employment, independent living and community engagement. Measurable postsecondary goals are how we make sure that special education is individualized for each student, and transition-related annual IEP goals are how we make sure we are progressing toward the postsecondary goals. When we know what the student wants for their adult postsecondary life, we can use the IEP process to help the student build academic and functional skills that can support the student in achieving that vision.

The next time you look at an IEP, take a look at the vision statement (or the section where your state records measurable postsecondary goals). Can you clearly tell what the student wants to do after high school? Are there both employment and education or training goals included? What about independent living and community engagement? These measurable postsecondary goals are the goalposts that provide direction for the IEP process and ensure that the team is working together to facilitate the student’s progress toward a meaningful adult life.

This link to a presenter’s guide for a presentation on Indicator 13 from NTACT:C is also a great resource for understanding the role of postsecondary goals and annual goals in the IEP process as outlined in IDEA: https://transitionta.org/indicator-13-presenter-guide/

For more information about postsecondary goals and annual IEP goals in Massachusetts, check out Technical Assistance Advisory SPED 2013-1: Postsecondary Goals and Annual IEP Goals in the Transition Planning Process from MA DESE: http://www.doe.mass.edu/sped/advisories/13_1ta.html. However, please note that the IEP will be changing in Massachusetts in Fall 2024 and postsecondary goals will be written on the first page of the document.

 

About the Author:

Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. Since 2013, Ms. Challen has served as Director of Transition Services at NESCA, where she provides an extensive array of services including individualized transition assessment, planning, consultation, pre-college coaching, training, and program development services. She is particularly skilled in providing transition assessment and consultation for students with complex profiles who may not be able to engage easily with traditional and standardized testing tools. Ms. Challen received her Bachelor of Arts in Psychology as well as a Minor in Hispanic Studies from The College of William and Mary. She pursued her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. Ms. Challen has been actively involved in the MA DESE IEP Improvement Project, is a member of the Association of Autism and Neurodiversity (AANE) Program Committee and has mentored multiple transition specialist candidates in the Transition Leadership Certificate Program at UMass Boston. She is also 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: Innovations that Enhance Independence and Learning. She is also the mother of two children and two puggles who continually help with her inventive and flexible thinking!

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

14

Why Do So Many Girls Get Diagnosed with ASD Later in Life?

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

In the 15 years that I have been doing neuropsychological evaluations, I have made countless diagnoses of Autism Spectrum Disorder (ASD) in females who are already in high school or even in college. Many times, the diagnosis comes as a surprise to the girls and the families alike, because no one has ever suggested it previously and/or their perceptions are colored by the stereotypes created in the media about autistic individuals. However, a discussion about what ASD is and how it manifests in females as opposed to males usually helps my clients and their families understand the nuanced and comprehensive nature of the ASD diagnosis. They often pivot to feelings of relief and gratitude for having a label for what they have been struggling with for a long time. Many of my clients learn to embrace this new diagnosis and use it as a framework for celebrating their strengths and looking for supports to address their vulnerabilities. They often say, “It totally makes sense!”

Autism Spectrum Disorder is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. When autism was first introduced by Dr. Leo Kanner in 1943, he described children (boys) who showed little interest in other people, insisted on routines, and displayed unusual body movements, like rocking back-and-forth and flapping their hands. Many of the children could talk but they rarely used their speech to communicate with others, and they had a variety of pervasive learning difficulties. For the most part, this continues to be the image that is conjured when people mention autism. However, with advances in research, especially within the last few decades, we have come to recognize the various manifestations of autism in children and adolescents who are higher functioning, have better communication skills, and have fewer learning issues. Thus, the newer conceptualization of autism as a spectrum with a wide range of capabilities and communication skills. More recently, researchers have also discovered that the presentation of autism varies in boys versus girls. This has made the diagnosis of ASD in girls difficult.

In their book Girls Growing Up on the Autism Spectrum, ASD researchers Shana Nichols, Ph.D., Gina Moravcik, MA, CCC-SLP, and Samara Pulver Tetenbaum, MA, outlined some preliminary findings of differences between males and females on the spectrum. They reported that:

  • The play of boys with ASDs is more restricted in range and more repetitive when compared to girls with ASDs who have stronger pretend-play skills.
  • Girls have stronger communication skills.
  • Sex-related social difficulties emerge over time – boys have more impairments early on (thus leading to earlier diagnoses), whereas for girls, the difficulties appear more in early adolescence.
  • Boys are more easily distracted when compared to girls.
  • Girls with mild difficulties may not be included in research samples.

They added that these differences could impact the assessment and diagnosis of ASD. They wondered if girls with ASD are being missed or overlooked during an evaluation because their presentation does not fit how professionals currently characterize ASD based on a male prototype. Other researchers have suggested that girls with ASD may be better able to compensate for symptoms despite having persistent core deficits associated with ASD, which might contribute to greater social “camouflage” or what is called “masking” (an individual hides or suppresses symptoms, behaviors, or difficulties). Indeed, as I have been learning more and working with girls diagnosed with ASD, I have been keeping in mind these potential sex differences. For example, I often compare my client’s social and communicative abilities to what is considered normative for girls their age and cognitive ability. I have been avoiding comparing my female clients with what has been the prototypical profile of autism in males. I also think about other manifestations of repetitive behaviors and interests in girls with ASD that are more socially acceptable, for example, an obsession on reading or running as opposed to preferred topics of males on the spectrum (e.g., trains, schedules, calendars, etc.).

Researchers have speculated that these differences in the manifestation of ASD in girls versus boys stem from how girls are socialized at an early age to pay attention to social cues/actions as opposed to boys. There is also research that suggests that girls are more able to follow social actions by delayed imitation. They observe and copy other children more effectively than do boys. This could lead to the phenomenon of masking and to milder presentations when compared to boys.

Sources:

Evans, S., et. al. (2019). Sex/gender differences in screening for autism spectrum disorder: Implications for evidence-based assessment. Journal of Clinical Child Adolescent Psychology, 48 (6), 840-854.

Nichols, S., Moravcik, G. & Tetenbaum, S. P. (2009). Girls growing up on the autism spectrum. London: Jessica Kingsley Publishers.

Ozonoff, S., Dawson, G. & McPartland, J. (2002). A parent’s guide to asperger syndrome and high functioning autism. New York: Guilford Press.

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

12

College Myth Buster – Your Child’s 504 from High School Does Not Apply in College

By | NESCA Notes 2024

By: Kristen Simon, M.Ed, Ed.S
Transition Specialist; Psychoeducational Counselor

There can be a lot of confusion for students who have received special education services or accommodations in high school about what stays the same and what changes in college. Some high school families and staff know that if a student has received IEP services throughout school, the IEP does not travel with them to college. This is because an IEP is a document that is developed in accordance with IDEA, a special education law that affords protections to students with disabilities up until they graduate or age out of their local high school. When a student transitions to work or a college or university, this law is no longer relevant and the IEP essentially “expires.”

There is often greater confusion for families around whether colleges are required to follow 504 plans (i.e., accommodation plans) developed in high school. While it’s true that students with disabilities are protected by Section 504 of the Rehabilitation Act, it’s important to understand that high school 504 plans also effectively “expire” once a child graduates. Students can still receive accommodations under Section 504, but they are unlikely to hear the term “504” or to have any written “plan” related to their disability or those accommodations. There are some important differences between Section 504 mandates under subpart E (which covers postsecondary institutions) and those that fall under subpart D (which covers secondary schools). The key differences are described below:

  • Eligibility: Colleges and universities will have their own process for eligibility, and students have to be determined eligible by their university – even if they had been deemed eligible for accommodations in high school. Students will usually need documentation from a doctor or a psychologist that demonstrates the presence of a disability as well as how that disability substantially limits learning.
  • Available Accommodations: Colleges don’t have any obligation to provide the same services and accommodations that students may have received in high school, and not all of the accommodations provided by high schools are available at the college level. Moreover, different accommodations may be available at different colleges because the law mandates that the college provides accommodations which are “reasonable” and effective, not the best or most expensive.
  • Shift in Delivery: Professors will not automatically provide an accommodation as was the case in high school. Students have to seek out accommodations and can register for them after they are officially enrolled. At the college or university level, the expectation is that the young adult knows what support is available to them and that they self-advocate for the accommodations they need. Also, even if a student qualifies for an accommodation, they have to make the choice to actively use that accommodation – if they don’t advocate, they won’t get it.

Students should also know that while accommodations help, they can only go so far (e.g., if you don’t understand the content, having extra time on the exam won’t help). Students should be sure to connect with disability services to hear about tutoring options, academic coaching, writing centers, counseling supports, and anything else that is offered.

Resources:

U.S. Department of Education: Students with Disabilities Preparing for Postsecondary Education

Elizabeth Cohen Hamblet Learning Disabilities Consultant website: College Disability Accommodations Information – Elizabeth C. Hamblet (ldadvisory.com)

 

About the Author

Kristen Simon, M.Ed, Ed.S, has worked with transition-aged youth as a licensed School Psychologist for more than a decade. She has extensive experience working with children and adolescents with a range of learning and social/emotional abilities. Kristen’s strengths lie in her communication and advocacy skills as well as her strengths-based approach. She is passionate about developing students’ self-awareness, goal-setting abilities, and vision through student-centered counseling, psychoeducation, social skills instruction, and executive functioning coaching. Mrs. Simon has particular interests working with children and adolescents on the Autism spectrum as well as individuals working to manage stress or anxiety-related challenges.

Mrs. Simon is an expert evaluator and observer who has extensive working knowledge of the special education process and school-based special education services, particularly in Massachusetts. She has been an integral part of hundreds of IEP teams and has helped to coordinate care, develop goals, and guide students and their families through the transition planning process. Mrs. Simon further has special expertise helping students to learn about their diagnoses and testing and the IEP process in general. She enjoys assisting students, families, and educators in understanding a student’s disability-related needs as well as the strategies that can help the student to be successful in both academic and nonacademic settings. Mrs. Simon has often been a part of teams in the years when students are initially participating in transition services, and she has helped countless students to build the skills necessary to be part of their first team meetings. She is committed to teaching students—as well as parents and educators—how to participate in student-centered team meetings and the IEP processes.

At NESCA, Mrs. Simon works as a transition specialist and psychoeducational counselor. She works with adolescents, their families, and their school communities to identify and build the skills necessary to achieve their postsecondary goals. Mrs. Simon provides transition assessment (including testing, functional evaluations, and observations), program observations and evaluations, case management and consultation, and individualized counseling and skills coaching.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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