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Accommodations for Computer-based Testing

By | NESCA Notes 2019

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-based Skills Coach

As a school-based occupational therapist, I found myself beginning each academic year by focusing on what my students needed to learn, the skills they needed to develop, and how I could best use my time to help them be successful in the classroom. Despite it being September, every year this inevitably led me to consider standardized testing – one of the many academic themes of springtime.

My third graders not only needed to know the foundational mathematics skills being assessed, but how to navigate the computer screen in front of them. They needed to practice the fine motor precision to move a mouse and click on small boxes or multiple-choice bubbles. My sixth graders not only needed to understand how to plot points on the x and y axes, but they needed to have the visual perceptual skills to plot these points on a computer screen that scrolls up and down.

This demand for computer literacy skills within testing was noted as early as 2003, when Thompson et. al noted the inherent disadvantage for students who lack access to computers. However, as we continue to move further and further into the digital age, it is clear that computer-based testing has become our nation’s go-to method for assessing its students’ grasp of academic content and subject mastery. Computer-based testing allows for more efficient administration, quicker result times, built-in accommodations, and other positive benefits that make commitment to this practice worthwhile. For many students, computer-based testing is hugely preferred, and the option to type an essay is far less daunting than writing pages and pages by hand.

However, the National Center on Educational Outcomes claims that, “Despite the fairly dramatic increase in attention to CBT (computer-based testing), accessibility challenges continue to have the potential to reduce the validity of the assessment results and to exclude some groups of students from assessment participation” (Thurlow, Lazarus, Albus, & Hodgson, 2010).

So, what happens when this manner of assessment is more difficult for our students with disabilities? How can we help? What can we do?

As is often noted by test creators and administrators, most computer-based tests have relatively comprehensive built-in accommodations. Options such as enlarged font, speech-to-text, and line masking are often built into the platform. Despite this, computer-based accommodations may not be enough. When it comes to being truly accessible, the assessment of skill areas, individualized accommodation, and significant practice of testing systems are all necessary to arrive at an accurate assessment of academic skills.

Consider Charles, a fourth-grade student who has been receiving occupational therapy for decreased fine motor precision, visual perception, and low visual and fine motor endurance. He has difficulty with visual memory and gets easily overwhelmed by visual clutter. As a student in the general education setting, it is initially assumed that Charles will take his standardized tests in the computer format. At his team meeting, Charles’ mother raises her concern that he will fatigue quickly due to the visual demands of staring at a computer screen for the testing period. The team offers to provide Charles with a paper-based version of the test so he can avoid having to look at a computer screen. But Charles has decreased fine motor precision and endurance! How do we accommodate his needs?

This one case displays the importance of considering the whole child, trialing different options, and working collaboratively. Charles could potentially be allowed to take the assessment on the computer with access to a paper copy. He could use a scribe to help him type or write while he takes a computer or paper version. Maybe Charles feels confident using the computer-based test and his mother’s concerns about visual fatigue were unwarranted. Realistically, the team does not know what is best for Charles until they try a few distinct options and get his input.

Computer-based testing tools are here to stay, and fortunately our children are becoming more and more comfortable with digital methods. As we continue to make this transition, it is important to maintain the commitment to be individualized. Each student has different needs, and I urge teams, related service providers, educators, and parents to consider these needs early in the school year and early in the student’s academic career.

References:

Thompson, S., Thurlow, M., & Moore, M. (2003). Using computer-based tests with students with disabilities (Policy Directions No. 15). Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes. Retrieved [9/09/2019], from the World Wide Web: https://nceo.info/Resources/publications/OnlinePubs/Policy15.htm

Thurlow, M., Lazarus, S. S., Albus, D., & Hodgson, J. (2010). Computer-based testing: Practices and considerations (Synthesis Report 78). Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes.

 

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.
To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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.

 

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2019

 

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

I recently attended the International Dyslexia Association Conference in Atlanta, GA (dyslexiaida.org). Among the conference attendees were researchers, teachers, speech-language pathologists, psychologists, and parents of children with dyslexia. One recurring key point was the importance of early identification of reading difficulties, as early provision of appropriate interventions and services leads to better outcomes.

It is important to remember that unlike seeing, hearing, and eating, reading is not something humans do naturally. Reading must be learned and it is not easy (Maryanne Wolf, Proust and the Squid).

As a parent, your early observations are important as there are many developmental indicators that may signal a risk for reading difficulties such as:

  • Experiencing repeated early ear infections
  • History of speech delay and/or pronunciation problems
  • Slow vocabulary growth, frequent difficulty finding the right word, use of less specific words such as “the thing,” “the stuff,” or “that place.”
  • Your child struggles to recognize words that start with the same sound (e.g., cat and car) or end with the same sound (rhyming).
  • Difficulty learning letter and number symbols when in preschool
  • Family history of reading problems

During first grade, you can watch for these warning signs as you listen to your child read aloud:

  • Does not know the sounds associated with all of the letters
  • Skips words in a sentence and does not stop to self-correct
  • Cannot remember words; sounds out the same word every time it occurs on the page
  • Frequently guesses at unknown words rather than sounding them out
  • If you ask your first grader to read aloud to you and he/she is reluctant and avoidant

Remember: 

Early identification of reading issues is extremely important for outcome. If children who have dyslexia receive effective phonological awareness and phonics training in Kindergarten and 1st grade, they will have significantly fewer problems learning to read at grade level than children who are not identified or helped until 3rd grade.

What should I do if I suspect my child has challenges with reading?
If you suspect your child is struggling to learn to read, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

To learn more about evaluations and testing services with Dr. Talamo and other clinicians at NESCA, you may find the following links helpful:

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

Sources used for this blog:

 

About the Author:

With NESCA since its inception in 2007, Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School Students.”

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders, and emotional issues. She is also interested in working with highly gifted children.

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.

 

To book a consultation with Dr. Talamo 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, 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.

 

This blog was originally published in 2017.

Epigenetics—Redefining Nature and Nurture

By | NESCA Notes 2019

 

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Parents often wonder why their children are contending with learning problems or attentional issues, or suffer from emotional difficulties, and if they could have done something different in their parenting to have spared their child. Alternatively, they assume their own genes are condemning their child to these difficulties and challenges. This is the nature-nurture debate, but beyond contributing to parental sleepless nights, this either-or construction is overly simplistic—and overly deterministic. A  better way to think about this problem is provided by the study of epigenetics, or the  interaction between genetics and environment (genetics x environment).

The word “epigenetic” refers to  any process that alters gene activity (“turning on“ or “turning off” genes) without changing the underlying DNA sequence. These changes are sometimes referred to as “mutations.”  Some of these mutations will be “reset” in the next generation, but some continue to influence gene expression for several generations. Nessa Carey, author of “Epigenetics Revolution,”  uses the analogy of a movie to help understand this process. If a person’s life were a movie, their DNA would be the script, and certain blocks of the DNA sequence (genes) would instruct key actions or events to take place. The concept of genetics could be compared to screen writing, while epigenetics  would be like directing. The script may stay the same, but the director can choose to eliminate or accentuate certain scenes or dialogues, thus changing the course of the story.

Epigenetic effects may occur anytime throughout the life span, from within the womb to old age. Epigenetic influences include what you eat, how you sleep, who you interact with and whether you exercise. They also include environmental factors, such as the quality of the air you breathe and how safe you feel in your home and in your community. For instance, children whose pregnancies occurred during the Dutch famine of 1944-45 have been found to have increased rates of coronary heart disease, obesity and schizophrenia in comparison to the children of mothers who were not exposed to famine.  Other research has shown that children who had experienced stressful events during the pregnancy or during childhood were more likely to experience depression if they have mutations on a small number of genes, including those affecting neurotransmitter serotonin.

The really exciting element of the new research on epigenetics involves the  possibility that lifestyle factors can reverse or mitigate the negative elements of gene mutations. For instance, there is intense interest in the impact of diet on ADHD symptoms. At this point, the findings from the analysis of a large number of studies indicate that Omega-3 (fish oil) can have a small but measurable effect in reducing symptoms, and food additives and allergens can cause or worsen  symptoms in children who are sensitive to these triggers. Exercise has been proven to improve cognition and brain plasticity, the effects of which can be felt for a long time. We are just at the beginning of these investigations, with more exciting findings to come.

References and Resources:

Neurosci Biobehav Rev. Author manuscript; available in PMC 2018 Sep 1.

Published in final edited form as: Neurosci Biobehav Rev. 2017 Sep; 80: 443–456. Published online 2017 Jun 27. doi: 10.1016/j.neubiorev.2017.06

Weinhold, Bob. Epigenetices: The Science of Change. Environmental Perspectives 2006 Mar: 114 (3): 160-167

A Super Brief and Basic Explanation of Epigenetics for Total Beginner: Epigenetics Simplified. https://www.whatis epigenetics.com/what-is-epigenetics

Epigenetics: Fundamentals: Epigenetics Simplified. https://www.whatis epigenetics.com/what-is-epigenetics

Nigg, Joel (2017) Getting Ahead of ADHD. New York. Guilford Press

 

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

 

To book an evaluation with Dr. Monaghan-Blout or one of our many other expert neuropsychologists and transition specialists, 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, 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.

 

Visual Skill and Academic Success – Looking Past 20/20 Vision

By | NESCA Notes 2019

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach

When a school nurse pulls a child into his or her office to complete a basic eye screening, he or she may write, “20/20 vision in both eyes. No visual concerns.” This child has successfully looked at an eye chart and read the letters; demonstrated the ability to look straight ahead, from an appropriate distance without things becoming blurry or illegible; and demonstrated visual acuity, or the ability to see with acceptable clarity.

But does this necessarily mean there are no concerns?

Visual acuity measures whether a stimulus is being seen – not necessarily if the information is truly being understood. The visual system is a complex part of the central nervous systems that incorporates the eyes, ocular pathways and brain to produce and interpret sight. It requires consistent communication between all of these individual anatomical pieces, the vestibular system and the skeletomuscular system. Essentially, vision is complicated and messy and requires many many different skills.

Breaking It Down

In terms of visual skills needed for academic success, we often break things down into three main areas: ocular motor control, visual perception and visual motor integration.

  • Ocular motor control describes the ability to physically move the eyes using the 9 ocular muscles. It encompasses the ability to track an object across a screen or a line of text across a book, or the ability to look up at the board and then quickly refocus on a sheet on paper on the desk. Imagine trying to watch a basketball game without the ability to track the ball across the screen smoothly. It quickly becomes tiring and frustrating. Occupational therapists often refer to these specific eye movements with technical terms, such as visual saccades, pursuits, convergence/divergence and accommodation. But in essence they describe eye movement.
  • Visual perception or visual processing is in many ways more nuanced. It focuses on the brain’s ability to organize, interpret and fully understand the information it receives from the eyes. Two main skills needed at school are visual figure ground and visual closure.
    • Visual figure ground is the ability to discern relevant information from a busy or cluttered background. A student with visual figure ground difficulty may not be able to search a busy white board and find a homework assignment. These students may also be visually overwhelmed by a worksheet with 20 math problems, but successful with the same problems presented individually.
    • Visual closure is a skill that specifically helps with reading efficiency and fluency. It is the ability to identify or visualize a complete form or picture when given incomplete visual information or when only a small piece of the image is shown. Visual closure allows us to read a sentence quickly without stopping to decode each individual letter. It is aslo oen raeosn taht mnay pelope can raed setneces wtih julmbled up ltetres. We recognize the form, not simply the sequential letters.  :  )
    • Visual closure plays a role in sight words and reading partially-covered papers or street signs in the community. While there are many more important visual perception skills, these two examples have functional, measurable effects in the classroom setting and are commonly identified through occupational therapy testing.
  • Visual motor integration (VMI) describes the ability to use all of these foundational visual skills in conjunction with foundational motor skills. It is the ability to interpret visual information and produce a precise motor response. In the classroom, this affects a student’s ability to copy shapes, produce legible handwriting and use scissors to cut along a line. Not only can these things be difficult, they can be exhausting as a child tries to use all of these skills at once.

While all of these visual components have multiple layers and intricacies, it is important to simply acknowledge that there’s more than the eye can see when it comes to vision. A child who “can’t see the board,” but has 20/20 vision, may just be visually overwhelmed. A child who looks at a page full of small block text and immediately gives up may not have the visual skill to read across a line. And a child who is learning to read beautifully, but still has difficult forming the letters in his name may have poor visual motor integration. Fortunately, there are many interventions and accommodations that can help build on and develop these skills further to foster confidence and success in the class and community.

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.

 

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.

 

Why does my neuropsychologist need that? What do the tests measure and why is previous testing important?

By | NESCA Notes 2019

 

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

When a family books an intake for neuropsychological evaluation, they are typically asked to complete a few pieces of paperwork and to bring previous testing and other educational documents such as an Individualized Education Program (IEP) for their intake appointment. Despite this request, many parents will come to the intake session with empty hands. Understanding that parents have an enormous number of tasks on their plate, one could expect that paperwork was left at home due to timing or organization difficulties. However, when I ask parents about the missing paperwork decision, the reasons for leaving it behind generally fall into two groups: (1) lack of knowledge about the purpose of testing; and (2) concerns about creating some form of bias in the examiner’s mind. Some parents don’t share prior testing with me because they don’t have a clear idea of what the testing is and how it is going to be used for my evaluation. This is very common with families who are new to the special education or mental health process. Some parents are reluctant to share past testing because they want a “fresh view” and are concerned that looking at someone else’s work may create a bias. This often comes up when there is disagreement between parents and their school or past provider as to the nature of the child’s difficulties. Sometimes the parents and child have had a bad previous experience with testing and/or with the examiner, and they do not feel that the test results accurately (or at least empathetically) describe their child. In any of these situations, I find that parents feel more comfortable if they know more about how the tests we use are developed and why we find it helpful to view previous testing.

Purpose of Testing: The purpose of neuropsychological testing is to find out if a child (or adolescent or adult) is developing skills at a rate and capacity commensurate with their age and ability level. In order to do this in an efficient, equitable, and consistent manner, test developers identify skills they think are important in learning, devise a task that appears to quantifiably measure that skill, give that task to children in different age groups and then transform the raw scores attained by the children into a common scale. This allows them to compare different children within an age group, and this also allows them to compare the same child at different ages. Some common measurement scales are standard scores, scaled scores, Z scores, T-scores and percentiles. All of these formats are based on a normal distribution (remember the bell curve?) in which the majority of scores fall within a certain area with increasingly fewer scores falling at either end. The “bump” where most scores fall is described as average (between 25th and 75th%ile) with the tails receiving an above or below average description. While these descriptions do not begin to capture the whole child, they do convey information about how a child is performing relative to developmental expectations based on what we know about children of the same age. They can also tell us if the child is making age expected progress according to their unique learning curve. Furthermore, most people are good at some things and not so good at others, and the pattern of their scores can often give us valuable information about their learning profile.

Question of Bias: The concern about bias is important, given that neuropsychological tests are often used to classify people and make decisions about providing or denying services. There are a number of ways in which we try to control for bias, starting with trying to make sure that the group of people that are used as test subjects when developing norms are representative of the population at large. Test makers are getting better at this, but we have a long way to go, which means that it is important that evaluators know how each test has been developed and normed. Test selection is also extremely important; some tests are not appropriate for some groups. Think about giving a Calculus test to someone who has not completed Algebra 1; this kind of mismatch is going to result in a spuriously low score on math ability.

The main way that neuropsychologists and psychologists try to control for bias is through what is referred to as standardized administration—giving the test in the same way to each child. A good deal of the training of graduate students, interns, and post-doctoral fellows involves learning and practicing these skills so that the test is given to every child in the same way, regardless of who gives it. At the same time, children are children, and sometimes they need something different. It is up to the evaluator to decide when to engage in “non-standardized administrative procedures.” One example of non-standard administration could be starting a child who has trouble catching on to novel tasks at a lower age starting point in order to help them master the task demands. Another example would be stopping a task before a ceiling of errors is reached because the child is very anxious and is having a hard time staying with the activity. It is important to make note of that break in protocol in the report; while it may somewhat reduce the validity of the scores, it also tells us something very valuable about the child’s learning style and tolerance.

Value of Having Previous Testing: Having the opportunity to review all previous testing is extremely valuable to neuropsychologists because it gives up some insight as to a child’s developmental trajectory. Scores that are higher than in previous testing may suggest improvement in a skill set. Scores that are consistent with previous testing indicate that a child is making age-expected progress along their unique learning curve. However, they may be falling farther and farther behind their same-age peers or progressing more quickly. Scores that are significantly weaker than in previous testing need to be closely examined. This could be a result of an imbalance between the environmental demands and the child’s internal resources. For instance, smart kids with executive function deficits are often not prepared for the organizational challenges of middle and high school. Significantly lower scores could also indicate stalled development due to ineffective educational interventions. It could also be a sign of emotional distress that is interfering with a child’s functioning. Rarely, it could be a sign of a medical or neurological problem. There are also some times when a change in average scores reflects a change in the exact tests or subtests used for the child. For example, when a teenager turns 16, it is common to begin administering adult intelligence scales and these tests may place higher value on slightly different skills (e.g., mental math). Without reviewing previous testing, a current evaluator may be able to provide a snapshot of a child’s current functioning, but might miss a critical developmental pattern important for understanding if/how the child is learning, what is needed to enhance their performance, and what can reasonably be expected over time for the child.

 

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. he is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

 

 

To book an evaluation with Dr. Monaghan-Blout or one of our many other expert neuropsychologists and transition specialists, 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, 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.

 

Modern Parenting: Moving Beyond the Standards of Screen Time

By | NESCA Notes 2018

 

By: Jacki Reinert, Psy.D., LMHC
Pediatric Neuropsychology Post-Doctoral Fellow

Content is king. Not all content is created equal.

Recently I received a sweet, hand-made Mother’s Day gift from my son. On small pieces of paper, he meticulously filled in a series of incomplete sentences, ranging from “My mom can do many things. I think she’s best at making art” to “Did you know that my mom is a sicalligist (psychologist)?” and “My mom is super smart! She knows that kids should have two hours of screen time.”

“Two hours of screen time” has been successfully drilled into each adult responsible for monitoring a child’s technology use thanks to a successful media push by the American Academy of Pediatrics (AAP). Beginning in October of 2013, AAP held a firm stance on screen time, indicating that children over the age of two should be limited to two hours of screen time. Over time, the guidelines once again shifted in 2016 to ensure that no child under the age of 18 months should have access to screen time, referencing research that indicated technology could have a profound effect on brain development.

Despite these significant implications, screen use among 0 to 8-year-old children continues to grow. In a large-scale study of screen use in the United States, researchers at CommonSense Media (2017) found that on average, children under two spend approximately 42 minutes per day on “screen media use”. Of that time, approximately 58 minutes is spent watching television, 17 minutes are spent watching DVDs, 48 minutes are on a mobile device, 10 minutes on a computer, and 6 minutes on a video game player. For kids ages 2 to 4, total screen media use clocks in at 2 hours and 39 minutes; for 5 to eight-year old’s, 2 hours and 56 minutes.

AAP has once again shifted their policy regarding media, permitting the use of video chat, such as FaceTime and video conferencing to facilitate social communication with family members living far away. They encourage adults to provide a social context for little ones. Further, an emphasis on the type of content has been further reinforced; Sesame Street is different than Power Rangers,

Finding a balance is key; you should feel comfortable putting on a 20-minute show while you prepare dinner, whereas allowing kids to binge before bedtime is heavily frowned upon by pediatricians. According to parents surveyed in the research conducted by CommonSense Media, nearly half of all children 8 and under often watch television or play video games during the hour leading up to bedtime. While outcomes vary, researchers have found that using any device at bedtime is associated with a statistically significant increased use of technology in the middle of the night, compromising sleep quantity and quality (Fuller, Lehman, Hicks, & Novick, 2017). Further, research also suggests that excessive television viewing in early childhood has negative implications for cognitive, language, and social/emotional development (Conners-Burrow, McKelvey, & Fussell, 2011).

So how do we provide the structure and balance for kids, particularly for our youngest viewers? One of the best ways is to track current usage to better inform decision-making. One easy-to-use application is the “Media Time Calculator” developed by HealthChildren.org. This application allows adults (in English and in Spanish) to calculate the amount of time your child spends on various activities, such as school, reading, homework time, unstructured time, chores, etc. to better inform how much “extra time” is permitted in a child’s day for media time. https://www.healthychildren.org/English/media/Pages/default.aspx#calculator 

Most importantly, decide what is most appropriate for your family and stick with your plan. Avoid using technology as a bartering tool for compliance or tacking on “extra time” for good behavior.

Another easy way to determine what content should be emphasized first is to have discussions with kids about what should “count” towards screen time. In our household, playing a movement-based game on the Wii, such as Wii Sports, doesn’t count towards the daily “two hours,” neither is playing a chess app on the iPad or solving math problems on Prodigygame.com. Armed with this information, you can then develop a Family Media Plan for both adults, teens, and children in the home: https://www.healthychildren.org/English/media/Pages/default.aspx#wizard 

 

About the Author:

Dr. Jacki Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and will join the Londonderry office in March 2018. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma.

 

To book a consultation with one of our many 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, 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.

 

The Role of Pediatric Occupational Therapy

By | NESCA Notes 2018

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach

In order to fully understand the role that occupational therapy can play in pediatric health and wellbeing, it is first important to understand the term “occupation.”  The World Federation of Occupational Therapy (WFOT) defines occupations as, “the everyday activities that people do as individuals, in families, and in communities that occupy time and bring meaning and purpose to life.”  As we know, these activities look different at every age, and our routines, habits, and responsibilities are continually growing and changing.

During childhood, the development of these skills moves more quickly than any other period of life. For example, a two-year old little girl, Katie, is learning to put on her shirt independently, kick a ball, and sort by color.  Within ten short years, Katie may be getting herself ready for the bus, writing a three-paragraph essay, and learning to play the saxophone.  The transition to adolescence comes with even more new experiences and expectations.

So where does occupational therapy come in?

Occupational therapy focuses on the child, the activity at hand, and the environment around them.  By considering all of these factors, OTs work to determine the correct modifications, adaptations, and strategies that may be necessary for success.

What is the goal?

Due to the fact that occupations are incredibly personalized, the goal of OT is often to simply increase independence and participation in valued activities.  One child may be working on learning to independently tie his shoes, while another may need help developing a morning routine to consistently follow.  These goals are only worth focusing on and problem-solving if they are important to the child and his or her family.

How do we get there?

Consider the child’s strengths and limitations. These may include physical, emotional, cognitive, sensory abilities, and much more.  A child’s particular interests, level of motivation, and understanding of themselves all play a role in their ability to engage in the things that are important to them.

Consider the environment. The environment in which a child lives and grows is physical, spiritual, social, and cultural. It is this individuality that makes it nearly impossible for an environment to be a “good fit for all users.”  Occupational therapists often work to modify the environment, or help individuals understand the role that the environment plays.

Consider the activity itself. The list of childhood occupations is seemingly never-ending.  From brushing your teeth, getting dressed, and doing chores, to maintaining friendships, navigating the digital world, and learning to take the bus, these skills all require numerous steps and different abilities.  These activities often must be broken down into small steps to determine how to help a child be successful.

My work at NESCA

At NESCA, I am currently working as a community-based skills coach, using occupational therapy to create experiential learning opportunities, and develop functional living skills.  I love having the ability to work with tweens, teens, and young adults in their own environment to collaborate on creating lasting strategies for participation and independence.

Dr. Bellenis works with a small caseload of clients aged 12-26 who have recently participated in neuropsychological evaluation and/or transition assessment at NESCA. If you have questions about working with Dr. Bellenis for Community-Based Skills Coaching, please email Kelley Challen, Director of Transition Services, at kchallen@nesca-newton.com.

 

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenisjoined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual motor skills must be taken into account to create comprehensive educational programming.

 

 

 

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.

 

Modern Parenting – Part 3: Sarahah, WhatsApp, Snapchat, Oh My! Navigating the Wide World of Apps

By | NESCA Notes 2018

 

By: Jacki Reinert, Psy.D., LMHC
Pediatric Neuropsychology Post-Doctoral Fellow

I recently had the opportunity to co-evaluate a young woman in high school who was recently suspended from school due to ongoing peer conflicts with classmates on a social media app called Sarahah. What initially started as an innocent question soon escalated into an online battle, fueled by a misunderstanding and magnified by an impulsive decision to post a verbal threat. Since that time, Sarahah has popped up in my social media feeds, particularly among parents, educators, and therapists on Facebook. Well-intentioned adults are scrambling to learn more about the app, how they can protect their children, clients, and students from the dangers of yet another social media platform which promotes anonymous bullying. This phenomenon highlights the significant and misguided, albeit well-intentioned, approach adults use to conceptualize social media and adolescent usage. It is March 2018, and Sarahah has been unavailable for download on iTunes for approximately two months. Teens have already begun to move on to the next app, while adults are only more recently learning about the obsolete app.

Some common misconception adults have about social media is that they need to know each of the apps that teens are using, an impossible feat considering the speed with which they become popular, trend on iTunes, and quickly become a relic of the past. As digitally competent adults, we are better served by understanding the types of social media apps teens use, how to talk to kids about which apps they should steer clear of and why.

Generally, there are four types of social media apps that are currently trending, moving adolescents away from typical texting to new social platforms. The first are new texting platforms, which include WhatsApp, KikMessanger, Telegram, and GroupMe. These types of apps allow teen to group chat for free in virtual “private chat rooms.” Live streaming group chats are also popular because they allow multiple people to participate in a group “FaceTime” experience. Apps that offer these experiences are HouseParty, Live.ly, and Live.me.

Microblogging is another popular social media platform which allows teens to quickly post relevant information. Examples of this are classified into platforms such as Twitter or Tumblr, which allow teens to share text, GIFs, and videos, and photo-based microblogging, such as Snapchat, Instagram, and the now-defunct Vine. Of these, photo and video-based apps are more popular.

Lastly, there has been a huge shift from identifiable users to anonymous platforms, which include Yik Yak, Saraha, Spillit, Secret, Whisper, and AskFm, as well as meet-up and online dating apps. These apps include Monkey, Meet.me, Omegle, Yubo, and Tinder. Apps that promote anonymity are arguably the most dangerous, primarily because people (adults and adolescents) are more likely to say things online that they would never say to someone face-to-face, increasing cyberbullying. In a nationally-representative sample of 5,700 middle and high school students, the Cyberbullying Research Center found that over the last ten years, 27% of students had been cyberbullied at some point in their life. Further, anonymous social media apps and increased incidents of cyberbullying have been linked to multiple teen suicides around the globe.

As I mentioned in a previous post (http://www.nesca-news.com/2018/03/modern-parenting-part-2-what-are.html), talking to teens about their digital footprints is the first step in opening a social media dialogue about expected behaviors when using social media as a member of an online community, and the ramifications associated with engaging with others online. As a social media consumer, I have found CommonSense Media to be the best spot to access relevant information about not only apps but also other types of media, including movies and video games.

Research conducted by CommonSense Media highlights misconceptions about age-appropriateness for apps; they often compare what parents think is an appropriate age for specific apps, what kids think, and what the specialists think. For example, Snapchat is one of the most popular apps currently used by teens. Parents think it is appropriate for kids ages 14 and up, while kids think ages 12 and up is okay. CommonSense Media recommends users ages 16 and up. What about Instagram? Parents, 14 and up, kids say 12 and up, and CommonSense Media? Ages 15 and up.

So, who’s right? When is it appropriate for a kid to use Instagram? A one-size-fits all approach is likely to mismatch kids, particularly those who may have complex cognitive or social-emotional profiles, with the appropriate social media platforms. Join me next week to learn more about how to start social media conversations with kids, pitfalls adults can make, and when to seek advice from a professional.

Read the rest of this series:

Modern Parenting – Part 1: A Heartfelt Series of Social Media Tips

Modern Parenting – Part 2: What are Digital Footprints and Where Do They Lead?

 

About the Author:

Dr. Jacki Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and will join the Londonderry office in March 2018. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma.

 

To book a consultation with one of our many 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, 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.

 

Modern Parenting – Part 2: What are Digital Footprints and Where Do They Lead?

By | NESCA Notes 2018

 

By: Jacki Reinert, Psy.D., LMHC
Pediatric Neuropsychology Post-Doctoral Fellow

In this week’s Modern Parenting blog, let’s talk a little bit about all of those footprints you have been leaving around.

Do you remember that photo you shared on Facebook last week, or that status you “liked”? Chances are high that you don’t remember which photo or what status I am referring to, but fortunately for busy parents whose memories are fading, the Internet never forgets. As a social media consumer, your digital footprint is a literal trail of all the “stuff” you leave behind when you utilize the Internet. Your digital footprint is more than just your Facebook profile or Pinterest board; it includes comments you have made on social media platforms, that scathing Yelp review you left for a restaurant, Google Voice calls you have made, apps you have utilized, and emails you have sent.

Whether we like it or not, our digital footprints matter. Students’ acceptances to Harvard were rescinded last year (http://www.thecrimson.com/article/2017/6/5/2021-offers-rescinded-memes/) following a commonly-utilized practice of looking at potential students’ social media accounts (Kaplan, 2016). College admissions officers aren’t the only ones looking at social media; perceived misbehavior and racially insensitive comments made by individuals who serve the local community are also being reported and for many this has resulted in disciplinary action such as being fired (http://www.wdtn.com/news/local-news/springfield-employee-fired-for-racially-insensitive-social-media-post/1034324069).

When was the last time you Googled your name? Your child’s name? That Instagram user name? A useful way to track your digital footprint is to routinely Google your name, and doing this with your child is a great way to open up a dialogue about social media and Internet use. Google your full name, your nickname, your maiden name, and your most popular social media user name to see what pops up. The information found in your Google search is part of your digital footprint. A quick and easy way to monitor what content is highlighted online is to establish a Google Alert. In order to do this, go to google.com/alerts and enter in names you want to track. Select “Show Options” to narrow your alerts to specific platforms, locations, and the frequency of your alerts.

Another simple way to maintain your own digital footprint, as well as assist your children in cultivating their own, is by utilizing privacy settings whenever possible, and Facebook (FB) is a great place to start. To begin, click on your FB profile, and notice those three little dots at the bottom right of your cover page? Click on “View As” and voila! You can view your profile as a stranger sees it. What do you notice? Are your photos visible? All of those memes you’ve shared, are they visible as well? Teaching kids to do this is an easy way for them to have autonomy over their profiles and can establish a teachable moment where you can further discuss what they want to project out into the world.

Read the rest of this series:

Modern Parenting – Part 1: A Heartfelt Series of Social Media Tips

Modern Parenting – Part 3: Sarahah, WhatsApp, Snapchat, Oh My! Navigating the Wide World of Apps

 

 

About the Author:

Dr. Jacki Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and will join the Londonderry office in March 2018. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma.

 

 

 

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.

 

Modern Parenting – Part 1: A Heartfelt Series of Social Media Tips

By | NESCA Notes 2018

By: Jacki Reinert, Psy.D., LMHC
Pediatric Neuropsychology Post-Doctoral Fellow

Prior to entering doctoral studies, my family and I had the opportunity to live overseas for two years. After spending most of my childhood in New England, complete with family vacations to upstate New York, my limited world view left me ill-prepared for the splendor and, at times, sadness of raising our two-year-old without the loving support of our extended families in one of the most beautiful cities in the world. To bridge this gap of time and space, I often looked to social media as a window into the lives of family and friends.

First came Facebook, where old high school colleagues, current English-speaking expatriate comrades, and family could follow our adventures. Then, with the new sensational “Instagram”, I found myself snapping away, first of myself, my son, and of course the Eiffel Tower, quickly followed by Francophiles, family, and new friends. My follower stats quickly climbed and I enjoyed sharing well-cultivated images of perfect macaroons, baguettes, and yes, images of my son, who, thanks to a sweet face, curly hair, and blue eyes, certainly garnished a lot of “likes”. Hashtags embedded into my photos drew strangers in search of #paris, #perpetualtourist. Social media was my connection to family but in my eagerness to share, I never thought about the potential negative outcomes one might experience through sharing photos of their child.

For those of you who do not dabble in Instagram, users have the option of following people and liking their photos. For those with public accounts, users can look at another user’s feed (pictures) without following the person. If someone “double taps” your picture, they “like” it and you are notified. At the time, I saw no harm in having a public account with a small group of followers (375 people) until someone liked a photo I had posted of my son, someone whose name I did not recognize. After clicking on the person’s name, I was horrified to find multiple images of my son in this young girl’s account.

In 2014, a community of teenagers began “baby role playing” which consisted of taking (or stealing) other people’s images of their children shared on social media sites. After capturing the image on their own phones, the teens then rename the child, create fictional information about the child, and engage in reciprocal conversations with other role players. In the comment sections below the images, users have the opportunity to have conversations with one another, pretending to be the child and/or the parent. While some of these users used the images in seemingly innocent ways, others shared photos of children naked or breastfeeding.

After the images of my son were stolen and used for #adoptionrp, I made my Instagram account private. I also stopped posting photos of my son’s face on all social media platforms. I deleted any pictures on Facebook and asked family members to do the same. Over the past four years, we have collectively abstained from sharing images of our son and now our daughter.

Research suggests that by the age of 2, most children in the United States have an internet presence (BusinessWire, 2010). For some children, like Mila and Emma Stauffer, who have over 3.7 million followers on their mother’s Instagram account, social media has led to profitable income.

For our family, it has led to many awkward requests of, “Can you please take down that photo?” and has fostered an interest in learning about social media, digital footprints, digital citizenship, and media literacy. In this series of blog posts, we will delve into the world of social media and address how parents and professionals can talk to kids about social media.

Read the rest of this series:

Modern Parenting – Part 2: What are Digital Footprints and Where Do They Lead?

Modern Parenting – Part 3: Sarahah, WhatsApp, Snapchat, Oh My! Navigating the Wide World of Apps

 

About the Author:

Dr. Jacki Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and will join the Londonderry office in March 2018. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma.
To book a consultation with one of our many 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, 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.