NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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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.

 

15

Creating a Kinder, Gentler New Year

By | NESCA Notes 2024

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

We use the start of every new year as motivation to set goals for ourselves, and we often ask children to do the same thing. A New Year’s Resolution is a tradition, in which we set our mind, heart, and spirit to change an undesired trait or behavior, accomplish a personal goal, or otherwise improve ourselves in some tangible way. We may set a goal to lose weigh, exercise more, eat less sugar, meditate daily for five minutes, do homework without a fuss, help out with chores around the house, or walk the dog when my parents ask, etc. Often, we make New Year’s Resolutions, but we don’t usually accomplish them. Within a month or so, we start slipping back into our old ways. Habits are hard to change, and we are resistant to change – it is partly due to our wiring. So, if you are one of these people who has good intentions and sets New Year’s Resolutions then fails, know you are not alone. Hopefully, this fact can help you feel less shame and guilt when you “fail” at keeping them.

I’d like to suggest that if you decide to set a New Year’s Resolution, you do it with yourself and other people in mind. There is so much angst and strife in the world right now that if we resolve to be kinder, gentler, and more patient with ourselves and each other, the world would be a better place.

One idea is to make group resolutions that impact the functioning of the collective. For instance, we could consider Family New Year’s Resolutions or Classroom New Year’s Resolutions. With this in mind, here are some sample suggestions for New Year’s Resolutions for families, classrooms, parents, teachers, and children. Keep your resolution(s) manageable – i.e., only pick one that you are truly committed to working on and putting the energy into changing, as your brain is partly “against you” changing! As they say, “May the Force Be With You!”

General New Year’s Resolutions

  • Sleep – It’s important for everyone, so try to set bedtimes for everyone and stick to them (parents included). Bedtimes should be different depending upon the ages of each child. Getting more sleep may afford us the ability to be more patient with others.
  • Unplug – Take time to unplug from your devices for an hour or more every day. Go for a walk, talk to each other, get the kids involved in preparing the dinner, play a board game. (i.e., take part in old fashioned “family time”). Unplugging affords us the opportunity to be more connected with each other, and being with others (Social Engagement) has been proven to improve one’s quality of life.

For All of Us:

  • Develop patience and compassion when you mess up, as you will mess up.
  • Develop patience and compassion with others because they, too, will mess up.
  • Develop a calming practice if you do not currently have one. Stress happens and is a “silent killer” (i.e., higher blood pressure, poor eating habits, etc.). We have smart watches that can remind us to take a breath…set it to remind yourself. Come back to your breath in moments of stress. Just a few minutes a day mindfully breathing can lower your heart rate and, over time, lower your blood pressure and reduce cortisol (a stress hormone) in your body.
  • Listen more/Talk less.

For Classrooms:

  • Encourage each student to identify one area related to Personal Growth (i.e., ask more questions in class, volunteer to help another classmate, remain calm when challenged academically, etc.). I will ___Settle Down___ when asked by the teacher by the end of the count; show ___Kindness___ to others in my class by___; Ask more questions; volunteer to ___.

For Teachers:

  • Start the New Year off with renewed energy and reimagine equity in your classroom.
  • Talk about fairness – Fair doesn’t mean equal; it means everyone gets what they need to succeed.
  • Talk about school-based stressors/triggers for students (i.e., a certain subject/activity type, tests/quizzes, speaking in front of the class, etc.). Teach them that stress is a normal part of life, then teach them simple stress-reduction techniques (i.e., mindfulness, deep breathing, yoga poses, etc.) they can weave into their day.
  • Teach students about perseverance, grit, and effort and how they are all entwined. Involve students in identifying when they are using them.

For Parents:

  • Self-care – Priority #1 for parents. Just like the airlines say, “Put your own oxygen mask on first.” Define what this means for you and make a plan to stick with it. One small step at a time.
  • “Be Present” with your kids. Often, we are “with” our kids a lot, but are we truly present in mind and body? Usually not; we are doing something else when they are talking to us (i.e., cooking, paying attention to our phones, packing lunches, etc.), so our attention is split. Try taking 10 minutes every day with each of your kids to be truly present in mind and body with your attention solely on them in the moment.
  • Talk with your children about home/life stressors/triggers (i.e., not getting to do what they want, having to do something they don’t want to do, moving from a preferred to non-preferred activity, etc.). Teach them that stress is a normal part of life, then teach them simple stress-reduction techniques (see above) and work together to weave them into the day. Model practicing them yourself!
  • Show gratitude for their words and actions.

Here’s to hoping we are blessed in 2024 with more peace in our hearts and a kinder, gentler, and more compassionate family, classroom, and world!

Resources on these topics:

Keeping Resolutions

Family Resolutions

Stress & the Body

Awesome Year by Kid President

 

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; 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.

 

11

How to Make the Holidays Less Stressful

By | Nesca Notes 2023

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Are the holidays the “most magical time of the year?” Maybe, but they can also be the most stressful. In fact, a recent survey by the American Psychological Association found that 41% of U.S. adults experience increased stress levels around the holidays, while 52% find their stress levels remain the same, and only 7% feel less stressed this time of year. A whopping 43% of American adults acknowledge that the stress that accompanies the holidays compromises their ability to enjoy them (and that number includes only the people willing to admit it!).

As an adult reading this, you may be thinking this information comes as no surprise and you’re all too aware of the stress that comes with the holidays. What you may not realize as fully is that this time of year can be stressful for children as well. While the holidays can bring excitement and fun, they can also present challenges, particularly for our kids and teens who struggle with underlying mental health issues (such as anxiety or depression) or neurodevelopmental conditions (such as Autism, Attention-Deficit/Hyperactivity Disorder, or Sensory Processing Disorder). For the next few weeks, many of us will be attempting to navigate our own holiday-related stress and manage the stress our children may feel and express in a variety of ways. So, if you’re feeling less overwhelmed with excitement and joy and instead simply overwhelmed, you’re not alone. Here are some strategies for making the holidays work for you:

Notice and recognize the impact of expectations. It all starts here. From Hallmark movies to the pictures posted by mom-fluencers on Instagram, we are bombarded with unrealistic images of what the holidays “should” look like. Social media is particularly insidious, as it tends to contribute to a sense that the everyday, real people around us (not just those celebrities in magazines) are living what we see reflected in their carefully edited and curated photos. It’s important to remind ourselves that these images don’t reflect the reality of life and that we don’t see 99% of what happens in the daily lives of those we follow on social media. We may see the images of perfectly decorated Christmas cookies but not the kitchen counters covered in flour, eggs, and frosting (or the parent yelling) in the background. We click on the beautiful photo of three kids all smiling at the camera from Santa’s lap but don’t see the 25 outtakes featuring those same children in tears, sticking out their tongues, or bolting out of the frame. Realizing this and taking a step back is key for ourselves and our children, who may also need explicit information about what they can expect (for instance, regarding the number of and type of gifts they will get based on your family’s budget versus what they envision).

Realize we also all harbor implicit ideas about what the holidays “should” look like based on our experiences growing up and the way our families did things, which we take for granted. If you’re in a relationship, you may have encountered your own hidden expectations if they ever come into conflict with those of your significant other. Even if you celebrate the same holiday(s), you may do so in very different ways. Some of you may be familiar with conversations, such as, “What do you mean your family decorates the tree Christmas Eve? Christmas trees go up as soon as we put our jack-o-lanterns in the compost on November 1st!” If you and your partner celebrate different holidays or your kids split their time between your home and that of another parent, all of this becomes much more complicated. So, talk about it openly and together. As a family, re-evaluate your expectations and traditions, and start with a blank slate. Sit down together, make your expectations explicit, then assess them together.

Ask some questions, such as:

  • What does each family member, kids included, envision the holidays will look like? This might be general and abstract (maybe Mom wants to ensure there’s downtime for rest and relaxation) or concrete (maybe the kids want to go ice skating over winter break, and Dad wants to make sure the family goes to midnight mass on Christmas Eve). How will you make this work both logistically and in terms of balancing different needs?
  • What traditions do you automatically take part in, and do they work for your family at this particular moment in time? Although traditions are important and meaningful, blind and rigid adherence to rituals and routines that don’t work for us don’t benefit anyone. We often take part in traditions without questioning whether they add to our lives or why we started doing them in the first place.

Once you’ve had these discussions, consider that you don’t have to “do” the holidays the same way ever single year. There’s no rule that says every holiday season has to look the same. Do you always go take photos with Santa at the mall even though your kids inevitably resist the idea, become anxious and overwhelmed, and you end up frustrated? Open up to the possibility of forgoing that tradition even if it’s just for the time being. Do you make an elaborate holiday dinner each year but aren’t up to it this year? Consider finding an alternative for now that takes the stress off of you and still aligns with your priorities. If what’s important to you is enjoying a meal with your family, maybe you can still do that while letting go of the need to do it all yourself.

Modify your expectations and make accommodations for your children given their unique personalities and potential challenges. This might mean forgoing busy and crowded events, such as parties, for children and teens who struggle with anxiety in social settings or become easily overwhelmed by sensory input. Or maybe you still attend, but you have a pre-established plan for leaving by a certain time and/or managing distress that may arise. These days, many public spaces that host events (e.g., museums, theaters) hold modified sensory-friendly versions of events at specified times. For many children, building in predictable routines, and previewing special plans or changes to their usual schedules can be very helpful. For kids or adolescents with significant “picky” eating or Avoidant-Restrictive Food Intake Disorder (ARFID), you might consider hosting a holiday dinner at your house so you have control over the menu or bringing food you know your child will eat if you’re visiting others. Many kids with ADHD will need movement breaks, so think ahead about how you’ll work those in depending on your plans. It helps to think ahead and have a flexible plan for meeting your kids’ needs in different scenarios.

Now for the twist. Remember that APA study I quoted at the start of this blog? Well, even though so many people reported significant stress, it also found that 69% of adults feel the stress of the holidays is “worth it,” and many endorse positive outcomes related to the holidays, including an increased sense of togetherness. No matter what or how you celebrate, the holidays can be a wonderful and meaningful time of the year, and the odds of finding joy, connection, and calm will be higher if you take a step back and figure out how to make the holidays fit into your life and work for your family.

References:
https://www.apa.org/news/press/releases/2023/11/holiday-season-stress

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s 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.

8

The Impacts of Handwriting Challenges

By | Nesca Notes 2023

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

After recently participating in the virtual conference of the International Dyslexia Association, two presentations that particularly sparked my interest were, “How Handwriting Impacts Literacy Development,” presented by Carol Armann OTR/L and Kathleen S. Wright of The Handwriting Collaborative LLC, and, “Dysgraphia – Recognize, Diagnose, and Remediate,” by Debi Buchanan, Ed.D. and Sheryl Frierson, M.D., M.Ed.

Within those webinars, research was presented that demonstrated the importance of handwriting and fine motor skills development, as those skills resulted in not only improved literacy skills, such as letter writing, but also kindergarten math performance, and these skills are associated with ongoing reading and math achievement as late as 5th grade (Dinehart et al 2013). Additionally, identifying early handwriting challenges and providing systematic handwriting instruction can reduce the number of children who ultimately will require special education services (Beringer, V& Wolf, B 2016).

Some fine motor skills necessary for the development of handwriting include in-hand manipulation (e.g., precisely picking up, manipulating, and releasing objects), graphomotor (e.g., handwriting strokes, lines used in forming letters), and visual-motor integration. Dysgraphia is an impairment in handwriting, characterized by deficits in legibility and/or fluency. However, it is not exclusively a motor impairment, but is a disruption in the coordination of the mental image (e.g., which letter, which way does it go? Where does it go in the word?) and motor output (e.g., motor sequencing, motor planning) that are required for legible and fluent handwriting.

As students move through the grades, handwriting becomes an essential component in gaining reading and writing skills. Handwriting fluency is particularly important as non-proficient hand writers cannot keep up with their ideas (Graham, 2010). While, positively, there are programs that can help students with graphomotor output challenges, such as speech-to-text programs, teaching early writing skills is essential to building literacy skills, as effective handwriting instruction has been linked to improved letter recognition, letter formation, spelling, and written composition (Berringer et al 2002, Graham Harris, &Herbert, 2011).

Depending on your child’s age, you can encourage fine motor skills development through fun activities. As examples, some good resources are https://napacenter.org/fine-motor-activities/ and https://www.understood.org/en/articles/6-fine-motor-activities-for-young-kids. If you are concerned that your child is not reaching outlined milestones in their development of the underlying skills necessary for writing accuracy and efficiency, consider asking Early Intervention (for children under 3 years of age) or your school district for an occupational therapy evaluation to determine if your child would benefit from specialized supports. For school age children, an occupational therapy evaluation to determine the functional level of your child’s writing skills would also be appropriate.

 

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 college-aged daughter.

 

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s 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.
11

Navigating Screen Time: Understanding the Impact on Child Development

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

At school, we have had increasing difficulty with children refusing to leave their car at drop-off because they are on their tablets and do not want to stop what they are doing to go to school. Screen time has long been discussed regarding how much is too much and recommendations offered for limiting screen time. Now, with mobile devices, screens can be taken anywhere. Furthermore, there is never a shortage of entertaining options to engage with, from games like Minecraft, Roblox, and Fortnite to YouTube, all of which draw children in and make it difficult to stop. This article aims to provide a nuanced exploration of the impact of screen time on child development. While screen time is not inherently negative, it requires thoughtful management and consideration, particularly in the context of the developmental needs of children.

Screens are pervasive in daily life and have become integrated into the fabric of 21st century family dynamics, mostly due to the numerous ways of engaging with screens. According to the American Academy of Child and Adolescent Psychiatry (AACAP), children between the ages of eight to 12 spend at least four to six hours a day watching or using screens. According to Common Sense Media, children between birth and eight spend an average of two and one-half hours per day, with children two and under spending approximately 49 minutes on average. While screens can teach and entertain, too much may lead to problems.

Excessive screen time can have a variety of effects on child development. These effects can be physical, cognitive, emotional, and social, and vary depending on the content and purpose of screen time. The is largely due to what children are not doing when they are using screens. Extended periods of screen time can lead to a sedentary lifestyle, which can lead to obesity, poor posture, and disrupted sleep patterns. In terms of cognitive development, overuse of screens with fast-paced and visually stimulating content can overwhelm a child’s developing brain and potentially affect attention span, impulse control, and the ability to concentrate.  It can also impede the development of language and communication skills. When children spend too much time in front of screens, they may have fewer opportunities to engage in real-life conversations and interactions, which are crucial for language development. And, while educational content can have benefits, excessive screen time can still disrupt the learning process. It may lead to reduced engagement with traditional forms of learning and limit a child’s ability to exercise critical thinking and problem-solving skills.

It is important to note that not all screen time is detrimental. Age-appropriate and high-quality content, as well as supervised and interactive screen time, can have educational and social benefits. Additionally, technology can be a valuable tool for learning and creativity when used in moderation and with parental guidance. Parent and caregivers can help mitigate the potential negative effects of screen time by setting limits, monitoring content, and encouraging a balanced lifestyle that includes a variety of activities, such as physical play, reading, and face-to-face interactions. Sometimes the best conversations happen in the car.

References:

 

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 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.

 

3

The ABCs of Challenging Behavior

By | Nesca Notes 2023

By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

When a child or adolescent is exhibiting challenging behaviors, it is helpful to understand why the behaviors are occurring. The first step is to analyze the situational factors surrounding the behaviors:

A: Antecedent. What is happening right before the behavior occurred?
B: Behavior. What is the specific behavior that the child/adolescent exhibited?
C: Consequence. What happened right after the behavior occurred?

By looking at the ABCs of a particular behavior, we can start to understand the function of the behavior. That is to say, why is the child/adolescent engaging in the behavior? How is the behavior being reinforced?

Let’s look at an example:
Tom is in 6th grade. He arrives to math class, and the teacher distributes a worksheet. Tom rips up the math sheet and throws it on the floor. The teacher sends him to principal’s office.

A: Math class, being given a worksheet
B: Ripping up the paper
C: Being sent to the principal/leaving the class

In this example, the aversive situation might be math class itself, it could be the worksheet, or it could be the specific concept being worked on (e.g., multiplication is hard for Tom). Alternatively, something might have happened right before math class that upset him.

The consequence is that Tom is allowed to avoid the problematic situation. Thus, the teacher is inadvertently reinforcing the behavior. Tom has learned that if he refuses to do the work, he gets to leave class.

The more effective intervention would be to understand why he refused the work. In this case, it would be important to have a conversation with Tom. Was the work too hard? Does he need extra explanation of the concepts being covered in the worksheet? Did something happen before math class that Tom was still upset about? If the teacher is not able to engage him in this type of conversation, perhaps it would be better to send him to the school counselor as opposed to the principal.

As you think about your own children, it might be helpful to consider the ABCs of any challenging behaviors that are occurring. What was happening right before? If you can identify antecedents, you might be able to make some concrete environmental changes in order to avoid the behavior. What happened right afterward? Did your reaction to the behavior somehow reinforce it? Could you do something different next time the behavior occurs that would be more effective?

Resources
The Explosive Child by Ross Greene
How to Talk So Kids Will Listen & Listen So Kids Will Talk by Adele Faber and Elaine Mazlish
The Behavior Code Companion by Jessica Minahan

 

About the Author

Erin Gibbons, Ph.D., evaluates children presenting with a range of attentional, learning, and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit 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.

11

Why Teletherapy?

By | Nesca Notes 2023

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

During the pandemic, providers all over the world implemented virtual services. While some therapy clients preferred and/or needed to shift back to in-person once deemed safe, others grew fond of meeting with their therapist virtually. Given the effectiveness, convenience, and flexibility, teletherapy is here to stay. Unlike medical doctors, most therapists don’t need to check your temperature or blood pressure when they see you. Rather, therapists aim to create a physical space where their clients feel safe and comfortable. That said, what if you feel the most comfortable being vulnerable in your home? While not everyone sees the appeal in teletherapy, having the option increases accessibility, and studies show clients attend teletherapy more consistently than in-person, yielding more desired outcomes.

Feeling emotionally and physically comfortable at home during teletherapy is just as important as its convenience. Perhaps you’re a college student or working parent with limited free time in your busy schedule. Teletherapy offers flexibility by removing transportation and wait times. With rates of anxiety, depression, and other mental health conditions rapidly rising, teletherapy is an option to consider if you’re seeking support.

Tips for preparing for your first teletherapy session:

  1. Consider privacy; place yourself in a room or space where you can discuss confidential information without others overhearing your conversation. Sound machines that make white noise can help to prevent sound waves from escaping the room.
  2. Limit any distractions; sign into the teletherapy platform in a brand new window versus a tab, so you’re not tempted to browse the web or check emails during your session. You want to set yourself up for success when it comes to being focused and staying present.
  3. Notice what’s in your background; in order to feel as comfortable as possible, make note of what your therapist may see behind you while on video.
  4. Sit back, relax, and trust the process!

Sources:

https://www.forbes.com/health/mind/teletherapy-for-mental-health-treatment/

How well is telepsychology working? (apa.org)

 

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 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.

 

6

Loving Individuals with Executive Function Challenges: Real-world Examples of Flexibility and Adaptability

By | Nesca Notes 2023

By Jasmine Badamo, MA
Educational Counselor; Executive Function Tutor

Last week I discussed how being flexible and adaptable is a great way to support individuals with executive function struggles. Today I’d like to give you a few examples of how that would look in real life!

Scenario #1
You are the parent from the nighttime routine debacle from last week. Instead of bedtime being relaxing, it fills you with anticipatory dread. Bedtime is in 15 minutes, and you are scrambling to get your child ready. After prompting your child for the 27th time to pick a pair of pajamas and put them on – something they have to do literally every night and should come as no surprise to them, you walk into your child’s room to see the contents of their backpack strewn all over the floor as they look for their favorite plushie to pack for school tomorrow. Pajamas are not on, teeth are not brushed, and now there is a room to clean. You feel your frustration boil over as you realize that it will be yet another night of everyone going to bed late and stressed out. You think to yourself, “This shouldn’t be this difficult! My kid should be able to do a simple nighttime routine and get to bed on time!”

→ Examples of Flexibility and Adaptability: You stop constantly prompting (or as your child calls it, “nagging”) and start providing external supports that help them foster more independence. After sitting down together and learning that visual reminders are helpful, you posted a nighttime routine checklist on the wall. In your discussion, you also realized that your little one runs out of steam about 15 minutes in, so you simplified the nighttime routine to the bare minimum. You even started shuffling some of the nighttime tasks to earlier in the day when everyone has more energy. It’s a little unconventional to put on pajamas before dinner, but it’s one less task to do later, and it makes dinner fun.

Scenario #2
You love your partner dearly, but for the life of them, they are incapable of arriving to any family event even remotely on time. The lead-up to walking out the door and into the car is always filled with shouting and frustration, and while you arrive together, you arrive late and grumpy.

→ Examples of Flexibility and Adaptability: You started traveling separately to family events. Yeah, it confuses some of your relatives, you’re using double the gas, and your partner shows up way later than they would if you drove together, BUT you both arrive at the family gathering in great moods and enjoy your time with everyone, which is your actual priority. It’s also helped your relationship because it’s removed a lot of the push-pull dynamic that was created by rushing to get somewhere together on time. You also notice how it has opened the door to more conversations around your spouse’s neurodiversity and ways to support them. But really, the best part of this new flexible arrangement is that you can get there on time before all the tasty food runs out, and when you’re feeling generous, you even save your partner a plate!

Scenario #3
No matter how hard you try, your fridge is a warzone. Vegetables rot before you can cook them; you have multiple bottles of hot sauce because you keep forgetting you already have some; and a pack of mushrooms stares judgingly at you every time you pass over it because you still haven’t bought the other ingredients for the mushroom soup you plan(ned) to make.

→ Examples of Flexibility and Adaptability: You let go of how you thought a fridge needed to look, and organized it in a way that makes sense for your brain and eating habits. Vegetables now go in the fridge door where you’ll have a visual reminder to eat them before they go bad. Condiments are on a lazy Susan so you can quickly check what you have and don’t have. You also started shopping for only 1-2 dishes at a time, and now keep all the ingredients needed for a dish together in bins so they’re ready to go when you cook. Yes, you know pasta doesn’t need to be in the fridge, but you know what, this is your life, and this makes sense for you. And while it’s true that this new organization system is suboptimal in terms of space usage, you’ve noticed that you’re actually using more of what you do have in the fridge, which is your priority.

Want to explore this topic more?
Here are a few social media accounts that are modeling a more flexible and adaptable approach to executive function demands:
@thecenteredlifeco
@strugglecare (along with her Podcast “Struggle Care”)
@divergentcoachkelly
@adriabarich

And, if you would like to explore additional solutions to executive function challenges, NESCA’s team of expert executive function coaches is available to work with you and/or your family. We have coaches who can work in-person or remotely. Let us know how we can support you.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s 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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