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43

Building Independence—How Independent Living Centers Can Help Youth with Disabilities

By | Nesca Notes 2023

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

Good transition planning is about building a “team” that can outlast special education and using resources wisely. There is often talk of “maximizing benefits” so that private funds can be reserved and made to last. In order to create an effective and individualized transition plan, you have to know what resources are available in your local community as well as on the state and federal levels. One resource that may be overlooked or underused is your local Center for Independent Living (CIL). In Massachusetts, and some other states, these are often named Independent Living Centers (ILC).

Across the United States, CILs are free community-based agencies that provide a range of services designed to help individuals with disabilities build skills for living more independently. The barrier to entry is typically very low as the intake process may sometimes just be a phone call and acknowledgement of having a disability.

At a minimum, each center is charged with providing the following core services:

  • Information and referral: Learning about services, providers, benefits, and programs within your local community that can help you achieve your goals (e.g., advocacy, daily living, housing, recreation, etc.). Also, learning about resources offered through state and national organizations.
  • Skills training: Explicit instruction of self-advocacy and/or life skills that can help you to live, learn, and work more independently. Examples areas for skill development include accommodations, personal care, housing and household management, managing finances, interview preparation, etc.
  • Peer counseling/mentoring: Talking with a peer by phone, video conference, or in person for mutual support, confidence building, and ultimately to make more independent and informed choices.
  • Advocacy: Learning to advocate on both individual and systems levels. Building skills to advocate for oneself, including filing complaints or taking legal action to remove barriers when needed.
  • Transition services: Services to facilitate transition to postsecondary adult life, services to facilitate transition from institutions to the community, and services to assist individuals at risk of needing to be in institutions.

Additionally, ILCs/CILs may have developed services that are specifically useful for consumers in their local community or state. And there is generally no age requirement for accessing services. For example, many ILCs in Massachusetts have specific youth programming or Transition to Adulthood Programs (TAPs) which offer advocacy, skills training, and peer counseling specifically tailored to students.

ILCs/CILs are awesome agencies run by, and for, individuals with disabilities. However, in my experience, they are not talked about or accessed nearly enough as part of transition planning. If you are reading the blog and interested in building independence at home and in the community for yourself, your child, or a youth you work with—I strongly recommend you look up your local Center for Independent Living and call to find out more about accessing services today.

Resources:

Administration for Community Living – What is Independent Living?  https://acl.gov/programs/aging-and-disability-networks/centers-independent-living

ILRU Directory of Centers for Independent Living and Associations – https://www.ilru.org/projects/cil-net/cil-center-and-association-directory

Massachusetts Independent Living Centers – https://www.mass.gov/independent-living-centers

 

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

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

14

NESCA Welcomes Back Carly Edelstein, MSW, LCSW, Licensed Clinical Social Worker and Executive Function Coach

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA welcomes Ms. Carly Edelstein, MSW, LCSW, back to its coaching and psychotherapy services teams. She previously interned with NESCA, and we are thrilled to have her back on board as both a Psychotherapist and Executive Function Coach. Read more about Ms. Edelstein’s career journey and her return to NESCA in the following Q&A interview.

 

This is your second time working with NESCA. Tell us what you did with NESCA previously.
Yes, and I am elated to be back! During my graduate studies at Simmons University, I interned at NESCA as a psychotherapist. In addition to providing individual psychotherapy to children, adolescents, and young adults, I worked with a few high school and college students as an executive function (EF) coach. I also provided psychotherapy to clients from India and the Philippines, which was an incredible and unique experience. I have yet to find a practice as dynamic and integrative as NESCA and look forward to rejoining as a seasoned clinician!

You will be splitting your time and talents in two roles here at NESCA. Fill us in on your dual role and what your previous experiences bring to both.
At NESCA, I’ll be providing psychotherapy and executive function coaching. Both of these roles have been a consistent focus of mine simultaneously throughout my professional life. After obtaining a B.S. in education at the University of Vermont, I worked in special education as a paraprofessional, supporting students with special needs in the classroom. In this role, I helped students learn new strategies to maintain their focus, self-regulate, and improve their organization. Additionally, throughout graduate school, I worked part-time as an EF coach at Engaging Minds, helping elementary, middle, and high schoolers with their homework and school assignments by finding ways to improve their task initiation, organization, time management, and planning skills.

My interest in social work/mental health counseling was sparked by my experience as a student teacher at UVM. During the entirety of my practicum, I found myself  gravitating towards students who struggled academically, mentally, socially, and emotionally. I was determined to help these students navigate their challenges by building meaningful connections, providing additional academic support, and increasing their self-confidence by focusing on their strengths.

My counseling experience officially started in graduate school with two full-year-long internships. My first internship took place in the counseling department at Boston Green Academy, a public charter school for grades 6-12, and my second was at NESCA. After graduate school, I worked as a school adjustment counselor at Newton South High School and also took on clients part-time at a private practice. In these roles, I supported the social and emotional wellbeing of students with special needs, as well as their families. After working in corporate wellness for the last year and a half, I am excited to return to the clinical setting, working for a practice that was a major part of my social work journey.

Having worked as a high school adjustment counselor, you must have seen many of the challenges students have with executive function. What are your biggest takeaways from that experience? How do you think that prepared you to be an EF coach?
The majority of my students struggled with executive function, therefore providing support in this area was part of my day-to-day routine. My biggest takeaways are:

  1. Identifying a “why” helps individuals become more motivated to be proactive in their EF journey. For example, I tend to ask people how improving these skills will affect their academic goals, mental health, social relationships, etc., so that there is significant meaning to the work being done.
  2. There is a system that works for everyone! Whether it’s electronic or physical, once someone identifies an organization system that increases their independence, it’s important that they stick to it and are consistent with it. Having a set system will allow them to easily locate their assignments, know when they are due, and how they’ll go about completing them. It’s always helpful for parents and teachers to be made aware of this system as well so that everyone is on the same page.
  3. Creating a regular homework routine is key to increasing productivity and limiting distractions. This includes having an identified start time, location, and plan. I always recommend structured breaks being part of this plan as well.
  4. I always advise folks to not compare themselves to others when it comes to their EF skills! We all have natural strengths. A skill that comes easy to you may be the most challenging task for someone else.

There have been countless reports and studies related to the negative impact COVID had on kids. As a psychotherapist to teens and young adults, what challenges are you seeing most in youth post-pandemic?
There’s no doubt that the impact of COVID on our youth has presented serious and complex challenges. The loss of structure, social opportunities, and extracurriculars (to name a few) is a shock to the system and very traumatic. The biggest challenges I’ve seen post-pandemic have been an increase in digital dependence, cyberbullying, school-based anxiety/refusal, and regression in social skills. That being said, as important as it is to identify post-pandemic challenges, there is value in pointing out gained strengths as well. A lot of students who I worked with learned new coping skills, acquired a deeper understanding of their needs, and discovered exciting new hobbies that they now get to share with others.

 

About Carly Edelstein, MSW, LCSW
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 Ms. Edelstein for psychotherapy or EF coaching, please complete our online intake form. 

 

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

 

15

On-the-Ground Parent & School Consultation in Honduras

By | Nesca Notes 2023

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

NESCA’s International Work
NESCA is well regarded as an expert in providing neuropsychological evaluations for children and teens from around the globe as part of its International Evaluation program. To date, NESCA has provided evaluations to clients from more than 20 countries across Europe, Asia, Africa, South America, and North America.

Many families bring their child/children to our offices in New England to be evaluated, and NESCA’s founder and director Ann Helmus, Ph.D., has traveled to many countries to provide evaluations overseas. She also has a long-standing history training neuropsychologists in the Philippines. Our Transition and Coaching Services teams also conduct transition assessments for international clients as well as virtual executive function coaching to many young adults overseas.

Based on a neuropsychological evaluation conducted by NESCA this past year, I began providing consultation with a 5th grade boy from Honduras who is a student at a non-profit, bilingual, independent, private PK-12 college preparatory school there. Because of my work with this student, his family recommended NESCA’s services to another Honduran family and their child’s school. As a provider, knowing that a family trusts us and finds what we do so beneficial that they recommend us to another family is extremely rewarding.

Setting the Stage: The Special Education Landscape in Honduras
The special education system in Honduras is very different than in the U.S. in that they do not have the variety of resources we are accustomed to in the U.S., and there are not many evaluators in Honduras in any discipline (i.e., neuropsychologists, speech/language, OT, etc.). For instance, there are only six neuropsychologists in the entire country. Another major difference is that it is the parents’ responsibility – not the school’s – to hire a 1:1 paraprofessional or aide if needed for their child. Paraprofessionals function similarly to their U.S. counterparts, but since they are not employed by the school, they are separate from the school.

The special education teachers and counselors also function similarly to those in the U.S.; however, there are unfortunately not enough of them, limiting treatment services. They work from documents similar to IEPs but that are qualitatively are very different from our IEPs.

There are only a couple of special education models used for students: 3 times a week for general special education support or 5 times a week for pull-out reading or math instruction. The 5 times a week options ends at 6th grade. Some of the teachers we worked with reportedly had training in Wilson and Orton-Gillingham, but there are no SLPs or OTs at the schools, and families pay for these services to be provided at the school or after school. Since there are so few professional service providers in the country, these interventions are extremely limited.

Parent & School Consultation in Honduras
As these consulting engagements progressed, both families asked for NESCA to consult to staff at each of the student’s schools in-person in Honduras, and the schools welcomed this support. The families were hoping that my expertise as an educational consultant focusing on inclusion, program design, and autism could greatly benefit the educators and service providers at the schools – ultimately having a positive influence on the students and their classmates.

Both schools are international, bilingual, non-profit, tuition-based college preparatory schools, and are accredited by the Honduran National Ministry of Education, AdvancED, and the International Baccalaureate Organization. One is a Christian faith-based school. Both serve students from nursery through high school and use N-12 American standards of Core Curriculum. They are similar to American schools in that they have a wide choice of classes/electives as students move up in the grades, as well as sports and after school clubs and activities. Upon completion of their high school careers, students at these schools have the opportunity to earn three diplomas: each school’s typical high school diploma, the Honduran Bachillerato, and the International Baccalaureate diploma. A high percentage of graduates go on to higher education in the United States and abroad. They accept students with a variety of “moderate” special needs and have special education teachers and mental health counselors to support them.

For these in-person school consults, I teamed up with another professional who was also already consulting at these schools. She is a Board Certified Behavior Analyst (BCBA) and speaks Spanish – a welcomed addition, as I do not. She is very skilled at providing behavioral support and is not overly rigid in her approach with students. Together, we presented Professional Development trainings for the two schools on the ground in Honduras. We brought a combined, well-rounded knowledge base to our work with the families and schools, offering lessons in a variety of topics, such as Universal Design in Learning (UDL), Differentiated Instruction (DI), Social Skills training/approaches, Mindset and Mindfulness, Sensory Integration, and Positive Behavioral Intervention and Supports (PBIS), along with the ABCs (antecedent-behavior-consequence) and functions of behavior (EATS: escape-attention-tangible-sensory). In this first engagement, we provided a broad overview of these topics, giving the staff much to think about regarding their instructional practices, behavior management, classroom design, and teaching styles. We will continue to provide both virtual and in-person consults this coming school year so their learning can continue to grow and deepen.

This is an ongoing training/learning process for the staff at these schools. As mentioned, we will continue providing ongoing training to help the staff implement Universal Design principles in developing their lessons. We will continue our discussion about viewing student aberrant behavior through multiple lenses – not just as “breaking the rules and needing consequences” (i.e., neurology-sensory, cognitive disconnect, attention, etc.), instead thinking about what the student is trying to communicate through their behavior. This education helps them to think differently about prevention and antecedents, thus impacting behavior management and discipline practices.

The Experience
Staff at both schools were willing to learn and collaborate, and welcomed our input, with one school attending the training the week before their school year started, because we were scheduled to be in-person! The Honduran teachers we worked with throughout the year, prior to our in-person visit, were so open to instruction, feedback, and learning more, often reaching out to us between our scheduled virtual meetings preceding our visit. They were eager to figure out how to support their neurodiverse (a new word for them) learners and allowed me to join their classes remotely so I could model different techniques and practices. They were willing to share their successes, questions, and challenges, making consultation both productive and powerful. They were open to the many “homework assignments” (i.e., articles/books to read, videos to watch, visuals to make, etc.) given to them and the recommendations provided. They implemented new class-wide and individual behavior plans (self-awareness plans) and benefited from the modeling of strategies I demonastrated.

It was a wonderful experience for them and us, and I am happy that our relationship is continuing and will deepen well into this new school year. I am looking forward to watching their continued growth – directly impacting the two students who started it all, as well as their classmates and those to come in future years.

If you are interested in learning more about NESCA’s international evaluation, transition, consultation, and coaching services, complete our online Intake Form.

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

6

NESCA Offers Vermont-based Transition and Coaching Services

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA recently announced that it is now offering transition services and coaching services in the Greater Burlington, Vermont region. Learn more about what is being offered by our Vermont-based staff from my interview with Vermont-based Program Manager Dr. Lyndsay Wood, OTD, OTR/L.

Why did NESCA expand to Vermont and how can clients benefit from your services?

NESCA is expanding our in-person services to Vermont to widen the breadth of transition services offered within the state. Through research and conversations with local professionals and parents, we recognized that there is an opportunity to bolster local transition services for students to meet their personal postsecondary goals and to live fulfilling lives post-high school. Through our variety of services, our goal is to empower teens and young adults to create their own vision for the future and build the skills necessary to achieve it. This is important for students currently in public middle and high schools as well as local college students and young adults new to the world of work. At NESCA, we take a relational approach with to build a strong foundational relationship between ourselves and the clients we support. Our priority to is create a safe, inclusive, and welcoming environment within our sessions.

What services do you offer?

At this time, NESCA’s Vermont-based practice will offer transition assessment, real-life skills coaching, executive function coaching, transition consultation, and functional community-based occupational therapy evaluations. All Vermont-based services are delivered by experienced occupational therapists and transition specialists with expertise in developing functional and relevant goals. For more information on each of these services, please visit our website and view our Post-Secondary Transition Services and Coaching Services links: https://nesca-newton.com/our-services/. Many folks are unfamiliar with transition assessments, so to learn more, see the following blog written by our Director of Transition Services Kelley Challen, Ed.M., CAS: https://nesca-newton.com/transition-assessment-what-is-it-anyway-how-is-it-different-from-neuropsychological-evaluation/.

What type of client does NESCA serve in Vermont?

NESCA’s Vermont-based practice primarily works with teens and young adults with autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), mental health diagnoses, specific learning disabilities, executive function (EF) challenges, and other complex cases based on the expertise of our providers. A specialty at NESCA is working with clients who have multiple diagnoses or who don’t fit neatly into a singular diagnostic box.

Where are you in Vermont? Are services in-person or remote?

Coaching services will be offered in the home, school, or community within the greater Burlington area. Services can also be delivered remotely if deemed appropriate for the client. Transition assessment is typically conducted within the client’s school setting.

What is different about what NESCA offers in Vermont compared to other organizations or services already available?

NESCA will be a premier independent transition assessment provider in Vermont. We are happy to collaborate with school districts or work with families directly. Additionally, we are unique in providing one-on-one occupational therapy services that specifically address life skills within a client’s home and community setting. Working within the home and community, and not only within the school setting, is incredibly important for the generalization of life skills as well as social skills, functional academic skills, and executive functioning skills.

Does insurance cover your services in Vermont?

NESCA is primarily a private pay service provider. Some families are able to obtain some coverage or reimbursement for our real-life skills coaching service with their health insurance, but it is vital that folks first check with their insurance provider to ensure our services would be covered.

How do people get more information about NESCA’s Vermont services?

To learn more about NESCA, please visit our website at: https://nesca-newton.com/.

If you would like to fill out an intake form, follow this link: https://nesca-newton.com/intake.

If you have more specific questions, do not hesitate to call: 617-658-9818

Additionally, you can contact our Vermont-based Program Manager Dr. Lyndsay Wood, OTD, OTR/L, directly at: lwood@nesca-newton.com

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

 

To book coaching and transition services at NESCA, complete NESCA’s online intake form. 

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

6

Pediatric-onset Multiple Sclerosis

By | Nesca Notes 2023

By: Ferne Pinard, Ph.D.
NESCA Pediatric Neuropsychologist

Although typically thought of as an “adult illness,” children and adolescents can get diagnosed with multiple sclerosis (MS). Pediatric-onset multiple sclerosis (POMS) occurs when MS is diagnosed before age 18.

Approximately 30% of POMS patients show evidence of cognitive impairment. Problems with attention, working memory, processing speed, and language (including word retrieval) are commonly reported. Poorer verbal expression/vocabulary acquisition have also been reported among patients who were diagnosed at younger ages. Overall IQ, memory, complex attention (i.e., shifting attention between competing stimuli) and visual-motor integration skills may also be impacted. These cognitive deficits as well as absences due to illness and fatigue can undermine the student’s academic performance (i.e., grades), leading to feelings of inadequacy and a sense of not being able to “keep up with” their peers academically.

However, POMS can also affect the child’s/adolescent’s social and emotional functioning. Fatigue, depression, bowel/bladder problems and physical limitations can decrease a child’s/adolescent’s interest in socializing. Heat sensitivity can limit participation in physical activities while in a warm environment, which can make them feel even more isolated. They may also feel embarrassed and have lowered self-esteem because they feel different from peers. Children/adolescents with chronic illnesses are also at an increased risk for teasing and bullying from peers. It is no surprise then that children/adolescents with MS are vulnerable to psychiatric disorders. Depression, anxiety, and bipolar disorder occur more often in the MS population than the general population.

Multiple sclerosis is an unpredictable disease. Symptoms can come and go without apparent reason or warning, and no two people experience MS symptoms in exactly the same way. Some symptoms are clearly visible (like weakness, causing walking problems) or less visible (like fatigue or cognitive concerns). It is not possible to predict when symptoms will occur or what parts of the body will be affected. MS symptoms can change from week to week.

It is important that school officials understand that because symptoms come and go without warning, accommodations need to be in place, even when symptoms seem to diminish for a time. Accommodations can include:

    • Home tutoring when students are not able to attend school
    • Excused absences and a reasonable plan to make up missed work
    • Extended time for tests/exams/projects
    • Second set of books at home
    • Preferential seating for visual, attention, or bladder/bowel issues
    • Bathroom pass/extended bathroom time
    • Portable air conditioner/fan
    • Elevator access
    • Psychotherapeutic support
    • Plan to manage fatigue:
      • Frequent/scheduled breaks
      • Modification of class schedule
      • Workload modifications

A detailed neuropsychological evaluation is essential for objectively measuring any neurocognitive deficits, tracking them over time, and informing treatment recommendations. Speech/language, audiology, occupational therapy, and physical therapy evaluations may also be warranted depending on the severity of symptoms to determine whether these services are needed. Psychologists, psychiatrists, school guidance counselors, teachers, and school administrators as well as support groups with other patients and families facing this disease should also be part of the child’s/adolescent’s care team.

 

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

Dr. Pinard provides comprehensive evaluation services for children, adolescents, and young adults with learning disabilities, attention deficit/hyperactivity disorders (ADHD), and psychiatric disorders as well as complex medical histories and neurological conditions. She has expertise in assessing children and adolescents with childhood cancer as well as neuro-immunological disorders, including opsoclonus-myoclonus-ataxia syndrome (“dancing eyes syndrome”), central nervous system vasculitis, Hashimoto’s encephalopathy, lupus, auto-immune encephalitis, multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and acute transverse myelitis (ATM), and optic neuritis.

 

To book a neuropsychological evaluation with Dr. Pinard or another expert neuropsychologist at NESCA, complete NESCA’s online intake form. 

 

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

10

Questionnaires, Rating Scales, and Checklists, Oh My!

By | Nesca Notes 2023

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

Before I had children, I knew parenting would bring with it new demands. If you’d asked me what tasks I imagined would take a lot of my time and energy as a parent, I would have listed things like feeding hungry little mouths, washing adorable clothes, driving kids to and from school and activities, dealing with bath time, and reading stories at bedtime. What I would never have guessed is how much time and mental effort I would spend filling out paperwork. From the moment a child enters a parent’s life—regardless of what process brings them together as a family—it seems like there are unending forms to complete. As a parent of three children, I cannot begin to calculate how many hours I’ve spent filling out forms for doctors, daycares, schools, camps, babysitters, and extracurriculars. It’s a lot.

Perhaps that’s why I sometimes notice a very relatable subtle sigh when I hand parents forms to complete as part of their children’s neuropsychological evaluation. I get it, and I never want to add to a parent’s already overwhelming list of tasks to complete. Nevertheless, carefully selected questionnaires are an important part of a thorough neuropsychological assessment. Here are a few of the reasons why.

  1. Simply put, parents are the experts on their children. No doubt about it, a parent (or primary caregiver) knows a child better than just about anyone else could. Parents are uniquely qualified to provide invaluable information about their children and are a tremendous resource.
  2. Parents have more data points. During an evaluation, I typically spend about five hours with a child over the course of two testing sessions. It’s a limited glimpse into mere hours out of years of a child’s life. Parents are typically positioned to observe their children much more frequently and on many more occasions. I may see a child at their best or on a particularly bad day, and I don’t want to rely on my observations alone. Having information from many points in time, and from different settings, is incredibly useful and helps capture a more complete picture of a child.
  3. I want and need to know what happens outside the testing office. By design, the testing environment is deliberately developed to be a quiet space as free of distractions as possible to maximize a child’s ability to focus and participate in formal testing. It’s a highly structured situation and a one-on-one interaction. Life outside the office is…well, quite different. I want to get a sense of what happens during the hectic morning rush to get out the door, on the playground and the soccer field, and at the family dinner table.
  4. On a related note, people present differently in different settings, and having data helps us make sense of this. Many parents can relate to the concept of “restraint collapse.” Essentially, kids often work hard to keep it together in the academic setting throughout the day and “fall apart” when they come home after a long day of school. Similarly, children are often on the “best behavior” in public settings and with adults other than their parents. For this reason, I often don’t get to see this important aspect of things, so I rely on parent reports.
  5. Some things simply cannot be readily assessed using standardized testing measures in an office environment. Two skill sets that fall into this category are executive functions and social skills. Executive functions, which include skills like working memory, are not easily captured through tests in the somewhat artificial environment of an office. To assess working memory, we rely on tasks such as asking a child to recall strings of numbers. In the real world, working memory applies to more complex tasks, such as following multi-step instructions in a busy classroom or home setting. A child may do well remembering single digit numbers, but this doesn’t always translate to being able to remember and complete a series of directions in the “real world.” Similarly, interacting with one adult in a highly structured environment doesn’t allow a glimpse into a child’s social skills within the more complex, unstructured situations they face day to day.

In short, neuropsychologists rely on information from parents to gain a clear and complete picture of a child and to provide answers to the questions that bring a family to us. One of the ways we obtain this information is through questionnaires, symptom rating scales, and checklists. So, parents, thank you, for taking the time to give us your unique and invaluable perspective. We couldn’t do our jobs without it or without you.

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

5

Why Knowing Yourself and Saying No Matters to Neurodivergent Individuals

By | Nesca Notes 2023

By Jasmine Badamo, MA
Educational Counselor; Executive Function Tutor

The ability to say “no” and honor your limits is a beautifully powerful skill that we can all benefit from. In a productivity-focused culture where today’s 40-hour work week is roughly equivalent to a 160-hour work week in 1950’s time (read more in Devon Price’s Laziness Does Not Exist), it’s easy to ignore our limits and put pressure on ourselves to perform at an otherworldly capacity.

While life requires all of us to push ourselves at times, it is impossible to work at 100% capacity 100% of the time. And by saying no, or deciding where to strategically place your energy, you leave yourself with the bandwidth and energy needed to be more effective and consistent in the activities that are priorities to you.

This is definitely not the first time you’ve heard these ideas. However, today I’d like to focus on why saying no and honoring your limits can be especially important for neurodivergent individuals.

Neurodiversity is the natural brain diversity that exists within the human population, similar to other forms of human diversity. The terms “neurodivergent,” “neurominority,” or “neurovariant” typically refer to individuals with a brain makeup that falls outside of the statistical majority of human neurotypes. Being a neurominority is not a problem, nor is it something to overcome. However, being a minority often means having to function within a world that is generally not designed by or for you.

Because of this, neurodivergent individuals are often implicitly or explicitly taught to modify their thoughts and actions to better fit their environment. Instead of being able to honor their individual needs and boundaries, they are frequently asked to push themselves beyond their limits. While every person—neurodivergent or not—must operate outside their comfort zone at times, for neurodivergent individuals it can become a default way of life. This is exhausting and can result in burnout.

During intake sessions with new clients, I make it a point to clarify that I’m not here to “cure” ADHD, autism, or a learning disability. I’m here to help reduce, and also cope with, the disconnect between the client, their environment, and the activities they are being asked to regularly manage. Together we find ways to make the environment better fit the individual and their needs, and then (and only then) we will implement strategies for navigating the remaining barriers to reaching their goals.

And in order to make the environment better fit the individual, each client needs to figure out what works for them and, most importantly, what does NOT work for them. For some neurodivergent folk, it can be truly ground-breaking to ask themselves, “What about my environment or current activities is not working for me? What can I start to say ‘no’ to?” It’s an important step in learning more about yourself and how your brain works, and what is sustainable for you (not someone else).

This can be hard, especially if your productivity or ability to “keep up” with others has become a pattern—or even a part of your identity. Learning to say no and to let go of not only what others regularly ask of you, but also what you have become accustomed to asking of yourself, takes time, patience, and practice.

Remember, you wouldn’t begrudge a cactus for wilting if it were asked to constantly absorb more water than its capacity, or if it didn’t get the amount of sun it required. And once you provide that cactus with the specific and appropriate external conditions, it will be able to flourish and show the world all the unique beauty it has to offer.

All of this is much easier said than done, but one of the most rewarding aspects of my job is being able to join clients as they learn how to work with their brains, accept their specific way of being in the world, and start to say no to the rest.

To read more on this topic:
https://www.simonandschuster.com/books/Laziness-Does-Not-Exist/Devon-Price/9781797120591

If your child, teen, or young adult needs support in this realm, complete our online Intake Form to learn more about NESCA’s Executive Function and Real-life Skills Coaching.

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

8

Redshirting: Pros and Cons of Delaying a Child’s Entry to Kindergarten

By | Nesca Notes 2023

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Redshirting is a phrase that has traditionally been associated with college athletics, such as when coaches “redshirt” first-year athletes, providing younger athletes an additional year to develop skills and extend their playing eligibility. Academically, redshirting your child means choosing to delay kindergarten for a year even though your child is technically old enough to attend kindergarten.

Current research suggests there are pros and cons to redshirting kindergarten depending upon your child’s development and needs. One advantage of redshirting is the opportunity for the child to develop emotional maturity. While some students are ready academically, they may not be ready emotionally. This difference becomes particularly notable in the middle school and high school years, as a year difference in age (or almost two years if some students have been redshirted and your child is young for their grade), can lead to exposure to topics and behaviors your child is not emotionally ready for.

However, if your child has an identified or suspected disability, or you feel they may need extra help in school, you may not want to redshirt, as doing so would result in delay of necessary services provided free through the public schools (e.g., occupational or speech therapy, specialized academic instruction), which research finds to have a meaningful impact on improving a student’s long-term outcome. Additionally, if redshirted, a child loses up to a year of special education eligibility at the other end of their school experience if a student has significant disabilities covered under the IDEA, as those services end based on age (e.g., special education rights end at the age of 22 in Massachusetts).

To help you make an informed decision, it is also recommended that you speak with your child’s preschool teacher in addition to any professionals (e.g., speech therapist or psychologist) working with your child. You may also want to consider meeting with an educational consultant who specializes in this area. Finally, you may consider a neuropsychological evaluation to gain a better understanding of your child’s strengths and challenges as well as to obtain educational recommendations.

Clearly, there is no right or wrong answer to redshirting in kindergarten. It is highly dependent on a child’s level of development and needs. Parents are encouraged to watch for signs of readiness, such as the ability of their child to communicate and listen well, follow instructions, and be able to sit and focus for 10-15 minutes at a time. Also, having a good understanding of your child’s developmental profile (language skills, self-regulation skills, social skills, etc.) can help a parent make an educated decision.

 

Sources

https://www.psychologytoday.com/us/

https://www.sciencedirect.com/

https://cepa.stanfod.edu

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

42

Transition Assessment: What Are You Testing that Hasn’t Already been Tested?

By | Nesca Notes 2023

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

Transition planning is a complex process centered around helping students, typically who receive special education services, to set goals for their postsecondary adult lives and to engage in learning, services, and experiences that will help them to ultimately reach those goals. Assessment is a critical aspect of this process, both as a means for collecting baseline information about the student and measuring progress throughout the planning process. Transition planning is federally mandated for students at age 16. However, some states require schools to start the process earlier. For instance, transition planning is required as part of the IEP process for students turning age 14 in Massachusetts.

Transition assessment is therefore required in middle school or early high school for most students in the United States. By this point in time, students on IEPs have often participated in lots of testing. Students may have had academic testing, psychological evaluation, speech and language testing, occupational and physical therapy assessments, functional behavioral assessment, and even home or health assessments. They have participated in so much previous testing, that some parents or professionals may ask, “What could a transition specialist be testing that has not already been addressed through other evaluations?”

The answer is, “A lot!” There are many areas that can and should be evaluated as part of an informed transition planning process, but which are not frequently evaluated when creating earlier IEPs. This is because initial IEPs and early reevaluations focus on helping students to access education and school life, but transition planning is about helping students to develop necessary skills for accessing learning, living, community, and employment as an adult. The following tables are based on on the Transition Assessment Planning Form developed by the Transition Coalition at the University of Kansas in 2008. These highlight many areas of assessment that can and should be considered as part of a comprehensive transition assessment and planning process. These also indicate which areas have usually not been considered for evaluation prior to a thorough transition assessment process.

Please note that every student on an IEP is an individual with unique strengths and disability-related needs and so these tables are offered as a general picture of what has been observed at NESCA in the majority of cases. Additionally, while all of the areas above are considered as part of a comprehensive transition assessment and planning process, they may not need direct assessment depending on student profile, postsecondary goals, and existing evaluation or report data.

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

 

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

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

12

The Benefits of Volunteering

By | Nesca Notes 2023

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

Volunteering has many benefits for school aged students beginning to participate in transition planning. Many charities and organizations rely on volunteers to continue their services and reach more people. In general, volunteering is a great way to form community connections, achieve a sense of purpose, and boost confidence and self-esteem, all while helping those in need. In thinking about a child’s eventual transition to adulthood, there are many additional hidden benefits to volunteering.

  • Build social connections: Volunteering allows individuals to engage and connect with others in a structured environment. Working with others through task completion towards a common goal is a great way for individuals to form friendships and positive connections in a low-pressure setting.
  • Mental health benefits: Volunteering has been shown to decrease symptoms of depression and loneliness. Many studies have shown that helping others and carrying out altruistic acts makes you happier. In fact, some therapists believe volunteering should be built into a treatment plan in the management of depression.
  • Employment/Transition Skills: Volunteering can help individuals build various skills that will help them in future jobs. Volunteering can help develop leadership skills, one’s ability to work in a team, customer service, following instructions, and punctuality to name a few important pre-employment skills. Volunteering helps individuals learn what type of work they enjoy through exposure to various work activities and work sites. Consistent volunteer work can also help build a young person’s resume.

It may be decided that a good match leads to long-term volunteering; however, it does not have to be a long-term commitment. Consistent volunteering can be a helpful tool in the stressful seasons of the year. Helping others can help to clear your head, reduce stress, and bring a perspective that allows you to engage more fully in your other commitments.

If your child and or family unit is looking for volunteer opportunities, you can start by contacting local animal shelters, senior centers, public libraries, community centers, or food pantries. Other websites to locate family volunteer opportunities in the greater Boston area include:

https://www.doinggoodtogether.org/family-volunteering-boston

https://community-harvest.org/

https://www.cradlestocrayons.org/boston/take-action/volunteer/

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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