Tag

NEUROPSYCHOLOGICAL ASSESSMENT

School Stressors in a Pandemic

By | NESCA Notes 2021

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

A recent article published by NBC News highlights the multiple stressors facing school-aged children and their families during this pandemic, with a more specific focus on the differing stress levels between remote and in-person learners. It is becoming clearer that during this time, learners and their families are facing higher rates of depression and anxiety, and there are concerns that students who are attending school remotely are learning less, particularly children with disabilities and those from low-income families.

A recent study from NBC News and Challenge Success, a nonprofit affiliated with Stanford Graduate School of Education, compared the differences between students who have been learning exclusively online and those who have been able to attend at least partially in-person. The study involved more than 10,000 students in 12 U.S. high schools who completed a self-questionnaire provided by the research study. The high schools were reported to come from multiple locations around the country (Arizona, Texas, New York and Midwest) and were descried as “demographically similar to the nation in terms of student family income,” though this was not true of being matched for race and likely other factors not discussed in the article. This also does not appear to be a peer-reviewed study, which suggests limitations to predictive power of the outcomes. Nevertheless, findings suggested that students who spent time in the classroom self-reported lower rates of stress and worry than students who were fully remote. An alarming finding was that half of all students, regardless of how they were attending school at the time of the study, reported they were more stressed by school than they had been during the previous year. Students reported exhaustion, headaches, insomnia or other stress-related ailments at high levels – regardless of whether they were in-person or not – with the highest rates being for remote learners: 84 percent fully remote learners; 82 percent hybrid students; and 78 percent fully in-person.

The article suggested that additional stressors found for remote students included on average more homework and that these remote students were also less likely to feel they had an adult they could go to with a personal problem. Anecdotally, one teacher commented, “In the room, you get more eye contact.” The teacher added, “On the screen, oftentimes the kid could be sitting in front of a window. You can’t see them, so it’s hard to make sure they’re attentive.”

While there are limitations to this study, it is clear that students and their families are currently experiencing a high level of stress. Many schools have been aware of this problem and have taken steps to embed extra programming into their students’ weeks. We need to continue to prioritize community connection and wellness for students attending school in-person and online. It is important to ensure that students know who they can reach out to and how, particularly those learners who are not stepping foot into a school building this year. It is also important to build in opportunities for stress management, as well as instruction in healthy habits, such as exercise, sleep hygiene and healthy eating. Clearly both children and their caregivers could benefit from this type of support right now. If you or a loved one is experiencing heightened emotional stress, it is important to reach out for help. This can include alerting your child’s school to their increasing stress, as well as bringing concerns to your child’s doctor. A referral to a psychologist or licensed mental health professional may be in order to help you and your child through this difficult time.

Source: Remote Students Are More Stressed Than Their Peers In The Classroom, Study Shows by Erin Einhorn, 2/15/2021 published by NBC News.

 

About the Author
Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

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

 

 

School’s Out For Summer

By | NESCA Notes 2020

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

With everyone home-schooling these last several months, there has been a push towards academics and getting work done. But now it is summer vacation, and the pressure is off. However, this is a summer like no summer we have ever known. Many families are continuing to spend more time at home, many activities are still closed, or at the very least, they are more limited. It can be hard to figure out what to do with all of this time.

The summer can be a great time to engage multiple aspects of our minds. I am often reminded of Gardner’s theory of multiple intelligences. His theory proposes there are eight aspects of human intelligence, each representing different ways of processing information. Without getting into the deep specifics of his theory, I think it is important to consider the many different ways that our brains interact with the world. When trying to plan out activities or experiences for our kids this summer, taking these multiple aspects of functioning into consideration might help to stir up some great ideas.

Visual-Spatial: This can include activities such as drawing and other art activities using maps, puzzles and patterning tasks. Young children can practice making patterns and completing puzzles while our older children can create using Legos or planning out a family outing on a map. The possibilities are endless.

Linguistic-Verbal: This can include reading, writing and speaking. Children and families can enjoy reading books together or creating stories. Even conversations at the dinner table can be a form of engaging these verbal skills.

Logical-Mathematical: Activities that tap into this skillset can involve the use of numbers and relationships using patterns. Science or experiment-based activities can fall into this category. Young children love creating volcanos with vinegar and baking soda. Allowing them to measure materials out and add food coloring is always a fun idea. Older children may enjoy cooking or other activities that involve numbers and measurement.

Bodily-Kinesthetic: These activities engage the body and can involve strength and physical control. During the summer, the options are endless: nature walks, running through the sprinkler, dancing, biking, scootering, etc. Anything that gets the body moving! These activities can be enjoyed by the whole family.

Musical: Think about rhythms and sounds. Activities can include singing and playing musical instruments. While certainly traditional tools like the piano come to mind, you can also turn pots upside down, get some spoons and create a drum circle. Or possibly work as a family to turn the lyrics of a favorite song into something silly or more meaningful to your family. This summer could also be a great time to learn a new instrument with plenty of music instructors offering virtual lessons throughout the summer.

Interpersonal: This one may be a little harder as many people continue to distance themselves. While our health remains a priority, we do have to acknowledge that practicing social skills is important for everyone. This can involve calling or virtually meeting with family members, possibly a distanced activity with others outside, or leaving notes for friends and neighbors. Anything that gets your child thinking about others, their own thoughts and feelings, and finding ways to stay connected is important. Embracing the relationships within your family during this time is also a great idea.

Naturalistic: This means being in tune with nature and exploring the environment. These types of activities involve being outside, interacting with plants and animals. Perhaps you start a family garden or go for regular walks in the woods. Focusing on bugs, sounds and smells within your environment. Outdoor activities are probably the most readily available during this time.

Intrapersonal: Personal enrichment and being in tune with oneself is so important during this time. Taking time to calm our own frustrations and anxieties is essential for our overall health as well as setting a good example for children. Numerous mindfulness activities aimed at improving self-regulation can be found online. Being more aware of what is going on in our bodies and minds is so important to help us get through this time.

The summer is a time to relax and enjoy being a family. This can be a jumping off point to get the creativity flowing then allow the kids to jump in and help find fun ways to spend this summer—one that is unlike any other we have experienced.

 

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

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

 

 

Testing at NESCA during COVID-19

By | NESCA Notes 2020

By: Ann Helmus, Ph.D.
NESCA Founder/Director

I’m sure you can agree, it’s been an interesting time due to the onset of COVID-19. Our worlds, livelihoods and professional lives have been turned upside down. At NESCA, where our entire business revolves around the in-person evaluations, assessments, coaching and treatment of children, adolescents and young adults, much of our “In Real Life (IRL)” activity had to be put on hold to prevent the risk of infection among our clients and staff.

After making the decision to temporarily close our physical offices, our clinical and administrative staff swiftly geared up to provide as many services as possible remotely. While we were considered an “essential” business by the State of Massachusetts, we opted to pause our neuropsychological testing for the safety of all involved while initiating research into how we could conduct this critical service to our families. We are keenly aware of the long wait times for testing and the associated stress that puts on parents while they seek out answers about their children’s behavior or learning differences—all the while making children who need supports earlier than later wait in the wings as well. We also knew there would be an increased need for testing because of the impact COVID-19 was and is likely to have on the mental health of children and teens; schools would eventually be inundated with a back-log of evaluations already in the works as well requests for new evaluations that, by law, have to be conducted within a specific time period; and to help fulfill the ever-present need to assist schools and parents in providing support to children with special needs.

Knowing our pause of testing was not a long-term, viable option, after careful consideration and much intense research, we identified several options on how we could bring our neuropsychological evaluation services back to the NESCA community. The options we identified as possibilities included conducting teletherapy, using a partial plexiglass screen (akin to what you would see protecting a store cashier), observing social distancing and constructing a two-office model. We examined the risk to both clients and clinicians, privacy and technology constraints, ethics surrounding the validity of the test findings and legal issues concerning the credibility of evaluation findings/diagnosis among other topics.

While we determined that teletherapy has a role in the testing process, including parent intake and feedback sessions, we ultimately decided that it would not be a solution for NESCA to adopt for the actual evaluation of a child. Next, the partial plexiglass shield did not provide enough risk mitigation for the child or evaluator, and it may not have been a secure enough physical barrier for some of the more aggressive children we test to keep both parties properly distanced.

So, where does that leave us? We do have social distancing in the mix as a potential option. While it does not provide maximum risk reduction, some families see it as the most natural option. The child, and if necessary, a parent helper, are at one end of a long conference table, and the evaluator is at the other end, at least six feet away at all times. All people in the room wear masks to further reduce risk. All testing materials are set up in advance for the child or parent helper. Most tests can be conducted on an iPad, which is controlled by the evaluator’s computer.

Since we were very aware that some parents would not be comfortable with this model, we continued our exploration and education, landing on an innovative two-office model. The two-office set-up involves a four foot by eight foot clear plexiglass window to be installed between two offices. This allows for clear observation of the child by the evaluator, the ability for the child and evaluator to communicate with each other via a high-quality intercom system and for the evaluator to visually demonstrate activities that the child is asked to perform during testing. A parent helper can be allowed in the room with the child should they need support during the session. Again, many of the tests would be administered via an iPad, which is controlled by the evaluator in the adjoining room. All additional test materials are organized and arranged in the office where the child is prior to testing.

NESCA’s two-office approach was piloted in our Londonderry, N.H. office by Dr. Angela Currie. Due to its maximum risk reduction for all parties and its similarity to the standard testing experience, NESCA expanded its testing capabilities with this model to the Newton office, where there are currently two of these testing areas available. While it does have some limitations, it is working very well with our families.

Along with the new testing models implemented, NESCA is, of course, taking all precautions available to reduce risk of exposure. We require risk assessment questionnaires, temperature checks and hand sanitizing; implemented a “touchless” check-in process; limit the number of people to a total of eight at one time in the 7,000 square foot Newton office, with testing being done at opposite ends of the office; provide private waiting rooms for parents who are not involved in the child’s testing; and sanitize all equipment and rooms used both before and after every appointment. We continue to follow the CDC and State’s guidelines for re-opening requirements.

We are very proud of our ability to continue to serve parents, children, families and schools during this extremely difficult time. I am once again so grateful to the cohesive and collaborative team we have in place here at NESCA and for its creativity, innovation, determination and dedication. The needs of families with children who have special needs never stop. While we may be forced to pause, NESCA will do everything in its power not to stop either.

Resources/Notes:

  • To view the Federation for Children with Special Needs webinar with Dr. Ann Helmus, visit Testing in the Age of Remote Learning
  • Dr. Helmus will present, “Testing in the Time of Covid,” to the Massachusetts Urban Project, a statewide network of special education leaders from 15 urban school districts across the state, on June 9.
  • Dr. Helmus will present on this topic in conjunction with Massachusetts Advocated for Children in June TBD.

 

About the Author: 

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

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

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

Neurodevelopmental Evaluations – Where and When to Start

By | NESCA Notes 2018

**Creating Roadmaps for the Lifespan: Preschool Neurodevelopmental Evaluations to Life After High School**

NESCA Pediatric Neuropsychologist Dr. Erin Gibbons will be presenting on neurodevelopmental and neuropsychological evaluations in a free educational workshop at NESCA’s Plainville, MA office on Monday, March 9 from 6:30 – 8:00 PM. NESCA Transition Specialist Becki Lauzon will be co-presenting to address the transition process/how to start preparing for life after high school.

For more information, visit the event page. To register to attend the event, email Jane Hauser at jhauser@nesca-newton.com. As a preview to what attendees can expect to learn at the event, read Dr. Gibbon’s blog post.

 

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

Parenthood is a daunting task to say the least. Not only must we worry about keeping our children healthy and safe, but we are constantly bombarded with information about potentially harmful foods, chemicals, toys, etc. Many parents also have concerns about whether their children are meeting developmental milestones on time and/or whether they should worry about certain behaviors their children are displaying.

When concerns arise about older children, parents are often advised to seek a neuropsychological evaluation to rule out possible attention, learning, or developmental challenges. However, parents of children under 5 are often urged to “wait and see” or might be told it is “too early” to seek an evaluation. The truth of the matter is that it is never too early to have your child evaluated when you are worried about his or her development.

Where do I start?

If you have concerns about your child’s development, it is always a good idea to start with your pediatrician. Describe what you are seeing at home and any difficulties you have noticed. Your pediatrician might recommend that you seek a comprehensive neurodevelopmental evaluation to assess for any developmental delays.

What is a neurodevelopmental evaluation?

This is a comprehensive set of tests designed to assess all aspects of your child’s development, including cognition, language, motor, and social skills. This type of evaluation is conducted by a pediatric neuropsychologist. First, you will be asked to provide information about your child’s developmental and medical histories. Your child will then be asked to participate in a series of activities over the course of 2 or 3 hours. For example, he/she will have to solve simple puzzles, label pictures, or play with different types of toys.

Why is a neurodevelopmental evaluation useful?

After completing the evaluation, the neuropsychologist will analyze all of the information and develop a comprehensive picture of your child’s developmental profile. In addition to helping you understand your child’s strengths and weaknesses, the neuropsychologist will also identify any developmental delays that require intervention.

What happens next?

An evaluation will identify developmental delays that need to be treated in order to help your child catch up with peers. Some examples include speech/language therapy, occupational therapy, physical therapy or applied behavior analysis (ABA).

For children under 3, this means they can start receiving Early Intervention services right away. Early Intervention is a system of services for babies and toddlers who have developmental delays or disabilities and is available in every state in the US.

For children over 3, parents can seek services privately, or can work with their local school district to develop an Individualized Education Program (IEP) for their child. Having an independent evaluation completed prior to your child’s transition to public education is extremely useful as it provides the district with the child’s type of disability and informs the process of developing necessary services.

Where can I go?

Neurodevelopmental evaluations are available at many local area hospitals as well as private neuropsychology clinics. Parents can also contact their insurance company for a list of providers or search through the Massachusetts Neuropsychological Society: https://www.massneuropsych.org/i4a/pages/index.cfm?pageID=3309.

At NESCA, we are proud to offer neurodevelopmental evaluations for children ages 1-5 and will provide parents with a comprehensive report, extensive recommendations for services, and ongoing consultation through the years. Our clinicians are able to do observations of children in their natural environments (e.g., day care, preschool) to gain a full picture of the child and provide environmental recommendations that would be most supportive. Moreover, we are available to attend meetings with early intervention specialists and special educators to help a child’s team fully understand their individual learning and service needs.

If you are interested in scheduling a consultation or evaluation at NESCA, please complete our on-line intake form: https://nesca-newton.com/intake-form/.

About the Author:

GibbonsErin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants, children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.


 

Why the Autism CARES Act Matters

By | NESCA Notes 2019

 

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

The CDC estimates that 1 in 59 children are diagnosed with an autism spectrum disorder (ASD), and studies by Autism Speaks also found that children with autism have a nearly four times greater chances of having unmet health care needs compared to children without disabilities. With those sobering statistics in mind, it’s important for us to take a closer look at recent legislation to help the growing number of people with an ASD diagnosis.

On September 30, 2019, President Trump signed the Autism CARES Act of 2019, which was due to expire on the same day. Originally called the Combating Autism Act, which was established in 2006. It was reauthorized in 2011, and again in 2014 when the name was changed to the Autism (Collaboration, Accountability, Research, Education and Support) CARES Act. This Act is the primary source of federal funding for autism research, services, training and monitoring

Because of this important Act, the 2014 legislation dedicated over $3.1 billion for autism programming. President Trump renewing this Act in 2019 allowed for an extension of the current primary autism law and authorized $1.8 billion in spending on the developmental disorder over the next five years.

The Autism CARES Act of 2019 renews federal support for existing autism research and programs, but also expands these activities, placing an increased emphasis on reducing health disparities and improving services throughout the lifespan. More specifically, the funding provides:

  • Autism research grants awarded by NIH, focusing on advancing scientific understanding of autism, expanded efforts to develop treatments for medical conditions often associated with autism and address the needs of people affected by it. The NIH also works to foster collaboration among research centers to increase the effect of their efforts.
  • Ongoing support for programs across the country focused on ensuring high-quality services for people with autism. This includes funding 52 Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) programs and 12 Developmental Behavioral Pediatric Training Programs. These programs allow for the continuation of education, early detection and intervention activities through the training of future leaders and healthcare professionals.
  • The continuation of Collaborative programs like Autism Intervention Research Network on Physical Health (AIR-P), which helps to translate research into improved care and tangible resources for families and clinicians.

The Act also calls for the Department of Health and Human Services to once again produce a report for Congress on the health and well-being of individuals with autism. In 2014, this important report to Congress emphasized the needs of individuals with autism as they transitioned out of school-based services and into adulthood. The 2019 Act has placed an increased emphasis on the needs of individuals with autism “across the lifespan,” highlighting a need to understand challenges faced by individuals of all ages. As noted by Autism Speaks President and CEO Angela Geiger, “this legislation ensures sustained funding to better support people with autism across the spectrum and at every stage of life.”

Indeed, as a neuropsychologist, working side-by-side with NESCA’s team of Transition Specialists, I have the privilege of following many individuals with autism spectrum disorders from early childhood throughout their transition to young adulthood.  I find that families begin to scramble as special education funding runs out and they struggle to understand how these young people will continue to get their needs met. For many years, the focus of funding and research was on children, but as these individuals aged out of school-based services, their needs did not end. Yet,  the funding was and continues to be well below what is necessary. While there have certainly been improvements, there continues to be many more needs than are able to be supported. Research remains essential in understanding the longitudinal needs throughout the lifespan, and I am encouraged that our country continues to support these efforts.

 

Reference:

Autism Speaks

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

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

 

 

Child Feedback Sessions: How and Why We Explain What Testing Means To Kids

By | NESCA Notes 2019

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

“Who get’s the results of the testing, me or my parents?” As a neuropsychologist, clients of all ages ask why they are being tested and who is going to get the information from the testing. Sometimes these questions come from a place of nervousness, while others are asking because they have a general curiosity.

Neuropsychological evaluation is an intensive process where students are trying out all sorts of skill sets, some activities that are familiar (e.g., math problems), and some activities that they will only ever do in the context of an evaluation process (e.g., putting pegs in a pegboard, drawing weird rocketship shaped patterns from memory). Even children as young as elementary school are often curious about the results of the assessment (e.g., how did I do? what were you testing? what is the report going to say?). These are such important questions and I am always excited when the children I am working with are curious about what this all means.

At NESCA, a neuropsychology and integrative treatment practice founded in Newton, MA, we conclude our testing with a parent feedback session where results and preliminary recommendations are clearly presented to parents. This is a conversational format so that we can ensure that there is good understanding and a shared picture of what we have learned about the child. Even with a lengthy conversation, parents often question about how to share the findings with their children because it often results in changes for the child like working with new people or getting more/less or different services at school.

Importantly, we offer child/adolescent feedback sessions for children of all ages. These mini-feedback sessions are presented in a developmentally appropriate manner to share the findings of the evaluation. Often with older children and adolescents this conversation includes discussing any diagnosis that came out of the evaluation. For all individuals the conversation always includes a strengths-based approach highlighting the things the child/adolescent did wonderfully using examples from the testing to explain these strengths and how they might show these skills in real life. Then we move on to also talking about some of the activities that were more challenging and how we envision teachers, providers, or other supports helping them to make progress. For example, a child might do extremely well on tasks of visual problem solving such as recreating block designs or on verbal tasks that ask them to define words, but have greater challenges on tasks that assess processing speed. These findings suggest a child is able to think and problem solve at a high level, yet processes information more slowly and might need more time to show off their strengths when they are expected to produce output. This important difference is so essential to explain to even younger children. Children often value speed over all else, and explaining to them that working slow but producing amazing ideas is a real asset. The same type of careful explanation can be taken when explaining learning disabilities, attentional issues, social difficulties and emotional vulnerabilities. There is a calculated effort to include the child/adolescent in a conversation about their own ideas on how to improve areas of need and I feel this really empowers them to work for the change and positive growth. Plus, these sessions are a great way to gain closure over the experience of testing and allow them to understand what was accomplished and learned through all of their hours of hard work.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

 

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

 

 

Addressing Anxiety through the IEP Process

By | NESCA Notes 2019

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

Anxiety disorders are becoming more and more common among children and adolescents. Recent data from the National Institute of Mental Health (NIMH) reported that 31.9% of adolescents between 13-19 have an identified anxiety disorder. Although fewer statistics are available, it is clear that students who have a developmental, learning, or attention disorder are at high risk for developing clinically significant anxiety in light of their struggles with academics, learning, and/or social development. Given the rising numbers of affected children and adolescents, it has become increasingly important that a student’s emotional health is addressed both at home through private counseling, as well as through the provision of school-based services. When students experience a high level of unmitigated anxiety throughout the day, they are less able to learn and meet their potential.

When parents are seeking services for anxiety through their school system, there are different levels of support. First, teachers can provide classroom supports and address emotional health with all students, whether or not they have an identified anxiety disorder. Some examples of useful classroom strategies include:

  • Create predictable routines and clear expectations.
  • Provide warnings about upcoming transitions.
  • Have a “cool down space” available in the classroom or another room in the school.
  • Incorporate movement into lessons throughout the day.

There are also programs designed to address emotional regulation that can be used throughout the school or district. For example:

If these supports are not sufficient to meet a student’s needs, then it is necessary to develop goals through the IEP process. In order to make needed progress, it is important that the goals and benchmarks in the IEP are specific. For example, a benchmark might state: “Johnny will show better emotional regulation in stressful situations.” A more specific benchmark might state: “When Johnny starts to shut down or refuse to participate during a math class, he will identify his current emotion(s) in 4 out of 5 opportunities.”

When parents seek supports for their child’s anxiety through the IEP, they should consider whether their child needs accommodations, specialized instruction or both.

Examples of accommodations for anxiety include:

  • Extra time in testing situations.
  • Opportunities to take tests in a quiet setting.
  • Access to breaks as needed.
  • Access to the school counselor as needed.
  • Student does not need to sign out of class to use the bathroom.
  • Student is prompted to take breaks when showing signs of distress.
  • Student has modified homework.
  • Teacher will check in with student before independent work blocks.
  • Specialized instruction can be provided in the classroom (push-in) or in a different setting (pull-out).

Push-in services might include:

  • Provision of an instructional aide to support emotion identification and regulation.
  • The school counselor/psychologist works with the entire class once or twice a month to discuss emotional health.

Pull-out services might include:

  • Regular sessions with the school counselor/psychologist.
  • Social skills groups.

Consultation services are also important, especially if a student participates in private therapy outside of school. Parents should consider giving permission for the private therapist to speak with the school counselor to discuss common treatment goals and ways in which the student’s coping skills can be supported and reinforced in school.

About the Author:

GibbonsErin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants, children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

Dr. Gibbons recently began serving clients in NESCA’s newest location in Plainville/Foxborough, MA. She is thrilled to bring her expertise in evaluating and supporting children with a wide range of abilities to this area of the state.

 

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

 

 

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

 

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

By | NESCA Notes 2019

 

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

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

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

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

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

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

 

About the Author:

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

 

 

To book an evaluation with Dr. Monaghan-Blout or one of our many other expert neuropsychologists and transition specialists, complete NESCA’s online intake form.

 

 

 

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

 

School Observations

By | NESCA Notes 2018

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

One of my favorite activities as a neuropsychologist is getting to conduct school observations. Many parents ask why would I need a school observation? And the answer is simple, they provide a wealth of information about your child and their everyday experience at school. For so many, understanding the comings and goings of a child’s day at school is something most parents do not have the opportunity to explore. You ask your child, “how was your day?” and for many, all you get is a “fine” or “okay” with no elaboration of what actually happened. Understanding a child’s experience of the school day is important for all families, but especially important if your child is having difficulties at school such as learning, social or emotional stressors.

After conducting a neuropsychological assessment of a child, I am able to get a good understanding of the child’s learning profile and a good grasp of the child’s strengths and needs. With this information, I am able to conduct school observations with a lens towards what the children I am seeing might need and how they interact with their environment. For the majority of the children I observe at school they are already getting specialized services and for one reason or another, their parents are concerned.

During the observation, I am able to gain a better understanding of a child’s social functioning within the context of their peers at school. I often purposefully schedule observations during a combination of structured class time as well as less structured time such as art or gym, and finally during an unstructured time such as lunch or recess. This combination of environments allows me to see the child interact with peers in a variety of settings. I am able to answer questions about where a child does best and what types of environments might be more challenging. Are they a rock star during group lessons or are they leading a group of peers across the playground? For other children they may fade into the background, refusing to participate during large group instruction but become more animated during one-on-one time with their teacher. Or maybe they are a child that cannot handle the unstructured recess time and hide in the corner isolating themselves. Gaining a better understanding of a child’s social successes and then relating that information to their neuropsychological profile can help to explain why a child is struggling and how best to support them.

Beyond looking at a child’s social functioning during the school day, I am also able to observe the delivery of instruction and how the child responds. I am always watching how a teacher deliveries information to the class and then seeing how the child is able to respond. Does the child follow the direction the first time they are heard or do they need them repeated and modeled by watching other students begin the activity first? I also look at how a child interacts during whole group instruction or discussion versus a small group or more individual work. I also love the opportunity to speak with teachers during the observation to understand what curriculums they are using as well as answering questions about how they see the child interacting in the classroom. If a child is on an education plan I am also paying close attention to how accommodations and supports are being integrated into and across the child’s school day.

In addition to being a fun and engaging part of my job, observations also provide such valuable information from which I can create very specific and targeted recommendations for a child based on their own school environment. There is definitely not a one-size-fits-all recipe for helping a child with a particular profile because an environment is so influential on a child’s successes and challenges. An amazing relationship with one teacher can go a long way toward helping a child take chances and make progress, just as the opposite is true. With a school observation, there is the opportunity to gain more clarity into a child’s everyday school life to help foster their strengths and support their vulnerabilities.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

 

 

 

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

 

 

Neurodevelopmental Evaluations – Where and When to Start

By | NESCA Notes 2018

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

Parenthood is a daunting task to say the least. Not only must we worry about keeping our children healthy and safe, but we are constantly bombarded with information about potentially harmful foods, chemicals, toys, etc. Many parents also have concerns about whether their children are meeting developmental milestones on time and/or whether they should worry about certain behaviors their children are displaying.

When concerns arise about older children, parents are often advised to seek a neuropsychological evaluation to rule out possible attention, learning, or developmental challenges. However, parents of children under 5 are often urged to “wait and see” or might be told it is “too early” to seek an evaluation. The truth of the matter is that it is never too early to have your child evaluated when you are worried about his or her development.

Where do I start?

If you have concerns about your child’s development, it is always a good idea to start with your pediatrician. Describe what you are seeing at home and any difficulties you have noticed. Your pediatrician might recommend that you seek a comprehensive neurodevelopmental evaluation to assess for any developmental delays.

What is a neurodevelopmental evaluation?

This is a comprehensive set of tests designed to assess all aspects of your child’s development, including cognition, language, motor, and social skills. This type of evaluation is conducted by a pediatric neuropsychologist. First, you will be asked to provide information about your child’s developmental and medical histories. Your child will then be asked to participate in a series of activities over the course of 2 or 3 hours. For example, he/she will have to solve simple puzzles, label pictures, or play with different types of toys.

Why is a neurodevelopmental evaluation useful?

After completing the evaluation, the neuropsychologist will analyze all of the information and develop a comprehensive picture of your child’s developmental profile. In addition to helping you understand your child’s strengths and weaknesses, the neuropsychologist will also identify any developmental delays that require intervention.

What happens next?

An evaluation will identify developmental delays that need to be treated in order to help your child catch up with peers. Some examples include speech/language therapy, occupational therapy, physical therapy or applied behavior analysis (ABA).

For children under 3, this means they can start receiving Early Intervention services right away. Early Intervention is a system of services for babies and toddlers who have developmental delays or disabilities and is available in every state in the US.

For children over 3, parents can seek services privately, or can work with their local school district to develop an Individualized Education Program (IEP) for their child. Having an independent evaluation completed prior to your child’s transition to public education is extremely useful as it provides the district with the child’s type of disability and informs the process of developing necessary services.

Where can I go?

Neurodevelopmental evaluations are available at many local area hospitals as well as private neuropsychology clinics. Parents can also contact their insurance company for a list of providers or search through the Massachusetts Neuropsychological Society: https://www.massneuropsych.org/i4a/pages/index.cfm?pageID=3309.

At NESCA, we are proud to offer neurodevelopmental evaluations for children ages 1-5 and will provide parents with a comprehensive report, extensive recommendations for services, and ongoing consultation through the years. Our clinicians are able to do observations of children in their natural environments (e.g., day care, preschool) to gain a full picture of the child and provide environmental recommendations that would be most supportive. Moreover, we are available to attend meetings with early intervention specialists and special educators to help a child’s team fully understand their individual learning and service needs.

If you are interested in scheduling a consultation or evaluation at NESCA, please complete our on-line intake form: https://nesca-newton.com/intake-form/.

About the Author:

GibbonsErin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants, children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.