Neuropsychological Evaluation

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Individualized Education program written on blocks, IEP Symbol

Guide to Transition Planning and the New Massachusetts IEP

By | NESCA Notes 2024

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

Transition planning has long been a critical component of special education, mandated by the Individuals with Disabilities Education Act of 2004 (IDEA 2004). Its purpose is to prepare students for life beyond high school in the areas of postsecondary education and/or training, employment, and independent living. While federal law requires transition services to begin at age 16, Massachusetts has gone a step further, requiring that postsecondary goals and transition services be included in a student’s individualized education program (IEP) by age 14.

However, the previous Massachusetts IEP format made it difficult to effectively integrate transition planning. Even with the introduction of a Transition Planning Form (TPF) to facilitate discussions, there was no consistent practice for embedding contents of the TPF into the IEP itself. As a result, much of the transition planning that was included ended up in the “additional information” section, limiting its visibility and coherence within the broader IEP process.

After over a decade of development, the Massachusetts Department of Elementary and Secondary Education (DESE) released a new IEP document last school year, which all districts are required to adopt during the 2024-2025 academic year. One of the most promising features of this new IEP is its heightened emphasis on transition planning, now driven more clearly by the student’s vision and voice. Notably, the new format embeds transition planning directly into the structure of the IEP, making transition assessments a more visible and integral part of the process. While the legal requirements for transition planning remain unchanged, the new IEP format makes it easier to document these critical steps, ensuring that important aspects of transition planning are not overlooked.

So, what’s important to know about transition planning in the New MA IEP?

Student Voice and Vision are Up Front
One of the most significant improvements in the new IEP is its emphasis on the student’s voice and future vision. The “concerns” section is clearly labeled Student and Parent Concerns, empowering students to express what they want out of their IEP process. This is immediately followed by the Student and Team Vision, placing the student’s aspirations firmly at the center of the IEP process. Students ages 3-13 are encouraged to participate in visioning, fostering earlier goal setting, and encouraging teams to think explicitly about the student’s goals at younger ages. For students who will be ages 14-22, the IEP now more explicitly asks for the student’s postsecondary goals in key planning areas: education and/or training, employment, and independent living. This focus ensures that the IEP reflects the student’s ambitions and drives a more outcome-oriented process for postsecondary success.

Disability Categories are Transparent
The new IEP introduces a more transparent Student Profile section, where teams no longer need to select one “primary” disability category, making a student’s full profile more visible to all team members. While students can participate in the IEP process without fully understanding their disabilities, they can be more fully engaged if they know that they have one or more disabilities as defined by IDEA. Learning to disclose their disability and understand how it affects their learning, work, and daily life is a critical component of the transition process, empowering students to self-advocate and seek the supports they need. The transparency in the new IEP can help students gain a clearer understanding of the connection between their disabilities, their disability-related needs, and the accommodations and services they receive. Although transition-aged students are not required to participate in all aspects of their IEP, they must be invited when transition planning is discussed. Research shows that students who learn to lead their team meetings and self-advocate regarding their disabilities experience more success when transitioning to adulthood. This revision to the IEP offers a more balanced view of how multiple disabilities shape a student’s overall profile and enhances transparency in disability disclosure.

Assistive Technology as a Critical Component of the Student Profile
Assistive technology (AT) plays a vital role in helping students build independence and reduce reliance on prompting and support from adults or paid providers. The new IEP appropriately increases the visibility of assistive technology within the Student Profile. Whether used to support communication, mobility, learning, daily living skills, or work-related tasks, assistive technology empowers students to succeed both in school and in adulthood. The updated IEP format requires teams to specify whether these needs will be addressed through accommodations/modifications, goals/objectives, the service delivery grid, or another method, as documented in the Additional Information section. By thoroughly considering and documenting a student’s assistive technology needs, the IEP ensures students have access to the tools they need for greater independence and long-term success—a critical step in transition planning.

Life Skills and Self-Determination Can Be Explicitly Included at Early Ages
The new IEP organizes a student’s present levels of performance into four main areas—Academics, Behavior/Social/Emotional, Communication, and Additional Areas, including “activities of daily living.” Even before age 14, teams now have more explicit opportunities to describe strengths and needs in a broad range of areas that impact transition planning. Many students with disabilities require earlier planning and support to build independence in areas like personal care, home living, and community integration. When skill development takes longer, being thoughtful about life skills instruction, parent training, referrals to community resources, and assistive technology is crucial at earlier ages. While not explicitly in the document, the new format also provides an opportunity for teams to evaluate self-determination skills at younger ages. Self-determination—encompassing self-awareness, self-advocacy, self-efficacy, choice-making, decision-making, goal setting, and self-regulation—is one of the strongest predictors of successful transition to adulthood. Current performance with these skills can be addressed across various categories (Academics, Social, Communication) or as a key “Additional Area.”

Current Performance Levels for Transition Services are Built-in
A major improvement in the new IEP is the explicit integration of transition assessment data and transition services within the IEP itself. For students turning 14 to 22, the IEP now includes a dedicated postsecondary transition planning section, which can also be used earlier if the team determines transition planning should start sooner. This section starts with documentation of the student’s current performance, strengths, preferences, interests, and disability-related needs in each postsecondary planning area—education/training, employment, and community experiences/postschool independent living. All of this documentation is informed by transition assessment data. Teams will also specify whether accommodations/modifications, goals/objectives, services, or other activities—documented in Additional Information—are needed to support the student’s transition planning. This ensures that all team members know exactly where to find details on how transition services will be implemented. As a caveat, all skills developed through special education support transition planning; thus, all general content in the IEP is relevant. Teams can confidently reference other parts of the IEP when completing the Postsecondary Transition Planning section to avoid unnecessary duplication of content.

Course of Study and Projected Graduation/Exit Date are Centrally Documented
Federal law has always required teams to identify a “course of study” that aligns with the student’s postsecondary goals, but there was no obvious place to include this in the old IEP. The course of study—a semester-by-semester plan of the classes the student will take—is a critical part of transition planning. For instance, a student aspiring to become a doctor will likely need lab science and advanced mathematics in high school. The new IEP provides places for teams to document the student’s course of study, the anticipated type of completion document (diploma, certificate of attainment, etc.), the student’s expected graduation date, and the student’s progress toward meeting exit requirements. This information is essential for monitoring and informing transition planning and creates a clearer link between the student’s transcript and progress toward their individualized postsecondary goals.

Transfer of Rights and Decision-Making
Adult decision-making is a significant milestone, and the new IEP emphasizes discussing the Transfer of Rights at least a year before the student turns 18. The IEP now includes designated space to document when both the student and family have been provided notice of this transfer and a copy of procedural safeguards. In addition, the new IEP encourages teams to discuss and document the student’s Decision-Making Options for adulthood. Although this is a requirement once the student turns 18, its more visible presence in the IEP encourages earlier conversations. This is crucial, because preparing for adulthood may require putting legal, educational, medical, and financial decision-making frameworks in place—processes that can take time to complete.

Community and Interagency Connections
Transition planning takes a village, and a central part of effective planning is to build a supportive network that extends beyond the protections of special education. The new IEP includes a dedicated section for community and interagency connections, ensuring that teams discuss and document connections to community partners (such as independent living centers, job centers, pre-employment transition service providers, etc.) that are supporting the student. Additionally, the IEP incorporates prompts to ensure timely referrals to adult service agencies well before the student’s exit. In Massachusetts, Chapter 688 Referrals—referrals to adult human services to engage in transition planning for students who will need continued support—must be completed at least two years before the student’s expected exit from special education. The new IEP provides even more guidance to ensure that teams can make and document these referrals on time.

Final Thoughts

The new Massachusetts DESE IEP represents a significant advancement in integrating transition planning into the IEP process. As teams implement the new IEP, prioritizing adequate transition assessments will be crucial, as effective transition planning relies on thorough assessment processes that reflect each student’s strengths, needs, and aspirations for the future. The law requires the use of age-appropriate assessments to identify the student’s strengths, interests, preferences, disability-related needs, and, most of all, their postsecondary goals. Involving diverse voices, such as guidance counselors, is also essential for ensuring a seamless connection between a student’s course of study and postsecondary goals. While the law has not changed, the new IEP makes transition planning more transparent. More importantly, it places the student’s vision and voice at the forefront of the process.

Additional Resources

Download Massachusetts IEP Form and Related Resources including the Transition Planning with the New IEP Quick Reference Guide and Discussion Questions to Get Ready for My Yearly IEP Meeting at https://www.doe.mass.edu/sped/improveiep/
Learn more about the specific language in the IDEA regulations that relate to important transition topics at https://www.pacer.org/transition/learning-center/laws/idea.asp
Explore NESCA Video Resources including webinars on transition planning, postsecondary learning and training options, fostering self-awareness and self-advocacy and more at https://nesca-newton.com/video-resources/
Learn about NESCA Transition Service offerings for students, schools, and families at https://nesca-newton.com/transition/

To download a PDF-Version of this Guide, visit https://nesca-newton.com/wp-content/uploads/2024/10/Guide-to-Transition-Planning-and-the-New-MA-IEP.pdf

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker with over 20 years of experience supporting youth and Kelley Challen headshot young adults with diverse developmental and learning abilities. Since 2013, she has served as Director of Transition Services at NESCA, offering individualized transition assessments, planning, consultation, coaching, and program development. She specializes in working with students with complex profiles who may not engage with traditional testing tools or programs. Ms. Challen holds a BA in Psychology and a Minor in Hispanic Studies from The College of William and Mary, along with a Master’s and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard Graduate School of Education. She is a member of CEC, DCDT, and COPAA, believing it’s vital for all IEP participants to have accurate information about transition planning. Ms. Challen has also been actively involved in the MA DESE IEP Improvement Project, mentored candidates in UMass Boston’s Transition Leadership Program, and co-authored a chapter in Technology Tools for Students with Autism.

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

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

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an image of a child thinking about how different each side of his brain is, used to describe the difference in functioning between both sides when nonverbal learning disability is present

What is a Nonverbal Learning Disability?

By | NESCA Notes 2024

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

At August’s Democratic National Convention, Gus Walz, the teenage son of Democratic Vice Presidential nominee Tim Walz and his wife Gwen, melted hearts throughout the country with his outward show of emotions upon his father’s nomination. He exhibited deep love and pride for his dad in that moment. His tearful cheers evoked a sense of tenderness among many, confusion for others, and, sadly, public mockery, as well. At that time, many people were unaware that Gus carries the diagnosis of Nonverbal Learning Disability (NLD or NVLD) – a cognitive processing profile that often impacts emotion regulation and social cognition; however, his family’s openness about his condition has brought new attention to this profile.

There is often lack of awareness or confusion about what a NLD is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management. As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning – On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception – In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration – Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills – Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive Functioning – Executive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning – With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges – Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD?

The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. One comprehensive resource is the NVLD Project (https://nvld.org/), a nonprofit organization that conducts research, offers educational workshops and community outreach, and has an extensive list of NLD-related resources for parents, clients, and schools.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at www.nesca-newton.com.

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

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

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Image of the MA State House with quote from the blog

Access to Mental Health Care in Massachusetts: Challenges and Opportunities

By | NESCA Notes 2024

By: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

Access to mental health care is an increasingly critical issue across the United States, and Massachusetts is no exception. While the state is often lauded for its comprehensive healthcare system and progressive policies, barriers to mental health care still persist. In this blog post, we will explore the current landscape of mental health services in Massachusetts, the challenges faced by individuals seeking care, and the initiatives being implemented to improve access.

The State of Mental Health Care in Massachusetts
Massachusetts has made significant strides in mental health care over the years. The state boasts some of the country’s leading hospitals, research institutions, and mental health professionals. Organizations such as the Massachusetts Department of Mental Health (DMH) and the Massachusetts Behavioral Health Partnership (MBHP) work to ensure that residents have access to necessary services, yet many still find it difficult to access care. There are also continuing racial inequities in medical and mental health care and a significant shortage of mental health providers of color.

Types of Services Available
Massachusetts offers a range of mental health services, including:

Inpatient Treatment: Hospitals provide acute care for individuals in crisis.
Outpatient Services: Clinics and private practices offer therapy and counseling sessions.
Community Support: Programs that focus on recovery and support that are community-based.
Telehealth Services: An increasingly popular option, especially since the COVID-19 pandemic, allows individuals to access care remotely.

Despite this variety of resources available, the gap between those in need and those receiving care remains significant.

Barriers to Accessing Mental Health Care

Stigma and Misunderstanding

Stigma surrounding mental health issues is a significant barrier. Many individuals hesitate to seek help due to fear of judgment or misunderstanding by others. This stigma can come from family, friends, or even within professional environments. Education and awareness campaigns are essential to reducing stigma and encouraging individuals to seek the care they need.

Insurance Limitations

While Massachusetts has implemented laws requiring insurance companies to provide equal coverage for mental and physical health services, discrepancies still exist. Many individuals find that their insurance plans have high deductibles, limited provider networks, or caps on the number of therapy sessions covered.

Workforce Shortages

There is a notable shortage of mental health professionals in Massachusetts, particularly in rural areas. While urban centers like Boston have many providers, individuals in more remote locations often face long wait times or a lack of available services altogether. The distribution of resources is uneven, exacerbating access issues.

Financial Barriers

Even with insurance, the cost of mental health care can be prohibitive. Copays, deductibles, and uncovered services can add up quickly, making it difficult for individuals to afford the care they need. Paying privately often leads to shorter wait times but is more expensive. Often families find themselves caught in a cycle where they need help but cannot afford it.

Current Initiatives and Improvements
To address these challenges, Massachusetts is taking steps to improve access to mental health care. Various initiatives are being implemented across the Commonwealth.

Legislative Efforts

The Massachusetts State Legislature has been active in introducing bills aimed at improving access to mental health care. The “Mental Health Parity” law ensures that mental health care is treated on par with physical health care in terms of coverage. Advocacy groups continue to push for reforms that address loopholes and improve enforcement.

Telehealth Expansion

The COVID-19 pandemic accelerated the adoption of telehealth services, which have proven to be a valuable tool for increasing access to mental health care. Telehealth allows individuals to connect with therapists and psychiatrists from the comfort of their homes, reducing barriers related to transportation, location, and time constraints.

Community-based Programs

Community-based mental health programs are essential in providing support and resources. Initiatives, like the Massachusetts Community Behavioral Health Center (CBHC) program, aim to create a network of services that meet the diverse needs of communities. These centers offer a variety of services, including crisis intervention and case management.

Educational Campaigns

Efforts to combat stigma and raise awareness about mental health are crucial. Organizations like the National Alliance on Mental Illness (NAMI) Massachusetts work tirelessly to educate the public about mental health issues, promote resources, and advocate for policy changes. These campaigns foster understanding and encourage individuals to seek help.

Looking Ahead: The Future of Mental Health Care in Massachusetts
The landscape of mental health care in Massachusetts is continually evolving. While significant challenges remain, the state is committed to addressing these issues through comprehensive reforms and community-based approaches.

Continued Advocacy

Ongoing advocacy at both the grassroots and legislative levels is essential in pushing for systemic changes. By uniting voices and sharing personal stories, advocates can influence policies that prioritize access to mental health care.

Innovative Solutions

As technology continues to advance, innovative solutions, such as mobile apps for mental health monitoring, digital therapy platforms, and AI-driven resources, could enhance accessibility.

Conclusion
Access to mental health care in Massachusetts is a multifaceted issue that requires ongoing attention and action. While challenges persist, the State legislature is committed to improving access to community programs and public awareness campaigns. By addressing stigma, financial barriers, and workforce shortages, Massachusetts can move closer to a system where mental health care is truly accessible for all. This journey continues. With continued advocacy and innovation, a brighter future for mental health care in the state is on the horizon.

How to Access Care
If you are or someone you love or care for is experiencing a mental health issue, you need to know how and where to find services. First, contact your primary care doctor or pediatrician. For parents or caregivers, the next contact should be someone at the child’s school. It could be an administrator, a teacher, or a mental health professional. Seek out additional information about what school personnel have observed about the child and find out about available resources at the school. This is an important part of treatment for a child.

If you or the person you’re seeking to assist requires a crisis response to meet immediate safety needs, call 911, go to your local emergency room, or find your local Emergency Service Program by calling 877-382-1609.

Call or text the Massachusetts Behavioral Health Help Line (MBHHL) at 833-773-2445 for free, confidential support 24/7. Live chat is available at: https://www.masshelpline.com/. This helpline is useful even if you’re not sure what kind of help you need. Interpretation in over 200 languages is available in real time. Deaf or hard of hearing individuals can contact MassRelay at 711.

NAMI Compass is the information and referral helpline at NAMI Massachusetts. They provide resources and support to help people navigate the complex mental health system and problem solve in challenging situations. The COMPASS helpline is available Monday through Friday, 9 AM – 5 PM. Call the helpline at 617-704-6264 or 1-800-370-9085, or email them at compass@namimass.org.

SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

The Massachusetts Substance Use Helpline is a good resource for finding substance use treatment and recovery services. Helpline services are free and confidential. Call 1-800-327-5050.

The William James INTERFACE Referral Service aims to increase access to mental health and wellness services for individuals. Call the helpline at 888-244-6843 or 617-332-3666 from 9 AM- 5 PM on Monday, Wednesday and Friday, and 8 AM- 6 PM on Tuesday and Thursday, to work with a Resource and Referral Counselor who will help you navigate the challenges of finding mental health services. Communities served can be found on their website, https://interface.williamjames.edu/communities.

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents, Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

If you are interested in booking an appointment for an evaluation with Dr. Dautoff or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form.

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

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Image of flowers coming out of a person's head, symbolizing various mental health disorders/diagnoses

Understanding Diagnostic Labels

By | NESCA Notes 2024

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Throughout the evaluation process, many families express concern about the potential negative impacts of placing diagnostic labels on a child. Unfortunately, parental worries associated with stigmatization, as well as others making incorrect assumptions and placing inappropriate expectations on their child are common and valid. As such, it is reasonable to ask, “where does diagnostic labeling come from?”

In 1952, the first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed by the American Psychological Association (APA) as the standard classification of mental disorders used by mental health professionals in the United States. Since that time, several iterations of the DSM have been developed. Most recently, the DSM-IV- Text Revision (TR) was published (2022), in which sections of text describing diagnostic categories and associated features were revised based on new research. Hundreds of international experts in all aspects of mental health contributed to the development of the DSM, as well as adjustments to subsequent versions.

There are certainly benefits and drawbacks for making specific diagnoses, a few of which are detailed below:

Pros	Cons
Provides a common language in an effort to help mental health and medical professionals communicate effectively. May provide some relief to clients who come to find their symptoms are associated with a disorder that others also experience. Helps guide providers in recommending appropriate treatment options based on diagnostic presentation.	May not fully account for contextual influences, such as ethnicity and culture on the development of psychopathology. Potential for disagreements related to interpreting diagnostic criteria when trying to make diagnostic decisions. Places individuals into “boxes,” which can lead to stigmatization.

Broadly, much of the neuropsychological evaluation process focuses on identifying how a child’s behavioral, emotional, and/or social functioning may be discrepant from that of their peers for the purpose of identifying appropriate treatment and educational services to support the child. Of equal importance is highlighting the child’s strengths, as well as understanding individual family values and cultural factors that may be contributing to a child’s presentation.

As neuropsychologists at NESCA, we take a holistic view of your child and consider multiple sources of information when answering referral questions, including information from parents, teachers, providers with whom the child has developed strong rapport, as well as our observations throughout the evaluation process. While we do refer to the DSM when making diagnoses, we pride ourselves on taking an incredibly individualized approach and high level of care when working with clients. Our goal is not to simply put your child in a “box” and send you on your way. We seek to understand your child’s symptoms and how they impact functioning across environments. We consider initial evaluations as the first step in your journey to fully understanding your child, treating the aspects of their presentation that you’d like to prioritize, and ultimately promoting their overall well-being and success.

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form.

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

11

Image of the words Fading Prompts fading out

Helping Students Become Independent: The Role of Fading Prompts

By | NESCA Notes 2024

Image of the words Fading Prompts fading out By: Sarah LaFerriere, M.Ed.
Transition Specialist & Special Educator, NESCA

Supporting students with disabilities is an experience filled with opportunities to help them grow and succeed. One key area to focus on is promoting independence, which involves carefully managing the use of prompts. If not handled well, prompt dependence can become a significant barrier, especially as students move toward transition age.

What is Prompt Dependence?
Prompt dependence happens when students become overly reliant on external cues, like verbal or written instructions or physical guidance – from teachers, therapists, or caregivers. While prompts are a helpful tool in teaching, over time, too much reliance on them can make it difficult for students to act independently. This can become a bigger issue as they get older and need to function more independently in real-world situations, such as in jobs or community settings.

Why Fading Prompts Matters and How to Do It
Fading prompts is a technique used to gradually decrease the level of support given to students, helping them gain the skills they need to act independently. The goal is to provide enough support initially so that students can learn, and then slowly reduce that support as they become more capable on their own. This isn’t about suddenly withdrawing help but rather about making a gradual shift that encourages students to rely on their own skills.

Start Early—Addressing prompt dependence early on is crucial. When introducing prompts, consider how you’ll gradually reduce them. For younger students, this could mean starting with more hands-on assistance and gradually moving to less direct forms of support, such as verbal or visual cues.
Reduce Support Gradually—Fading prompts involves a step-by-step reduction of assistance. Begin with more direct prompts and, as the student improves, shift to more subtle forms of support. It’s important to pace this reduction based on the student’s progress, ensuring they have enough opportunity to practice and succeed before making further changes.
Promote Self-awareness—Encouraging students to recognize when they need help and how to seek it can be very effective. By developing self-monitoring skills, students can learn to manage their own needs and understand when they are capable of performing tasks on their own.
Be Consistent and Patient—Consistency among all those involved in a student’s education is key. This means that teachers, therapists, and family members should use the same approach and follow the same plan for reducing prompts. Patience is also important, as progress can be gradual and may require repeated practice.
Customize Approaches—Every student is different, and so their path to independence will be unique. Tailoring the approach to each student’s specific needs can make a big difference. This might involve adjusting how quickly prompts are faded or choosing the types of support that work best for the student. Regularly reviewing and adjusting the plan ensures that students are receiving the right level of support.

Involving Families and Service Providers
Families and service providers are essential in this process. Good communication and teamwork between educators, therapists, and families help create a consistent approach to fading prompts. Families can support the skills being taught in various settings, and service providers can offer valuable insights and guidance.

Preparing for the Future
As students reach transition age, being able to act independently becomes even more important. By addressing prompt dependence early and using effective fading techniques, we can help students develop the skills and confidence they need for adult life. This preparation not only aids students but also benefits their families and communities by fostering a more inclusive environment.

In summary, fading prompts is a crucial practice in helping students with disabilities become more independent. By understanding and applying strategies to reduce prompt dependence, we can better prepare students for a future where they can navigate the world with confidence and self-sufficiency. This not only supports the students but also contributes to a more supportive and inclusive community.

About the Author

Sarah LaFerriere, M.Ed., is a transition specialist and special educator who has nearly a decade of experience working with transition aged students in public schools, college, and home-based settings. She provides transition assessment, consultation, and coaching services to a wide range of clients, and specializes in supporting students with autism, intellectual disabilities, developmental disabilities, mental health conditions, and medical conditions.

To book a consultation with Sarah LaFerriere or one of our many other expert transition specialists, neuropsychologists, or other clinicians, complete NESCA’s online intake form.

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

8

Child in bed suffering from a concussion, holding their head in pain

What School Supports Does My Child Need After A Concussion?

By | NESCA Notes 2024

By: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Unfortunately, every year, many children and adolescents experience concussions. A concussion is a mild traumatic brain injury that occurs when an individual sustains a blow to the head or body that results in the brain moving rapidly back and forth. This causes the brain to stretch and strain, resulting in a vast array of possible symptoms. Symptoms of a concussion include:

list of physical, cognitive, emotional, and sleep concussion symptoms

Recent studies have shown that while it is important to rest for the initial few days after an injury, slowly reengaging in cognitive activities at a tolerable level helps to promote recovery. This period of rest followed by a slow increase in cognitive activity means that children are often out of school/slowly transitioning back to school for an unspecified period after injury. As such, many children will benefit from support and accommodation at school during the recovery period. Parents are encouraged to talk to their child’s academic team and school personnel to discuss the need for these supports. As children and adolescents experience differing sets of symptoms after an injury, the accommodations and supports should be tailored to the individual’s unique symptom profile.

Physical Symptoms: Students who experience headaches or fatigue may benefit from rest breaks or even a nap during the school day. Dizziness, balance problems, or nausea may necessitate the need for an elevator pass and it may be helpful for the student to transition to class before the bell rings when there are less people to navigate around in the hallway. Light and noise sensitivity can be particularly hard within the school setting. Students may need to wear sunglasses or a hat, be seated away from the window, and may need teacher notes as looking at a smartboard may be painful. In addition, computer-based work may need to be printed during the recovery period for light sensitive students. Students with noise sensitivity may need to wear ear plugs, avoid crowded and noisy areas, such as the lunchroom, assemblies, or music class, and they may need to transition to the next class before the bell rings and the hallway becomes noisy.

Cognitive Symptoms: A concussion can temporarily impact an individual’s attention, executive functioning skills, and processing speed. Therefore, it may be necessary to reduce a child’s workload (e.g., odd/even problems only, outline a paper instead of writing it fully, reduce homework load) and assign only essential work (i.e., waive non-essential assignments, quizzes, and tests). In addition, it may be helpful to break down tasks into smaller “chunks,” repeat information or instructions, and allow for extended time to complete essential classwork, quizzes, and tests. They may need access to teacher notes if they are unable to keep up with the pace of the instruction to take proper notes, and they may need information presented in a slower manner or repeated to ensure comprehension. Teachers should consider alternative ways to ensure mastery of information (e.g., oral discussion, multiple choice instead of open-ended questions) as students may not be able to demonstrate their true knowledge in standard ways while recovering from a concussion. Tests and quizzes should only be given if symptoms do not interfere, and the student is adequately prepared.

Emotional Symptoms: Emotional symptoms following concussion are often overlooked as they are not a commonly known symptom of concussion. Some children and adolescents may become overwhelmed about missing school and the accumulating workload, and they may feel isolated from their friends. This would also suggest the need to reduce a child’s workload for a short period of time, including waiving non-essential assignments, quizzes, or tests. Students should also be allowed to socialize with their peers as tolerated (e.g., quiet lunch setting with a few close friends).

Sleep Symptoms: A child or adolescent experiencing sleep difficulties as a result of their concussion may not have the energy to complete a full day of school. They may need a later start time or only be able to complete a half day of school. Some students with disrupted sleep may be able to complete a full school day, but they may require a nap in the nurse’s office.

In sum, a concussion presents in many ways and often has a significant impact on the day-to-day functioning of a child or adolescent. In particular, school is often disrupted after a concussion, even for children and adolescents who have a short recovery. School supports and accommodations should be tailored to the child’s individual profile of symptoms to best support them throughout their recovery.

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

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

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

48

How Do You Know if an IEP Addresses Transition Planning Requirements?

By | NESCA Notes 2024

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

As educators and professionals who support parents, having a checklist focused on transition planning requirements for students with disabilities can help to ensure that students are prepared for life after high school.

The most obvious source for such a checklist is Indicator 13, which is a compliance indicator required by the Individuals with Disabilities Education Act (IDEA) of 2004.

Every IEP must include a transition plan that addresses the student’s future goals, including postsecondary education, vocational training, employment, and independent living (when appropriate) and the steps needed to achieve those goals.

Here’s a checklist of what should be included in a transition-rich IEP:

Age-appropriate Transition Assessment: Adequate transition assessment information (including input from the student) about the student’s strengths, preferences, interests, and needs.
Measurable Postsecondary Goals: Clearly defined goals related to training, education, employment, and, where appropriate, independent living skills. These goals must be based on age-appropriate transition assessments and be updated annually.
Transition Services: A detailed outline of the transition services (e.g., life skills training, job coaching, vocational training, career counseling, work-based learning, agency linkages, etc.) that will reasonably enable the student to meet their postsecondary goals.
Course of Study: A multi-year description of the coursework that will reasonably enable the student to meet their postsecondary goals. Indication as to when the student is expected to exit public education and what type of completion document the student will attain.
Annual IEP Goals: Specific, measurable, annual skill-based goals related to the student’s transition services needs. Skills that need to be addressed this year to ensure the student progresses toward their goals.
Student Involvement: Indication that the student was invited to meetings where transition services were discussed. Documentation that the student has been involved in the transition planning process.
Interagency Coordination: If appropriate, evidence that outside agencies (e.g., vocational rehabilitation, pre-employment transition service provider, department of developmental services, postsecondary education admissions or disability services, center for independent living) are involved in the transition planning with appropriate consent from the adult student and/or parent/family.

Remember: Transition planning is a collaborative effort. Student and parent/family involvement are vital to creating a successful roadmap for the student’s future.

For more detailed information, feel free to reach out or visit the IDEA website: https://sites.ed.gov/idea.

National Technical Assistance Center on Transition also has excellent Indicator 13 checklists and training resources: https://transitionta.org/i13-checklists/ (registration is required to use the site, but there is no paywall).

Together, let’s empower students to make a successful transition into adulthood!

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

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

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

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

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

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

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. Also, she worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skill and transition programs.

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

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

She is also co-author of the chapter, “Technologies to Support Interventions for Social-Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation,” for the book Technology Tools for Students with Autism: Innovations that Enhance Independence and Learning.

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

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

48

Correct Pronoun Use Saves Lives

By | NESCA Notes 2024

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

Let me explain…

For anyone who is working with children, teenagers, or young adults in 2024, there is no question that we are working with more openly transgender and nonbinary youth than we were in 2004. Because of this, NESCA recently held a staff seminar led by Dr. Sebastian Barr, speaking about the Psychosocial Wellbeing of Trans & Nonbinary Youth.

As Dr. Barr eloquently identified, “more people are recognizing their trans and nonbinary identities earlier in life.” These youth “have more unique needs” and are “more likely to struggle and need services.” But, for most of us working in education or health care, our academic experiences taught us very little, if anything, about supporting trans and nonbinary youth. Fortunately, in current times, there is research and publishing around this topic. And I was lucky to be able to absorb some of that research in just 75-minutes listening to Dr. Barr.

I learn well in lectures, and there is a lot that will stick with me from the presentation, but the most impactful point made was that “correct pronouns are suicide prevention.” If we care about kids and people, we should do whatever work we need to ourselves in order to learn and use correct pronouns. Trans and nonbinary individuals, especially teens and young adults, are at much greater risk of experiencing mental health issues, and suicidal thinking. There are many studies identifying factors associated with this risk such as bias, non-affirmation, exclusion, marginalization, trauma, etc. Fortunately, there are also studies identifying protective factors that are associated with wellbeing. Some of these variables include:

Parental and sibling acceptance
General affirmation of gender, like correct pronoun use
Access to competent medical support
Community support

Importantly, research from the Trevor Project, indicates that “transgender and nonbinary youth who reported having pronouns respected by all or most of the people in their lives attempted suicide at half the rate of those who did not have their pronouns respected.” *

This is why Dr. Barr indicated that many people in the field will say “correct pronouns are suicide prevention.” He emphasized that if you do make a mistake, you should “correct it quickly, not draw attention, and practice so you don’t repeat the mistake multiple times.”

I am not sharing this with any interest in getting into a debate about feelings or beliefs. I am sharing this in hopes that someone reads this, finds it useful in their parenting or professional work, and makes an effort to use correct pronouns in order to potentially save a life.

Resources:

If you want more information about Dr. Barr or his work, you can visit: https://www.sebastianmitchellbarr.com/

To download a Pronoun Fact Sheet from the @American Psychological Association, you can click here: https://www.apadivisions.org/division-44/resources/pronouns-fact-sheet.pdf

*For more information and data regarding #LGBTQ Youth Mental Health, check out the National Survey on LGBTQ Youth Mental Health 2020: https://www.thetrevorproject.org/survey-2020/