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Neuropsychological Evaluation

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2

Early Detection of Autism: NESCA’s New ASD Diagnostic Clinic

By | NESCA Notes 2020

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

Children with autism spectrum disorder (ASD) vary widely in terms of the intensity of their symptoms as well as the age at which symptoms emerge. In some cases, signs of autism are apparent during infancy. For other children, concerns about autism might not arise until toddlerhood or even early childhood.

As neuropsychologists, we have become increasingly adept at detecting and diagnosing ASD using a combination of developmental history, clinical observation and standardized assessments. We are constantly learning more about ASD and fine-tuning the tools we have available to us to make a diagnosis.

One of the most important things we have learned through longitudinal research over the past 10 years is that early detection of ASD is a crucial part of a child’s prognosis. Young children who receive intensive services are much more likely to develop language, play and social skills. Because their brains are still in a state of rapid development, they are much quicker to acquire new skills and make progress in the areas where they are struggling. Children who receive early intervention for ASD are typically better able to participate in inclusion settings with same-age peers once they enter elementary school.

Unfortunately, many parents are told to “wait and see” when they express concerns about their child’s development – especially with children who are not yet in preschool. This is a risky and sometimes harmful approach as it leads to children with developmental disabilities not receiving the services they need.

In light of our understanding about the importance of early detection of ASD, NESCA is proud to introduce its ASD Diagnostic Clinic. The clinic offers testing that is targeted specifically at identifying ASD in children between the ages of 2 and 5. For children who do receive a diagnosis of ASD, the report will allow parents to start accessing services immediately. As with all of our families, we hope to establish a lifelong relationship and will be available for follow-up consults and additional evaluations at any time.

 

About the Author: 

Erin 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.

 

If you are interested in booking an appointment for the ASD Diagnostic Clinic or an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our 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, 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.

21

Key Facts about Early Diagnosis of Autism Spectrum Disorder (ASD)

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Early diagnosis is a catalyst for propelling children on positive trajectories. If a family and child identify and focus on areas of growth earlier rather than later, there is more time and more possibility of change and improvement. This tenant is particularly critical for diagnosing ASD in toddlerhood and early childhood.

Here are critical facts about the diagnosis of ASD in early childhood and the positive impact of early diagnosis on youngsters as they age into adulthood.

  1. Most children with ASD are not diagnosed until approximately 4 years-old, yet ASD can be reliably identified by the age of 2. There is also expanding research on early identification of infants who may be at risk for ASD. Early detection is possible.
  2. Genes play an important role in ASD. A child’s odds of having an ASD diagnosis increases if he/she has a sibling or parent with ASD, attention deficit hyperactivity disorder (ADHD), intellectual disability, schizophrenia, depression, bipolar disorder or anxiety. Family medical history is an important factor for families considering a diagnostic evaluation.
  3. Co-occurring disorders (such as anxiety and depression) are more likely in individuals with ASD than the general population. Identifying emotion regulation issues in early childhood is thus essential.
  4. Neuroplasticity matters. Because ASD is a neurodevelopmental disorder, early treatment improves neuroplastic brain functioning and subsequent behavior. As a child develops, his/her brain becomes less plastic.
  5. Interventions geared at a child’s “first relationships” with their caregivers may exert a strong positive effect on the developmental trajectories of toddlers at high-risk of ASD and also have a positive impact on a child’s social skills with peers as they age.
  6. Research indicates that parent-child interactions in early childhood predict long-term gains in language skills into adulthood for individuals with diagnoses of ASD. Acquiring communicative, pragmatic and useful language by kindergarten has also been identified as a strong predictor of adaptive or functional “real life” skills, which are needed to navigate the environment in adolescence and adulthood.
  7. Social skills instruction in a child’s early years increases competency with peers in school. This social competency is associated with greater adaptive independence in children with ASD.
  8. Working with a “diagnostic navigator” early in your child’s life improves outcomes. Research clearly indicates that social support is vital to relieve stress associated with caregiving for a child with ASD and that a positive parent–professional relationship is helpful in alleviating family stress.

If you suspect your child has or is at higher risk for ASD and you are looking for a “diagnostic navigator” for your child, consider an evaluation with NESCA.  While early diagnosis of ASD can make a positive impact on a child’s trajectory, obtaining the accurate diagnosis and recommendations for interventions at any age is critical.

 

References:

Elder JH, Kreider CM, Brasher SN, Ansell M. Clinical impact of early diagnosis of autism on the prognosis and parent-child relationships. Psychol Res Behav Manag. 2017;10:283-292. Published 2017 Aug 24. doi:10.2147/PRBM.S117499.

Dawson G, Jones EJ, Merkle K, Venema K, Lowy R, Faja S, Kamara D, Murias M, Greenson J, Winter J, Smith M, Rogers SJ, Webb SJ. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012 Nov;51(11):1150-9. doi: 10.1016/j.jaac.2012.08.018. PMID: 23101741; PMCID: PMC3607427.

Jokiranta-Olkoniemi E, Cheslack-Postava K, Sucksdorff D, Suominen A, Gyllenberg D, Chudal R, Leivonen S, Gissler M, Brown AS, Sourander A. Risk of Psychiatric and Neurodevelopmental Disorders Among Siblings of Probands With Autism Spectrum Disorders. JAMA Psychiatry. 2016 Jun 1;73(6):622-9. doi: 10.1001/jamapsychiatry.2016.0495. PMID: 27145529.

Kasari C, Siller M, Huynh LN, Shih W, Swanson M, Hellemann GS, Sugar CA. Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behav Dev. 2014 Nov;37(4):711-21. doi: 10.1016/j.infbeh.2014.08.007. Epub 2014 Sep 26. PMID: 25260191; PMCID: PMC4355997.

Mayo, J., Chlebowski, C., Fein, D.A. et al. Age of First Words Predicts Cognitive Ability and Adaptive Skills in Children with ASD. J Autism Dev Disord 43, 253–264 (2013). https://doi.org/10.1007/s10803-012-1558-0.

Siller, M., Swanson, M., Gerber, A., Hutman, T., & Sigman, M. (2014). A parent-mediated intervention that targets responsive parental behaviors increases attachment behaviors in children with ASD: results from a randomized clinical trial. Journal of Autism and Developmental Disorders, 44(7), 1720-1732.

Xie S, Karlsson H, Dalman C, Widman L, Rai D, Gardner RM, Magnusson C, Schendel DE, Newschaffer CJ, Lee BK. Family History of Mental and Neurological Disorders and Risk of Autism. JAMA Netw Open. 2019 Mar 1;2(3):e190154. doi: 10.1001/jamanetworkopen.2019.0154. PMID: 30821823; PMCID: PMC6484646.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant 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, 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.

 

18

Linking Strengths and Interests to College Majors and Careers: The MassHire Career Information System

By | NESCA Notes 2020

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

Due to Covid-19, many schools are functioning in a hybrid or remote learning status, making access to school-based guidance counselors, college counselors and transition personnel more complicated. Consequently, I am working with an unusually high number of high school students and families to provide assistance with the college selection and admissions process this year. For these students and others, working with a private transition specialist or college consultant/coach provides the structure and consistent support needed to ensure the student is able to find colleges that will be a great match, highlight the student’s strengths as a college applicant and complete the application process efficiently. Most importantly, the added support reduces anxiety—which is a natural response to the college process as well as living through a pandemic.

There are so many factors to consider when choosing a college—size, religion, location, tuition and fees, availability of internships, academic support, etc.—and one of the most important differentiating factors is often the availability of majors that a student is interested in. As such, career exploration is a very important part of my work with college-bound students. There are certainly many online resources that are useful for career exploration—YouScience, O*NET OnLine, Naviance, Khan Academy, Dr. Kit, CareerOneStop, etc.—but my personal favorite site to help teenagers learn to use is MassHire Career Information System (Previously MassCIS; https://portal.masscis.intocareers.org/).

MassHire CIS is a portal that any individual, from middle school to adulthood, can access for free by logging in with their Massachusetts City or Town Name and their Zip Code. Once inside, users can complete assessments related to their interests, skills and values, preferred lifestyle and more. The site also allows students to link results from previously taken career assessments to information about occupations and occupation categories within MassHire CIS.

Using career interests, from assessments or just a self-reported interest (e.g., photographer, elementary school teacher, personal trainer), users can research occupations and find out everything from the tasks associated with the occupation, to helpful high school courses that relate to the job, and expected future wages and occupational outlook. Users can also watch videos to learn more about occupations.

Importantly, users can easily click from careers of interest to programs of study and ultimately to Massachusetts Schools or other US Colleges and Universities that offer majors leading to occupations of interest.

MassHire CIS is one of my favorite resources to share with teens, young adults and families as part of a college transition process—but also when students are building career awareness at other times or seeking a different path to employment. I hope that by spotlighting this in my blog, more families, educators and professionals will also explore and adopt this resource as a favorite!

 

About the Author:

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

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.

16

Positive Coping Strategies for Stress, Anxiety and Trauma During Times of Crisis

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Amidst the global pandemic, children, their caregivers, their teachers and therapists are naturally experiencing heightened stress and anxiety. We are more likely to be sent into “fight, flight, freeze, mode” – the body and brain’s critical survival strategy to prepare and deal with perceived threat. For example, when you see a Grizzly Bear on your hiking trail, you instinctually run, fight back or hide.

However, we can become “stuck” or more sensitive to this instinctual urge, which is not adaptive and can negatively impact physical, emotional and social health. For example, chronic deployment of the “flight, flight, freeze” response occurs for individuals who experience post-traumatic stress disorder. Chronic deployment of “fight, flight, freeze” responses is also more likely amidst a global pandemic, such as COVID-19. Importantly, chronic deployment of “fight, flight, freeze” responses also occurs for individuals and communities who experience chronic racial injustice and oppression.

Under chronic experiences of stress and threat, our body remains activated and hyper-aroused, even when deploying this response is not helpful. For example, children may shut down or dysregulate when faced with even small stressors – making an error on a math worksheet or even accidentally spilling something on the table. Children and teens may be more irritable, defiant or isolative. Overall, chronic deployment of the “fight, flight, freeze” response heightens anxiety, stress and general feelings of malaise.

So, what can we do? What can we do to “turn off” or lessen this stress response? What are some ways to positively cope during these difficult times?

  1. Research shows that the #1 resiliency factor is the reliable presence of at least one supportive relationship with an adult. Build connection and community through shared activities and conversations about your experiences. Remember to always take care of yourself before taking care of others – self-care is critical.
  2. Focus on validation first; problem-solving second. Validating, acknowledging and accepting pain, distress, hurt and the like builds communication and naturally decreases tension and stress. Validation is the essential first step prior to action, problem-solving and positive coping.
  3. In order to grow positive coping, it is helpful to build mastery and self-expression. Strategies that can help to both organize and “release” feelings and stressful experiences rather than “bottle them up” include:
  • Use your body to heal your mind: play, do yoga, engage with nature, exercise;
  • Engage in shared action to promote communication and change at a community and systemic level. Volunteer or advocate for a cause of importance. Contact your local legislators and express your concerns;
  • Write or draw about your experience. Use collages, images or videos to express your goals, experiences and fears;
  • Engage in therapeutic movement. Create a music playlist for various emotions. Dance or engage in rhythmic actions (e.g. knitting, pottery);
  • Identify your strengths and what you value in life. Happiness is fleeting – goals and values last longer and support positive coping. For a free strengths and values survey, check out: https://www.viacharacter.org/;
  • Connect with community resources available in your area, such as therapists, mentors, religious organizations, support groups, local-nonprofits, etc.; and
  • Be kind to yourself and practice self-compassion.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant 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, 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.

 

9

Organizing Screen Time During Remote Learning

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Working remotely has placed all of us on our screens more. My eyes, back and head hurt!  For months, screen time has been our lifeline to our family and friends, work and learning. Adults and children are on screens to connect with our families/friends, to learn, to play etc. And with remote or hybrid learning most likely here to stay to some degree for the 2020/2021 school year – even with lessening restrictions – our students will remain on screens. Helping students manage the amount of screen time they have is and will remain a daunting task.

I often talk to parents about what goes into their day for healthy living (i.e. exercise, sleep, work, play, outdoor time, etc.). We can add things like responsibilities/chores, alone time, down time, family time, etc. A child’s day also consists of routines, activities, chores, sleep, outdoor time etc. This becomes even more critical as we think about all the ways we are using screens nowadays.

To help manage screen time for our kids, it is important for parents to set boundaries and guidelines around screen time and clearly communicate the specific activities they do on screens. Create a clear way to communicate about screen time:

  • “Friend Time/Social Time”
  • “Family Time” (talking with relatives, playing Pictionary over Zoom)
  • “School Time” (Math, ELA, etc. – whether it be asynchronous or synchronous)
  • “Down Time” (i.e. meditation apps, sleep apps, etc.)
  • “Free Time” (the child’s choice with parent guidance)
  • “Indoor Exercise Time” (movement apps, online exercise shows or classes, etc.)

By creating a clear and common language around screen time/use within your home, children will better understand what their role is within each of these blocks, and communication related to screens becomes easier. Children and parents can talk more clearly about what the child is doing, what the child should be doing, what they want to be doing, and about learning expected behaviors and limits around each specific time. For instance, during family screen time (talking with grandma and grandpa), it’s okay to be wearing your pajamas or be in bed,  but for school screen time, this is not okay – the child needs to be dressed and at their designated workspace.

Establishing some guidelines, expectations and rules around screen time also allows parents and caregivers to talk with their children about healthy living and responsibilities (i.e. getting outdoors, exercising, eating, chores/responsibilities, relaxation, etc.) and how all this fits into a day. For example, 30 minutes of exercise is part of every day, playing a board game as a family is a part of every week, doing chores and completing daily living routines (dressing, brushing teeth, etc.) are a part of every day, reading a book or being read to happens every day, etc.

To help children understand and comply with screen time and use guidelines, Create a screen time agreement/contract jointly with your child. After explaining the above distinctions, guide them to figure out what goes into each category. The types of activities, games they play, who’s on the calls, etc. and what the expectations are for each. Take notes during this brainstorming session to then create an actual agreement/contract from those notes. Make sure to include rewards and consequences. There are “have-to” or “non-negotiable” activities that parents want children to do. Make these clear to the child, especially about the number of warnings they receive to get off of a device when prompted. Use and make sure your child knows that parental controls exist and that you will use them as well as time- tracking technology to help them be successful in meeting their goals, getting their rewards and being a great family member. Make sure there are screen time-free zones/hours (no one in the house is on a screen). This helps the child develop and learn non-technology-based entertaining behaviors. Everyone agrees to and signs the contract.

Finally, you might want to create creative/imaginative time activities, quite time activities, among others, to round out your child’s development. Get a hold of screen time before it takes hold of you and your child. Screen time can be a very slippery – even dangerous – slope for all of us these days. Help your child and yourself to be more mindful of the amount of time you are using screens and for what purpose. Good luck!

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

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

 

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.

 

7

Developing Self-Motivation So It Sticks

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Motivation can be elusive for many of our students especially for activities they don’t like, they don’t find interesting or they find challenging. In other blogs, I’ve written about the 3 S’s: self-awareness, stress management and social competency, as keys to thriving in life. For this blog, self-awareness and stress-management are relevant. Being able to handle failures, set-backs and challenges are a part of life whether you are a child or an adult. Developing internal-motivation and self-efficacy are two powerful ingredients to thriving in life. So, how do we help children tolerate distress, rebound from setbacks and stretch beyond their comfort zones?

Russian psychologist Leo Vygotsky proposed a concept called the Zone of Proximal Development (ZPD). He defined ZPD as the area just beyond a student’s independent functioning level where he/she may need some assistance but isn’t too far out of reach. To hit the ZPD accurately, one has to assess the student’s knowledge and experiences accurately.

If we haven’t helped children recognize that new learning is challenging and takes effort, we have done them a disservice. When they struggle and haven’t learned that it is a part of learning, we see students push back with comments such as, “It’s too hard,” “I don’t know how to do it,” or “I can’t do it.”

Tasks in the student’s comfort zone don’t take much effort; they just “breeze through them” with little exertion or motivation. If adults raise the bar just beyond the student’s reach, but the student can reach it with minimal support, this develops efficacy, stamina and internal-motivation. Once they’ve reached the bar, there is often a sense of accomplishment and pride with the feeling of, “I did it!”

How do we encourage, support and guide students to “push themselves beyond their comfort zone”? The answers to this question are important, as they can backfire on us and discourage a student or encourage a student to move into their ZPD. In general, there are four approaches/steps:

  • Adults model what it means to be in the ZPD
  • Students imitate the adults
  • Adults fade the support/instruction
  • Adults offer feedback on the student’s effort and performance.

Adults model, guide, encourage and praise authentically. Think out loud about how you persevere. Provide support and guidance, such as, “I know this is hard for you, but let’s start with what you do know.” Or, “I like how you stuck with it even when you wanted to give up.” Finally, “You’re building tolerance and stamina for new learning.” As students become more comfortable in their ZPD, they become more self-motivated and develop greater self-efficacy.

Helping children get there can be a journey, but if the adults in their lives take the time and effort, the pay-off is worth it! When you give children guides to know when they are in each zone, it helps them know what to expect, how to think and what to do. For instance, when students are in their comfort zone you may hear, “I get it (and it is quick), “this is a breeze,” “this won’t take me any time,” or “I’m bored.” Little to no effort is required in this zone. In the ZPD, students may be saying, “I have to think,” “I have to work at this,” “I’ll get some wrong,” “I may get stuck,” or “It’s ok, I know some of it, so maybe I can do more.” It takes effort, thinking and the student feels challenged. And finally, in the OMG Zone, you may hear, “I don’t know where to begin,” “I can’t figure this out,” “I’m spinning my wheels; this makes no sense,” “I don’t care,” and “I’m frustrated and angry.” Adults are doing most of the work at this stage, and the student’s effort doesn’t pay off. He or she is not ready for this learning yet – it’s too far of a stretch. Helping students develop their comfort in their ZPD is paramount to developing self-motivation and self-efficacy.

 

Resources

Vygotskian Principles on the ZPD and Scaffolding

https://www.open.edu/openlearncreate/pluginfile.php/5904/mod_resource/content/1/Vygotskian_principles_on_the_ZPD_and_scaffolding.pdf

What is the Zone of Proximal Development

https://www.healthline.com/health/zone-of-proximal-development

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

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

 

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.

 

5

Supporting Your Child’s Reading Development – Even During a Pandemic

By | NESCA Notes 2020

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

Aside from allowing children to access school instruction, the ability to read provides a child with the opportunity to read for pleasure. Reading for pleasure has been shown to support a child’s cognitive development, improve concentration, increase a child’s vocabulary, expand a child’s level of creativity and imagination, improve empathy and provide the child with a deeper understanding of the world around them.

Here are some ideas to support reading for children of all ages:

Pre-school Years:

  • Develop awareness of different sounds
    • For example, have your child look for things around the home that start with a certain letter sound.
    • Play rhyming games.
    • Sing songs.
  • Read the same book to them daily for several days
    • Point out and talk about different vocabulary words each time.
    • Repetition helps build vocabulary and comprehension.

Early School Years:

  • Practice rhyming
    • Say a word and have your child see how many real or made-up words they can say that rhyme with that word.
  • Practice reading
    • Have your child read a page of a “just right” book aloud. Be sure it’s a page they can read with fewer than two or three reading mistakes.
    • Have your student use their finger to ensure they stop and look at every word rather than guess or skip words.
    • Another goal may be to pause whenever they see a period, since many struggling readers miss punctuation.

For All School Grades/Ages:

  • Read books of interest aloud to your child that they may not yet be able to read independently. This will allow your child to enjoy more sophisticated stories and increase their exposure to complex syntax and new vocabulary.
  • Continue to introduce a wide range of books.
  • Let your child’s areas of interest(s) help determine the books you choose.
  • Provide your child with experiences that help increase their background knowledge before reading about a topic, as this will then help with reading comprehension.
  • Ask your child questions about what you’re reading as you go. For younger children, this may involve them retelling the story. Ask older students to identify the key points in the text.

Finally, here is a list of apps and websites that can provide activities and books for you to enjoy as a family.

 

If you suspect your child may have reading challenges, join Dr. Talamo for a webinar on how to spot those early signs on October 15, 2020, from 2:00-3:00 PM ET.

Register in advance for this webinar: https://nesca-newton.zoom.us/…/WN_4XOoaw4IS-e8xEkHt6ev_A

References

https://www.childrensmn.org/2020/05/13/help-kids-keep-reading-stay-home-order-distance-learning/

https://www.eschoolnews.com/2020/06/30/how-to-effectively-support-struggling-readers-during-distance-learning

https://hr.uw.edu/coronavirus/caring-for-self-and-family/child-care/at-home-learning-resources/

www.commonsensemedia.org/lists/reading-apps-games-and-websites

 

About the Author:

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

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

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

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

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

She is the mother of one teenage girl.

 

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

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

5

Encouraging Your Child to Read

By | NESCA Notes 2020

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

According to Sally Shaywitz M.D., (Audrey G. Ratner Professor of Pediatrics-Neurology; Co-Director, Yale Center for Dyslexia & Creativity), dyslexia is highly prevalent, affecting one in five people, and it represents over 80% of all learning disabilities.

Even when a child does not meet the criteria for dyslexia, they may be a reluctant reader. Children who do not practice reading perform poorly on reading tests relative to children who do read on a regular basis. In addition, reduced reading time results in exposure to fewer words. In general, people use limited vocabulary during conversation compared to the language one is exposed to while reading. As such, a reluctant reader is at risk to have poorly developed vocabulary knowledge compared to same-age peers. They are also less likely to improve their reading skills over time. In her book, Overcoming Dyslexia (2003), Dr. Shaywitz shared the following information:

Through reading, a child is introduced to new concepts and information. In addition, the more a child is exposed to literature, the more likely reading will become an integral part of their daily life. However, how does a parent encourage a reluctant reader? Here are some ideas:

1.  Read a story to your child. Then ask them to talk about their favorite parts of the story.

2. Be ready to read or listen to books over and over again – this is how children learn. FYI – Did you know you can listen to the audio version of Mrs. Piggle-Wiggle (a series of children’s books by Betty MacDonald originally published in 1947) four times in a row on a drive from Boston to Maryland and four times in a row on the way back? I did this with my daughter when she was 4-years-old (she is now 16) and I do believe that, to this day, I can still quote parts of the book!

3.  Surround your children with reading material – this can be comprised of books, graphic novels, or magazines, anything that is of interest to your child.

4.  Let your child take out their own library card and go with you to the library to pick out their own reading material. Allowing a child to read for pleasure is the best way to create a more engaged reader. However, it is also important to make sure the child is choosing an age-appropriate book. A librarian can be very helpful in providing recommendations based on a child’s age and areas of interest.

 5.  Have your children practice reading whenever possible. Baking a cake? Ask them to help you read the instructions (perhaps your hands are too messy to turn the page!). Ordering food? Let them read the menu aloud to a younger sibling.

6. Use technology to your advantage. For example, I worked with a 14-year old boy with dyslexia who was intimidated by the size of the first Harry Potter book. However, I mentioned to him that, on the iPad, the book is no bigger than the iPad itself. He was more willing to carry an I-pad around and read at his own pace. Another advantage is that with an e-reader the child can place as much or as little text on a page as they wish, another way to reduce reading stress.

 7. Take advantage of audiobooks. This technology is a huge benefit for students who struggle to access books that are written for children their age but beyond their current independent reading level. The child can simply listen along, or they can hold the book and follow along with the text while listening. There are several ways to access audiobooks, including downloading them from your library for free!

8. Finally, model good reading habits. If your child never sees you reading, but you insist that they read, they will see reading as a chore rather than a pleasure. If you are not a strong reader, that is ok, you, too, can listen to audiobooks!

While these recommendations will hopefully help your child experience increased reading pleasure and exposure to literature, it is still important to find out the reason why your child is struggling to read. If your child has not had a thorough reading evaluation, you can ask your child’s school to complete such an assessment. In addition, you may wish to have your child evaluated by an independent evaluator.

 

This blog was previously published in NESCA Notes. 

 

About the Author:

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

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

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

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

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

She is the mother of one teenage girl.

 

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

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

4

Adapting Academic Accommodations for Return to Learning

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, Director of Training and New Hampshire Operations, NESCA

As students with disabilities return to learning, the accommodations provided through their 504 Plan or Individualized Education Program (IEP) may no longer meet their needs within the structure and limitations of remote learning and/or return to school protocols. For example, when remote learning, teachers are not as readily available to provide “in the moment” redirection, check-ins for understanding or modifications to the presentation or length of assignments. When at school, many students are at the same desk all day, for academics, “specials,” snack and lunch, meaning teachers have to identify new ways to provide movement and sensory breaks while maintaining social distancing. For hybrid learners, teachers have to consider how to provide structure and predictability in the face of frequent transition and increased demands on independent work.

Within all return to learning plans, parents and school teams are having to be more creative than ever before, working to quickly and flexibly identify and implement new accommodations to address a range of new challenges. While this is new territory for all, there is fortunately an increasing number of online resources to aid this process, some of which are listed below. Foundational to the success of any COVID-era accommodations plan will be the team’s ability to regularly assess its feasibility and effectiveness, engage in open communication between home and school, and steadfastly and flexibly adapt the accommodation plan as individual needs and/or school instructional plans change.

See the following websites for information about how to implement accommodations during COVID-19:

In IEP Accommodations During Distance Learning, Amanda Morin of www.understood.org presents a list of many standard accommodations for presentation of information, assignment completion and daily management/organization, with ways to adapt each for remote instruction, giving specific consideration of available tools within Microsoft and Google suites.

Socially Distant Sensory and Movement Break Ideas by Katie McKenna, M.S., ORT/L, of The Autism Helper provides a range of creative solutions for meeting regulation needs for a wide range of students.

The State Educational Technology Directors Association (SETDA) eLearning Coalition website provides webinars and a host of information regarding the development and implementation of accessible educational materials during remote learning.

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. 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.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

2

How Do I Prepare My Child for a Neuropsychological Evaluation?

By | NESCA Notes 2020

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

Parents often ask us what they should tell their child about their upcoming neuropsychological evaluation, especially when it is their first experience with testing. I advise parents to refer to the neuropsychologist using his or her first name, as the term “doctor” can be scary and raise fears about medical exams. I might also add that the visit will not involve any shots! In order to describe the evaluation itself; here is some helpful language:

  • They are going to ask you questions, and you just need to do your best to answer.
  • They might ask you to do some drawing or writing.
  • Some activities might feel like you’re in school; for example, reading stories or doing math problems.

It may also be helpful to create a simple social story prior to the evaluation to help preview what to expect for your child.

To explain the reasons for doing the evaluation, some key phrases to use with your child include:

  • We want to understand how you learn, because everybody learns differently.
  • We are going to be “brain detectives” and figure out how your brain works!
  • This will help us identify your strengths and areas that we need to work on. That way, we can help you with things that are harder for you.
  • This will help your teachers understand your learning style so they can help you better at school.
  • Just try your best!

Testing in the age of Covid-19 is different. It can be harder to help children feel at ease when everyone is wearing masks, and we can’t offer a high five for good work. But as we are all learning, children are often more resilient than adults. Prior to coming in for an evaluation, you might want to remind your child to wear their mask, wash their hands and not approach people too closely.

It is also important to understand that a neuropsychological evaluation is a lot of work for your child! Finding a way to reward them for their effort will go a long way in helping them stay motivated and positive. This could be as simple as swinging by the drive-thru for a donut or something more extravagant, like a new video game. Whatever you choose to do, create a plan with your child and let the neuropsychologist know. When I have a child in my office who is starting to fatigue, it’s always a great motivator to remind them of the special prize they’ll get at the end of the visit!

 

About the Author: 

Erin 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.

 

If you are interested in booking an evaluation with Dr. Gibbons or another NESCA neuropsychologist, please fill out and submit our 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, 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.

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