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Neuropsychological Evaluation

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1

The Next Pandemic: Mental Health Issues

By | NESCA Notes 2020

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

The return to school, whether remotely or in person, will be a transition that is bound to be stressful for many children and adolescents as well as their parents and teachers. Coming on the heels of five stressful months of lockdown, remote learning, loss of social contact and so many other changes,  children will be meeting this challenge with depleted resources for coping with stress and may show new signs of anxiety or mood issues. This will be particularly true for children and adolescents who have underlying issues with mental health, attention or learning. Prioritizing the mental health of students and focusing on providing emotional support will be key to helping children manage the transition back to school. “When children feel connected, they’re going to learn better, do better, stay on track,” commented Dr. Nadine Kaslow, professor of psychiatry at Emory School of Medicine and past president of the American Psychological Association, in this article. She emphasized that “loving warm interactions need to take precedence” over struggling with them about behavior or about schoolwork.”   Remembering that undesirable behaviors are often driven by emotional distress and are a form of communication can be helpful for parents in responding in a positive and supportive manner. As we continue through this period of unprecedented levels of stress and change, children need to feel connected to and supported by their parents even more than is usual; maintaining this connection is far more important than any academic goals, no matter how far behind parents fear their child is as a result of the interruption to regular schooling.

If you have concerns about your child’s mental health, clinicians at NESCA are available for expert consultation or evaluation of your child’s emotional functioning so that the appropriate supports can be put in place. This work can be done either through teletherapy or in-person through contactless evaluations in all three of our locations (Newton and Plainville, MA and Londonderry, NH). NESCA has several suites in which there is a large plexiglass panel in the shared wall between two offices so that the child/parent and evaluator/therapist are in separate offices but have the benefit of full visibility and communication through headphones. For more information, please view, “Testing in the Age of COVID-19” on our Video Resources page.

If you have questions about your child’s mental health and would like professional help, please reach out to Dot Lucci, M.Ed., CAGS: dlucci@nesca-newton.com for an intake and screening.

 

About the Author: 

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

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

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

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

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

18

Processing Speed Deficits and College – Part 2 – Finding a Fit

By | NESCA Notes 2020

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

In my last blog, Processing Speed Deficits and College – Part 1 – The Dilemma, I discussed specialized instruction for students who have processing speed deficits in high school in comparison to the accommodations process in college. Below is a list of some of the accommodations and instructional modifications that are often afforded to students with processing speed deficits in high school, and if/how that support can be replicated in college as well as how hard a student may need to work to bridge gaps in support. One of the most important things to remember when reviewing this list is that modifications to the course of study or workload in a college course are typically not available in college. Students with processing difficulties must be able to keep up with the same instruction provided to every student in the class through a combination of accommodations, self-help strategies and use of supports (tutoring, academic coaching, office hours, study groups, etc.) outside of the classroom.

In the classroom

  • Reduced pace for instruction – High school educators may be used to heavily modifying their instruction (i.e., providing instruction at a slower pace, in manageable “chunks,” sometimes even with breaks between content) when they are teaching a class that includes students with reduced processing speeds. This is a typical methodology for many private special education schools and for special education classes in public schools. However, this is not the typical instructional style at a traditional college. With that said, there is great variety in the pacing of classes from one institution to another, and even from one teacher to another within the same institution. For students who have received specialized instruction in high school, it is important to consider the pace of available instruction and to sit in on college classes when considering this transition. Depending on the student’s learning profile, it may be necessary to seek out a college or support program that is specifically designed for students with learning disabilities or has had targeted programming for students with learning disabilities—especially those with processing speed deficits—for many years.
  • Copies of teacher notes or fill-in-the-blank notes – Note-taking is an important skill for life, and even students who receive accommodations to enhance their note-taking need to build skills for retaining instruction and oral direction. However, some students exit high school without note-taking skills. Upon request, colleges often have one or more ways that they can accommodate students who are unable to effectively take their own notes in class. Students may be able to get copies of teacher notes/slides, copies of notes taken by another designated student or professional note taker, recordings of class or opportunities to use other technologies in class, such as a Livescribe Smartpen. When note-taking is a challenge, it is important to understand what accommodations are typically available at a particular college, including what support might be provided for assistive technology training and usage.
  • Follow-up questions and review of learning – Students who have difficulty processing classroom learning in real-time are often provided lengthy opportunities to ask questions about materials outside of class and/or provided with copies of the teacher’s lecture materials and study guides for separate review. When thinking about college, easy access to course information and resources from outside of the classroom is an important consideration. While many universities and professors use learning management system (LMS) technologies like Blackboard, Canvas, Google Classroom, etc., there are still some professors who have not made the shift to using these systems for the majority of their coursework or student communication. Getting a sense of technology use is important if a student expects to preview and review course materials outside of the classroom (independently or with support). Understanding how easy it is to get ahold of professors outside of class (e.g., percentage of faculty who work full-time at the school, have offices, have office hours), and how to schedule brief times for individual communication with the instructor is also useful.

Managing assignments

  • Reduced writing – In high school, students who struggle with processing speed may be expected to complete fewer assignments or have longer deadlines than typical peers. In college, students are expected to complete the same number of assignments and to have all of their work for each course completed by the end of the semester. It is possible at some colleges to request extensions on assignments as an accommodation or on a case-by-case basis. However, extensions on assignments should be something that are needed as an exception rather than a rule or students may find themselves unable to keep up toward the end of a semester. Instead of extending deadlines, students who struggle with writing demands may benefit greatly by taking a reduced course load (i.e., fewer classes per semester) or by diversifying the types of classes they enroll in during one semester—for example, taking a kinesiology class at the same time as an English Composition class. If these types of accommodations are important, students will need to carefully understand a school’s policies on underloads as well as how much control/flexibility a student is able to have when managing their course of study.
  • Grading based on quality not quantity – Just as described above, it is important to remember that every student in a college course is expected to complete the same quantity of work and same course requirements. Both quality and quantity matter in college and for those reasons it is important to pick a school that is well suited for your pace and style of learning as well as a major that will enable you to fulfill course requirements using your learning strengths.
  • Support with reading fluency – Specialized instruction during K-12 education may have focused on helping a student to increase their reading pace. Reading intervention and readers are not typical in college. However, technology can be a lifesaver in supporting a student’s independent reading fluency. Students may benefit from audio books or from text-to-speech technology so that they can take in information in multiple modes and a faster pace. Practicing with technologies and understanding the related accommodations that will be available in college are important for continued reading success. Some high school students have additionally needed tutoring support because they learn best when discussing aloud content that they have read in a supportive setting—for those students, it has been important to seek out schools or learning disability programs that can provide this type of tutoring (a less common support) or to pay privately for tutoring in addition to college-based learning supports.

Testing

  • Extra time – This is one accommodation that is fairly common in both high school and college settings. One major change is that many high schools provided unlimited extra time to students, even those with no identified learning disabilities. In college, students will typically receive 50% or 100% extended time based on their needs as demonstrated in diagnostic testing. Good executive functioning can be helpful if you are a student who uses extra time on exams, because you may need to schedule your exams in a separate testing setting each time they occur.
  • Shorter length/Reduced writing requirements – As a college student, you are required to meet the same testing requirements as every student in your class. If you are accustomed to reduced writing requirements on tests, you will need to consider some of the other available accommodations (e.g., extra time, assistive technology, etc.) to successfully manage. You may also need support building your test taking strategies so that you can use your time most efficiently on tests.
  • Separate testing space – Taking a test in a reduced distraction environment, or possibly a private room, is another accommodation that is common in both high school and college. Similar to students who receive extra time on tests, there can be a high degree of planning and organization involved in scheduling one’s exams in a separate setting according to school guidelines. Students may want to inquire about the level of support that college personnel will provide to a student when they are first learning to organize and implement their testing accommodations.

Social and daily life

  • Two additional factors that may have been important in high school include Smaller school/class size and Similar peer cohort. Matriculating from a small homogenous class or school environment, where all of your peers have similar learning styles and accommodation needs, can be a shock. When researching and visiting schools, it will be extremely important to get a sense of who the other students on campus are, how common processing speed deficits are among students with learning disabilities on campus, how diverse the school is and how tolerant students generally are, etc. Sitting in on classes and taking part in accepted student days can be critical activities for students who are looking for a college that will meet them where they are at.

When students enroll with disability support services, they are often asked how their disability impacts their learning, what accommodations they were provided in high school, and what accommodations they think they will need. For students with processing speed deficits, it is critical to be able to answer these questions before beginning a college search and to find colleges that truly match their learning needs as well as their more general wishlist!

 

 

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.

7

Coronavirus & Social Injustice: A Crisis or an Opportunity? – Part 2

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

Last week in my blog post, I wrote about one’s perspective about the coronavirus as an opportunity or as a crisis. Initially, most everyone thought it was a crisis and we needed to mobilize to fight it. Massachusetts Governor Charlie Baker recognized it as a crisis early on and has handled it with steadfastness and clarity; whether or not you agree with his decisions. Recently, he mobilized a commission to discuss the re-opening of schools in the fall. This commission has stakeholders from across the Commonwealth, including parents, business leaders, community leaders, educators and administrators. As part of guidance on the reopening of schools, Governor Baker and the Massachusetts Department of Elementary and Secondary Education (DESE) told school district administrators to plan for three scenarios of returning to school in the fall: in-person, a hybrid of remote and in-person, and all remote learning. The districts were given deadlines to submit their plans – a daunting task for all involved. But this pandemic has created many daunting tasks for all of us, and we must come together thinking flexibly, creatively and collaboratively to handle this crisis and move towards thinking about it as an opportunity. Our world as we know it and much of the workings of our world have changed and probably will remain changed for the foreseeable future (i.e., open floor offices are a thing of the past; working from home is proving for some to be more productive).

We are all in this together and when parents, students, teachers and administrators think about the return to in-person instruction in the fall, it brings about many different emotions as well as concerns. Administrators have to plan for all three scenarios, because there are so many unknown variables to consider. For instance, we could start in-person learning then need to switch to remote if there is an uptick in positive cases of the coronavirus. School re-entry in the fall is an unknown, but our leaders are trying to plan as best they can for all possibilities. Ultimately, returning to in-person learning will be a personal decision for every parent based on many variables for each of their children. What’s good for one child may not be good for another in the same family, let alone one family to another.

I wonder about viewing the coronavirus and the havoc it’s wreaked on our educational systems as a genuine opportunity to truly rethink how we educate students. Maybe it is seriously time to consider dramatic school reform. Our education system is antiquated and has not changed much over the years even with the advent of STEAM. We still have achievement gaps with many students not succeeding even with reforms and many dollars spent. Maybe the coronavirus and the social injustice movement are just the crises that are the opportunity that will really change how we think about education, bringing about dynamic and dramatic school reform.

In last week’s blog, I quoted John F. Kennedy as saying, “The Chinese use two brush strokes to write the word ‘crisis.’ One brush stroke stands for danger; the other for opportunity. In a crisis be aware of the danger – but recognize the opportunity.” The coronavirus and social injustice are certainly crises of today, yet I do see them as an opportunity to heal the divisions in our country, increase dialogue and create change.

Last week Massachusetts DESE Commissioner Riley’s Weekly Update included “Protocols for Responding to COVID-19 Scenarios.” This guidance provides more information and protocols to answer the following questions:

  • What should a district do if there is a symptomatic individual – at home, on the bus or at school?
  • What should a district do if someone in the school community tests positive for COVID-19 – be it a student, teacher, staff, bus driver, or one of their household members or close contacts?
  • Who should get tested for COVID-19 and when?
  • In what circumstances would someone need to quarantine (when they have been exposed but are not sick) or isolate (when they are sick)?
  • What should school districts do to monitor COVID-19 spread in their communities?”

These guidelines may change as the situation changes, but as they stand now. I have heard a variety of responses to these guidelines, such as:

  • “This makes my head hurt and eyes blur.”
  • “They have got to be joking.”
  • “It’s an attempt. They’re trying.”
  • “Kids have to go back some day.”
  • “Deep breaths and an open mind are needed.”
  • “We’re all in this together. We have to try.”

As these comments demonstrate, there are many different feelings and thoughts about going back to in-person instruction in the fall. Our administrators and leaders are juggling so many different variables in making decisions. It “requires” us to trust them and show concern, compassion and gratitude in their attempts at re-opening schools. I recognize the three options presented are just that – three options. No matter what the decisions are about how we return to school, it will be what it will be in each community.

It is my hope that our leaders can view this pandemic, this crisis, as an opportunity to seriously contemplate and delve deeply into discussions about school reform within our country. This pandemic has dramatically shown the inequities that exist across our state and country and in our cities and towns. We knew they were there before, but now they are in our faces. We have an opportunity to think about education as not related to one’s zip code, socio-economic status, color of one’s skin/ethnicity or other factors; instead we can think about it as a basic human right that should be equal for all.

Education is about preparing children to become a competent member of our society and community. We have an opportunity to think about how and where we educate students. Education is about learning and preparing students for tomorrow. Many districts that were socially-emotionally-focused and had good technology capabilities were able to be nimble and pivoted smoothly to remote learning during the pandemic. These districts also had good leadership, solid communication with families and students, and staff felt cared for. There were many other districts that struggled to pivot to remote learning for a myriad of reasons, and this points out that equity in our educational system is necessary. So, while you think about the fall and schools reopening, do what you think is right for your child and family. Also, remember that this “new normal” of remote learning can be okay if done well.

In the special education vernacular, you often hear that special education isn’t a place or a program. That is also true for all education – education isn’t a place. It is so much more. The Center for Education Reform states that the future of schools is students, not systems. This might be a good time to devote some energy to reforming our educational system for the future.

 

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.

 

18

Processing Speed Deficits and College – Part 1 – The Dilemma

By | NESCA Notes 2020

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

By nature, transition specialists are generalists—professional who support students with a wide range of disabilities in moving toward an even wider range of learning and life outcomes. Working in Massachusetts, with an early background as a guidance counselor in a college preparatory high school, I often support students who are contemplating whether and when they should matriculate to a four-year college program. Many of these students experience processing speed deficits. This means that these students may be capable of reasoning at average or above average levels, and therefore being stimulated and actively engaged by college course content, but these students also need extra time to process visual and verbal information, to make sense of this information, and to produce output.

Landmark College in Putney, Vermont, assembled an assessment for parents and students—A Guide to Assessing College Readiness—that includes five areas considered essential for students with learning disabilities who want to succeed in a traditional college setting. These include academic skills, self-understanding, self-advocacy, executive function and motivation/confidence. Some of the academic items include being able to read up to 200 pages of college level text in a week, writing an organized 10-page paper that cites multiple sources, and being able to complete all of the steps of a long-term project in a timely manner. Within the assessment, it is carefully noted that this is not a diagnostic tool and is intended to inform discussion about the appropriate environment and supports that the student will need to achieve success and struggle less in college. So, when I recently received a question from a parent who was wondering if it actually mattered that her student was not able to read 100 pages in only a few days, the answer I provided was, “it depends.”

While there are many ways that we accommodate and modify instruction for students who have processing speed deficits during high school, some of these methods are easy to replicate across college environments and others are heavily dependent on the environment or only replicable with a good deal of external support provided by people and technologies. For example, in high school, students with significant processing speed deficits may be supported through accommodations, such as teachers reducing their pace of instruction, providing copies of instructional materials and/or fill-in-the-blank note-taking templates, actively following up with students to confirm their understanding of material, and actively assisting students in digesting complex reading materials. They may also receive modifications such as reducing the amount of work a student is expected to do per quarter or on a test and offering lighter or alternative reading. When all of these accommodations and modifications are added together, a student has a highly specialized high school experience and may be left with gaps in their academic, executive functioning and self-advocacy skills that need to be carefully bridged when the student aspires to participate in college learning.

While high school accommodations and modifications center on supporting a student to successfully make progress in school, accommodations at the college level focus exclusively on what a student needs to be able to access the instruction that is already available at that college. Rather than individually modifying the curriculum or work load in a college course, a student must be able to keep up with the same instruction provided to every student in the class and the same requirements as every student in the college through a combination of accommodations, self-help strategies and use of supports (tutoring, academic coaching, office hours, study groups, etc.) outside of the classroom. Accommodations are still very individualized, but educational programming is typically not. This makes the college search and selection process complex and important for students with processing speed deficits. Not every college that specializes in supporting students who face learning difficulties is a good choice for a student with slow processing speed. And not every student with a processing speed deficit has the same skills, or faces the exact same challenges, when navigating college.

Stay tuned for our next Transition Thursday blog where I will elaborate on some of the common modifications and accommodations provided to high school students with processing speed deficits and how to think critically about college selection, support and accommodation based on experience with those accommodations.

 

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.

7

Coronavirus & Social Injustice: A Crisis or an Opportunity? – Part 1

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

As our leaders try to handle the crises of today, we can be angry or pleased at their attempt. I know I’ve been both, but yet recognize that they are trying to make tough decisions while taking into consideration many uncontrollable variables. In making these tough decisions (i.e. opening/shutting down schools, stay at home orders, managing protesters, etc.), it is almost impossible to please everyone. As the days turn into months, panic, anger, guilt and irrational thinking won’t work for us as individuals nor as a community. Instead it would behoove us to come together, show care, concern, empathy and gratitude toward each other. Recognizing that the divisions that exist amongst us are what keeps us fighting, in fear and not working towards common goals. We must acknowledge our differences, yet come together to be problem solvers and be optimists to handle the crises of the coronavirus and the social injustice that is plaguing our cities and impacting our children.

John F. Kennedy was quoted as saying, “The Chinese use two brush strokes to write the word ‘crisis.’ One brush stroke stands for danger; the other for opportunity. In a crisis be aware of the danger – but recognize the opportunity.” The coronavirus is most certainly a daunting, unprecedented crisis that has befallen our country and our world.

In March, our lives changed dramatically as schools in Massachusetts were shut down and we were told to quarantine. Now five months later, we begin to reopen. Now, I wonder if we can look at this crisis a bit differently – maybe as an opportunity. But an opportunity for what? Seeing a crisis as an opportunity takes courage and faith and requires a peace of mind that is rooted in a sense of calm, not fear. This allows creative and flexible thinking to emerge. We become problem solvers. As days turned into months of quarantine and we tried to “settle into the new normal and go with the flow,” my hope is that some of the initial panic and fear has subsided slightly in your hearts and minds. Maybe new rhythms or routines have been created – we’re commuting less, enjoying time with family, cleaning the basement, cooking more, etc. Some opportunities have arisen whether we’ve noticed them or not and whether we’ve liked them or not. Do you think you’re ready to think differently about this crisis? Can you find moments in each day that arise because of the crisis that open up opportunities or possibilities?

As we settle into mid-summer, we also begin to think about schools reopening in the fall and what that will look like. Will it be a crisis or an opportunity? Only you can decide.

 

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

There Is No Wrong Decision

By | NESCA Notes 2020

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

We are living in an unprecedented time. As such, parents are faced with decisions that they have never faced before. For example, families are facing the challenging decision about whether or not to send their children back to school for in-person classes in the middle of the COVID-19 pandemic. Parents have to wrestle with the idea that, on the one hand, sending children to school could increase the risk of COVID-19 among children and family members; while on the other hand, children who don’t return to in-person school may experience disruptions in their education and may miss out on the social interaction and community feeling within the school building. In addition, some families simply don’t have a choice because they need to go to work or a family member at home is immunocompromised.

What is most important is to recognize is that whether or not to send a child to school in the fall means something different to everybody. It is imperative that, as parents, you give yourself permission to feel whatever it is that you are feeling, and that you do what feels right for you and your family. It may be difficult to accept, but we have little control over much of what is happening around us right now. While it is important to acknowledge how you are feeling, it is equally important to remember that, in fact, any reactions are normal under the current circumstances.

How you respond to stress during the COVID-19 pandemic can depend on your background, your financial situation, your health and emotional background, your social support system, the community you live in and many other factors. When it comes to parenting, every day can be a challenge, and the coronavirus has made an already scary world feel even more menacing.  Remember to “ignore the noise” and give yourself credit for taking care of yourself and your family.

 

 

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.

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.

To learn more about this topic, a helpful webinar is available at “Supports for Students with a History of Trauma and Significant Anxiety,“ presented by Dr. Renee Marchant, PsyD, and Dr. Stephanie Monaghan-Blout, PsyD.

 

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.

 

5

“Can I Hug You?” – Why the pandemic has us craving closeness

By | NESCA Notes 2020

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

At the end of a testing session last week, my young client and I stood looking at each other through the large glass window of our contactless, adjoined testing rooms. Our hands were newly washed; the fresh scent of antibacterial wipes emitted from the tables; and our face coverings were in place. And while looking at one another from our respective bubbles, inside this necessarily sterile setting, my client looked me in the eye and asked: “Can I hug you?”

The question hung in the air for a moment. In the 15 years that I have worked with children, I have rarely hesitated when a child asks me this. But there we were, mid-pandemic, in this brief, perhaps imperceptible, moment of uncertainty.

One thing I have become keenly aware of since starting to see family and friends for socially distanced visits is how much I, and my children, have to consciously fight the physical urge to embrace the people we love. The urge is palpable. But where does this come from?

There is a great body of research demonstrating the importance of physical touch, particularly hugging. Hugs are not just a simply a way of demonstrating your love or support for someone, but hugging actually causes physiological changes within the body. Stress hormones, such as cortisol, reduce, and the nervous system slows down. Oxytocin – a hormone integral to bonding – is released, increasing closeness and affection. Over time, close physical contact results in improved brain development, heart health, emotional health, relationship patterns and immune function.

In many ways, physical touch is a basic human need that must be met. Individuals who are deprived of these experiences, particularly early in life, can experience detrimental effects. Fortunately, some of these effects can be mitigated once opportunities for closeness are offered. As such, our bodies and brains never fully give up on the urge for closeness, even after long durations of it being unmet. And this urge has a name – skin hunger.

Most people have felt skin hunger at some point – a driving urge for human contact and connection. This may come after a particularly stressful day at work, an argument with a friend or just a general feeling of loneliness. In times of uncertainty, distress or instability, the human need for closeness increases. And yet, for so many who are enduring the COVID-19 pandemic, closeness is the exact thing that they are being deprived of. Even when we are lucky enough to still have access to our families, or perhaps a small group of close friends, our emotional needs are high. Physiologically, psychologically, we need more hugs.

The good news is, there are things that you can do to meet this need:

  • Consciously make an effort to hug those you can, and do it more often than typical.
  • Snuggle up with your dog, your cat or other pet of choice.
  • For those who live alone and do not have pets, a weighted blanket, warm bath or hugging a pillow can simulate the effects of human touch.
  • Maintain social connection through video chat, phone calls and socially distanced visits. Interpersonal contact without hugging is better than no contact.
  • Be careful to not accidentally over-associate hugs or touch with danger. Coronavirus will eventually be managed, but training our children to fear closeness could have enduring, negative effects. Choose words wisely, teaching pragmatic, unemotional caution, not fear.

 

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.

18

Transition Planning Timelines for Students with Disabilities

By | NESCA Notes 2020

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

When families come to NESCA for transition support, a common request is to work with a transition specialist to create a detailed step-by-step transition plan with action items and deadlines that will ensure their child makes a successful transition to postsecondary adulthood. As you can imagine, many hours are needed to create an appropriate plan individualized to the student—their goals and their needs—and this plan requires frequent updating as students progress toward adulthood, have new experiences, stumble at new hurdles and make developmental leaps. However, for families who are interested in creating an individualized transition timeline plan for their student at home, there are a number of readymade timelines and checklists that can be used as starting points. While I am presenting several options below, I would encourage picking the one that you like best and that fits your child best, and using that as a foundation for your planning. Please note that even though the resources below that have been assembled by agencies who specifically support individuals with autism and are therefore described as focusing on autism spectrum disorder (ASD), they may still be important for individuals with other disabilities to review.

Transition from School to Adult Life – Time Lines, by The Arc of Massachusetts, is a two-page brochure that includes bulleted timeline recommendations for students ages 13-22

A Resource Guide for Transition Aged Youth and Young Adults with Autism Spectrum Disorder (ASD), by the Autism Commission, is a 12-page pamphlet compiled to help families and individuals in the state of Massachusetts to better understand the resources available for students aged 14-22 with ASD. If viewing this pamphlet online, it is important to closely follow the page numbers. The Transition Timeline starts on page two and continues through page four.

Transitioning teens with autism spectrum disorders: Resources and timeline planning for adult living, by the Autism Consortium, is a 73-page guide intended to provide resources and information for parents and guardians of children with ASDs in Massachusetts. Pages 64-70 outline critical timelines related to education, guardianship, housing, postsecondary education, employment, healthcare, recreation and more for students ranging from age 11-22.

A Family Guide to Transition Services in Massachusetts, published by the Massachusetts Rehabilitation Commission (MRC) in collaboration with the Federation for Children with Special Needs (FCSN), is a 44-page guide intended to assist parents, students and professionals in understanding the requirements of transition services for all individuals with disabilities that are eligible for special education in Massachusetts. Pages 22-23 offer an easy-to-read timeline covering important steps for youth ages 14-18.

Important Transition Information Every Family Should Know: Transition Information Fact Sheets, by the Massachusetts Department of Developmental Services, is a 44-page compilation of fact sheets with important information for all families of individuals with developmental disabilities in Massachusetts. The fifth fact sheet, on page 9, is a simple but detailed visual timeline covering steps for students ages 14-22.

Turning 18 Checklist, by Autism Housing Pathways, is not a timeline! But it is a detailed and continually updated three-page document with a checklist of critical steps to take when a student with a disability turns 18 as well as a list of useful transition resources that correlate with the checklist. While the document was created by Autism Housing Pathways, the checklist is applicable for many individuals who are turning 18 and who may be seeking human service supports and disability-related benefits.

 

If you are interested in working with a transition specialist at NESCA for consultation, coaching, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

 

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.

1

Preparing our Kids to Reenter the Community

By | NESCA Notes 2020

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

For many children, new experiences are frightening and anxiety-provoking. Children thrive on routine and predictability; when these get interrupted, it can be hard for them to understand what is happening. As we all know, the last few months have been fraught with unpredictability and change. Now, we are starting to go back to work, eat at restaurants and visit retail stores. As adults, we might have mixed feelings about this – relief to get out of the house but also fear about the ongoing pandemic. For our children, we are expecting them to reenter their communities with a new set of “rules” after months of being in the safety of their homes. This is going to be a difficult process, especially for children with special needs.

So how do we prepare children for all of the new experiences they are about to face?

One method that has been found to be effective is the use of Social Stories™. Social Stories were first developed in 1990 by Carol Gray, a special education teacher. In essence, Social Stories are used to explain situations and experiences to children at a developmentally appropriate level using pictures and simple text. In order to create materials that are considered a true Social Story, there are a set of criteria that must be used. More information can be found here: https://carolgraysocialstories.com/social-stories/what-is-it/.

While special educators or therapists are expected to use this high standard in their work, it is also relatively easy for parents to create modified versions of these stories to use at home. I was inspired by one of my clients recently who made a story for her son with Down syndrome to prepare him for the neuropsychological evaluation. During her parent intake, she took pictures of me and the office setting. At home, she created a short book that started with a picture of her son, a picture of their car, a picture of my office, a picture of me and so on. On each page, she wrote a simple sentence:

  • First we will get in the car
  • We will drive to Dr. Gibbons’ office
  • We will play some games with Dr. Gibbons
  • We will go pick a prize at Target
  • We will drive home

Throughout the evaluation, she referred to the book whenever her son became frustrated by the tests or needed a visual reminder of the day’s schedule. Something that probably only took a few minutes to create played an important role in helping her son feel comfortable and be able to complete the evaluation.

The options for creating similar types of stories are endless, giving parents a way to prepare their children for a scary experience.

Some examples of stories to create during the ongoing pandemic:

  • Wearing a mask when out of the house
  • Proper hand washing
  • Socially distant greetings (bubble hugs, elbow bumps, etc.)

Some examples of more general stories include:

  • Doctor’s visits
  • Going to the dentist
  • Getting a haircut
  • Riding in the car
  • First day of school

You can use stock photos from the internet or pictures of your child and the actual people/objects they will encounter. If you have a child who reads, you can include more text; if your child does not read, focus on pictures only. Read the story with the child several times in the days leading up to the event. For ongoing expectations (e.g., wearing a mask) – you can review the story as often as needed. Keep it short and simple. And have fun with it!

 

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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