NESCA is currently accepting Therapy and Executive Function Coaching clients from middle school-age through adulthood with Therapist/Executive Function Coach/Parent Coach Carly Loureiro, MSW, LCSW. Carly specializes in the ASD population and also sees individuals who are highly anxious, depressed, or suffer with low self-esteem. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

Tag

Neuropsychological Evaluation

3

How to Use a Neuropsychological Evaluation Report from NESCA

By | NESCA Notes 2024

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

A neuropsychological evaluation is a big investment of your time and financial resources. At the end of the process, you are provided with a lengthy report. You might think, “Now what? How do I use this report?”

At NESCA, we pride ourselves on writing reports that are comprehensive and highly individualized to each client. We always recommend sharing the report with people who work with your student, including pediatricians, schools, and private providers (e.g., therapists, speech-language pathologists, etc.). In many cases, the report includes a clinical diagnosis or diagnoses. Other providers often need to see those diagnoses in writing in order for the student to “qualify” for services.

In the short-term, the report should be used to seek services that the student needs. This often includes working with the student’s school to ensure that the student is receiving any necessary academic, social, or emotional supports. The report includes specific, explicit recommendations, such as the type of classroom the student needs, what interventions should be happening during the school day (e.g., reading instruction, speech/language therapy, occupational therapy), whether or not they need access to counseling services, and so on. By having all of those recommendations laid out in the report, families can then advocate for their student effectively.

Aside from the school setting, NESCA reports can be used to access services privately. This might include academic, therapeutic, or behavioral interventions. Managed care organizations often require specific types of documentation in order to access insurance-based services. By having a written report that includes clinical diagnoses and specific recommendations, this essentially acts as a prescription for services.

NESCA reports can also be useful for long-term planning and progress monitoring over time. The report captures the student’s current profile and provides recommendations for what should be done to address areas of weakness, with the goal of improving the student’s prognosis. An evaluation is typically considered to be valid for the next 2-3 years. At that point, it will be important for the student to be evaluated again to see whether there has been progress and, if not, what changes need to be made to the interventions in order for them to be more effective.

 

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

11

When Average Doesn’t Feel Like Average

By | NESCA Notes 2024

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

When we conduct a neuropsychological evaluation with a child, adolescent, or adult, one important component involves administering a battery of assessments. This is certainly not the only, or many times the most important, component, but it is part of the unique skill set of a neuropsychologist. A large percentage of these assessments are interpreted by comparing an individual’s performance to the performance of others who are similar in age. For example, we may compare an 8-year-old’s reading skills to the reading skills of a nationally-representative sample of 8-year-olds. This comparison helps us to understand if the child’s reading skills are generally below their peers, about at the same level as their peers, or above the level of their peers.

A nationally-representative sample of children may not be the most salient comparison for some families. In fact, the concerns that bring parents to a neuropsychologist in the first place can often include comparing their child to friends’ children, classmates, or other children in their community. This is an almost inescapable process. As parents, it is nearly impossible not to compare children – meeting milestones, academic skills, temperament, behavior, sociability, etc. Although it can have significant negative impact when done in front of a child or in a detrimental manner (e.g., “Why can’t you be more like Johnny?” “Susie has already figured that out and she’s younger than you!”), comparing your child to others can be valuable in specific circumstances. Many parents have little experience with child development before having children, and the children in their community and friend group can serve as helpful “guideposts” for what to expect at different ages. Many times, a parent has brought concerns to a neuropsychological evaluation along the lines of “my child seems different than my friends’ children/nieces and nephews/other kids at daycare,” and I have confirmed a significant disability or disorder was present. Parental instincts are valuable and can be an important first step.

However, there are times where comparing a child to a very specific set of other children can be a fraught process, particularly when seeking neuropsychological evaluation. Parents may live in an area or socialize with a group of families who are far from the nationally-representative samples that we utilize in our evaluations. Cousins and the children of close friends may have unusually well-developed skills, unusually calm or easy-going temperaments, or unusually easy progress through school. Children may be learning in a school environment that is extremely competitive, the result of a highly selective admissions process, or inaccessible to most of the general population. Any or all of these can make a child seem more impaired than neuropsychological assessments may indicate.

This is certainly not to discount valid, important parent concerns. A child who is far behind their classmates, even when those classmates are part of a highly selective school environment with academic expectations far beyond most schools, is still struggling and may be suffering. What is vital for parents to understand is the profile of their own child, and from where the challenges that they see are coming. A mismatch between a child and their environment, be it a social environment or an academic environment, can still result in real, impactful struggles – even if the child appears “average” on neuropsychological assessment measures.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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

 

To book an appointment with a NESCA clinician, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

11

Busting a Common Autism Myth

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

I often hear from parents and caregivers that their child has several friends and likes going to social events, leading them to wonder how they could have autism.

First, let’s take a look at what autism is:

Autism spectrum disorder is a neurodevelopmental disorder classified by persistent deficits in social communication and social interaction skills.

To meet criteria for an autism spectrum disorder, one must exhibit the following social communication deficits across multiple contexts:

  1. Deficits in social-emotional reciprocity—this may include feeling unsure or uncomfortable when approaching others, having difficulty initiating social interactions, or having difficulty responding appropriately when approached by others. When engaged in conversation with others, it may be difficult to engage in back-and-forth conversation and share interests/emotions.
  2. Deficits in nonverbal communication skills—examples include poor eye contact, poorly integrated gestures in conversation, reduced facial expressions, difficulty reading the facial expressions and gestures of others, and not picking up on subtle body language cues.
  3. Deficits initiating, maintaining, and understanding relationships—characterized by difficulties making new friends, not wanting to engage with peers in any capacity, or difficulties maintaining long lasting friendships.

One must also demonstrate evidence of at least two of the following: repetitive behaviors, inflexibility/rigidity, restricted and intense interests, and sensory sensitivities.

Next, let’s look at what autism isn’t:

While individuals with autism experience social challenges, it is a common misconception that having autism means not having any friends or social skills at all. Contrary to this popular misconception, I evaluate many children, adolescents, and adults who are on the autism spectrum, are socially motivated, and have numerous friendships.

It is important to remember that while a diagnosis of autism requires social communication deficits, that does not mean a complete lack of skills must be evident. For example, I see many individuals on the autism spectrum who have several longstanding friendships but have difficulty making new friends. Conversely, some individuals find that they initiate friendships well, but have difficulty maintaining friendships over time. It is also possible for an autistic individual to demonstrate appropriate eye contact and facial expressions but have difficulty reading subtle nonverbal cues of others. With high social motivation, it still may be challenging to know how to participate in social conversation, how to build on the interests of others, and how to respond to emotional reactions.

Individuals with high-functioning autism often get overlooked as they have learned to “mask” or “camouflage” really well. That is to say that they work hard to “fit in” or hide areas of vulnerability. It might not feel comfortable for them to participate in group conversations or to interpret nonliteral language. They may feel as though there are written social rules that everyone else has access to except for them. When observing them, it may appear as though they are social and well-integrated into social environments; however, they may report a vastly different internal experience.

Taken together, having an autism diagnosis does NOT mean there is a complete inability to form friendships or participate in social settings. Rather, aspects of social communication can be challenging and warrant supports and services designed to enhance these skills.

If you have any questions or concerns regarding your child’s social development, speak with your pediatrician and/or schedule an evaluation with one of our neuropsychologists at NESCA.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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

 

1

Educational Assessment – Measuring What We See and Understanding What Underlies

By | Nesca Notes 2023

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

At NESCA, all neuropsychological evaluations from ages pre-k through young adult include assessment of academic skills, in addition to assessment of other domains, including intellectual, language, memory, attention, executive function, social, and emotional skills. Because learning is a primary “job” for any individual in this age range, it is important to understand how their unique profile of skills impacts their learning process as well as consider whether underlying learning issues may be impacting observed challenges with stress, inattention, etc.

Just because all evaluations include educational assessment, it does not mean that the battery of tests always looks the same. If that is so, what tests might you expect your child’s neuropsychologist to include?

First and foremost, when an evaluator is selecting tests, it is important to first consider whether learning is a specific area of concern. When caregivers and/or teachers are specifically concerned about reading, writing, and/or math, it is important to assess both the child’s achievement level as well as assess underlying reasons for any observed challenges. This can be thought of as assessing both functional (i.e., actual academic performance) and foundational (i.e., the underlying problems) skills. While understanding a student’s functional academic skills is critically important, giving insight into their day-to-day performance in school, if the foundational skills are not examined, then interventions are likely to be misinformed and ultimately less effective.

For example, a child may be referred for evaluation due to difficulties with reading, and perhaps there is a family history of dyslexia. For this child, the educational portion of the evaluation would consider four functional skill domains, including:

  • Decoding – ability to sound and blend together unfamiliar words
  • Sight word reading – ability to recognize whole words
  • Fluency – reading efficiency, or speed
  • Comprehension – understanding of written material

While information about the above functional reading skills may tell us a lot about how the child’s reading skills are presenting, the scores alone do not elucidate the underlying neurocognitive pattern that contributes to these scores. So, in addition to assessment of cognition, processing, and memory, the evaluation will also examine the following foundational skills for each domain:

This graph demonstrates that these skills build directionally – without having the underlying ability to hear sounds in words, appreciate what words look like “in your head,” quickly access information from memory, or understand meaning within language, then individual, functional reading skills will not develop as expected, and overall reading will be behind. Similar analysis can be done for writing, such as examining skills for language expression and retrieval, mechanics, grammar, and word forms. For those with math concerns, examination of applied problem solving, calculations, and fluency as functional skills is important, but so is examination of the foundational skills of orthography, retrieval, visual-motor integration, visual processing and imagery, and quantitative reasoning.

Even for those who are referred for neuropsychological evaluation for concerns that are not directly academic, it is still critical to assess reading, writing, and math achievement and efficiency (i.e., fluency) as key skills on which they rely for their “full time job” of learning. This is also important because many individuals with ADHD, anxiety, mood challenges, or other neurodivergence often experience challenges with executive function. Executive function is a set of cognitive and regulator skills that allow for efficient, goal-oriented problem solving and task completion. This includes skills such as planning, organizing, managing time, self-monitoring work process, and controlling impulses. With this, it is very common for individuals with such challenges to experience slow academic fluency or efficiency, despite strong achievement. Academic achievement scores are thus critical for informing the appropriateness of various academic accommodations, such as extended time for tests or accessing teacher notes.

Children, teens, and young adults spend much of their time learning – both in and out of the classroom. It is for this reason that, at NESCA, full consideration of their educational profile is considered to be a critical component of any neuropsychological assessment. We aim to understand what we see – the functional skills, or achievement ­– but we also aim to see the foundational needs so that interventions and accommodations can truly meet the student’s needs. More information about NESCA’s approach to neuropsychological assessment can be found on our website at https://nesca-newton.com/neuro_eval/.

 

About the Author

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

 

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

 

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

7

Technology Tools to Boost Your Productivity Part 3

By | NESCA Notes 2024

By: Lyndsay Wood, OTD, OTR/L
NESCA Executive Function and Real-life Skills Program Manager

Summer is coming! We are finally feeling that sunshine on our skin. You may be noticing your motivation increasing as you thaw from your winter hibernation. A lot of people find that this is a great time to start tackling those goals and projects you have been putting off through the dark days of winter. Perhaps now it is time to do that thorough spring clean, or maybe you want to meet a new fitness goal. No matter what you are trying to do, there are technology tools that can help. Below is a list of apps that can help kickstart that renewed sense of motivation you may be feeling. These are just a few tools, but please feel free to check out my previous two blogs on this topic to find even more helpful tools and apps.

  1. Todoist: Todoist is a task management app that helps you organize and prioritize your tasks effectively. Through this app, you can create to-do lists, set deadlines, and manage your activities. Todoist integrates with various other apps and platforms, making it easier to keep track of your tasks across all your devices.
  2. TickTick: No, I do not mean TikTok, which typically has the opposite effect on productivity and motivation! TickTick combines a to-do list and a calendar. It allows you to create tasks, set reminders, and even track your habits.
  3. Shmoody: Shmoody is an app designed to help improve your mood and overall mental health. Whether you’re dealing with stress, anxiety, or just feeling down, Shmoody offers practical activities and tools to boost your spirits. The app provides daily mood check-ins, gratitude journaling, and guided exercises to help you develop a positive mindset. It also allows you to set goals and objectives for the day.
  4. Remove Distracting Apps: Perhaps it is time for a social media detox. Are you finding yourself scrolling endlessly through TikTok, Instagram, etc.? Discover which app you are using the most and take a break. Maybe it is just for the afternoon, or maybe a whole month. See how your productivity, mood, and motivation change when you step away from the scroll. Use built-in features on your smartphone, like Screen Time on iOS or Digital Wellbeing on Android, to track your app usage and set limits. Taking a break from distracting apps can free up your time and mental space, allowing you to focus on more meaningful activities and goals.

Embrace the summer energy and make the most of these tools to boost your motivation and productivity. Whether you’re aiming to improve your mental health, get organized, or eliminate distractions, these apps can help you achieve your summer goals. Happy summer!

 

About Lyndsay Wood, OTD, OTR/L

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

Dr. Wood accepts Vermont- and Massachusetts-based transition and occupational therapy assessments. Her in-home and community-based coaching services are available in the greater Burlington, Vermont area. Dr. Wood can accept virtual coaching clients from both Massachusetts and Vermont.

 

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

 

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

10

Supporting Teens: Helping Them Engage in Treatment

By | NESCA Notes 2024

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

I was fortunate to join my colleague, Kelley Challen, Ed.M., CAS, in a recent presentation about fostering self-advocacy and self-determination for young adults. The focus of our conversation was around encouraging teens to participate in the special education process as active members of their IEP team. It got me thinking: what are other ways that teens should be included in decision making? How do we ensure that teens are included in vital treatment decisions? And what do we do about those teens who are reluctant to engage?

There is a robust body of empirical evidence to suggest that the combination of medications and therapy is most effective at reducing symptom severity for emotional health disorders including anxiety and mood disorders. While adults on a treatment team may be well aware of this evidence, teens may look elsewhere to gather information – turning to the less than reliable sources of anecdotal conversations and social media. If we want teens to participate in the treatment planning process armed with greater information, there are a few steps we can follow to support their treatment engagement.

First, when the question relates to medications, I always encourage teens to have very open discussions with their parents and providers about the risks and side effects of medications. It’s incredibly helpful to open conversations by asking teens what they already know or what they have already heard or read about different types of medications. This helps to eliminate any confusion or misperceptions, either about negative side effects or about their unrealistic expectations that things will be “magically cured” in a very short period of time. It is important for teens to understand how long medications may work in their system, how long they need to take the medication to reach the therapeutic dosing, and the risks of not taking it or experimenting with other substances which may interfere with the mechanisms of action. For anxious kids who may not feel comfortable speaking up within an appointment, I encourage families to make a list of their teen’s questions and a plan for who will read the list of questions in the appointment. There are valuable supports that can help with the executive functioning demands needed to remember medications (e.g., daily pill boxes, setting alarms, or reminders on their phone, etc.).

When it comes to therapy, it is relatively common for me to hear a parent state that a child is reluctant or unwilling to attend therapy. There may be many very valid reasons why a teen may feel this way, and it is a sign that they are engaging in the developmental task of individuation when they push back on this recommendation. We don’t need to fear this struggle, and we can use it as an opportunity to invite a conversation. For teens who struggle to explain why they are reluctant about treatment, I might share a few common explanations to see if they resonate with the teen: “Some teens think it’s boring, or it’s too hard, or it’s a waste of time. Some worry their parents will know each thing they say, or feel like they are not in control of the treatment goals.” It may also be as simple as finding virtual sessions to be frustrating and impersonal, or finding the commute to an office for an in-person session to be time consuming. Many of these logistic concerns can be addressed with scheduling. It is also important for teens to know that therapy is not “one size fits all.” There are different forms of therapeutic treatment, and it is important to find a provider with experience delivering evidence-based treatments for the specific diagnosis that your teen carries.

One of the most important factors in treatment adherence is a trusting therapeutic relationship. Those relationships take time to build. If a teen is not feeling well connected to their therapeutic provider, I encourage them to have a discussion either directly with their provider about this or to explore other treatment providers. The same way someone may not wish to be friends with every person they meet, there are certain connections that just “feel right.” Skilled providers also use techniques, such as Motivational Interviewing, to encourage teens to develop their own goals for treatment. This can help to diffuse the argument that a teen is only engaging in a treatment to appease their parent or caregiver. These powerful tactics include important elements of empathy, highlighting discrepancies in thinking (or in conflicting actions and behaviors), accepting (and even expecting) resistance, and promoting self-efficacy.

In helping teens to find their own voice in the treatment process, a power struggle or a demand for engagement from a parent is unlikely to get us very far. Bringing in the support of other trusted people in a teen’s life (e.g., teacher, school counselor, coach, uncle or aunt, older cousin) may also be a useful way to open the discussion about why therapy feels stressful. While teens may wish for things to get better on their own, ignored or avoided struggles do not just go away magically. Treatment can be hard as it does involve facing anxiety-provoking material. However, teens will be facing this content with a trusted adult and armed with new tools to master these triggers. It is important to acknowledge that therapy can be hard work, and they will not be doing it alone. Engaging in special self-care routines after a therapy session, particularly if parents can acknowledge and create space for these, can be a powerful way to encourage commitment to treatment. When teens feel more control in engaging with their treatment, they are far more likely to persist.

For more information on enhancing motivation for treatment engagement, consider the following resources:

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

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

 

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

14

You’ve Got a Friend – The Importance of a Mentoring Relationship in ASD

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

It is graduation time again. Graduation speeches usually include a portion where the graduates thank their parents, siblings, friends, and teachers for their success. Most of the time they also thank coaches, mentors, and counselors for their accomplishments. Listening to them takes me back to my own graduation experience where I credited part of my success to people who came alongside me to mentor and support me through the various stages of my development. The encouragement and feedback provided by these mentors shaped me in ways that I would not have gotten simply by sitting in the classroom or reading books. The role of mentors is also important, and I should say more so, for children and adolescents who are on the autism spectrum.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in problems with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. Children and young people with ASD usually have problems with what are called social pragmatic skills – those skills that are necessary for knowing how to act in social situations, reading social cues, and conducting back-and-forth conversation with others. Some persons with ASD have a hard time appreciating the unwritten “rules” of social engagement, for example, that you should look at a person you are talking to, smile, and nod occasionally to signify that you are paying attention and interested in what other people are saying. It is difficult for persons with ASD to read subtle cues and “feel” the room to know how to react to certain dynamics. Appreciating sarcasm or humor could be difficult for them. These skills are often the hardest to “teach” a child or adolescent with ASD because of the complex and dynamic nature of social interactions. Also, these are skills that come naturally or instinctively for many of us, so it is hard to break down interactions and make subtle behaviors (e.g., eye contact, nonverbal cues, gestures) more salient. This is where an older sibling or a mentor – a camp counselor, a coach, or a tutor – could be a wonderful resource for teaching these skills to a young person with ASD. Have you ever had a camp counselor model for you how to react when you are introduced to a new person? Maybe you had a coach hang out with you after a game to model how to engage in back-and-forth conversation and listen to other people’s interests. These mentoring relationships are a good venue for practicing skills that may have been taught to the person with ASD in the context of a formal speech/language therapy session or in the classroom. Indeed, I have found over the years that children and adolescents with autism and have older siblings or mentors do better in these social pragmatic skills than those without this kind of guidance.

Beyond teaching social pragmatic skills, mentors also provide guidance about practical everyday decisions. Has an older sibling ever given you feedback about how your top does not match your pants? Or that you should slow down eating that burger because you are such a messy eater? You may have had an older friend who has shared with you how they navigated dating. Teenagers, not only those with autism, are usually more open to receiving such feedback or information from those who are a little older than they are as opposed to older adults or parents because of wanting to develop their own personalities apart from parents. Therefore, for these young people I usually recommend having a mentor who is a little older than they are who can serve as a friend/mentor/model.

Many skills that are crucial in navigating social situations – how to behave appropriately, how to make friends, how to be a good team member – are usually learned in the context of organic relationships, such as a mentoring relationship, as opposed to a classroom lesson because the interaction itself is the “content” of the instruction. The mentor must be reminded, though, to be more intentional in modeling/teaching these social pragmatic skills to the client.

There is no better way of learning how to be a good and caring friend than to experience having a friend come alongside you to show you how it is done. As my favorite singer, James Taylor, sings, “Ain’t it good to know you’ve got a friend?”

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

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

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

 

6

Allow Them to be Challenged! (Examples of Balancing Support with Challenge): Part 2

By | NESCA Notes 2024

By Jasmine Badamo, MA
Educational Counselor; Executive Function Coach

Last week’s blog discussed the “zone of proximal development” and the importance of providing young people with calculated challenges in order to facilitate their executive function development (https://nesca-newton.com/allow-them-to-be-challenged-building-childrens-executive-functions-part-1/). Because the balance between providing support and allowing challenge is highly individual, I wanted to write a follow-up blog providing some examples of how this balance can be implemented:

EXAMPLE 1: A middle schooler is struggling to turn in their assignments on time, even when they already have them completed.

EXAMPLE 2: An elementary-aged child is struggling to keep their work desk clean, and it’s causing a lot of conflict and stress during homework time.

EXAMPLE 3: A high school student wants to find a summer job so they can earn some money and build their resume.

Remember that every child and family is unique, and there is no one right answer. It may take time to find the right balance for your child, but it is well worth the effort!

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Did you know that NESCA offers parent coaching tailored to helping parents facilitate their child’s executive function growth? While many families take advantage of the opportunity to have their student’s work directly with our executive function coach and utilize parent coaching as a support for generalizing the strategies the students are learning, this has also been an invaluable service on its own for many parents.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form. 

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

6

Allow Them to be Challenged! (Building Children’s Executive Functions): Part 1

By | NESCA Notes 2024

By Jasmine Badamo, MA
Educational Counselor; Executive Function Coach

Executive function – the ability to engage in goal-directed behaviors, such as planning, organization, focus, and self-regulation – is a set of cognitive skills that all individuals possess and use on a daily basis.

Like any skill, each person’s executive function is at varying stages of proficiency and development. Furthermore, a person’s day-to-day capacity for executive functioning can fluctuate based on a variety of factors, including age, cognitive profile, environment demands, emotional state, physical illness, stress, mental health, etc.

As the role of executive function in learning, working, and general life tasks is becoming more widely acknowledged and understood, it is also becoming more common to make accommodations for young people to support their executive function challenges. It is exciting to see more of this consideration and inclusion; however, I often find myself in conversations with families, educators, and related professionals regarding the difficulty of balancing executive function support and accommodation with allowing space and opportunities for growth and skill development.

How can we resist the temptation to completely alleviate a young person’s struggle, especially when we know that the individual needs opportunities to practice the executive function skills they are attempting to master? It comes down to exposing young people to calculated challenges.

Facing challenges is an important part of learning and developing independence. It is also important to be thoughtful about the level of challenge we present to an individual. In my coaching, I like to think of Lev Vygotsky’s theory of learning in which every person has a “zone of proximal development” that encompasses the skills or tasks that they cannot yet do on their own, but that they can achieve with guidance or assistance (often referred to as “scaffolding”). When a learner receives support attempting a task that is just beyond their individual reach or capacity, it allows them to stretch their skills and current knowledge. With guidance and repeated practice, the learner develops the ability to utilize the skills and knowledge independently; their zone of proximal development shifts, and they can tackle more complex and challenging skills (citation).

Challenge is essential to growth. But finding a person’s zone of proximal development is not an exact science – it’s individual, shifts with time and circumstances, and it can be difficult in the moment to know if you’ve struck the right balance between supporting your child while simultaneously allowing for sufficient challenge.

You may be thinking, “What’s too little challenge? What’s too much? Is my child facing an overwhelming amount of executive function demands, or are these challenges good growing and learning opportunities for them?” Next week’s blog will give a few examples of how parents and caretakers may be able to balance support vs. calculated challenge. And, in the meantime, consider collaborating with an executive function coach! It’s a great way to answer these questions and learn how to independently identify the appropriate level of challenge for your child.

——————————————————————–

Did you know that NESCA offers parent coaching tailored to helping parents facilitate their child’s executive function growth? While many families take advantage of the opportunity to have their student’s work directly with our executive function coach and utilize parent coaching as a support for generalizing the strategies the students are learning, this has also been an invaluable service on its own for many parents.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form. 

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

16

Working to Make Traffic Stops for Autistic Drivers Less Stressful

By | NESCA Notes 2024

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

Any driver who has ever cruised down a highway and suddenly sees flashing blue lights and hears the siren of a police car pulling up behind them knows that feeling of panic and dread – that immediate stress response that runs through your body. The internal questioning begins…What did I do wrong?, Was I speeding?, Did I not use my turn signal?, etc. The flight and fight response courses through our body. We pull over and wait while the officer gets out of their car and approaches. We know to keep our hands visible, wait patiently, and wait to be spoken to. These “unwritten rules” may not be specifically taught, but we just know to do them. Now, imagine for a moment that you are autistic and unwritten rules are difficult for you in general – never mind in this stressful situation. This situation is exacerbated in intensity by the very nature of their Autism Spectrum Disorder (ASD) diagnosis, which may lead to the driver experiencing difficulty with communicating, their ability to manage the stress of the situation, interacting as expected socially, and managing the total flooding of their sensory systems. If the driver is a minority and autistic, the stress may be further compounded.

Recently in Massachusetts, The Blue Envelope initiative was unanimously passed by both the House and Senate. This initiative assists autistic drivers in auto accident situations and traffic stops. While it is voluntary for police departments and autistic individuals to participate, the hope is that both groups will avail themselves of this potential to support and be supported in driving situations that arise. It is designed to make experiences like the one outlined above safer, and to ease communication between autistic drivers and police officers. The program began through a collaborative effort among autistic individuals, their parents, and multiple agencies and organizations, including the Massachusetts Chiefs of Police Association, Massachusetts State Police, Advocates for Autism of Massachusetts, and The Arc of Massachusetts.

The Blue Envelope Program is literally based on a blue envelope that autistic drivers keep in their vehicle with their important papers inside (i.e., driver’s license, registration, insurance card, and a contact card). The Blue Envelope isn’t just an ordinary envelope to keep things organized. Rather, it’s meant to be a “life saver and game changer,” as it is specially designed to provide critical communication guidelines and support as well as other important information about ASD. The communication information is printed on the outside of the envelope, thus alerting the officer that they are interacting with an autistic person. Along with general information about ASD, the information in the envelope can be personalized –  since we know that each person’s strengths and challenges are never the same from one individual with autism to the next. Also included on the outside of the envelope are “instructions/guidelines” for the individual. The intent of this program, by alerting officers that they are interacting with an autistic individual, is so they may potentially modify their interaction approach and style; possibly averting the individual becoming escalated, leading to more serious encounter. The Blue Envelope Program is available in many states, including RI, CT, ME, NJ, PA, AZ, and CA. It is currently in use by the Massachusetts State Police and some local communities. The program also includes training for law enforcement officers on how to approach and interact with individuals should they have a Blue Envelope.

The Blue Envelope Program hopes to, “enhance understanding, reduce anxiety, streamline communication and encourage preparedness,” and create a “positive outcome” for all. There are tips for officers that include things like, “use simple, direct language, avoid idioms, be observant, allow drivers longer time to respond, and clearly tell the driver when the stop is done.” If signs of distress are visible, try to reduce sensory inputs (turning off flashlights, sirens, etc.). Tips for drivers include handing the officers the Blue Envelope and telling them you’re autistic, following instructions, and asking for clarification if they do not understand something the officer is saying. The general guidance remains to always keep your hands visible – on the steering wheel; and if you need to reach for anything, tell the officer what you are doing before doing it.

The goal of the Blue Envelope Program is to create an outcome that is safe, respectful, and positive for all parties involved in a traffic stop, whether it be an accident or a traffic violation. Its aim is that autistic drivers will feel safer, calmer, more secure, and less stressed during traffic stops and that the officer training will help them be more aware of whom they are interacting with, be more prepared, exhibit greater empathy, and be more patient when interacting with an autistic driver. It has the potential to be a win-win program for all involved.

If you would like to apply for a Blue Envelope in Massachusetts, visit: https://www.mass.gov/info-details/blue-envelope-program#tips-for-a-safe-traffic-stop-

Additional Resources:

 

About the Author

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

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

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

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