Tag

Neuropsychological Evaluation

Dealing with End of the School Year Uncertainty

By | NESCA Notes 2021

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

The end of the school year can bring a lot of emotions, such as excitement for summer activities, sadness about closing relationships, and anxiety related to change. Often, children are experiencing these mixed emotions without truly understanding them. The end of this particular school year may bring some unique emotions, as it is the second consecutive ending that “looks different,” be it because students were remote for all or some of the year, class parties and field days are not happening, or children cannot give their teacher an end of the year hug. The loss of such traditions may cause kids to feel a lack of closure. Further, this transition is happening at a time when the world is starting to change again. While the loosening of restrictions and return to a semblance of “normal” may be positive for most, children may not know how to cope with all of this simultaneous change.

Here are some tips for things that adults can do to help children cope with what may be a difficult or uncertain end to the current school year:

  • Watch for signs that your child may be struggling with this transition. This may include new sleep difficulties, low frustration tolerance, heightened emotions, meltdowns, reduced appetite, loss of interest, etc.
  • Talk about their feelings related to the end of the year in an open and responsive manner, validating their emotions (e.g., “I can see why that would make you feel sad,” rather than accidentally dismissing them (e.g., “Don’t worry.”).
  • Help provide some closure with their teacher, such as writing a card or letter about what they enjoyed, learned, or overcame together this year.
  • Using artwork or journaling, help your child reflect on their development, accomplishments, and experiences this past year.
  • Create a plan for how they can stay in touch with friends over the summer and schedule some specific playdates or events to reduce worry about losing touch.
  • Maintain your basic schedule, such as morning and bedtime routines.
  • To reduce worry related to uncertainty, provide some age-appropriate opportunities to feel a sense of control, such as allowing your child to design a new daily schedule for “home days,” choose individual or family activities, etc.

The end of any school year provides a great opportunity to teach children about transition and change. We can teach them that it is okay to celebrate their accomplishment while also simultaneously feeling discomfort about what is to come and sadness about saying goodbye. Particularly during a year that has been marked by adversity, learning how to recognize, “sit with,” and manage these mixed emotions will help to build resiliency for the future.

 

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.

Why Work Matters for Teens

By | NESCA Notes 2021

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

“The share of teens participating in the labor force peaked 40 years ago and has declined ever since.”[1] There are many reasons why employment rates among teens ages 16-19 have declined, such as increased schoolwork and graduations requirements, summer program and extracurricular opportunities, and work competition. Now, roughly only one-third of youth in this age range are part of the workforce. But research tells us that teens who work during high school, whether during the school year or summer months, are more likely to persevere in college (if they choose this academic route) and also more likely to be hired in adulthood. For teenagers with disabilities, a population of young people who face a high risk for unemployment in adulthood, work experience in high school is even more critical.

Some of the benefits of paid employment for all students include:

  1. A new sense of identity—as a worker
  2. Learning workplace norms and expectations
  3. Developing important executive functioning skills, like time and task management
  4. Building social skills by collaborating and negotiating with other workers and/or customers
  5. Improving self-awareness through receiving coworker and employer feedback
  6. Reading a paycheck and learning to manage earned money
  7. Starting to identify learning and career goals (“I never want to do this again, so I am going to need to get a degree or some training.”) and/or gaining experience in a field of interest

Even failed work experiences—and failed application processes—are extremely valuable tools for learning the above skills as well as building coping and problem-solving skills.

And since it is almost summer and teenagers are finishing, or have finished, their classes for the school year, this is a great time to make a plan for summer employment. Teens can look in traditional places such as grocery stores, retailers, and fast-food restaurants, or may want to pursue something non-traditional like doing yard work, dog walking/pet sitting, cleaning/detailing, or odd jobs for family friends and neighbors. Those 18 and over with driver’s licenses may enjoy the flexibility of working with a delivery service like Instacart or Uber Eats.

Because work—whether a summer, part-time, traditional or non-traditional job—is such a critical aspect of transition planning, my colleague here at NESCA, Transition Specialist Tabitha Monahan, M.A., CRC, will be authoring a series of blogs focusing on career planning and counseling beginning this summer and continuing into the fall. Be on the lookout for her blogs. In the meantime, get out there and work!

Reference:

[1] https://www.cnbc.com/2019/10/06/why-so-few-teenagers-have-jobs-anymore.html

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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, call 617-658-9800 or complete our online Intake Form.

Why Kids Need to Outdoor Free Play

By | NESCA Notes 2020

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

One of the best ways to make the most of your summer is to get outside and engage in lots of outdoor play. We live in a society where we tend to over-schedule ourselves and our children. Particularly during the school year, this makes it very difficult for children to get the amount of free play that they require. With this, I’m going to tell you five great reasons why you should throw away your schedule, put down the tablet, and get outside.

The first reason is probably the most obvious. Outdoor play provides great benefits to physical development. It improves motor coordination, strength, and balance, and it puts kids in an overall healthier position.

The next reason to play outside is that there are benefits for internal regulation. Not only does it make kids sleep better at night, but there is research to show that it aids attentional control and stress reduction. Being outdoors also provides kids with different sensory experiences – such as feeling the texture of sand and mud, or feeling the wind blow on your face – which will help to build children’s sensory tolerance.

The next reason to get outside is to improve cognitive development. Being outdoors provides a lot of opportunities to make observations, draw conclusions about things, see cause and effect, and be imaginative.

Next, playing outside aids emotional development. When we are over-scheduled, children do not have the opportunity to feel confident in their ability to step outside of their comfort zone or take risks. Experimenting and taking risks during outdoor play can help children understand that they have some control over what they can do within their environment, as well as begin to recognize boundaries.

Finally, the last reason to get outside is that it really bolsters social development. When there is no structure or there are no rules to follow, kids have to learn how to initiate their interactions, engage in conversation with each other, communicate, problem solve, and find ways to along, even when others have different ideas.

With all of the above benefits, outdoor free play is one of the best things you can give to your child. So as the weather is getting nicer and summer is fast approaching, if you are looking for something to do, sometimes it is best to just put down your schedule, get outside, and get dirty.

 

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.

When the Worry Bug Makes You Mad: Understanding the Importance of Positive Behavior Plans for Anxious Kids

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

“Don’t Feed the Worry Bug,” by Andi Green is a wonderful book for children who are anxious or experience a lot of worrisome thoughts. The story is about a monster who constantly feeds his WorryBug, only to find that as he worries more and more, the WorryBug continues to grow until the monster is totally overwhelmed by the emotion. Eventually, he learns to control it. In my practice, I evaluate a number of children with lots of worries…but they don’t actually look worried. Instead, children may appear defiant, hyperactive and aggressive. Why do children overwhelmed with anxiety sometimes become frustrated and angry or have poor behavioral control at home and in the classroom?

Children with anxiety “on the surface” may appear angry, oppositional and defiant to adults. However, these behaviors oftentimes reflect secondary responses to an underlying cause: anxiety. Responses to anxiety can be categorized as “fight, flight or freeze.” As a classic example, if you run into a grizzly bear on a hike, your body’s natural physiological response is to fight, flee or freeze. Your anxiety about the demands of a situation send your body and brain into a state of “threat alert.” Similarly, when a child is worrying about something, is socially anxious, or is feeling nervous about their ability to handle a task, this “threat alert” system is activated and the child’s ability to make well-thought out decisions is impaired. The child may be labeled a “behavior problem” because of the impulsivity, defiance, disruptiveness or aggression (fight mode). Or the child may appear distractible, silly and immature, or avoidant of challenging tasks (flight mode). An anxious child may also show difficulties shifting gears/transitioning, problems letting go of events, or seem unmotivated or apathetic (freeze mode). It is also not uncommon for children with anxiety to have challenges demonstrating appropriate social skills, such as problems with insight into how their behaviors may affect others. They may also experience challenges reading the nonverbal and verbal cues in their environment because their brain is “soaked” with high arousal, immobilizing their capacity to apply logic to everyday situations. How do we help children manage their anxiety and the resulting behavioral challenges from that anxiety?

A neuropsychological evaluation can provide insights into your child’s behavioral challenges to determine if there may be an “underlying cause,” such as anxiety, (or other causes such as learning disabilities, depression or poor information processing) which are driving weak emotional and behavior control. Once identified, a neuropsychologist can provide guidance on the most effective interventions for a child at school and at home.

In my experience, one of the most important interventions for a child who experiences anxiety and secondary behavioral challenges is the development of a Positive Behavior Plan at school, which can then be included in a child’s IEP. However, many children with anxiety do not respond well to traditional behavioral reward systems that solely focus on increasing or decreasing behaviors (e.g. follow directions, sit calmly, keep your body safe, etc.), as these systems do not teach the child the self-regulation skills necessary for controlling emotional and behavioral responses. Instead, an effective Positive Behavior Plan for a child with anxiety includes behavioral targets or “goals” that focus on the attempt at coping strategy application. Importantly, a child with anxiety should be rewarded for trying to use a coping strategy, as it will take time, practice and reinforcement before a child develops the capacity to apply coping strategies consistently and successfully.

Sample coping strategies that a child should be taught by a special educator, counselor or other specialist include “taking deep breaths, jumping jacks, taking a break, using words to say how I feel,” or other self-regulation tools. When the goals of a Positive Behavior Plan focus on using a coping strategy before or during moments of distress rather than a plan that is tied to increasing or decreasing specific behaviors after they occur, a child builds independent capacity to appraise and react appropriately to physical and emotional responses in the classroom and the community. Children learn the signs (e.g. in their body, mind and in their environment) that the WorryBug is approaching, and feel better equipped, confident and more in control of their emotions and behaviors. For more information on how to appropriately develop Positive Behavior Plans for children with anxiety, “The Behavior Code” by Jessica Minahan and Nancy Rappaport is an excellent resource for parents and educators.

When the “WorryBug” or anxiety makes kids mad, mean and aggressive, a comprehensive and thorough neuropsychological evaluation can determine how to best tackle the anxiety “beneath the surface” through therapeutic and educational interventions. A neuropsychological evaluation can also direct the development of strategic Positive Behavior Plans that are individualized and appropriate for the child’s home and school environment.

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.

 

Why Taking Competency Tests, like the MCAS, can be Critical for Transition and College Planning

By | NESCA Notes 2021

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

Most states require some form of competency testing for students, particularly students who will graduate with a state standard diploma. But in the past year, standardized competency testing has become more complicated, if not impossible, to carry out.

In Massachusetts, graduation requirements have been altered for several grades of students. Students graduating in 2021-2023 are being offered alternative options for meeting state competency determination in one or more of the required subject areas (e.g., science and technology/engineering, mathematics, English Language Arts). For more details about those alternatives, see MA Graduation Requirements and Related Guidance on the Massachusetts Department of Elementary and Secondary Education (DESE) website.

The opportunity for students in the Class of 2022 to graduate without ever sitting for 10th grade MCAS is something that many students, parents, and teachers are excited about. While I understand, and even agree with, criticisms of standardized testing, there are also many reasons that I am disappointed for the students who are missing out on the opportunity to sit for this testing. These students, especially those with disabilities, are missing out on a vital transition planning activity.

Preparing for, and sitting for, (and coping with,) high stakes tests is an important part of life. Whether you pass or fail, being able to show up and perform your best in a high-pressure situation is a valuable life skill. Moreover, being able to demonstrate competency in a test situation is a reasonable and necessary college and career skill.

Additionally, standardized tests like MCAS provide objective feedback regarding the student’s level of achievement with high school material. Grades can be tremendously subjective, and are highly dependent on the teachers and types of classes that the student is exposed to during high school. In contrast, students participating in honors, college prep, and functional math classes all sit for the same standardized math tests. This is especially important when students in all three of those classes are interested in heading off to college after high school, and when we want to get a sense of their readiness for handling college coursework. Generally, students who do not earn passing scores (i.e., students who score in the “Needs Improvement” or “Partially Meeting Expectations” categories) on the MCAS, especially by 12th grade, will struggle with college placement exams, such as the Accuplacer, and may end up needing to take remedial coursework at the start of college. Students have a right to know how ready they are for the academic rigors of college as they are making their college plans, and standardized testing results can be helpful information (although they are by no means the whole picture).

With the new competency determination options, many students in Massachusetts view sitting for MCAS as something that is only worth doing if they are possible candidates for the John and Abigail Adams Scholarship (a merit-based state scholarship program). However, I hope students will also consider the other positive reasons I have listed above when deciding whether to sit for the test. For college-bound students who do choose not to sit for MCAS, I strongly recommend sitting for other standardized exams during high school, such as SAT, ACT, Accuplacer, etc. These experiences are important opportunities to build confidence in high stakes situations, to assess college readiness skills, and to identify skill gaps that may need shoring up.

Certainly, there are many legitimate concerns about standardized test contents and validity, including significant equity issues. I also believe that competency tests and college placement tests provide important information for many college-bound students. They are one metric, among many, that are worth having for transition and college planning.

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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.

Daily Journaling While Social Distancing

By | NESCA Notes 2020

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

*This post was originally published almost a year ago. While we slowly start to emerge from our quarantine and begin to safely re-engage in some of the activities and duties from our pre-pandemic lives, it is important to remember to participate in activities to better ourselves and others on a daily basis.

This is such a unique time that we are living in, but one day it will be a distant memory. Get a special journal book, make it from scratch or create one online. It will give you something to look back on and remember how you achieved something every day, smiled and made it through a very surreal time in history. Keep your journal to share with future generations. While we are practicing social distancing or being asked to stay home, challenge yourself to do something out of every category below on a daily basis. Do something for your brain, your mental health, your body, your home, your community, your creativity, your family, the environment and your friends/neighbors. Adults and kids can do this.

 

While Physically Distancing, Do Something For:

Your Brain

❏     Do a puzzle

❏     Listen to a podcast

❏     Tour a Virtual Museum

❏     READ

❏     Challenge yourself with a game, crossword puzzle, Sudoku, etc.

Your Mental Health

❏     Try a meditation app, like “stop, breathe, think” or www.calm.com

❏     Find an example of someone giving back or helping others

❏     Laugh out loud at least twice a day, tell a joke, watch a funny movie

❏     Turn off the news

❏     Record how you are feeling using the Yale Mood Meter

Your Body

❏     Take a walk, go for a run, ride a bike

❏     Create a dance play list and dance, dance, dance – We Are Family!

❏     GoNoodle Indoor Recess

❏     YouTube: workouts, yoga or dance

Your Home

❏     Do a chore – vacuum, dishes, laundry

❏     Clean your room

❏     Put your things away

Your Creativity

❏     Learn something new

❏     Draw/paint

❏     Build with LEGO

❏     Learn Calligraphy or Hand Lettering

❏     Play an instrument

❏     Search Pinterest for “DIY” or “upcycle”

Your Community

❏     Follow CDC Guidelines – stay home and wash your hands

❏     Go through clothing and toys to donate

❏     Check out your community website for what is needed

❏     Make cards to send to a local nursing home, nurses, doctors

The Earth

❏     Go for walks and enjoy nature

❏     Plant something

❏     Pick up litter – wear gloves

❏     Find another use for something before you recycle it

Family, Friends, Neighbors

❏     Stay in touch with each other

❏     Connect on FaceTime calls

❏     Have dinners together over FaceTime, Skype, Zoom

❏     Call people instead of text, write a letter, draw a picture

❏     Make a photo book of memories with a service like shutterfly

❏     Cook something for your family, neighbors

❏     Ask if someone needs help

 

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.

 

Diplomas, Graduation Dates and IEP Transition Services Revisited

By | NESCA Notes 2021

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

Three years ago, on March 26, 2019, the Massachusetts Department of Elementary and Secondary Education (DESE) sent out an important administrative advisory regarding transition services and graduating with a high school diploma (Administrative Advisory SPED 2018-2: Secondary Transition Services and Graduation with a High School Diploma). At the time, I wrote a blog about the advisory, wanting to bring attention to the much-needed guidance clarifying when and how students with IEPs (Individualized Education Programs) should be issued a high school diploma.

Today, more than a year into the COVID-19 pandemic, seems like a very important time to revisit what it means for a student on an IEP to be ready to graduate high school with a diploma this June. Given the lengthy school shutdown in Spring 2020—followed by ongoing limitations in social contact, community engagement, employment opportunities, and more—many students and their families are questioning whether they are ready for graduation. In fact, I sat in a team meeting last week where a special educator asked an adult student whether they would like to take their diploma or “refuse” their diploma in June. [This phrasing, “refusing” or “rejecting” a diploma, is often used but is inaccurate as a student is not refusing to take their diploma. Rather, the team is instead delaying or deferring graduation in certain circumstances.]

As a parent and professional regularly involved in the IEP process, a comfort throughout this pandemic is that while education has been reinvented several times, and community safety and engagement is highly variable, special education laws (including the Individuals with Disabilities Education Act of 2004, which outlines the requirement for school districts to provide transition services) remain the same. The decision for a student receiving special education services to take a diploma, or defer taking a diploma, continues to be based primarily on the same variables:

  1. Meeting local graduation requirements;
  2. Passing the state Competency Determination (CD); and
  3. Receiving Free and Appropriate Public Education (FAPE) that includes secondary transition services based on age-appropriate transition assessment.

Prior to COVID-19, passing the state CD in Massachusetts typically involved passing on-demand tests in English Language Arts (ELA), Mathematics and Science or successfully completing an alternate assessment competency portfolio. For students who have an anticipated graduation date prior to October 1, 2021 (as noted in their most recent signed IEP), something that has changed during the pandemic is that there are now Modified CD requirements that allow for CD in ELA and mathematics to be awarded upon district certification that the student earned full credit for a relevant course aligned to the curriculum framework in the subject matter and demonstrated competency in that subject. A similar Modified CD requirement for science is also available for students graduating in classes of 2021-2023. Therefore, a student who did not pass on-demand MCAS testing in 2019 may be eligible to graduate with a diploma using the Modified CD requirements.

However, as students, their parents, and their education teams ponder June 2021 graduation dates, it is important to keep focus on the same variables that we have always used for considering whether a student is ready to accept a local diploma. Here are some questions that may help when considering these variables.

  1. Has the student met all local graduation requirements? Did they complete the core courses required by the district? Or, were they given credit for courses/activities that varied greatly from courses that general education students completed? What about attendance requirements? Did the student stop attending classes or have a significantly lower rate of attendance than general education peers in the past year? Did the student meet requirements for community service hours or a capstone project if those were required of general education students?
  2. Did the student pass the state Competency Determination? Did the student have the opportunity to participate in MCAS on-demand testing? If they did not, did the student have a track record of passing MCAS tests? Was the student scheduled to graduate this June or did someone from the school district propose changing the student’s graduation date to take advantage of the Modified CD requirements currently being used by the department of education due to COVID-19?
  3. Did the student receive FAPE including secondary transition services based on age-appropriate transition assessment while in high school? Is there a Transition Planning Form (28M/9) that the team has been updating annually? Are there appropriate measurable postsecondary goals in the student’s IEP vision statement that are based on transition assessment (PLEASE remember that interview is an important assessment tool for many students)? Was the student’s voice part of team meetings where transition services were discussed? Does the student’s IEP have measurable goals that will reasonably help the student to progress toward their IEP vision statement? Has the student made effective progress on the goals outlined in the IEP over the past year? Has the student been able to engage in transition services that were described in the IEP? Was the student’s graduation date supposed to be this June or was it “TBD”? And, if appropriate, was a representative of an adult human service agency (e.g., Department of Mental Health, Department of Developmental Services, Massachusetts Rehabilitation Commission, Massachusetts Commission for the Blind, Massachusetts Commission for the Deaf and Hard of Hearing) involved in one or more IEP meetings?

Having missed out on school and community-based activities in the past year can create an immediate concern that a student needs to hang on to their special education protections and should not graduate this June. But the truth is that the pandemic created opportunities for students to generalize skills and practice functional skills, and some students are more ready than ever to move on from special education. And, as I stated in my previous blog, there is no universal set of skills or level of knowledge that deems a student on an IEP “ready” to graduate. In fact, students on IEPs, just as with mainstream students, graduate all the time without being ready for many adult activities (e.g., apartment hunting, changing jobs, applying for a bank loan, comparing health insurance plans).

When you are considering whether the student has received FAPE, it is important to remember that every student missed some typical high school planning steps over the past year. When school buildings closed down and community engagement came to a halt, educators and special educators had to pivot many times. Transition planning steps may have been missed or services may not have been delivered in originally anticipated ways without any clear fault or person to blame. If a student’s progress towards their measurable postsecondary goals was substantially halted, this might be important for the team to discuss. But there are many circumstances where students continued to make progress in spite of the missed opportunities. Perhaps the pandemic even created new opportunities for progress that would not typically be available until a student exits high school (e.g., a paid job, increased self-direction through participation in remote learning, easier access to pre-employment transition services, increased communication with peers through technology, etc.).

Regardless, as you are thinking about graduation, please remember that the most important question to ask is not, “Is my child/student ready to graduate?” Instead, the critical question to ask when a student approaches their graduation date is, “Has the student received a Free and Appropriate Public Education (FAPE)?” If the answer is “yes,” it is vital to give the student the opportunity to step into adult postsecondary life and begin applying the skills they have learned through their education and special education. Although the pandemic has created a lot of anxiety and uncertainty, let’s not fall victim to a pattern of rejecting IEPs (essentially rejecting/refusing diplomas) out of fear.

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

Resources:

Transition Resources and Advisories from MA Department of Elementary and Secondary Education:

While this blog includes some specific content that applies only to families of students in IEPs in Massachusetts, the requirement to deliver transition services for students on IEP is a federal mandate and impacts graduation in all states.

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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.

Counseling/Therapy: So Many Types and Approaches…Which One Should I Choose?

By | NESCA Notes 2021

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

Many adults, teens and children struggle with a myriad of challenges from everyday stressors, feelings of worthlessness and insecurities to official diagnoses of anxiety, depression, PTSD, eating disorders, OCD, addiction, and more. Deciding how to grow and change and alleviate the pain and suffering can be daunting. There are so many different ways to address psychological pain. Psychological, medical, behavioral, psychopharmacological, complementary (e.g., acupuncture), and educational treatments, among others, are possible choices and can assist in lessening an individual’s anguish. How do I decide which one(s) to try? Usually, treatment involves more than one of these, so the decisions may not be as difficult as you think. The first step is recognizing that you, your child, your marriage or family needs help and taking a step to get help.

Psychological treatments include many options: psychotherapy (i.e., “talk therapy or insight-based therapy”), psychoeducational counseling, biofeedback, social training, behavior therapy, mindfulness, stress management, anger management and so many more. Therapy can be individual, group, family or couples work, and there is no single approach that works for everyone. It often depends on the referral question and complaint. Counseling is typically provided by a psychologist, social worker, mental health counselor, marriage and family counselor, expressive therapist, psychiatrist and/or psychiatric nurse. Many factors go into making psychological treatment decisions (i.e., referring question/complaint, cost, location, approach, etc.). When it comes to therapy, it is most important to have “goodness of fit” between the clinician and the client. The client needs to have a connection with and feel valued, supported and understood by their practitioner. This allows whatever treatment approach or method to be more readily accepted by the client.

Reviewing the differences between treatment approaches may help with the decision-making process beyond “the goodness of fit.” Psychotherapy involves talking with a clinician to address emotional, psychological and behavioral challenges that can be both conscious and unconscious. The client’s past experiences, perceptions and history may play an important role in psychotherapy. The client “tells a story” that helps the clinician understand their life experiences through their eyes, therefore allowing treatment to be tailored to that client’s personal experience. By working through one’s thoughts, past experiences and stressors with a caring clinician, the client is able to gain insight and perspective, reduce symptoms, change behavior, learn strategies to lighten the load and improve quality of life. Often psychotherapy is long-term and involves good communication/language skills as well as higher level of thinking, often abstractly, and insight capacity.

Psychoeducational treatment is somewhat different than psychotherapy. Education is central to treatment and is a more directive approach. It can have very specific goals and may be short-term. The past is not actively addressed; rather, the purpose is to teach the client to acknowledge, accept and understand their disability and/or mental health condition and provide ways to support growth, change and meet goals. Psychoeducational treatment can be provided to individuals, groups, families, couples, employers and others and may include reading informational text, video analysis, homework, data collection, biofeedback, journal writing and more.

Some of the goals of both treatment approaches may be to:

  • connect how thoughts, feelings and behavior are intertwined;
  • improve coping and problem-solving skills to better deal with life’s stressors;
  • increase positive self-regard; and
  • recognize and better deal with strong emotions.

Many clinicians have training in specific techniques and some use a combination of approaches and philosophies. Psychotherapy typically falls into broad categories: Psychoanalysis and psychodynamic, Behavior Therapy, Cognitive Therapy, Humanistic Therapy and Integrative or Holistic Therapy.  Sometimes a specific approach may be the best method of choice given a specific condition or specific goal of the client. Some techniques have been researched on large samples of people and proven to yield positive results with certain diagnoses; while others are newer, less researched (yet are still effective).

In determining what technique is most appropriate, consider the age, diagnosis, goal of treatment, efficacy of the treatment, as well as the personality, cognitive and language capacity, cultural/family background, location, cost, etc. Many treatment approaches share common techniques, but some techniques are better suited with certain conditions/diagnoses. There are upwards of 100 different types of psychotherapeutic approaches, so knowing which one works with what conditions, resonates with you as the client and can meet the needs/goals.

Another option is online treatment. In recent years, many in-person practices and newer standalone online treatment options have emerged. Often these are for mild depression and anxiety. As you search out any treatment, ask for references and reviews and assess treatment efficacy. Some online sites include Talkspace, TeenCounsleing and more. There are also online apps to help with stress management, anxiety, depression and more, such as Moodfit, HeadSpace for Kids, MindShift, Inner Balance, and so many more. Needless to say, online therapy and apps are not the same as in-person therapy but may augment and be helpful in some situations.

Many clients at NESCA present with learning differences, anxiety, OCD, depression, trauma, addiction, ASD, and more. The following partial list includes just some of the treatment approaches recommended by many of NESCA’s neuropsychologists. At NESCA, we currently offer a psychoeducational approach to psychological treatment and short-term pandemic related issues of anxiety and depression. If interested in learning more, please visit: https://nesca-newton.com/integrativetherapeutic/.

  • Acceptance and Commitment Therapy (ACT)
  • Attachment-based Therapy
  • Animal-assisted Therapy
  • Bibliotherapy
  • Biofeedback
  • Cognitive Behavior Therapy (CBT)
  • Dialectic Behavior Therapy (DBT)
  • Exposure & Response Prevention (ERP) Therapy
  • Expressive Therapy (art, music, drama, etc.)
  • Family Systems Therapy
  • Hypnotherapy
  • Mindfulness-Based Cognitive Therapy (MBCT)
  • Motivational Interviewing
  • Narrative Therapy
  • Positive Psychology
  • Parent-Child Interaction Therapy (PCIT)
  • Play Therapy
  • Psychoeducational Counseling
  • Trauma-Focused Cognitive Behavioral Therapy

Additional information about treatment approaches can be found at: https://www.psychologytoday.com/us/types-of-therapy.

https://www.nami.org/learn-more/treatment/psychotherapy

https://apa.org/topics/psychotehrpay/approaches

https://talkspace.com/blog/different-types-therapy-psychotherapy-best/

https://verywellmind.com

 

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.

 

Looking for Answers? Ask the Right Questions.

By | NESCA Notes 2021

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

Many parents have met with me concerned that, “We had a full evaluation and got a lot of scores and a diagnosis but we still don’t understand why our child has this problem and what we can do about it.” This outcome can be avoided if parents and the evaluator are both clear on why the child is being evaluated, have laid out specific questions to be answered and what kinds of recommendations are being sought. Determining the referral question(s) should be a key goal of the intake session.

During the intake meeting, the evaluator can help the parent to shape their concerns into a specific referral question that can be addressed effectively through the process of neuropsychological evaluation. The evaluator can manage parental expectations in this process so there is not disappointment with evaluation results that don’t answer the parents’ questions. For example, I’ve had parents request an evaluation because they want to know if their fifth grader will get into Harvard or their child with high-functioning ASD (autism spectrum disorder) will get married. These questions can’t be addressed through a neuropsychological evaluation, but they can be re-worked into answerable questions. A neuropsychological evaluation can tell us if a child’s cognitive and academic skills are in the range of students who attend the most competitive colleges. However, there are many other factors that influence the college acceptance process. In this case, the referral question might be revised into “assess the child’s potential for academic success in a rigorous academic setting.” Similarly, it is beyond the scope of a neuropsychologist to determine if anyone will get married, but through the evaluation process we can assess the child’s current social and emotional functioning and offer some predictions about their likely developmental trajectory in the social domain.

While the previous examples of referral questions are too broad or abstract, I am also often confronted with referral questions that are too narrow, such as, “Does this child have ADHD?”.  In this case, I would work with the parents to reframe the referral question to, “Why does this child appear to have difficulty paying attention in school?” This referral question recognizes the fact that there are many reasons that a child may have difficulty concentrating or appear distractible – ADHD being only one of the possibilities.

When I train neuropsychologists, I emphasize the importance of understanding “Why now?”. What is it that motivated the parent or school team to seek evaluation at this point in time as they work to frame the referral question with parents? Common reasons include: concern about how the child will manage an upcoming transition (e.g., to middle school), sudden appearance of a problem, obvious widening of the gap between a child and peers, inability to meet increased developmental demands, lack of response to interventions, change in emotional status, or deterioration in academic performance.

It is extremely helpful when parents and/or school teams prepare for the intake meeting by brainstorming what they are seeking from the evaluation, questions they hope will be answered, issues to be assessed, and specific guidance that is being requested. The evaluator can then work with the parents or school team to fashion these into a referral question that is specific and relevant to the child so that all parties are “on the same page” as they undertake the evaluation process.

 

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.

Autism Awareness Month

By | NESCA Notes 2021

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

So what? What does it really mean to have an awareness month and a designated day? April is Autism Awareness month, and this year April 2 was World Autism Awareness Day, established by the United Nations (UN) in 2008. In general, these designations are meant to bring awareness to ”causes.” You will see a lot of blue in April as blue is the color of autism spectrum disorder (ASD) awareness. There will likely be many federal, state and local municipal buildings, private homes, as well as national and international monuments bathed in blue lights. People will wear blue, there will be blue autism products to buy, and our air waves will be flooded with autism awareness commercials. In a typical year, many commemorative and educational events would be held. It is usually a time of celebration for people with autism as well as their families and friends everywhere. For instance, in pre-pandemic years, sports teams, movie theatres, museums, Broadway and other venues would host ASD-friendly days. Autism Speaks has its “Light it Up Blue” initiative and is celebrating this year specifically with its #LightUpWithKindness campaign. The United Nations (UN) has a different theme every year, and this year’s theme is The Transition to Adulthood.

When the United Nations established April 2 as Autism Awareness Day, it had high hopes.

In 2008, the Convention on the Rights of Persons with Disabilities entered into force, reaffirming the fundamental principle of universal human rights for all. Its purpose is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. It is a vital tool to foster an inclusive and caring society for all and to ensure that all children and adults with autism can lead full and meaningful lives.”

Well said…but far from the reality of many individuals with autism and their families. If only our schools, communities and societies were as inclusive, respectful and welcoming as this statement. If it were today’s reality, many people diagnosed with ASD and their families wouldn’t have to struggle as much as they do on a day to day basis with stigmatization, discrimination and a lack of respect and inclusive opportunities.

Autism is a lifelong neurological condition that originates in childhood, and its presentation changes over time. Autism is a spectrum with social, communication, sensory and behavioral differences manifested uniquely in each individual. While we have come a long way in understanding autism, recognizing the breadth and diversity of those with it; embracing their talents, unique abilities and strengths; and addressing the day to day challenges that autistic people face. The UN’s vision is still far from a reality, and there is still much work to do.

It is my hope that during Autism Awareness Month, you become more aware. If you support the “cause” and buy a shirt, bracelet or puzzle piece and shine a blue light on your porch, that’s great – spread the word.  Take the Autism Speaks #LightUpWithKindness” campaign to heart do something to create a world that is kinder, gentler, more respectful and inclusive of autistic people with autism. Watch a movie about ASD, read a book by an autistic author, take the time to educate yourself and your children. If your child has autism, educate your child’s classmates, neighbors, family members and community members. If a child with autism is in your child’s class or school, connect with them and their parents. You are modeling for your own kids and those around you, so spread kindness, acceptance and inclusiveness. If you are an employer, connect with your local school district and offer to partner with them to provide internships for transition-aged youth with autism and maybe even hire them as employees! While this is a financially challenging time for so many, if you do have the means, donate and give to an ASD agency (whether it be locally-, nationally-, medically- or research-based, etc.) – whatever brings you joy. Donate your time at an autism support center.  There are so many ways to recognize Autism Awareness Month that go beyond the color blue – choose something that resonates with you and be the light! Be the light that goes beyond Autism Awareness to Autism Action, Autism Acceptance, Autism Access and Autism Advancement.

 

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.