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neuropsychology and education services for children and adolescents

Interest Inventories

By | NESCA Notes 2021

By: Tabitha Monahan, M.A., CRC
Transition Specialist/Counselor

In the last Transition Thursday blog, Kelley Challen, Director of Transition Services at NESCA, discussed vocational assessments and aptitude testing. As Kelley stated, vocational assessments should be the start of the career exploration process, not the end. When most people think of vocational assessment, interest inventories and surveys are the first things that may come to mind. While each inventory asks and reports information differently, inventories generally ask individuals to rank how much they like the concept of a job or activity. Individuals are not supposed to consider whether they can do a task (such as in aptitude testing or skill inventories), but if completing the task seems enjoyable or of interest. Results are frequently displayed as occupational themes that help individuals have a starting point on a wide variety of jobs that may be worth exploring. The most well-known of which is based on the work of John Holland. Holland Codes are used as the basis of many well-known interest inventories (including the O*NET Interest Profiler). Other inventories that utilize different occupational themes may also loosely relate to Holland Codes. Thus, the information from multiple inventories may provide clarification of a person’s interest. As many of the shorter inventories have a limited number of activities per career cluster, it can be helpful to take more than one inventory to establish areas of interest. If a person has the same code (or sets of codes) in multiple inventories, it further indicates strong areas of interest. Frequently, however, results may indicate a different career code, indicating many areas of interest and the need for broader career exploration in order to develop a better sense of their working selves.

Most inventories indicate a career code of a person’s top 3 career clusters, e.g., RIC. What does that mean? It means that the individual identified that they would likely most enjoy careers that include interests in the Realistic, Investigative, and Conventual career themes. Examples of such jobs could include dental laboratory technicians, RV service technicians, computer support specialists, electricians, model makers, and many others (www.onetonline.org). The types of work and preferences for the different themes include:

Realistic – Individuals interested in this area like to work with things, use tools and machines and prefer physical, outdoors, and mechanical work.  They are doers and often described as persistent and practical.  They prefer a structured work environment.  Workers with high realistic interest are found in construction and skilled trades, production and manufacturing, agriculture, transportation, hospitality and recreation, food service, and natural resources.

Investigative – Individuals interested in this area like to work with ideas and data and prefer figuring out problems mentally.  They are thinkers and often described as curious, intellectual, and independent.  They favor jobs that require abstract thinking, research, and analysis.  Workers with high investigative interest are found in the life and physical sciences, health and behavioral sciences, applied technologies, academics, research and development, mathematics, and engineering.

Artistic – Individuals inter5ested in this area like to work with forms, designs, and patterns and prefer creative and self-expressive work.  Artistic individuals are creators and often described as imaginative and original.  They favor flexible and less predictable work environments.  Workers with high artistic interest are found in design, applied arts, architecture, culinary arts, performing arts, fine arts, education, communication and media, and fashion.

Social – Individuals interested in this area usually like to work with people and prefer helping, teaching, and healing work.  Social individuals are helpers and often described as supportive, understanding, patient, and generous.  They favor jobs that require listening, comforting, serving others, and advising.  Workers with high social interest are found in education, health and human services, recreation and fitness, safety and service, and religious vocations.

Enterprising – Individuals interested in this area alike to work with start-up ideas and new projects and prefer leading.  Enterprising individuals are persuaders and often described as confident, ambitious, and energetic.  They generally favor jobs that involve selling and achieving set goals.  Workers with high enterprising interest are often found in business and administration, marketing, finance and insurance, sales, regional planning, and law.

Conventional – Individuals interested in this area usually like to work with set procedures, data, and details and prefer clerical and computational work.  Conventional individuals are organizers and often described as organized, efficient, and careful.  They generally favor jobs that involve routine work with numbers, machines, and computers to meet required goals.  Workers with high conventional interest are found in accounting, banking, office work, and computer applications.

Definitions provided by/taken from the PICS-3 Administrator’s Guide 2020[i].

Knowing the types of careers which may be of interest is just the first step. An individual’s preferred work setting can make the difference in a person’s success. Having a preferred setting is also likely to increase work satisfaction. A great way to take an extensive and potentially overwhelming list of career options is to determine the most critical factors for that person. These aspects can be explored through informal conversations and worksheets or even more formal assessment measures. Basics, such as whether a person wants to spend most of their time standing or sitting, being inside or outside, or having a consistent schedule, can help the individual more easily decide which career options are worth a deeper look. From there, options, such as beginning salary, needed education and training, and career outlook, are important to consider. Research, including finding videos showing a typical day and tasks, informational interviewing, job shadowing, and internships, helps provide individuals with an extensive understanding of their career choices and determine the skills they need to build to meet their vocational goals. Be sure to check out the next Transition Thursday blog in our vocational assessment and career exploration series as it will go into more detail about these later career exploration activities.

[i] Picture Interest Career Survey-Third Edition.  Administrator’s Guide Robert P. Brady, EdD.  Published 2020 by JUST Publishing, Inc.

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

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

 

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

 

What’s the Big Deal about a Pencil Grip?

By | NESCA Notes 2021

By: Jessica Hanna MS, OTR/L
Occupational Therapist, NESCA

With kids back in school, drawings, coloring pages, and written work will make their way from the classroom to backpacks and eventually to the fridge for everyone to admire.

From infancy to adulthood, we all hit many milestones in life. Some milestones stand out more than others, but the little ones are no less important. The ability to hold a writing tool is a milestone that moves through various stages from infancy through adulthood. If you get the chance to view and capture each stage along a child’s development, it’s genuinely fascinating!

So, what’s the big deal about the stages involved in holding a writing tool, such as a crayon, marker, or pencil? These stages are the foundation for developing the tiny muscles and arches of the human hand, creating strength and endurance during a writing/drawing activity, and developing stability to manipulate the writing tool to use it the intended way. As humans, we all move through these stages at one point. The progression through each stage is not uniform or standard. The ultimate goal is to reach the ability to hold a writing tool with a functional grasp pattern that promotes adequate speed, accuracy, and legibility without it being the cause of pain or fatigue.

For many kids, achieving fine motor precision and the skill for written output is challenging. However, as NESCA Occupational Therapist Sophie Bellenis, OTD, OTR/L, reminds us in her recent post, “Handwriting vs. Typing: Where do we draw the line?,” handwriting is still a valuable life tool.

So, what does the progression of pencil grasp development actually look like?

Primitive Stages – Observed between 12 and 36 months. The art of drawing and coloring is often the first exposure and gateway to children learning how to hold a writing tool. There is all the freedom, no pressure of writing, and no right and wrong to their drawing.

  • Radial Cross Palmer Grasp (Fig a.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, and the forearm is fully pronated with elbow winged high out to the side.
  • Palmer Supinate Grasp (Fig b.) – Full arm and shoulder movement is used to move the writing tool. The writing tool is positioned across the palm of the hand, held with a fisted hand, with slight flexion of the wrist, and the elbow slightly lowered out to the side.
  • Digital Pronate Grasp (Fig c.) – Full arm and shoulder movement used to move the writing tool. Arm and wrist are floating in the air, and only the index finger extends along the writing tool toward the tip.

Schneck, CM, and Henderson (1990)

Children will begin to shift between the various pencil grips as their shoulder and arm muscles become stronger and steadier.

Immature grasp or transitional grip phase – This grip has been observed as young as 2.7 years of age through 6.6 years of age as stated through research (Schneck, CM, and Henderson (1990)).

  • Static Tripod grasp (Fig g.) – The child will use their forearm and wrist movements only keeping fingers stationery and wrists slightly bent. Movement of the hand can be observed as not graceful. The thumb, index and middle finger will work together as the shaft of the pencil is stabilized by the 4th finger.

Ann-Sofie Selin (2003)

Mature grips – There is so much talk about what looks right and what looks wrong. Traditional pencil grips have evolved through time. There have been four pencil grips now classified as a mature grasp pattern. All mature grips use precise finger movement to manipulate a writing tool while keeping the forearm stabilized.

  • Dynamic Tripod Grip (Fig 1) – Previously known as the golden standard of all grips, where the thumb, index, and middle finger function together, while the pencil shaft rests on the middle finger.
  • Dynamic Quadrupod Grip (Fig 2) –The thumb, index, middle, and ring fingers function together while the pencil shaft rests on the ring finger.
  • Lateral Tripod Grip (Fig 3) – The pencil shaft is stabilized by the inner (lateral) side of the thumb and index finger while resting on the middle finger.
  • Lateral Quadrupod Grip (Fig 4) – The pencil shaft is stabilized by the inner (lateral) side of the thumb, index, and middle finger while resting on the ring finger.

Koziatek SM, Powell NJ (2003)

Pencil grips are generally believed to affect handwriting, and awkward pencil grips become the most commonly assumed cause as to why that is (Ann-Sofie Selin, 2003). However, the production of untidy or illegible handwriting does not always correlate to an unusual pencil grip. The most efficient pencil grip for a child is the one that will help them write with speed and legibility, without pain for an extended period of time.

When should a parent, caregiver or educator be concerned?

  • There is pain and excessive pressure on the writing tool by holding on too tight
  • Illegible handwriting
  • Writing speed is compromised
  • Complaint of hand fatigue during writing and coloring activities
  • Holding the pencil with a primitive grasp (e.g., full fist) after 4 years of age
  • White knuckles or hyperextended joints in fingers holding a writing tool
  • Visible flexed wrist and forearm lifted off the writing surface
  • Inability to choose a clear hand preference between ages 4 and 6 years of age
  • Complete avoidance of all drawing or writing activities

If you are concerned about your child’s pencil grip and/or handwriting, an Occupational Therapist can work with you to identify challenging areas and determine next steps. Let us know if we can help support your child.

References

Koziatek SM, Powell NJ. Pencil grips, legibility, and speed of fourth-graders’ writing in cursive. Am J Occup Ther. 2003 May-Jun;57(3):284-8.

Schneck, CM, and Henderson (1990) Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. American Journal of Occupational Therapy, 44, (10) 893 – 900

Ann-Sofie Selin (2003). Pencil Grip: A Descriptive Model and Four Empirical Studies. Åbo Akademi University Press.

 

About the Author

Jessica Hanna has over 10 years of pediatric OT experience in conducting assessments and providing treatment of children and adolescents with a broad range of challenges and disabilities, including autism spectrum disorders, sensory processing disorders, visual impairments, cerebral palsy, executive function deficits and developmental disorders of motor function. Prior to joining NESCA, Jessica trained and worked in a variety of settings, including inpatient and outpatient hospital settings, private practice, schools and homes. She has served on interdisciplinary treatment teams and worked closely with schools, medical staff and other service providers in coordinating care. In addition, Jessica provided occupational therapy services at Perkins School for the Blind and Spaulding Rehabilitation Hospital pediatric inpatient unit, where she conducted comprehensive evaluations and interventions for children with a broad range of presentations.

 

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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.

 

When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

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

 

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

 

The Safe and Sound Protocol: Increase Self-regulation and Decrease Sound Sensitivity

By | NESCA Notes 2021

By: Julie Robinson, OT
Director of Clinical Services; Occupational Therapist, NESCA

NESCA is excited to announce that we now offer our clients the Safe and Sound Protocol (SSP)—a therapeutic listening program, designed to increase self-regulation and decrease sensitivity to sound. This new service is provided through our occupational therapy (OT) department and is facilitated by either Julie Robinson or Maddie Girardi, both of whom have been trained and certified in its administration. The process begins with an initial phone intake with Julie, who will help you determine if the program is a good fit for you as an adult, or your child. For new patients, we always initiate the program in the office for two to three visits. After this point, (if it seems feasible), you can transition to a home program. If not, we can continue through direct office visits until the program has been completed. In addition, we can offer the program as part of an existing OT treatment protocol.

Who is SSP appropriate for?

SSP is appropriate for anyone over two years of age through adulthood, who has the capacity to listen to music with over-the-ear headphones. It is ideal for patients on the autism spectrum, or individuals with sound sensitivity, sensory processing disorders, or difficulty with self-regulation. It can be used to facilitate more frequent calm and settled states of arousal for those under stress, or who have experienced trauma. It has been also observed to improve sleep and even feeding patterns in some of our clients who have difficulty in those areas. We have seen this carry over into improved behavioral control, independence, and focus in completing daily routines and academic work, as well as more availability for social interactions.

What if my child cannot tolerate wearing headphones?

Your OT will work with you to find an appropriate pair. In our experience, most children can learn to wear headphones with a bit of gentle coaxing and positive reinforcement. Sometimes we need to start with music, outside of the listening program, that a child is already interested in. Other times, we can start right in with the program and, bit by bit, build up increased tolerance.

What type of music is played in the program?

All programs are offered with both children’s music (common tunes from TV or movies, such as Disney programming) as well as adult-oriented songs (pop music or classical music).

NESCA offers two programs, each described below:

  • SSP CORE—This is the basic listening program, appropriate for most patients who are program, and what most individuals are ready to start with. This program has been used since 2017 as a mechanism to reduce stress and auditory sensitivity. It consists of a five-hour long listening protocol, that can be done ideally across five one-hour or 10 half-hour sessions, depending on tolerance levels. For some of our clients who cannot tolerate it as easily, listening sessions can be even shorter in duration. For clients who tolerate it well, and would be compliant, it can also be delivered as a home program after initial set-up through a clinician. It presents music that has been acoustically modified based on a specific algorithm that triggers physiological states of safety and trust. Calming the physiological state helps to promote social engagement and self-regulation, and further therapy can be enhanced or even accelerated. It has music with high frequency sounds gradually filtered in, allowing for slow and steady desensitization to auditory stimuli. It is suited for those who are accustomed to listening to music with headphones, those with subtle sound sensitivities, or those with general difficulties with self-regulation.
  • SSP CONNECT—SSP CONNECT is intended to be used as a less demanding introduction and foundation to the SSP CORE program, specifically for those who are not yet used to headphones, or who do not tolerate filtered sounds well. There is a classical music playlist—one for adults and another for children. It can be used for individuals who are highly sound sensitive, or very young listeners without high frequency filtering to get them ready for the CORE program. It also has five hours of listening time and is intended for use before the SSP CORE program, therefore resulting in a total of 10 hours of active listening time. The SSP CONNECT program should yield a sense of safety with the listening process and expectancy of what is to come next. It is important for the therapist and client to establish a strong rapport, with since there is a good deal of support from the clinician.

If you are interested in talking with a clinician who can determine if this would be a good fit for you or your child, please contact Julie Robinson, OT, Director of Clinical Services, at: jrobinson@nesca-newton.com.

 

About the Author

Julie Robinson is an occupational therapist with over 25 years of experience as a clinician. The work Julie does is integral to human development, wellness and a solid family unit. She particularly enjoys supporting families through the process of adoption and in working with children who are victims of trauma. Julie has extensive experience working with children diagnosed with an Autism Spectrum Disorder (ASD), or who have learning or emotional disabilities. She provides services that address Sensory Processing Disorder (SPD) and self-regulation challenges, as well as development of motor and executive functioning skills.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services or other clinical therapies, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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.

 

Voting Support in Local Elections

By | NESCA Notes 2021

By: Tabitha Monahan, M.A., CRC
Transition Specialist/Counselor

It’s after Labor Day, and the signs for local elections will increase significantly over the next two months. Non-presidential election years see a drastic drop in participation in the voting process. This drop extends even more for years where there are only local elections. However, it is our local elections that have the most significant impact on our day-to-day lives. Whether it is the town selectman, city council, zoning board, or school committee, voting for these candidates can make a big difference in the priorities and projects that become the focus of your community.

So how can we help our young people with disabilities exercise their right to vote? Even individuals with guardianship maintain their right to vote in Massachusetts unless the court documents specifically state otherwise. There are many ways to support individuals, but it starts with helping them register. Massachusetts residents can register to vote online when obtaining or renewing a driver’s license or state ID or at the local registrar of voters’ office. Notices from MassHealth and the DTA also include voter registration forms.

Our young people may need more guidance in understanding the importance of voting in local elections and the purpose of those positions. Below are some great resources to support our young people in voting. This article by Rock the Vote explains more about the importance of voting in local elections. Reach out to your local election official to determine what positions will be on the ballot and if there is a local primary election before the November election. Be prepared to explain the role of the positions to youth who may not have had experience dealing with the department.

While there has been less news this year about Absentee/mail-in ballots, and the COVID-19 vaccine is available to all persons of voting age, Absentee/mail-in ballots have long been an excellent strategy for individuals with disabilities who would have difficulty voting in person. Absentee ballots are a great option for individuals who may have difficulty navigating the multiple steps in person or have a lower processing speed.

All citizens are also allowed to bring a person to help them while they are at the polls. Encourage your young person by educating them that many people require assistance at the polls, and it is completely normal to have the help available if they need it. Each polling location should also have at least one AutoMARK Voter Assist Terminal, which helps individuals with visual impairments vote independently.

No one wants their vote not to be counted due to errors filling out their ballot. People can request a sample ballot in advance from their local registrar of voters (the Secretary of State’s website can give you the address and phone number of your local registrar). Practicing filling out ballots in advance (even ballots from previous elections) can help a new voter become comfortable with the form and is great fine motor skill practice for those who may need it!

While typically not applicable to local elections, it is important to remember that the Massachusetts Secretary of State also creates a voter information booklet for each election regarding the ballot initiatives. These red booklets can be found at many community locations and frequently include the local library, post office, and city/town hall. These booklets offer information on what a yay or nay vote would mean and have information from each initiative’s proponents and opponents. Use that sample ballot as a starting point for the different types of elected positions.

Help your young adult find out what the different boards do and why there is an election for things such as town selectman or zoning board. Help your young adult find the websites for candidates running for office and review the candidates’ stances on issues. Ask what issues they want to learn more about and are important to them.

Most importantly, remind them that their voice counts. As many disability rights activists have said, “nothing about us without us.” Individuals with disabilities are greatly affected by the policy decisions that occur in government at all levels. Individuals with disabilities have frequently experienced disenfranchisement, and many groups are working tirelessly to lessen and remove these barriers. How have you helped your young adult exercise their right to vote?

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

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

 

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

 

Back to School: Tips for the Sensory-savvy Parent

By | NESCA Notes 2021

By Lauren Zeitler, MSOT, OTR/L
NESCA Occupational Therapist; Feeding Specialist

Just like that, summer is over and it is finally time for children to head back to school! This year might look a little different as we move from remote learning and ease back into the school building full time. For children with sensory processing issues, the school building poses a great deal of anxiety as they try to deal with various sensory stimuli. The noisy bus, smells of the cafeteria, and visually overwhelming classroom are just a few examples of the daily overstimulating experiences a student with sensory processing issues encounters. Don’t fret! We will break down the school day and the core sensory systems that are impacted along with strategies to help your student succeed.

Starting the Day: Auditory Processing

As the day starts, many children hop on the bus and ride to school. This means they are encountering a noisy, chaotic vehicle filled with many other children. You might see kids respond negatively by running away, crying, or holding hands over their ears to block out the noise. Startling easily, the bus ride can be a stressful start that will set the tone for the rest of the day for students with sensory issues. It is important to utilize different strategies to prepare your child for the bus. Try these ideas to help with auditory processing:

  • Provide over the ear noise canceling headphones to wear on the bus ride
  • Provide calming music on an iPod, etc. to listen to during bus ride
  • Wear a weighted vest or lap pad during bus ride
  • Provide heavy work input to the student’s body in the morning before entering the bus

Learning in the Classroom: Visual Processing

Walking into the classroom, there are bookcases lined up, posters on the walls, desks in rows, and lots of bright lights. When it comes to visual processing, children respond in different ways. Some children avoid these stimuli, while others seek out visual input. Squinting, blinking, and covering their eyes are just some of the quick fix responses to the bothersome lights. Some kids have trouble paying attention if there are too many things to look at. To some children, the flickering lightbulb in the corner of the ceiling is much more interesting than whatever the teacher has to say. It is very easy to become distracted and overwhelmed in the visually overstimulating classroom environment. Teachers: try these strategies to help with visual processing:

  • Remove distracting posters, pictures, etc. from the walls
  • Place busy bookcases, lockers, etc. in the back of the room
  • Have easily visually distracted children sit in the front of the room closest to the board
  • Provide a calming corner with a sensory bin filled with items, such as noise cancelling headphones, stuffed animals, lavender lotion, books, etc.

Time for Art Class: Tactile Processing

It is time for art class, and your child freezes at the doorway refusing to enter the room. Glitter and glue are everywhere, and the fear of being dirty strikes again. The feeling of touching messy media can send some children into panic fight or flight mode. This goes well beyond art class’s requirement to interact with different media, often branching out and impacting their ability to participate in social experiences, such as playing on the playground. To avoid overstimulation, prepare your child’s body with these strategies:

  • Prepare the student before art class by reviewing the schedule
  • Provide heavy work breaks, such as wall push-ups before entering the art room
  • Provide a weighted vest or lap pad to use during art class
  • Find adaptations to the art project to decrease interaction with sticky substances (i.e., using glue sticks, spoons to spread glitter, etc.)

Lunch in the Cafeteria: Olfactory and Gustatory Processing

It is now time for lunch. As your child walks into the cafeteria, they look around to find their friends and are greeted with a really strong smell. What is that?! Your child is no longer looking for their friends; instead, they are trying to find a way out because the smell is too overwhelming. Try these strategies to help kids with sensitive noses:

  • Find a place in the cafeteria that your child can eat away from the food serving area (where the smells are the strongest)
  • Provide an essential oil patch or roller ball that the student can smell to calm their body and move their focus away from the cafeteria smell
  • Use essential oils, such as lavender or eucalyptus, which help calm
  • Provide heavy work opportunities before entering the cafeteria to help organize the body

Once your child has gathered their food and found the best place to eat, they sit down and look at their meal. Oh gosh – why does it look so squishy? This sandwich is slimy – that is a big no! The gustatory – or taste system – kicks in, and it does not appear happy. What can we do to help kids with sensitive taste systems? Try these strategies to help make mealtime easier:

  • Provide lunch from home to help control what options the child has to eat during the day
  • Provide crunchy food items, such as pretzels, raw veggies (carrots, peppers, cucumbers, etc.), or popcorn to promote “heavy, organizing input” to the mouth and jaw
  • Provide thick drinks, such as smoothies, to drink through a straw
  • Promote drinking water through a water bottle with a mouth piece, such as those from Camelbak
  • Provide a special treat, such as licorice, Twizzlers, or sucker candy to provide alerting and organizing input

Gym Class Makes Me Nervous: Vestibular and Proprioceptive Processing

Afternoon gym class has arrived, and your student is too afraid to participate. Bumping into the wall, being hit by a ball, or playing in a coordinated group activity is hard for some children. Echoing voices and shoes squeaking on the floor, bright colors and moving objects are enough to overstimulate anyone. With the right environment, gym class can be fun for everyone! Here are some strategies to help with vestibular and proprioceptive processing in gym class:

  • Provide the opportunity for the student to leave the gym. Let them know that if the class becomes too overwhelming they can ask the teacher for a break. Going for a walk to the bathroom or grabbing water is a great, brief break.
  • Adapt games or activities as necessary. Students will be at different skill levels, and physical activity can present unique challenges. Provide simpler options when possible.
  • Create space boundaries. Using visual cues for personal space, and working in small groups can relieve anxiety. Visual cues may also be helpful in showing children where they should position themselves for games and exercises.
  • Provide activities that promote consistent, linear movements instead of sporadic, rotational movements, to help keep these sensory systems organized.

Remember to keep school fun! The school day is where kids spend most of their week, and we want to ensure they have the best experiences possible. Recognize that not all students with sensory processing issues will have the same strengths and difficulties. Meeting a student where they’re at and discovering their specific strengths is the greatest way to set them up for a successful school year! If you have any questions or to learn more about occupational therapy services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

About the Author

Lauren Zeitler is a licensed Occupational Therapist in Massachusetts, specializing in pediatric occupational and feeding therapy. Ms. Zeitler joined NESCA full-time in the fall of 2020 to offer occupational therapy assessment and treatment for children of all ages, as well as to work in conjunction with Abigael Gray, MS, CCC-SLP, on the feeding team.

 

 

 

 

 

 

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.

 

Transition Training in Today’s Environment

By | NESCA Notes 2021

By: Becki Lauzon, M.A., CRC
Transition Specialist and Consultant

As we head back to school and continue to live with COVID in our lives, it has become apparent that transition services must include training our students to live in this “new normal.” When I sat down to write about back to school tips and suggestions, I was reminded of the blog post that I wrote last summer in preparation of our return to the classrooms. I never would have thought that we would be returning to masks in the fall of 2021, but here we are! Below are some basic ideas from my blog last summer about how to continue developing transition skills if community-based options are not fully available.

Independent Living
Practice using Peapod or other online grocery delivery services
Cooking within the school building
Research how to order prescriptions online or over the phone
Practice mock phone calls to order food, make a medical appointment, etc.
Review public transportation schedules and research how long it takes to get from one place to another

Vocational
Folding clothes or stocking shelves in the school store
Learning how to use Microsoft Word, Excel, PowerPoint, etc.
Practice mock interviews
Use free online resources to watch short career videos and start a binder of likes and dislikes about each job
Identify places you might like to work (MANY places are hiring due to a shortage of workers)

Functional Academics
Access your bank account online and see where you spend your money
Use mock online banking resources to understand the do’s and don’ts
Practice ordering at a restaurant by using an online menu

Helpful Resources

In addition to the above suggestions, there are many other resources that parents, educators, and individuals may find helpful.

“Coping With COVID” Anxiety Worksheets
https://www.teacherspayteachers.com/Product/Coping-with-Covid-19-Anxiety-19-Worksheets-for-Teens-Google-Slides-option-5763713?st=16ac0d9101b4f377d4a58d35e2284100

Vaccine Lesson
https://www.teacherspayteachers.com/Product/COVID-19Coronavirus-mRNA-vaccines-Pfizer-vs-Moderna-6573582?st=16ac0d9101b4f377d4a58d35e2284100

Updated DDS guidance (8/11/21)
https://www.mass.gov/news/coronavirus-update-from-dds-commissioner-jane-ryder

 

About the Author

Becki Lauzon, M.A., CRC, works with teens, young adults and their families out of the Newton, MA and Plainville, MA offices. Lauzon has unparalleled experience as a Transition Specialist, Transition Consultant and Vocational Program Coordinator. Lauzon will be providing transition assessment (including testing, functional evaluations and observations) consultation, case management, training and professional development for schools; and transition planning, consultation and coaching for transition-aged students and their parents.

 

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

 

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

 

The Value of Mulligans

By | NESCA Notes 2021

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Let’s face it – a lot of parenting involves socializing children whose brains are in the process of being built. This means:

  1. They do not yet have the cognitive capacity to understand the moral principles behind such behaviors as “sharing, “being nice” and “using our words.”
  2. They are in the process of learning how to inhibit the impulse to grab, say whatever one thinks and using physical force to get what one wants.

Behavioral reinforcement strategies (rewarding desirable behavior) can be quite effective as a socialization technique – but only if the strategy is keyed to both an understanding of the level of the child’s cognitive/moral development and their capacity for impulse control. All too often, the parent’s efforts to shape their child’s behavior run aground because of problems in assessing either (or both) of these areas. The concept of a “mulligan” can be a very useful in compensating for either child or parent error.

The term “mulligan” comes from the game of golf where it means getting an extra stroke after a poor shot. There are several stories about the origin of the term, but most involve a player named Mulligan who had been so rattled by a variety of events that he made a very poor shot on his first effort and claimed a “correction” – basically a do-over. This fits well with the dilemma presented to parents when a child has not been able to stick to an agreement, like “if you boys can work out your differences without verbal or physical fighting this morning, we will get some ice cream this afternoon.”

The first step in taking a mulligan, or correction do-over, always involves giving everybody involved some time to calm down, thus restoring the capacity for flexible thinking and problem solving. Once this is achieved, it is time to figure out where things broke down: was it overestimating the child’s capacity for controlling their impulses over time, in certain situations, or with certain people? Or was it because the child did not know how or why to take certain actions? If the problem involves impulse control, it will be up to the parent to restructure the situation in order to make it more realistically doable for the child or children – in other words, the parent takes a mulligan. For instance, s/he might say, “Look, this is not working out. I’m going to take a mulligan. Every 15 minutes that you guys can get along and work out your differences, I will give you a point. If you can get 3 points this morning, we will go for ice cream this afternoon.” Notice that this directive leaves some room for inevitable error, but still imposes reasonable expectations.

When the problem falls in the “how” or “why” category, parents also need to consider the child’s developmental status before engaging in problem solving. It is really important to appreciate that a child’s understanding of common conventions, like “sharing” and “fair.” In the egocentric and preconventional thinking of young children, “sharing” is too abstract of a concept and “fair” means “I get my way.” To speak about “taking turns,” make more sense to them. In the more conventional thinking of elementary school children, the key element in sharing is “fairness,” or, is the exchange equal? (In high school or college, some students will begin to struggle with the concept of equity, or how to allocate resources and opportunities in order to ensure an equal outcome, but this is a foreign thought to most children when it applies to their own resources, like candy or access to video games). Once the parent is clear about how the child is viewing the problem and where their strategies broke down, they can offer a chance for a mulligan while teaching more effective strategies than brute force or crying. Concrete aids, such as wind-up timers that show minutes, can help children understand the passing of time. Whimsical strategies, such as “shooting fingers” or “Rock, Paper, Scissors” are fun ways of determining who goes first or who gets to choose the video that also teach tenets of compromise and collaboration.

 

Resources:

https://www.golfdigest.com/story/did-you-know-where-did-the-term-mulligan-originate

 

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

To book an evaluation with Dr. Monaghan-Blout or one of our many other expert neuropsychologists and transition specialists, complete NESCA’s online intake form.

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

Sensory-friendly Sunscreen for Tactile-sensitive Kids

By | NESCA Notes 2021

By: Madelyn (Maddie) Girardi, OTD, OTR/L
Occupational Therapist, NESCA

Our Sense of Touch

Tactile processing is our ability to sense and interpret information from our environment through our sense of touch. Information from our tactile system allows us to gauge everyday sensations such as light touch, temperature, vibration, pressure, or pain.

Tactile Defensiveness

Tactile defensiveness is a term used to describe an individual who is hypersensitive to touch. As occupational therapists (OTs), this is something we come across often on our caseloads. Sensitivity to tactile stimuli can interfere greatly with a child’s functional, day-to-day activities. It can impact one’s ability to tolerate certain types of clothing, perform self-care tasks (bathing, toothbrushing, hair brushing), or eat a range of foods. Another activity that may cause difficulty in the summer months is tolerating the feeling of sunscreen on the body. While we want our families to enjoy the beach, the pool, or spend time outdoors, this task can be daunting for tactile-sensitive kids. The anticipation of this event alone may elicit an aversive response, or, in many cases, the child may begin avoiding the task altogether.

(Movement Matters, 2020).

The Role of OT

Occupational therapists help children and families participate in meaningful daily activities. When a child is sensitive to certain stimuli, the therapist will provide an environment where controlled and guided exposure can take place. This process allows for ongoing positive interaction with the medium, often through play-based activities. The therapist can help the family find alternative solutions and to identify positive coping mechanisms that allow the individual to be successful in the given task.

Tactile Defensiveness and the Beach

As a pediatric occupational therapist, a question that often comes up in the summer months is: “What do I do if my child is having trouble tolerating the feeling of sunscreen on his skin?” The first thing you can do is consider the sensory properties of the sunscreen. Is it lotion? Is it thick? Sticky? Clumpy? Smooth? Does it absorb quickly, or does it stay on the skin? Is it greasy? Does it have a certain smell to it? Stick, spray, and powder options are great alternatives for children who may be sensitive to some of the less desirable lotions. Here are some of the most recommended, sensory-friendly sunscreen options:

      Stick options

  • Neutrogena Wet Skin Kids Stick *
  • Neutrogena Dry Touch Ultra Sheer Stick *
  • Aveeno Baby Face stick sunscreen

      Spray options

  • Babo Botanicals Sheer Zinc Spray
  • Banana Boat Light as Air

      Powder-based options – primarily for the face

  • Brush on Block Translucent Mineral Powder Sunscreen
  • Sunforgettable Total Protection Brush-On Shield

      Lotions

  • Neutrogena Dry Touch Ultra Sheer *
  • Supergoop Unseen Sunscreen
  • Biore UV Aqua Rich Watery Essence

(Evolution, 2021; No Author, 2018).

Additional Recommendations

As an occupational therapist, I am always thinking of other ways to adapt activities to make them easier for my clients. Beyond changing the actual sunscreen, here are some more ways to help make protection from the sun easier for our kids.

  • Coolibar Clothing – Limit the amount of skin that is exposed directly to the sun using protective clothing. This brand offers sun protective clothing options in shirts, hats, bottoms, and swimwear.
  • Make it a routine! – Like any other daily activity, such as getting dressed or brushing teeth, make it a part of the day! This way, it is familiar and expected.
  • Make it fun! – Play a game or sing a song while applying sunscreen. Use a timer so that the child can know when the activity is going to end.
  • Involve the child in the process as much as possible – As appropriate, have the child help with putting on the sunscreen. Use a mirror so that the child can see what is going on.
  • Proprioceptive input – Providing proprioceptive input prior to sunscreen application can help to reduce touch sensitivity. This is the sensory input one receives from the movement and force of muscles and joints. Some examples include massage/deep pressure to applicable areas, any pushing/pulling movement, use of weighted items, digging in sand, animal crawls, or wheelbarrow walks. Have the child rub down arms, legs, and back with a towel before applying sunscreen.

References:

Evolution, M. (2021, May 26). Sunscreen Ideas for Tactile Defensive Kids. Mommy Evolution. https://mommyevolution.com/sunscreen-ideas-tactile-kids/

No Author. (2018, March 31). Autism Inclusivity [Facebook page]. Facebook. Retrieved August 6, 2021, from https://www.facebook.com/groups/autisminclusivity

Movement Matters. (2020, May 3). Occupational Therapy ABC. https://www.movementmatters.com/

 

About the Author
Madelyn (Maddie) Girardi is a Licensed Occupational Therapist in Massachusetts with experience in both school-based and outpatient pediatric settings. Maddie received her undergraduate degree in Exercise Science/Kinesiology at The College of Charleston in South Carolina and  earned her Doctorate degree in Occupational Therapy from The MGH Institute of Health Professions in Boston.

Maddie is a passionate therapist with professional interest in working with young children with neurodevelopmental disorders, fine and gross motor delays and Autism Spectrum Disorder (ASD).

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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.

 

The Relationship Between Dyslexia and Dyscalculia

By | NESCA Notes 2021

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Reading disability (RD) and math disability (MD) are common developmental disorders that are defined by significant academic underachievement that is unexpected based on an individual’s age and development (e.g., American Psychiatric Association, 2000).”

Research has shown that children who struggle with learning to read often also struggle with math and understanding numbers. It is not uncommon for students to have both a reading disability (dyslexia) and a math disability, with this co-occurrence found at a rate of approximately 40% (2013, ncbi.nlm.nih.gov).

Dyscalculia is a learning disability that makes math challenging to process and understand, with these problems not explained by a lack of proper education, intellectual disabilities, or other conditions. At this time, the estimated prevalence of dyscalculia in school populations is 3 to 6 percent. There is no medication that treats dyslexia or dyscalculia; however, treating any co-occurring issues (e.g., AD/HD, Anxiety) can be helpful.

What are some signs of dyscalculia?

Elementary School Difficulties:

    • trouble learning and recalling number facts
    • trouble processing numbers and quantities, such as connecting a number to the quantity it represents (the number 2 to two books)
    • difficulty counting, backwards and forwards
    • difficulties recognizing quantities without counting
    • weak mental math and problem-solving
    • trouble making sense of money and estimating quantities
    • difficulty quickly identifying right and left
    • difficulty identifying signs like + –
    • trouble recognizing patterns and sequencing numbers
    • poor processing of graphs and charts
    • persistent finger-counting is typically linked to dyscalculia, especially for easy, frequently repeated calculations
    • lack of confidence in areas that require math

Adolescent Difficulties:

    • trouble applying math concepts to money
    • difficulty counting backward
    • slow to perform calculations
    • weak mental arithmetic
    • poor sense of estimation
    • high levels of math anxiety

Under the Individuals with Disabilities Education Act (IDEA), students diagnosed with a Specific Learning Disability (SLD) with impairment in math (i.e., dyscalculia) are eligible for special services in the classroom. In-school dyscalculia services and accommodations may include:

    • direct, specialized pull-out instruction to target core, foundational skills
    • extra time on assignments, quizzes, and tests
    • use of a calculator
    • modifying the task
    • breaking down complex problems into smaller steps

If you believe that your child may be experiencing difficulties in the area of math, one step is to determine the root of the difficulty. For example, does the student have an underlying learning disability or reduced self-regulation that may be negatively impacting their progress? Receiving a neuropsychological evaluation could be a useful tool in determining the appropriate supports and services to best help your child. If you are interested in learning more about NESCA’s Neuropsychological Evaluations, email: info@nesca-newton.com or complete our online intake form.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987869/

https://www.understood.org/

https://safespot.org

https://www.additudemag.com/

https://dyslexiafoundation.org/

 

About the Author

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

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

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

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

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

She is the mother of one teenage girl.

 

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

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