Tag

neuropsychology and education services for children and adolescents

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.

Handwriting vs. Typing: Where do we draw the line?

By | NESCA Notes 2021

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

For many of our students with dysgraphia, or those who struggle with the fine motor precision and the skills necessary for written output, digital tools and accommodations that promote the use of tech and keyboarding in the academic setting are immensely helpful. These tools allow our students to show their knowledge, demonstrate their written abilities, and fully access their curriculum.  When implemented correctly, these accommodations can have a huge impact on a student’s academic career. While all of this is true, it is worth discussing whether fully taking away the need to produce and practice handwritten work is leaving some of our students at a disadvantage.

When working with adolescents and young adults to help figure out future career or education plans, I am consistently reminded of the fact that despite our continuing transition toward a more and more digitally-based world, the need for handwriting has not disappeared. While we absolutely do not need to be handwriting essays, papers, or long letters sent via snail mail, there are aspects of almost every profession and daily life that require the skill. Here are a few common issues that I am seeing pop up that speak to the need for some continued practice –

  1. Job or rental applications. While some of this has moved over to an online format, many of these still need to be filled out appropriately and legibly by an applicant.
  2. Jotting down notes. The importance of this skill should not be diminished. Whether taking a phone message, making a grocery list, or writing down a phone number, most young adults are expected to be able to read their own handwriting at a later date, or leave a message for someone else who will need to be able to read it.
  3. Vocational responsibilities. Many of our students with disabilities choose to forgo the traditional college path and find a more suitable career field to pursue. Many of my clients have become successful carpenters, mechanics, or other tradespeople. These fields all require vast skill and talent, and often require employees to mark down measurements or make quick notations.
  4. Signing documents. Many banks, institutions, and legal documents require a handwritten signature and initials on any paperwork.

While I am not advocating that we take away accommodations from our students who do not have the foundational skills to write long paragraphs or essays, I am advocating that we stop fully eliminating the demand. By expecting some quick, consistent practice of handwriting, we are building a skill that will be needed multiple times throughout life. I would suggest that students who are being given a keyboarding fine motor/visual motor accommodation, also continue to receive instruction or opportunities to practice writing activities that are less fatiguing in order to continue to build the motor planning and skill necessary. It is unfair to equate the inability to use handwriting as a tool for academic output, with an inability to learn handwriting as a useful functional tool for life.

 

About the Author
Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

 

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.

 

Career Counseling at NESCA

By | NESCA Notes 2021

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

Career Counseling is a fluid process that typically occurs throughout a person’s lifetime. It begins when children are young and learning about different jobs that their family members have and what they see on television. As children get older, more pieces get added to that initial exploration.

What does Career Counseling through NESCA look like? It can be broken down into three distinct categories. Still, students and young adults frequently jump back and forth between the categories several times throughout the process. Today’s blog focuses on discussing these categories in a little more detail.

Who am I?

Each case begins with an initial interview with the client to learn more about them, their interests, goals for the future, and goals they wish to achieve in counseling. Often formal assessment measures are given to discover the client’s areas of interest and aptitude. We will then explore those results and connect them to their stated goal. Sometimes the results align well with the person’s initially stated goal; frequently, this is an eye-opening experience. Depending on the client’s needs and goals, additional formal and informal exploration activities will be completed to allow the client to build further understanding about who they are as a learner, worker, and what motivates them.

Exploration

Career Counseling at NESCA is a data-driven process. Whether the data is from formal or informal measures, the client is guided through and assisted in understanding who they are and how that can connect to a happy and successful career. At this stage, clients will be assisted in exploring careers of interest that they have identified and learn about the careers in more detail, such as learning education requirements, typical job tasks, and how their strengths and areas of challenge will affect their potential success in the identified jobs. Additional skills worked on will include writing resumes and cover letters, interview preparation, and identifying possible reasonable accommodations and disclosure. If appropriate, informational interviews and job shadowing opportunities will be explored.

Moving forward

Once a client has learned the type of work they would like and understands foundational work skills, the next step they will take with the career counselor is to start the job search. In a systematic fashion, clients will be supported in finding available openings, applying for specific jobs, customizing cover letters and resumes for individual jobs, and pre-interview preparation. Additionally, goal setting, time and task management, and other employment success skills are explored during this process.

Continued success

Once a client has successfully been hired for a position, many continue their work with a career counselor. Typically, sessions decrease after a person becomes employed, but it is recommended that follow-up meetings occur at 1-week, 1-month, and 3-months post-employment to check in and problem solve any areas of concern that arise. Clients are encouraged to reach out before these times if an issue occurs to assist in finding a solution before the problem affects their employment.

Who is a good fit for Career Counseling at NESCA?

  • High school students who are not sure of what they want to do after high school and have a hard time developing their vision for their future (whether in creating their IEP vision or in general).
  • High school or college students who do not know what major to pick as they do not know the type of work they want to do after college.
  • Recent college graduates who need support in their job search and interview preparation.
  • Young adults who are looking to figure out their next employment steps or have had difficulty remaining employed once hired.

While the above is a general idea of what a Career Counseling client can expect, each person’s journey through the process is unique. For an in-depth conversation on how Career Counseling at NESCA may support you or your child in meeting their career goals, please fill out our intake form or call our main office at 617.658.9800. Services are currently being offered remotely, with limited in-person services starting this fall.

 

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.

 

Don’t Let Summertime Chores Deflate Your Vibe

By | NESCA Notes 2021

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

It’s summertime, and let’s face it, nobody wants to do chores. However, through learning about the benefits of chores in a previous NESCA blog post, we realized all that it can bring to the table to improve child development skills.

Nevertheless, let’s step back. No one ever said chores must be painful or that it is all business and no play. Even when it comes to chores, you can keep it fun! The beauty about chores is that in addition to learning personal responsibility, improved self-care skills, and teamwork, chores help children to incorporate and work on an array of skill sets, such as:

  • Visual perceptional skills
  • Executive functioning skills
  • Bilateral coordination skills
  • Fine motor skills
  • Upper body strength
  • Sensory regulation

Let’s take a closer look at exactly what that can look like:

 Water play chores

Stop what you’re thinking…yes, it can seem messy, but remember the goal: participation, have fun, work on important skills (bilateral coordination, sequencing, crossing midline, integrating sensory input).

  • Cleaning off sandy beach items Works on a 2-step or 3-step sequence and bilateral coordination skills.
    • 2-step sequence (rinse and dry using a water bucket or water hose)
    • 3-step sequence (rinse/dry/store back in beach bag)
  • Watering plants/flowers outside – Provides heavy work and promotes bilateral coordination to hold a water-hose and use upper body strength to maintain arms lifted above gravity.
  • Rinse dishes in the sink – Works on sequencing steps, crossing midline, upper body strength, and bilateral coordination.
  • Wipe down indoor/outdoor tables – Incorporates motor planning, crossing midline, and promotes upper body strength.
  • Clean reachable outdoor/indoor windows – Remember it is not about the streaks left behind. The task promotes and builds on upper body strength, hand strength, motor planning skills, and bilateral coordination skills.

Chores that work on visual perceptual skills

  • Sorting clean laundry – Play assembly line with clean clothes or turn it into a mini obstacle course. Sorting and putting away laundry can be a group effort for everyone in the family!   
    • Matching socks
    • Color coding clothing
    • Sorting by category (pants/shirts/undergarments)
  • Putting away groceries…what is more fun than playing store? – Have your child follow a pre-made visual or written checklist to make sure and check off all items purchased (e.g., create your shopping list on Prime Now or Peapod where visuals are supplied, and you print a copy for your child to follow and mark up).
  • Loading the dishwasher – When it comes to loading the dishwasher, we all know it can be a game of Tetris, even for adults! When helping your child load the dishwasher safely, make sure you place one item first in a designated area and see if they can sort items accordingly.
  • Cleaning up toys on a floor – When asking your child to pick up toys, reduce visual clutter, and be specific.
    • Place a perimeter (e.g., use a hoola hoop/painter’s tape) around toys that need to be picked up.
    • Use a visual checklist to identify toys to be picked up (e.g., books, Legos, crayons).
    • You can turn it into a scavenger hunt game (e.g., find 10 crayons on the floor).

Chores that promote regulation

Heavy work chores/activities help with sensory regulation through the act of pushing, pulling, and lifting heavy items.

  • Laundry – If you have a front-loading reachable washer and dryer, have your child pull wet clothes out of the washer, or dry clothes from the dryer. Or have your child (depending on size and strength) help carry a basket of clean or dirty clothes to and from the washer and dryer. (To add a fun twist, have them walk over items, around items, spin, bend, etc., with a basket of clothes).
  • Vacuuming/Swiffering – Make sure the size is appropriate. Little ones love handheld vacuum cleaners and dust pans if they cannot manipulate larger sized appliances. Handheld vacuums are fun for kids to use in helping to clean out the car! Turn it into a game to vacuum the treasures your car “ate” during those summer outings can be an adventure for them and a bonus for you!
  • Bed making – Have your child sit in the bed and help pull up those sheets and blankets from the sitting position. It’s fun when it fluffs up and gets tricky when you must sneak or crawl out without pulling the sheets down!

Always keep in mind what you want the goal of a chore to be and remember that they do not have to be done perfectly. When chores are broken down into steps, are provided and paired with a verbal and visual demonstration, and are concrete, your child will be successful in participating in your chore of choice. You must remember to create the just-right challenge regarding your child’s age and pair it with fun!

 

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.

 

Is It Sensory? Or Is It Behavior?

By | NESCA Notes 2021

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

As parents or other caregivers of children with special needs, we can often find ourselves confused between what is a sensory response and what is behavior. Although this is often a complex question, and one without a straightforward answer, there are some tools of the trade that OTs use to help us determine just what is going on with these children. What makes this so complex is that each child is an individual, with their own unique ways of responding to sensory stimuli, to social interactions, and when out in varied settings in their community or with family. Children may also present differently from minute to minute or day to day, depending on sleep, hunger, and fluctuations in mood. But we can often look closely for patterns that may help to guide us in finding the answers.

When working with a child who seems to be in a meltdown, one of the best things you can do is take a quick scan of the environment. Is there a loud or distracting sound in the background? Did someone touch the child unexpectedly? Is the overall environment too busy and overstimulating, such as at party or a restaurant? Sometimes just naming or removing the stimuli, if possible, is enough to help get things back under control. If you know a triggering situation might arise that provokes a meltdown, see if you can give the child a warning and a plan of where to go for comfort. “We will be having a fire drill in 10 minutes, so when it happens you can hold _____’s hand, or we can get you some headphones to cover your ears to make you more comfortable” is one example. Find something soothing from a sensory perspective to help the child settle: a quiet corner with books, some tactile play or fidgets, calming music, a tight squeeze ( but only if tolerated and given permission to do so ). If you know you are entering a highly stimulating environment, it may be best to go in for short periods, with frequent breaks built in for your child every 10 minutes or so to take a walk, use the bathroom, or get a drink.

If you do not see something sensory in your environment creating the discomfort or the meltdown, then behavior and emotions are more likely at play. You child may feel confused about a social interaction, about expectations, or what may be coming next in a transition. Your child may feel a lack of confidence or anxiety in a situation, that although may be seemingly simple and straight forward to you, may not to him or to her. An academic task may feel misunderstood, and not knowing how to start can result in a meltdown for many of our children.

When you see that the child you are caring for is beginning to ramp up, that is the best time to intervene. Once a meltdown has begun, language processing will be limited, and the child may not be reachable for a period of time in order to settle down. The best thing you can do in those moments, is to help the child to stop. I often use a stop sign to hold up in my therapy sessions, that cues the child to take a quick break from interacting with me when I see things starting to spin out of control. I limit my language, provide a calming sensory activity, then we can talk about the upset once I have the child back in my court.

Here are some things to think about and questions you might ask yourself to help guide your interactions and expectations when you, as the adult, are confused about whether this is sensory or behavior:

  1. What are the undesirable behaviors that my child observes when he or she is upset or uncomfortable? Are they different when there is sensory discomfort, in comparison to when he or she is upset with a person or a demand? Notice quality of voice, bodily tension, inability to stay still or focused, aggression, flight or an attempt to get away, shutdown or inability to interact. You may start to see patterns in behavior when you look at them in relation to a sensory event or something that is more emotionally-laden.
  2. What occurred just before this behavior appeared? Was there a sensory distraction or discomfort or was he or she upset with a person or a demand?
  3. How did the child behave during this episode?
  4. How did adults or peers interact with my child during the episode? Did it calm the child, or make him or her more agitated?
  5. List sensations that may have triggered a meltdown: tactile, auditory, visual, smell, taste, movement. Were they loud, distracting, uncomfortable? Was the child in a space that may have been too small or too large? Was the child able to get away from the uncomfortable stimuli, or did he or she feel stuck in the moment?

It will be beneficial for team members to share information and write these things down, perhaps in a format of a journal, so that the team can work together to uncover the patterns, find strategies that are successful, and provide consistency across the board. We all know consistency for these children is one of the most effective tools for learning, and although it may take some extra work up front for caregivers, the pay off on the other side is often so rewarding that it is worth the effort.

If you would like to explore this topic further with NESCA OT Julie Robinson, join us for a free webinar on this topic on September 13, 2021 at 10:30 am ET. Register in advance for this webinar at:

https://nesca-newton.zoom.us/webinar/register/WN_-edHNIwkRBKnjk0gq6-bUw

 

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.

 

Vision Statements

By | NESCA Notes 2021

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

Having been a transition specialist, evaluator and consultant, as well as having worked different roles within the special education system for many years, I have come to learn that the “Post-Secondary Vision Statement” for a student is one of the most overlooked pieces of the transition and IEP process. To me, this is one of the MOST important parts of the transition planning process for students, their families, and their Team members. The vision statement is a key part of a student’s IEP, as well as their Transition Planning Form (TPF), once a student turns 14. Prior to a student turning 14, the vision statement should be completed collaboratively by the Team. Once a student turns 14, I encourage the student to have as much input as possible, no matter how realistic or unrealistic the vision is. There have been times when I have seen two vision statements on an IEP, one for the student and one for the parents and/or Team, depending on the situation. Many times, parents or school staff will ask for guidance on what information should be gathered and how to get that information from a student.

Below are some of the tips that I have learned and shared along the way:

  • The vision will most likely change from year to year.
  • The vision is what should be driving the development of the IEP.
  • Starting at age 14, the vision statement that is in the IEP needs to correspond with the vision statement on the TPF.
  • From age 14 on, the vision statement (as well as the TPF) should be read at the beginning of the IEP meeting to make sure the Team is focusing on the areas needed to assist a student in reaching their vision.
  • If a student is unable to write their own vision, it is important that the Team incorporates what they know about the students’ strengths, interests, etc.

A vision statement can be long or short. It is not the length of it that matters, but the content. With the summer now starting, it is a good time to sit down with your student and start to discuss some of the below areas to be prepared for the upcoming school year.

  • Education
    • Do you want to pass MCAS?
    • Do you want to earn a high school diploma?
    • Do you want to stay in school until the age of 22?
    • Do you want to go to a 2- or 4-year college?
    • Do you want to take classes towards a certificate program/trade?
    • Do you want to attend a community-based day program?
  • Employment
    • Do you want to have a part-time job while you are still in school?
    • What do you want to be when you are older (even if it is unrealistic)?
    • Do you want to participate in volunteer work?
    • Do you want to work part-time or full-time?
    • If you are unsure about what job you might like, what tasks/activities do you enjoy doing?
  • Independent Living
    • Do you want to live on your own, in a shared living setting or stay living with family?
    • Would you like to live alone or with a roommate?
    • Do you want to live in the same area?
    • How will you access the community (i.e., public transportation, driver’s license, family, etc.)?
    • Do you want to work on developing your independent living skills, such as money management/budgeting, domestic skills, cooking, shopping, first aid, etc.?
    • What do you want to do for fun (i.e., community events, sports, acting, working out, etc.)?

There are many resources available to families regarding what to do and not to do when it comes to writing a strong vision statement for a student of any age. Below are a few examples of resources that I have found helpful:

https://www.concordspedpac.org/IEPvision.htm

https://datamomkristen.com/developing-a-measurable-vision-statement-for-an-iep-or-isp/

https://adayinourshoes.com/iep-vision-statement/

 

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.

 

ADHD: Setting Up A Successful Environment

By | NESCA Notes 2020

Co-authored by: Lauren Zeitler, MSOT, OTR/L, NESCA Occupational Therapist; Feeding Specialist, and Lindsay Delling, OTS, Occupational Therapy Graduate Student

Before any assessments, treatment planning, or suggestions of adaptations take place, we must first understand what attention-deficit/hyperactivity disorder (ADHD) in childhood means, and how it may present and affect each individual child. The American Psychiatric Association defines ADHD as one of the most common neurodevelopmental disorders affecting children, with symptoms including, “inattention (not being able to keep focus), hyperactivity (excess movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment without thought)” (2017). There are three different types of ADHD: inattentive type, hyperactive/impulsive type, or combined type, that come with specific criteria within each to provide a diagnosis. While some symptoms of ADHD are common amongst young children, such as difficulty sitting still or limited attention spans, the difference in children with ADHD is the inability to control it without external forces providing regulation for them. This blog post will outline the sensory systems and will provide environmental suggestions and adaptations for children with ADHD to help them succeed and increase focus!

It is estimated that 8.4% of children have ADHD; so, that being said, what can we as occupational therapists recommend to enhance attention and regulatory strategies in children with ADHD using the sensory systems as a guide?

  1. Touch – Children with ADHD may actually scientifically benefit from utilizing fidget toys to increase their attention to a task. This thought process comes from the fact that using a fidget toy, such as a fidget spinner or some putty, allows children to exert some energy while also keeping their hands busy. This then makes them more likely to attend to another task, such as listening to a teacher speak, because they have sustained alertness while working with the fidget toy and can therefore sustain attention to the overarching task. We have seen this in most people on a smaller scale as they twirl their hair or tap a pen while attending to a task; they are essentially using these items as fidget toys to enhance their alertness and sustain attention to the task at hand (CHADD, 2021). The same can be said for a wiggle seat cushion or chair to promote seated movement so the child can gain that sensory input of movement, while staying seated and attending to the task.
  2. Sight – Because children with ADHD exhibit hyperactive tendencies, this means that they are likely hypersensitive to lighting and types of lighting within environments, such as fluorescent lighting which is prevalent in many school systems. Providing children with ADHD breaks from this harsh light and allowing time for their eyes to relax is a great way to promote improved attention throughout the school day. Hypersensitivity in sight is also important to be aware of regarding any schoolwork a child may be doing. If there is a lot going on within the page, a child with ADHD can become easily overwhelmed and may be quick to abandon the activity due to overstimulation. Covering portions of the page so that the child can only see one activity at time may be helpful in keeping them focused and on track and will likely decrease frustration.
  3. Hearing – Due to the hypersensitive nature of children with ADHD, sounds can be very distracting for them when they are trying to focus on a task. One solution would, of course, be to find a quiet space for them to complete schoolwork and other activities. This, however, may not always be readily available or even an option. In that case, providing these children with other adaptations, such as noise cancelling headphones, while they complete their work or even just frequent noise breaks and allowing them to take a walk or play with a preferred item can be great alternatives in promoting sustained attention in a noisy environment!
  4. Smell – Just like the other senses, certain smells can also become overwhelming and even distracting for some children with ADHD. This can happen for many reasons, such as smells of food reminding them how hungry they are at school, smells that make them think of a certain memory that promotes daydreaming, or even simply gross smells that the child cannot seem to get their mind off of. To promote sustained attention and a calming effect with children with ADHD, essential oils can be a good option to trial! While they are not scientifically proven to directly help with symptoms of ADHD, they are proven to ease anxiety and stress, which can occur with ADHD. Scents such as lavender, vetiver, and chamomile are known for their stress-relieving abilities that promote relaxation and serenity within the body.
  5. Taste – Snacks…a fun way to wrap up this post! Similar to fidget toys, crunchy snacks can also provide attention-enhancing qualities when eaten during a time where sustained attention is necessary. The child will be focused on the task of chewing the crunchy item, such as carrot sticks, an apple, or some chips, and will therefore be present in the moment and better able to attend to the task going on around them. This strategy can be used in a variety of settings where eating is appropriate – school, home, tutoring, etc. And, it’s a fun contribution to the repertoire of strategies to enhance attention and self-regulation strategies!

As always, we recommend reaching out to your occupational therapist or getting an occupational therapy evaluation. Contact NESCA’s Director of Clinical Services Julie Robinson, OT, to learn more at: jrobinson@nesca-newton.com.

References

https://chadd.org/adhd-weekly/fidget-toys-and-adhd-still-paying-attention/#:~:text=Putty%2C%20squeeze%20toys%2C%20fidget%20cubes,classroom%20without%20becoming%20a%20distraction.

https://www.psychiatry.org/patients-families/adhd/what-is-adhd

 

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.

 

Lindsay Delling is a graduate student at Regis College working toward obtaining her master’s degree in occupational therapy. She previously completed fieldwork at Spaulding Rehabilitation Hospital in Charlestown and many school-based settings before coming to finish her fieldwork with NESCA. Prior to graduate school, Lindsay worked with children with disabilities in the Boston Public School system, as well as in a special education preschool setting in her hometown. Lindsay is open to working with many different populations once she completes her degree.

 

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 Joys of Career Counseling

By | NESCA Notes 2021

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

One of my favorite parts of being a Certified Rehabilitation Counselor is career counseling. In an ideal world, work is not just a paycheck. It’s another way for people to find joy and connect to the world and their community in a way that makes sense for them. Whether it is being a young person creating a lemonade stand, going around town to shovel people’s driveways, or getting that first real feel of a work environment and learning the social dynamics of having coworkers and a boss, those early jobs can help a person figure out what they don’t want to do and bring them closer to finding that right job. There is nothing more rewarding than when I get that email from one of my career counseling clients that they rocked their interview and were offered the job.

I’m looking forward to spending the next few months talking about career counseling and the career search process for individuals with disabilities. Career counseling and exploration are a vital part of every teenager and young adult’s life. This is especially true for students with disabilities who are struggling to figure out their next steps. As NESCA’s Director of Transition Services Kelley Challen, Ed.M., CAS, wrote in her last blog, employment in the high school years is an evidence-based method of having better postsecondary outcomes in both college and the workforce.

Career exploration is nothing new. But exploration starts a lot earlier than we think. We have all seen pictures of the first and last day of school that include a board with the student’s favorite color and what they want to do when they grow up. The answers to those questions change over time. If I had the job that I wanted when I was in 5th grade, I would be a zoologist right now! My future dislike of biology notwithstanding, I love the career that I ended up choosing. Still, it is not a career I ever would have thought of when I went off to college.

As we go back to a different world than before the pandemic, we will have to relook at what career exploration means. By the nature of the pandemic, there were lost opportunities for students and young adults to have looked at and tried different careers. So, what can we do instead? One of the best silver linings to come out of the pandemic is the number of YouTube videos and free resources that became available. If a student has never heard of or seen a career, how can they know if they like it or not? So, whether your child is 10, 18, or 25, if they are looking for a new job or a new area to find joy, the first place to start is exploration.

Throughout my summer blog series, I look forward to sharing more about career exploration with the following topics:

  • Career Counseling Services at NESCA
  • Interest Inventories and the benefit of informal career assessments
  • The benefit of informational and practice interviews

 

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.