NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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154

The Benefits of Working on a Vertical Surface

By | NESCA Notes 2021

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

What do you mean by a vertical surface?

If you think about it, most of the activities children do day to day are completed on a horizontal surface, where toys and tools remain static, in one position. Picture a vertical surface, whether it be a wall, window, or an easel. Working in this anti-gravity position activates new muscles and makes activities more challenging for kids. Think “tummy time,” but for our elementary-aged kids.

What are the benefits of working on a vertical surface?

  • Shoulder, wrist, and elbow stability – These activities require a child to practice bigger arm movements that may not be utilized on a traditional, flat surface. These movements promote both strength and flexibility in the joints and muscles of the upper extremities.
  • Core strength & postural control – If a child is completing vertical work in standing, he or she must reach outside of their base of support, activating those core muscles. Further increase the demands of the task by having the child complete the task in kneeling or while sitting on a therapy ball. This promotes balance and use of the stomach and leg muscles. Building this solid ‘core’ foundation is extremely important so that a child can develop more controlled movements in the upper extremities.
  • Hand strength – Working against gravity requires a child to exert increased effort while building hand strength and endurance with a utensil.
  • Visual spatial awareness & crossing midline – Working on a large vertical surface means more space to cover. This requires a child to visually scan a greater distance left to right, reaching across the imaginary “midline” of our body. Crossing midline is essential for developing bilateral coordination skills.
  • Wrist extension for pencil grasp – This is a big one! Writing on a vertical surface naturally puts the wrist in extension, the ideal position for handwriting. In contrast, a flexed wrist limits finger mobility and control.
  • Proprioception & force modulation – When performing a task on a vertical surface – think stickers or drawing – the child is required to practice grading movements so that he or she can apply the right amount of pressure for success (Boitano, 2020; Drobnjak, 2015).

What pediatric population benefits from this?

All kids would benefit from participating in these kinds of activities! Working on a vertical surface work can particularly help children to further develop the essential fine, visual, and gross motor skills. Sensory integration can also be targeted, as these kinds of activities allow a child to explore and develop proprioceptive, tactile, and visual processing skills.

Activities that can be done on a vertical or slanted surface (Boitano, 2020; Drobnjak, 2015)

  • Writing
  • Drawing/coloring
  • Tracing (stencil) activities
  • Stickers
  • Painting (finger painting or with brush)
  • Magnets
  • Spray bottle activities
  • Squigz or suction cup games
  • Felt or Velcro boards
  • Chalkboard, easel, or whiteboard activities
  • Shaving cream
  • LEGO wall
  • Window or wall washing using sponge

 

Resources

Boitano, C. (2020, April 20). The benefits of writing and working on a vertical surface! OT Outside. Retrieved October 6, 2021 from https://www.otoutside.com/news/2020/4/19/the-benefits-of-writing-and-working-on-a-vertical-surface.

Drobnjak, L. (2015, June 27). Why Kids Should Work on a Vertical Surface. The Inspired Treehouse. Retrieved October 6, 2021 from https://theinspiredtreehouse.com/motor-skills-and-more-working-on-a-vertical-surface/

 

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.

 

156

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.

 

11

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.

 

152

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.

 

4

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.

158

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.

 

8

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.

157

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.

 

155

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.

 

153

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.

 

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