Tag

organization

The Power of a List

By | NESCA Notes 2021

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

For so many children, adolescents, and young adults, I find myself recommending something that seems too simple to be of much use – a list. The power of lists has been identified and described in depth by several experts, such as Atul Gawande (The Checklist Manifesto – an excellent read). These books often discuss efficiency in the workplace, health and safety practices, and maintaining consistency in products or services. As adults, these are the things we often care about – ensuring that we are efficient, consistent, and getting things done.

In my practice, I recommend lists for different reasons. I recommend lists to teach executive functioning skills, such as planning, task initiation, organization, and task monitoring. Lists are also incredibly helpful for children who struggle to hold on to information. These children often miss information that is stated aloud, such as a parent giving directions or a teacher explaining instructions. Their brains often struggle to “keep up” with the pace of information presented in the world. Having the information written down in an organized manner, such a list, can help them access the information without time constraints.

Here is a quick example:

On a typical weekday morning, parents alternate checking on their 8-year-old as he gets ready for school. They give reminders of all the things left to do – “Brush your teeth!” “Get dressed!” “Put your homework in your backpack!” Time before the bus becomes shorter and shorter, as does everyone’s patience. Parents think, “We do the same things every single morning! Why is it so hard for him to remember?” Child thinks, “Why can’t they just leave me alone!” Voice volumes increase, tone shifts, and before anyone knows it or means to, there is a shouting match as the bus is pulling up.

Of course, a list won’t stop hurt feelings or eliminate frustration. However, if the child’s “morning routine” is posted somewhere easy to see, he may need far fewer reminders from his parents of all the tasks he has left to do. Frustration may be reduced, and the child can feel successful completing tasks with greater independence.

A list may be steps in a routine, as illustrated above. A list could also be of materials the child needs for baseball practice, the chores that should be done each week, or the limits and expectations around “screen time.” I often spend time with parents discussing the contents of a list, where the list should be placed, and the format it might take. For example, do you want checkboxes next to each item? Do you want the steps to be numbered? Maybe you love arts and crafts, and you want to laminate the list and have Velcro tabs with a “checkmark” that can be placed next to each completed task. The format and purpose vary, but lists are infinitely useful.

For many children, practice using lists is not only helping them to build skills in the moment, but is excellent practice for later life. Developing comfort with the tools and strategies that work best for you is an invaluable aspect of raising our children to become independent adults who can achieve their goals.

 

About the Author

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

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

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

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

 

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.

 

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, 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.

 

Put Me In, Coach!

By | NESCA Notes 2021

 

Coaching Services at NESCA

For students and young adults with social, emotional, organizational and/or learning differences, hands-on instruction in real-world environments is a critical means of developing skills for postsecondary living, learning and working. NESCA is pleased to offer individualized home-, community-,and office-based coaching services as well as remote coaching services, delivered by a team of seasoned Occupational Therapists (OTs), Vocational Counselors and Transition Specialists to support the needs of transition-age youth.

 

Meet the Coaches

 

Sophie Bellenis, OTD, OTR/L

Dr. Sophie Bellenis is Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy, including school-based service delivery. Dr. Bellenis has expertise in working with tweens, teens, and young adults with a wide range of social, emotional, and developmental needs. She joined NESCA full-time in the fall of 2019 in order to oversee the Real-life Skills Coaching program as well as to carry out transition assessment, occupational therapy assessment and treatment services. One of the keys to Dr. Bellenis’ success coaching students and young adults is her ability to form a meaningful relationship with each client and use that relationship to motivate lasting change.

 

 

 

 

Aubrey Matthews, OTD, OTR/L

Aubrey Matthews, OTD, OTR/L, is an occupational therapist who has focused most of her career on mental health and skill building for adolescents and young adults. She currently works full-time at a behavioral health hospital, splitting her time between the inpatient adolescent unit and the young adult intensive outpatient program. Aubrey tends to focus on building emotional regulation, executive function, and social skills through occupation-based strategies. Aubrey’s doctoral research at the MGH Institute of Health Professions focused on using LEGO therapy to build social skills at a pro-bono pediatric program, and she uses many of these creative strategies to increase client motivation and success.

 

 

 

 

Jasmine Badamo, MA

Jasmine is an executive function coach, and a New York State Certified ENL and Special Education teacher. She earned her bachelor’s degree in Biological Sciences from Cornell University and her masters degree in TESOL from CUNY Hunter College. She has over 10 years of teaching experience across three countries, and has worked with students ranging in age from 7 years to adults.
Her work focuses on creating individualized supports based on the specific needs and strengths of each client, and supporting the development of metacognition, executive function skills, and independence. Building an authentic connection with clients is a top priority, as this allows her to provide the best supports possible.

 

 

 

 

Lyndsay Wood, OTD, OTR/L

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

 

 

 

Visit our website for more information about NESCA’s Coaching Services or complete our online Intake Form

Executive Function Tips: The Google Drive

By | NESCA Notes 2021

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

As we slowly start to emerge from lockdown measures, social distancing guidelines, and living life through the screen, there are few lessons that we have learned that still hold importance and should maintain their place in our lives. When it comes to executive function, a lesson that sticks with me is the need for digital organization and functional systems that help us stay in control. One tool that students often use every day, but very rarely receive direct instruction in, is the Google Drive. I have found that students often do not fully understand the concept of an online drive, including how this differs from saving a document to a hard drive, or why it is important to have folders and systems in place.

Now that students often have email address that they set up early (some parents reserve email addresses long before their children can use them!), and stay with them long-term, there is a risk of Google Drive quickly becoming unmanageable or filled with unnecessary documents. Once the drive becomes cluttered, many students are unable to reign it back in and put systems into place. Below, find some tips for how to help students use the Google Drive as a tool to promote digital organization, as opposed to a landing spot for any new download, file, or assignment.

Tips

  • Set up folders. Through high school and often beyond, our students live their lives on a September through August calendar. They see September as the beginning of a year and often think of time in terms of grade level, as opposed to biological age or calendar year. Starting in either kindergarten or first grade, students should have a folder for any academic work from each grade. By setting up this system early, students start to build the habit of saving documents to the correct place. It can also be helpful to have folders for extracurricular activities, such as Boy Scouts, Math Tutoring, Club Soccer, or simply Personal Work.
  • Set up subfolders. Once students start taking multiple classes at a time, there is a need to further organize. Starting in fourth or fifth grade, many students switch classrooms to see different teachers for their core subjects. As soon as this starts, add folders for each subject, such as Math, Science, History, and ELA.
  • Name documents purposefully. Some of the students I work with spend longer trying to find their assignments than they do working on the assignment itself. This is often because folders are not set up, but also because students often do not remember what they named an assignment. Teach your children to name their files in a fashion that they can quickly find again. Examples include: year_subject_assignment (20/21_math_knowledge check1), teacher name_year_assignment (Smith_20/21_WWII Article), or teacher name_assignment (Jones_Mockingbird Essay).
  • Set up an end of year clean out. At the end of each school year, take the time to sit with your student and clear their drive of clutter. Many students will only want to save a few important assignments or essays from each school year. That being said, make sure they do not delete important resources! This sets them up for success when they jump back into school in the fall.
  • Review the hard drive. Teaching our students which documents should be saved to a hard drive or printed out and saved as a hard copy is hugely helpful. Even reviewing the difference between a hard drive and an online drive helps provide valuable information. Many of us were introduced to computers when saving to the hard drive was the only option. Once an online drive was introduced, we naturally knew the difference. This is not the case for current students. For most of their academic lives, there have been two options or places to save their assignments, and it can be hard to define the differences between the two.

 

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.

 

Executive Function Tasks – Medication Management

By | NESCA Notes 2021

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

Medication management is an extremely complex executive function task that many of our students will have to master before they are able to tackle living alone. While there are many executive function tools available to help organize and remind individuals about their medication, there are also some long-term teaching strategies and opportunities for habit building throughout a students’ middle and high school career that parents may want to capitalize on before their children leave the home. Today we will explore some of the commonly used tools to help with medication adherence and touch on a few tips and suggestions to help adolescents develop a base of knowledge around their own health status and need for medication.

Tools

Seven Day Pillbox – The most ubiquitous tool to help individuals keep track of medication is a weekly pillbox. This may seem like a simple tool, but pillboxes are hugely varied and have many different additional features. Make sure to consider how many boxes there are per day (morning, afternoon, evening, etc.), whether there is a need for different colors to help with visual discrimination, and whether an audible or vibrating alarm could be beneficial. All of these are potential options that are built into the different pillbox options provided below:

Automatic Pill Dispenser – Some individuals may benefit from having the added support of a pill dispenser that automatically dispenses the correct prescriptions at the time they should be taken. Here is one example of this tool:

The Calendar – Those who have read my previous blog regarding the wonders of a functional digital calendar are likely unsurprised by this suggestion, but make use of this fabulous tool! Adding in an appointment to refill pillboxes, marking down anticipated dates to refill prescriptions, and setting notifications or alarms to go off when it is time to take medication each day can help students remember each step of the process.

Tips

Involve children in filling their pillboxes as early as possible. Many children will enjoy sitting down with a parent to place the pills in each little box and feel special when they are given some responsibility. When this is normalized as a typical part of a week, it becomes an expected activity of daily living for children. Make sure to point out the things that you notice as you fill the box. For example, stating, “Oh! I only count five pills left, that means I need to call and refill the prescription today,” each month will help your child to associate a nearly empty bottle with the need to problem solve.

Set a specific time or day of the week to refill pillboxes. Many children will continue to stick to routines and habits that they built up through childhood once they venture out of the home. Consider designating a specific time of the week to fill a pillbox together. For example, if Sunday after dinner works consistently, make this part of the family routine.

Pair medication with a daily task. Some individuals enjoy using alarms as reminders; however, others feel much more empowered by simply building medication into their routine. Pairing medication with an activity that happens daily anyways, such as brushing teeth in the morning, makes it easier to remember without direct prompting.

Help your child or adolescent put together a medication chart. Many of our children do not know the reasons for their medication. They are unaware of the intent, potential side effects, exact dosage, or name of the medication itself. The more our children and adolescents understand, the better they are able to advocate for themselves to doctors or other health professionals. Putting together a one-page medication chart that outlines all of this important information – in terms that can be easily understood and communicated to others by the child – can help children feel empowered in their conversation about their health. Consider adding a picture of each pill or capsule if they routinely appear the same. At times, pharmacies may unexpectedly need to fill generic prescriptions from different manufacturers, based on availability or other factors, therefore lending to a different appearance of the same generic prescription. This medication chart can also be a helpful tool to reference when adolescents start to independently fill their pillboxes.

Refill prescriptions together. While refilling prescriptions at the pharmacy is often a task that needs to be led and managed by adults, it’s still possible to include adolescents so that they start to learn the process. A great first step is to call the pharmacy on speaker phone and allow your child to listen in for a few months in a row.

 

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.

 

Executive Function Tools: Natural Consequences

By | NESCA Notes 2021

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

In my last blog that focused on executive function tools, I delved into the benefits of using and committing to a digital calendar. The calendar is a concrete tool that can be directly taught to students using traditional methods. Less concrete, but in many ways equally useful, is this next executive function tool – the natural consequence.

When most people think of natural consequences, they think of younger children refusing to do things like eat a meal that their caregiver prepared or put on a coat when it is cold outside. If a child refuses their dinner, the natural consequence is hunger. If a child refuses to wear their coat, the natural consequence is feeling cold. These are consequences that will happen without parents or caregivers explicitly providing a consequence. When it comes to executive function mishaps, the natural consequence is often the need to independently deal with the fallout.

Many of the students I serve directly need scaffolded executive function support with direct instruction and specific opportunities for practice. I am not advocating for removing these services or throwing these students to the proverbial wolves. What I am advocating for is using mistakes or lapses in executive function skill as learning opportunities, as opposed to absolving our students from all responsibility and continuously jumping in to save the day. To demonstrate this difference, here are a few examples of ways I have seen parents successfully use natural consequences as a tool to teach executive function.

Case Studies

  1. Amber is a student who has had consistent difficulty organizing her time after school. While she attends many different afterschool activities, such as recycling club and track, she is often late to practice or misses important changes to the schedule. To help Amber, her parents set up a calendar with notifications and reminders that appear on her phone and her computer directly after school. Recently, Amber started driving lessons with the local driving school. A few weeks ago, Amber had a conversation with her mother in the morning about the fact that she would be picked up for a lesson 10 minutes after the end of the school day. Amber’s notification on her phone went off 15 minutes before the lesson, and she received a pop-up on her computer screen 30 minutes before the end of the school day. Despite these reminders, Amber hopped onto the bus at the end of the day. While this was an honest mistake, Amber was not using her tools or the time management strategies that she has been taught and is expected to use. Amber’s parents decided that as a natural consequence, Amber would need to deal with fixing her mistake. They were there to support her as she called the driving school, apologized to the instructor, and rescheduled her appointment. If she was not willing to take these steps, another natural consequence would have been a delay in getting her license. This caused some heightened anxiety for Amber, but with encouragement from her parents, she practiced the phone call out loud and looked through her calendar to see where she had availability for a make-up appointment. Amber’s parents could have easily called the driving school and fixed these problems for her; however, Amber would have missed out on an opportunity to practice problem solving.
  2. Another student who benefited from natural consequences is Albert. Albert’s parents hired a tutor to meet with him over Zoom twice per week to prepare for the SATs. He was expected to meet with his tutor, Barry, two times per week to start building up his skills. Unfortunately, despite frequent reminders and systems being put in place, Albert often missed or was late to these meetings as he was distracted by playing video games. When Albert’s parents started to receive charges for missed appointments from Barry’s company, they thought carefully about how to impress on Albert the importance of using his strategies and making it to his appointments. Eventually, Albert’s parents informed him that if he missed another session, he would be responsible for the late fee, as the charge was an inevitable consequence. When Albert eventually missed another session, his father drove him to the bank and helped him withdraw the money from his own savings account to pay his parents for the missed session. Unsurprisingly, this was hugely frustrating to Albert in the moment; however, his meetings with Barry became a priority and Albert quickly started making it to tutoring on time. After experiencing the natural consequence himself, Albert began to change his actions.

Both of these examples led to increased buy-in from the adolescents who were actively working on building up their executive functioning skills. As they started to participate in problem solving after they made a mistake, they were more aware of the work that their parents had typically been doing for them. Some language that can be productive includes:

  • “I know it was a mistake and now we just need to figure out how to fix it. What do you think we should do?”
  • “What are the next steps you need to take to solve this problem?”
  • “I can tell you what I think we should do, but I would love to hear your ideas first. Where would you start?”

As adolescents forge toward young adulthood, they will inevitably make mistakes, miss appointments, arrive late, and misplace some of their belongings. If we are constantly picking up the pieces, then they are missing out on the opportunity to learn how to solve their own problems and build an understanding of the consequences.

 

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.

 

Executive Function Tools: The Calendar

By | NESCA Notes 2021

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

When working with young adults and adolescents to build up executive function skills, my main goal is to find systems and strategies that are truly helpful, easily accessed and that will eventually be used independently. While there are many fabulous apps that have been developed to target specific organizational skills, such as medication management, creating to-do lists and taking notes, I would argue that the number one, most important tool is an accurate, up-to-date calendar. The format of a digital calendar provides three hugely important supports.

  1. Visual Map of Time – Time management is tricky, and for many of our students, the concept of time itself is quite abstract. A calendar that has chunks of time visually blocked out helps to concretize an abstract concept. Additionally, having a calendar can help students plan their work. If a student has five different assignments to work on in a given week, looking at a calendar to find available segments of time will often help them realize that leaving everything until the last minute will not be possible. Notably, this requires guidance at first. Asking students questions, such as, “how long does an assignment like this generally take you?” or “would that available hour on Tuesday give you enough time for your problem set?” will help them start to internally ask themselves the right questions.
  2. Built-in Notification Systems – Some students use the alarms on their phone as reminders that they need to complete academic or daily living tasks. For example, they may have an alarm at 7:00pm every evening as a prompt to take their medication. Digital calendar apps allow for notifications to be linked to an event or task. Sometimes a simple reminder 10 minutes before a meeting or class is plenty, and our students can arrive on time with that quick prompt. For other appointments, I have students set two separate notifications, one in the morning and one at the time they would need to start getting ready or prepared for an appointment. For example, if a student has a doctor’s appointment two months in the future, a student could benefit from setting a notification eight hours and 1 hour before the appointment. This way, they start their morning with an acute awareness of their responsibility that afternoon and are reminded again when they need to start getting ready to leave.
  3. Constant Access when Synced across Devices – Calendars, such as the Google Calendar, sync seamlessly across digital devices. The same calendar can be accessed from a phone, a tablet, a laptop or a desktop quickly and easily. Students can refer to their phone when they are out and about or their computer if they are focused in class.

Research shows us that building executive function skills requires direct instruction and the opportunity to practice (Semenov & Zelazo, 2019). While using a calendar may seem like a simple skill, many of the systems provided in high schools take away the opportunity for students to practice setting up and maintaining their own calendar. Online portals have calendars that are immediately synced to the teacher’s schedule with assignments and due dates already entered. Additionally, many of our students rely on their parents to keep track of any and all appointments (medical or otherwise), meetings and other scheduled activities. This means that when starting a more independent schedule – whether at a university, vocational program or first job – these students often find themselves overwhelmed by the deadlines and the number of responsibilities that they must track. I urge parents to slowly increase the number of appointment and activities that students are in charge of remembering on their own. Helping a student enter doctor or dentist appointments, vacation details, such as flight or bus times, and deadlines into their personal calendar helps them start to build this habit and provides opportunity for practice. We have the tools to help students make this transition more easily, and with small, intentional changes to expectations of responsibility and independence, we can provide students with tools in their back pockets so they are ready to support (and schedule) themselves!

References

Semenov A, D, Zelazo P, D: Mindful Family Routines and the Cultivation of Executive Function Skills in Childhood. Human Development 2019;63:112-131. doi: 10.1159/000503822

 

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.

 

Digital Literacy, Executive Function and Remote Learning

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L

Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA

The experience of watching a small child who is only two or three years old pick up a smartphone, quickly type in a passcode (as they have memorized the pattern) and open up their favorite game can be jarring for adults who remember the days of dial-up internet and who learned to use technology as it staggeringly evolved. For many of today’s children, handheld electronics have always been a fundamental part of their world. Flipping between apps, using their pointer finger to manipulate games and opening a screen using facial recognition all feel like second nature to many in the current generation of school age children. We assume that children have higher digital literacy than we do and intrinsically understand technology in a way that many of us never will. But what do our children actually know? And, are they missing out on vastly important direct instruction when adults make an assumption that they are already tiny experts in the digital field?

Over the past six months, a time fraught with a monumental shift in education, I have worked one-on-one with a widely diverse group of learners. If I had to pinpoint one theme that comes up over and over, across ages, levels of ability and school systems, it is frustration, confusion and lack of problem-solving strategies as they relate to technology. Statements I have heard during this period of remote learning include:

  • “I don’t turn off my Chromebook. I lose everything, and I’m actually not quite sure that I know how to turn it back on.” – High school honors student
  • “I didn’t know that Google Slide and PowerPoint were different things. I lost so much trying to switch between them.” – High school senior
  • “Hardware or software? I didn’t realize there was a difference.” – Middle school student
  • “I just save my document with whatever my computer suggests as a title. I guess it does make it tricky to find things later.” – High school junior

As an occupational therapist focused on making sure our students can access their curriculum, comments like these teach me a few incredibly important lessons.

  1. Students are lacking information on the basics. The same student who is not sure how to turn off his Chromebook can quickly navigate Google Classroom without any support, both uploading files and opening modules with ease. We need to focus on teaching the fundamentals of technology. What are hardware and software and how to they interact? What options exist within the system preferences of a particular device? How is an iPad different from a Chromebook, a Windows laptop or a MacBook? Why do we need to power down devices sometimes? What are the downsides to never restarting a computer or updating an operating system?
  2. Successful digital organization does not come naturally. Students are typically taught specific systems for organizing physical space and materials, such as color-coded folders, binders and labels. Teaching students to organize their digital space and their digital materials is equally, if not even more, important. Learning to create folders for each class and systematic ways of labeling documents saves students time and energy, and this often decreases frustration in the moment.
  3. Academic and professional tools are not particularly intuitive (a stark contrast to entertainment tools). There are incredible programs designed to help students create presentations, synthesize data and put documents together. These include, but are not limited to, the Microsoft Suite and Google Workspace. These tools can be tricky to manipulate and many middle and high school students would benefit from taking an introductory course, watching online tutorials or working directly with teachers to explore their functionality before layering on assignments requiring competent use of the tools.
  4. Students are often completely unaware of their gaps in knowledge. This is potentially due to the fact that today’s students are so impressive when it comes to using technology for leisure purposes. They seamlessly transition from an iPad, to a Chromebook, to a Samsung phone and can access games or social media without difficulty on each device. Unfortunately, very few schools have programs focused on teaching computing skills or digital literacy in the academic context. Our students piece together enough information to get by for a short while, but often come up against challenges later. Students also may believe they have built competency because they have some exposure to a tool. For instance, I have worked with students who are building resumes and including claims such as, “Proficient in Excel, PowerPoint and Word” but score poorly when tested on these computer abilities.

So, what do can we do?

The first step towards ensuring that a child or adolescent has adequate digital literacy skills is to actually assess how much they already know. Some students do have these skills mastered and others will have unexpected deficits or gaps. This assessment can be done formally or informally. A starting point I often use is to sit down with a student at a computer and ask how they organize, how they navigate, how they save files, etc. I also like using online assessment resources, such as TypingClub.com and Northstar Digital Literacy.

Once the skills that a student needs to grow are identified, there are many opportunities available to teach them. A few options include:

  • Online courses in specific software programs. Sites, such as Coursera, LinkedIn and Udemy, have comprehensive courses focused on specific programs for all different levels of learners.
  • Free online videos. A quick search on YouTube often leads to short, accurate videos and tutorials filmed by teachers or professionals. If your student learns well through video format, these can be a great tool.
  • Ask your school for support. Often, students learn better with direct instruction. If a student’s team is aware of their lack of knowledge regarding technology, there are many professionals at school who may be able to teach these skills during a free period, study hall or meeting.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. 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. Dr. 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, Dr. 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.

 

I Can Tell You a Story…I Just Can’t Write It

By | NESCA Notes 2020

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

According to understood.org, “Written expression disorder is a learning disability that results in a person having trouble expressing their thoughts in writing… They might have the greatest ideas, but their writing is disorganized and full of grammar and punctuation mistakes.” Experts believe that between 8 and 15 percent of people have a written expression disorder and it often co-occurs with other learning challenges, with two of the most common being dyslexia and attention-deficit/hyperactivity disorder (AD/HD).

Writing is difficult because it depends upon many separate components that need to be integrated into a complex whole. For example, to write well, a person needs to have acquired knowledge about the topic, retrieve needed vocabulary and express the information in a way that can be followed by the reader. At the same time, the writer needs to be able to self-monitor their progress, including switching between the main idea and writing mechanics, such as spelling, punctuation and grammar. People with written expression disorder might be able to tell an organized and interesting story, but struggle when asked to recreate that information in written form. Receiving a formal diagnosis can help a child receive extra help at school or even specialized instruction. Also, a diagnosis can possibly lead to accommodations at college.

There are also several methods of instruction that can help a student organize their writing. These programs help a student visualize or represent abstract ideas by using visually-based templates. While many of these methods are copyrighted and cannot be reproduced in this blog, some examples are programs such as Thinking maps by David Hyerle, Ed.D. or “Brain Frames.” These programs have developed specific graphic organizers to help a student with a variety of writing assignments (e.g., comparing and contrasting, ordering and sequencing) and provide specialized instruction that can help a student greatly improve their ability to express their ideas in writing.

If you believe that your child may be experiencing difficulties in the area of writing, 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.

Sources:

https://www.understood.org/en/learning-thinking-differences

http://www.ldonline.org/article/33079/

http://www.thinkingmaps.com

http://www.architectsforlearning.com

 

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.

OTs’ Remote Learning Equipment Tips!

By | NESCA Notes 2020

Co-authored by: Sophie Bellenis OTD, OTR/L and Jessica Hanna MSOT, OTR/L

With the momentous shift in education this year, many families are looking for support with the remote learning or hybrid learning process. Children are facing new barriers to education, such as inability to focus within the home setting, inappropriate work space and lack of independence with attention, initiation and motivation. Fortunately, many fabulous educators are stepping up to the plate, acknowledging these struggles and advocating on behalf of their students. Many families are working to help in their efforts by finding new products, tricks, tools or strategies to help promote learning and access to curriculums. Some of these products are gimmicky tools promising a “quick fix.” Some of these new tricks and tools may be beneficial, but today we are going to advocate for getting back to the basics and truly analyzing how best to use, set up and care for the foundational tools that children currently employ for learning. If using these tips feels difficult or is not helping your child to achieve the level of focus and commitment to learning that they need, we recommend reaching out to your school-based occupational therapist or getting an occupational therapy evaluation.

Things to Consider:

Laptops/Tablets

  • Basic Functionality – Your child is never too young to be part of the process. Teaching your child basic functionalities of their computer and tablet, as well as specific platform features is hugely important. Your child may find a visual checklist helpful to recall what basic features do, where to find them and when it is ok to use them.
  • Keep Screens Clean – As expected, kids often touch everything and anything, including computer and tablet screens. Make sure to check and wipe down screens to limit glare and distortion caused by sticky little fingers. Encourage your child to respect and handle their device with care.
  • Screen Height – According to the American Optometric Association, most people find looking at screens more comfortable when their gaze is pointed slightly down. Ideally, try to set up a computer screen with the center of the screen about 15-20 degrees below eye level (AOA, n.d.). This may be especially tricky with little learners, who tend to crane their necks up to look at a monitor or laptop screen, or students who tend to set their laptop way down on their lap.
  • Screen Distance – To decrease eye strain, try to position a screen about 20-28 inches away from the eyes (AOA, n.d.). Recent evidence shows that there is a significant increase in visual symptoms, such red eyes, blurriness and visual fatigue in individuals who look at screens from a distance of 10 inches or less (Chiemeke, Akhahowa, & Ajayi, 2007). While it is easy to set a computer a certain distance away, make sure that children are not holding an iPad or phone right up to their face during the school day.
  • Simplify Access to School Webpages and Links – Make sure that when your child opens up the computer, they can quickly and easily access all of their school websites and links for Zoom, Google Classroom, etc. One easy way to do this is by creating shortcuts on the desktop or having a visual guide printed next to them for exactly how to access their work.
  • Limit Access to Distracting Apps or Webpages – Is there a way to disable your child’s access to games and apps during school hours? While our students are working hard to attend to remote learning, the pull of distracting digital fun may be too enticing to pass up. Consider looking into some of parental control options on your device.
  • Learn the Limitations of Chromebooks – Due to the digital demands of remote learning, many school districts and community organizations are providing Chromebooks for students to use at home. While this is excellent and allows students access to the curriculum, some of these devices have limitations, such as not allowing communication to certain website or software platforms. Consider reaching out to your district if you need your child’s device to allow communication with an outside therapist or service provider.
  • Back Up Your Personal Work – Many families are sharing one computer or device between multiple family members. It is important to make sure that any important documents, folders or programs are fully backed up before giving a computer to your student. Accidents happen, and children can quickly delete files without meaning to! Creating a separate user login for each family member allows different privileges for each user and helps keep work separate and organized.
  • Say No to Open Drinks! – Water bottles with a lid will help to prevent any hardware damage from spills.

 Extra Equipment

  • Invest in a Mouse – Using a touchpad often requires substantially more fine motor precision and finger isolation than using a mouse. Most devices can connect with a mouse either through a USB port or a Bluetooth connection.
  • Headphones – Different children may benefit from different types of headphones. Some of our learners need earbuds or overhead headphones during Zoom meetings to help them attend to the class going on virtually. Some of our students may prefer being in a quiet space and listening to their teacher and classmates out loud. Additionally, some students may benefit from wearing noise cancelling headphones during independent work to limit the distraction from noises in their environment.
  • External Camera – Using an external camera that is not embedded in a computer or laptop may be helpful for our students who need movement or want to look at a screen while a teacher or therapist observes their work. An external camera pointed down at a student’s hand during an activity can help a therapist to evaluate a child’s fine and gross motor movements, while the student still sees a friendly face up on the screen.
  • Chargers – Help your children remember to keep their devices fully charged and to transport their charger between school and home if necessary. Many students benefit from a visual checklist when packing their bag for the next day. Chargers are hugely important for students who need to access their curriculum and may be especially difficult for students learning in a hybrid model.

 

References

American Optometric Association. (n.d.). Computer vision syndrome. Retrieved from https://www.aoa.org/patients-and-public/ caring-for-your-vision/protecting-your-vision/ computer-vision-syndrome?sso=y

Chiemeke S.C., Akhahowa A.E., Ajayi O.B. (2007) Evaluation of vision-related problems amongst computer users: a case study of university of Benin, Nigeria. Proceedings of the World Congress on Engineering. London: International Association of Engineers.

 

About the Co-authors:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. 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. Dr. 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, Dr. 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.

 

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.