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pediatric neuropsychology

Transition Assessment: How to Prepare for the Team Meeting

By | NESCA Notes 2022

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

Every child who receives special education services in the United States is entitled to transition services—a coordinated set of activities that will facilitate the student’s preparation for postsecondary education and/or training, competitive employment, independent living, and community participation.[1] In order to provide these services, an IEP team has to first conduct “age-appropriate transition assessment.”[2] I have written about transition assessment in previous blogs, including Transition Assessment: What is it anyway? How is it different from neuropsychological evaluation? and Vocational Assessment and Transition Planning.

A challenge for students and families who are participating in transition assessment for the first time, is knowing how to prepare for team meetings where transition planning and services will be discussed. When you attend a team meeting after an occupational therapy evaluation or academic evaluation, you know that you are going to be discussing what occupational therapy services or academic instruction your child may need as part of their IEP process. However, when a student has participated in transition assessment, the team will be discussing a whole variety of activities (e.g., regular and specialized instruction, related services, community experiences, linkage to adult human service agencies) that the student will need to participate in as the student is preparing for adulthood. Some transition assessment reports contain dozens of recommendations for comprehensive planning. Recommendations may include activities that you are used to discussing with your team, such as instruction and services for a current IEP period, but recommendations may also include other activities that should occur outside of school with support from a parent or community member or actions that may need to occur at a later date. To make the most of your team meeting, it is helpful to do a little bit of homework and preparation after you receive your transition assessment report.

As discussed in previous blogs, if the student is going to be part of the team meeting (which they should be), then the student should have the opportunity to discuss the assessment results with the evaluator or another trusted adult. If your school district conducted the transition assessment, ask when and how they are going to review the results with the student prior to the meeting. If you obtained an independent or private evaluation, ask if you can schedule a student feedback meeting with that evaluator prior to the student’s team meeting. Students need to be aware of the findings and the recommendations that are being made, and they need to be prepared to actively participate in discussion about the results. Whether a student supports or disagrees with recommendations from a transition assessment can have a large impact on changes that are made, or not made, to the IEP.

In addition to student preparation, all team members should be prepared to discuss the assessment recommendations in a planful and organized manner. As a parent, it is helpful to read each recommendation in the report and consider the following questions:

  • Is this a skill or activity that you can reasonably tackle at home this year or in coming years? Do you need any training or consultation to be able to support the student?
  • Is this a skill or activity that would be best supported by a community provider rather than a parent, family member, or school staff?
  • Is this a skill or piece of knowledge that the student must attain this academic year in order to make progress toward their long-term goals? Do they need specialized instruction or related services to learn the skills or gain this knowledge?
  • Is this a skill, piece of knowledge, or service that needs to be focused on at a later time, but documented somewhere so that the team does not forget the recommendation?

It can be helpful to put together an abbreviated list of the goals, objectives, or services that you know your child will need this school year based on the assessment. Alternatively, some families find it useful to create a table or grid to organize transition planning activities. Here is one possible presentation that a family might use to prepare for a team meeting.

 

  Parent Community Providers School/IEP
Education/Training ·   Tour three colleges

·   Attend summer program on college campus

·   Counseling on enrollment process for postsecondary educational programs with Pre-Employment Transition Service (Pre-ETS) provider ·   Update postsecondary goals

·   Instruction of Study Skills, including notetaking

·   Assistive technology consultation

·   Personal Finance course

·   Sexual Health Instruction

Employment ·   Create first student resume

·   Set up informational interview with family friend who works as an accountant

·   Self-advocacy counseling with Pre-ETS provider ·   Help student obtain work permit

·   Support student in applying for paid part-time work

Independent Living ·   Review family health history

·   Teach student to complete medical history paperwork

·   Prepare questions with student ahead of medical appointments

·   Assist student in opening checking account

·   Include student in home maintenance activities

·   Individual counseling

 

 

·   Instruction in tracking sleep hygiene, diet, and exercise activities

·   Assistive technology consultation for health habits

Community Engagement ·   Support student in learning to carry out personal shopping activities ·   Social skills group with insurance-based provider

·   Study for driver’s permit test with Transition to Adulthood Program (TAP) provider

·   Travel orientation with local public transit authority

·   Make referral to Vocational Rehabilitation (VR) service provider

·   Invite VR service provider to team meeting with parent & student consent

 

 

It is also helpful to consider how the information from the transition assessment can flow through the IEP document. Information learned about the student’s postsecondary goals (i.e., the student’s goals for their life after high school) must be documented in the IEP and used to guide IEP development. Portions of the assessment may also be included as key evaluation results and current performance data, may inform how the team considers various federal and state special factors such as the students need for assistive technology or more functional means of communication, may suggest linkages that are needed with state resources and adult human service agencies, and may inform other aspects of the IEP. It is important to think about each section of your child’s IEP and how the assessment results might impact the team’s discussion of that section.

Many schools and families are familiar with transition assessment services at NESCA but do not realize that our transition specialists will consult with students, parents, and teams to plan for transition assessments, review assessments that have been conducted by other clinicians, or support the team meeting process. For more information about transition planning, consultation, and assessment services at NESCA, visit our transition services page and our transition FAQs.

[1] https://sites.ed.gov/idea/regs/b/a/300.43

[2] https://sites.ed.gov/idea/regs/b/d/300.320/b

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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

Pediatric Neuropsychologist Maggie Rodriguez, Psy.D., Joins NESCA

By | NESCA Notes 2022

By: Jane Hauser
Director of Marketing & Outreach

In today’s blog, I have the pleasure of introducing you to NESCA Pediatric Neuropsychologist Maggie Rodriguez, Psy.D., who recently joined our team of expert clinicians.

How did you discover your interest in neuropsychology?

It was a long and winding road! I went into college, interested in a wide range of subject areas, including medicine. Eventually, I realized my area of interest was truly in psychology. I discovered that I really enjoyed neuropsychological evaluations, since they combined my interests in psychology, neuroscience, working with medical providers, educators, as well as writing and the creativity involved in making a child come alive in a report.

In graduate school, I was fortunate to learn from a number of extremely talented neuropsychologists in a variety of settings. While completing a placement at Children’s Hospital Boston, I remember hearing my very wise supervisor say that, “one year in the correct school placement is worth two years of therapy.” As I continued on with my coursework and clinical training, I repeatedly saw the truth in that statement. I witnessed the value of nuanced neuropsychological assessment in allowing students to receive accurate diagnoses and, in turn, the correct academic accommodations and interventions. I wanted to be part of that, not only to help children and teens succeed academically but to prevent the secondary effects that undiagnosed and untreated learning disorders, neurodevelopmental disorders, and cognitive challenges can have on emotional health, self-esteem, and social functioning.

On the personal side, my interest in neuropsychology was sparked again when I had my own child evaluated. It was surprisingly powerful to go through the process on the parent side, and after taking some time off to have a family, I knew that I wanted to get back into neuropsychology again!

Why did you choose to come to NESCA when re-entering your professional career?

There were several reasons that I looked into NESCA and ultimately opted to join its team. I learned about NESCA while researching neuropsychologists for my child’s evaluation and was impressed with what I saw. Additionally, one of my former testing supervisors told me NESCA is among the best in the business. Having that kind of endorsement from such a trusted source provided me with great confidence being part of NESCA.

I also was really drawn in by NESCA’s emphasis on the continued growth and learning for its clinicians. It was obvious that NESCA is comprised of a highly invested and collaborative team. Every one of us has a lot to learn still, and I valued the opportunity for not just a job, but the continued learning.

NESCA also offers a great work/life balance. Having a family of my own and parents who are approaching the stage where they also require care is a lot to balance. NESCA’s emphasis on supporting its staff in balancing work and life has made it very rewarding. I’ve seen several examples of how the culture of understanding is very much active.

On a very practical level, having clear protocols for handling day-to-day Covid strategies, like masking, cleaning, etc., has been comforting. Returning to clinical work in the midst of a pandemic has been a big transition, and knowing NESCA has put in place measures for keeping staff and clients safe is tremendously important to me. Seeing the creativity and agility in the way the team here tackled the larger challenges—evaluating clients safely and in-person—during Covid was inspiring and told me a lot about the team and culture. Learning that NESCA adapted its methods of testing via the two-office model demonstrated to me that they, as a practice, they are able to roll with those kinds of challenges. That was also very reassuring.

Finally, the interview process provided me with the chance to speak with a number of NESCA’s clinical staff. I was able to get a great feel for the culture and high standards the practice has, which made me confident that this was the right fit for me.

What kinds of concerns do you evaluate or enjoy the most?

I really enjoy working with kids of varying ages, but I do have a keen interest in working with families and children who are just hitting the adolescent years. I get the opportunity to help them understand how all the, sometimes confusing, pieces fit together.

I really enjoy working with kids who may be deemed as “complicated,” where things may have previously been overlooked. Maybe things were going fine for them until they hit a wall academically. Perhaps they got to middle school or high school or even college and began to wonder why things seemed to be falling apart for them. I enjoy the challenge of working with kids who are experiencing executive function deficits, social communication issues, kids whose disability or disabilities are not as straightforward. I like to tease apart whether there are executive function (EF) issues, Attention-Deficit/Hyperactivity Disorder (ADHD), or sensory integration challenges…or perhaps explore whether it could be something else altogether. Is a child’s rigidity due to anxiety, an Autism Spectrum Disorder (ASD), Obsessive-Compulsive Disorder (OCD), cognitive issues or a combination of overlapping challenges? I love teasing all of these things apart. I also work with children whose families have concerns about potential language-based learning disabilities (LBLD), communication issues and challenges with social pragmatics.

It’s incredibly rewarding when you are able to help families understand answers to these kinds of questions that they may have been grappling with for a long time.

 

About Pediatric Neuropsychologist Maggie Rodriguez, Psy.D. 

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

To book a neuropsychological evaluation with Dr. Rodriguez or another expert neuropsychologist at NESCA, complete NESCA’s online intake form

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

Testing the Limits

By | NESCA Notes 2022

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

In the world of assessment, “testing the limits” means essentially bending the rules of test administration in order to see if the change in administration allows the test-taker to demonstrate their knowledge more effectively. For example, some children and adolescents respond impulsively to multiple-choice tests, picking the first choice that appears to be correct without looking at all of the choices. Standardized test administration dictates that the evaluator accepts that impulsive response and, as such, impulsivity will compromise the client’s score.

In the example above, the student was unable to demonstrate their knowledge or skills effectively on tests because of the standardized administration procedures. While it is important to generate these scores, it is also important to gain an understanding of what the student actually knows, and this is where testing the limits comes in. For the impulsive student, the evaluator would test the limits by reminding the student to slow down and look at all the choices before responding. This is non-standard test administration, and so the score is not considered valid but the results give us a great deal of information about the student’s strengths and weaknesses. There is a big difference between the student who is able to achieve the correct score when cued to slow down and the student who still answers incorrectly, even with reminders to slow down. The former student can be said to have much higher potential than the latter student. However, their ability to demonstrate their potential is hampered by impulsivity, a problem that needs to be addressed.

In the course of most neuropsychological evaluations, we are trying to understand the student’s profile of strengths and weaknesses, which often requires testing the limits. This raises the question of the value of the standardized scores. The standardized scores likely reflect the level at which the child or adolescent is functioning in the “real world.” Impulsive test-takers are almost certainly impulsive students; just as they don’t demonstrate their true potential in testing, they are not doing so in school.

Many students are able to fully demonstrate their skills and knowledge with standardized testing and don’t require “testing the limits.” However, at NESCA, we also see many highly complex students whose ability to access their potential is limited by issues of attention, executive functioning, communication, or emotional/behavioral regulation. In these cases, we routinely “test the limits” and report both standardized administration and non-standardized (“testing the limits”) scores and explain what these scores mean for the individual, what the scores tell us about daily functioning as well as untapped potential.

 

About the Author
NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists, complete NESCA’s online intake form

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

My child is nonverbal. Should I still get a neuropsychological evaluation?

By | NESCA Notes 2022

By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

The short answer to this question is YES. As a neuropsychologist, I enjoy evaluating students who have complex profiles, including intellectual/developmental disabilities, genetic conditions, and medical complexities. In many cases, these students have been deemed “untestable” and have never had a comprehensive evaluation.

This is problematic for two major reasons.

  • First, we cannot understand a student’s potential if we have no data or assessments available. Following from this, it is very hard to develop realistic and measurable goals without using the student’s innate potential to guide those goals.
  • Second, lack of testing causes practical and logistical problems later in the student’s life. As a child approaches adulthood at 18, it is necessary to have documentation of their cognitive and adaptive skills as well as diagnoses in order to seek adult services. More specifically, the Department of Developmental Services (DDS) requires documentation of intellectual disabilities prior to age 18.

Having assessed thousands of children and adolescents over the years, I’ve learned that I can ALWAYS gather important information from a neuropsychological evaluation. I have evaluated students who are nonverbal, students with severe intellectual disabilities, students with limited to no motor abilities, students with vision and hearing impairments, students with severely challenging behaviors…. In every case, a neuropsychological evaluation has been meaningful and useful in terms of A) understanding the student’s capabilities, and B) developing educational and treatment goals.

It is important to understand that a neuropsychological evaluation with a more developmentally complex student will look different than an evaluation with a neurotypical student. There are standardized tests that I will not be able to administer based on the student’s language skills, motor abilities, and academic knowledge. Some students can only tolerate 20 or 30 minutes of testing at a time, so the evaluation is broken into 9 or 10 sessions. Some students provide their responses using a communication device. Some students need to be supported by a behavior therapist to help them maintain a safe body.

In some cases, students cannot engage in any standardized tests due to multiple disabilities. However, I still have them come into my office at least once so that I can meet them in person and gather information about their communication skills, social interest, and activity levels. I will then spend time observing the student at their educational program, interviewing school-based staff, and gathering information from the student’s caregivers about their skills at home. With all of these data points, I can then provide a thorough set of recommendations for school-, community-, and home-based goals – even though I might not have “valid” standard scores.

For all of the families who think that a neuropsychological evaluation cannot be done with their child for one reason or another, I urge you to reconsider your perception of the purpose of an evaluation. In these cases, the emphasis of the evaluation is not on test scores, but on developing a better understanding of the student’s strengths and weaknesses. More importantly, the evaluation should be used as a reference to guide treatment goals to help the student achieve the highest level of independence of which they are capable based on their potential.

 

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

If you are interested in booking an appointment for the ASD Diagnostic Clinic or an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit 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.

Transition Planning: The Important Difference Between Postsecondary Goals and Annual Goals

By | NESCA Notes 2022

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

One of the most important aspects of transition planning for students with individual education programs (IEPs)—and for every student—is development of postsecondary goals. These goals are often described synonymously as the student’s postsecondary vision: the outcomes that the student and their IEP team expects the student to achieve after exiting public education. Legally, every IEP in the country needs to include explicit postsecondary goals in the areas of education or training, employment, and independent living, when appropriate. In Massachusetts, students need to have goals for Independent Living as well as Community Engagement. Because this topic is so important, I previously wrote a blog describing the importance of measurable postsecondary goals including a formula for writing such goals.

But, two years later, I am still finding that this is a misunderstood aspect of the IEP process, particularly here in Massachusetts. This is in some ways because our state IEP was not designed with transition planning or student-centered planning at the foundation. Currently, when you read an IEP from Massachusetts, there is only one section of the IEP used for describing the Vision Statement for the student. For students under the age of 14, this section is typically used to describe what the parents and team hope and dream for the student over the next 1-to-5-year period. But then, no later than when the student turns 14, we use the same section of the IEP to write out the student’s vision statement for after high school, and that statement legally needs to reflect the student’s preferences and interests and the student’s desired outcomes (i.e., postsecondary goals) for adult independent living and community engagement, work, and learning or training environments. For reference, this is the language currently in the Massachusetts IEP.

This shift is confusing! Parents are used to coming to IEP meetings ready to share their visions for their children, and students are often unprepared to share their goals for life after high school. But this shift is also absolutely critical for ensuring that students receive appropriate transition services. This is because every student on an IEP is legally entitled to participate in a coordinated set of activities that promotes their movement toward their postsecondary goals (i.e., their vision). These activities can include instruction, related services, community experiences, development of employment and post-school living objectives, and acquisition of daily living skills and functional vocational evaluation.[1] The only way a student can receive appropriate transition services, and an appropriately calibrated and coordinated set of transition activities, is if we clearly identify and define appropriate postsecondary (i.e., post-high school) goals for the student. And, these need to be listed out at the start of the IEP. In Massachusetts, these need to be listed in the vision statement.

Nevertheless, once we have done the important work of defining the student’s postsecondary goals or vision (which always involves transition assessment), then we have more important work to do. We have to make sure that the IEP that is developed includes necessary annual IEP goals, and related services, that will effectively support the student in making progress toward their postsecondary goals. We need to carefully crosswalk between each of the postsecondary goals set for the student and the annual goals we are developing. It is vital to make sure that there is at least one annual goal (or objective/benchmark within an annual goal) that addresses each of the student’s measurable postsecondary goals. We are very good at making sure that each of the services a student receives relates to the annual goals a student is working on. But we rarely pay attention to whether each of the student’s measurable postsecondary goals (i.e., each of the goals listed in the student’s vision statements) is supported by an annual goal. Annual goals for transition-aged students need to be determined from two sources: the student’s disability-related needs AND the student’s measurable postsecondary goals. Annual goals and coursework for a student with autism and language-based issues should be different depending on whether the student intends to be an artist or a veterinarian technician. Goals should be different for a student who intends to be a licensed driver and a student who intends to use door-to-door van transportation. In all cases, the team needs to annually discuss what skills the student needs to build this year in order to be able to attain their postsecondary goals in the future. The team needs to make sure that each postsecondary goal that the student has is supported by the student’s annual goals. If this is not explicitly discussed at the team meeting, we are not effectively planning for the student—and we are not effectively supporting students in being able to plan for themselves.

For more information about postsecondary goals and annual IEP goals in Massachusetts, check out Technical Assistance Advisory SPED 2013-1: Postsecondary Goals and Annual IEP Goals in the Transition Planning Process from MA DESE: http://www.doe.mass.edu/sped/advisories/13_1ta.html

 

[1] https://sites.ed.gov/idea/regs/b/a/300.43

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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

Managing Stress while Navigating the Initial IEP Referral Process

By | NESCA Notes 2022

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

The special education process is naturally stressful, particularly when submitting a first request for eligibility. It is difficult to watch your child struggle in school, and while the IEP process may bring hope for things improving, there are complex procedures and timelines, as well as feelings of anxiety and uncertainty, that must first be navigated. Luckily, there are some things that families can do to help manage the stress that comes with the IEP eligibility process:

  • Acknowledge from the onset that the process will be stressful and that stress is okay. Stress is telling you that something is important and requires your attention. Try to accept stress as part of the process and use that to help prepare yourself.
  • Build a team. Allow yourself to just be the caregiver, and find professionals who can take on other duties. This may include hiring an educational advocate or attorney who can help you understand special education laws as well as advocate for your child’s needs at meetings. This may also include seeking a private evaluation to obtain an expert opinion on your child’s needs and inviting this individual to participate in the meeting. The goal is to divide responsibilities, focus on your child, and speak to your concerns as the caregiver.
  • If you had an evaluation and are working through a new diagnosis, take in information at a pace that you can handle. Ask your evaluator for clarifying information when needed, and try to reduce your Googling and online research. Do not get yourself stuck in a rabbit hole of online information that may or may not pertain to your child. If you feel uncertain about things, use your team and ask questions.
  • Maintain effective communication with your IEP team. Know your goal for each meeting and plan your input ahead of time. Be concise but include observations or history to support your point, and state your specific goals for each meeting.
  • Manage your expectations. Concerns and requests may not be entirely resolved within one meeting, and there may be many steps you have to go through before a plan is in place.
  • For children who “fly under the radar” at school, take some basic notes of what you observe at home, such as difficulty with homework, “meltdowns” after school, etc., which you can share with the team. That said, only take these notes for a manageable time frame (e.g., two weeks), allowing you to maintain your sanity.
  • Lastly, engage in self-care. While this may sound cliché, it is indeed important to take time to yourself and do activities that bring you some peace and enjoyment while navigating through these stressful procedures.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Neuropsychological Evaluation Results: What, When and How to Share with Children and Teens

By | NESCA Notes 2022

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

During intake and feedback meetings with families, I find the same question comes up often from parents: what do I tell my child about all of this? NESCA’s Dr. Erin Gibbons gracefully tackled how to prepare your child for their neuropsychological evaluation. After an evaluation is done, you as a parent now have more than 20 pages of historical information, test descriptions, tables, summaries, and recommendations. How do you translate that information into something a child or teen will actually understand? It does not need to be a secret code or a hidden message. Feedback about a child’s strengths and weakness can be an incredibly powerful intervention.

Let’s take a page from Carol Dweck’s work and use a growth mindset to frame the experience. A growth mindset tells us that skills can be learned and neural connections can be strengthened. I advise parents to tell children and teens that testing is a chance for a “healthy check-up” for our brain and our learning, just the same way that the pediatrician performs a yearly healthy check-up for our bodies. The same way that a doctor pays attention to how all of our systems grow and interact with each other, a neuropsychologist can see how a child or teen is growing and how parts of the brain can talk to each other. I shape the dialogue right away that this kind of evaluation can tell us how strong some of the parts of our learning are, like a super strong muscle that has been exercised and practiced with gusto. The evaluation can also tell us what muscles or parts of our learning are a little weaker and need some more “exercise.” Pulling in a growth mindset, we can set the frame that any weakness can be made stronger if we have the right types of exercise, the right amount of practice, the right coaches, and a willingness to work hard. Most children and teens are pretty savvy and can often predict what their weak muscles are (e.g., “math is so hard!”; “I can’t spell!”; or “I can’t pay attention in school and I’m always in trouble for getting out of my seat!”).

Now, back to those 20-plus pages of dense text. It’s rarely helpful for a child or teen to read each page. There are parts of the normal curve, standard scores, confidence intervals, on and on that children and teens have not even learned yet! Those scores are an incredibly important source of information for schools, pediatricians, psychiatrists, therapists, and other neuropsychologists. They are not nearly as helpful when sharing information with children and teens, so do not stress about trying to translate it for kids. It is also not as helpful to have this conversation with your children when you are late for a meeting or they cannot find a soccer cleat on the way to practice. Plan your conversation for a time when your stress level is low as a parent and your child or teen is also more relaxed.

Your neuropsychologist can help you in your personal feedback meeting to identify a few important strengths to share with your child or teen – from your child’s positive attitude, to their strong decoding of new words, to their memory for things they see, to their ability to make and keep friends. With a sense of confidence about their strengths, I share what the “weaker muscle” is using language like, “I can see that word problems can be harder for you,” or “Keeping your anxious thoughts quiet when you are at school so you can concentrate on schoolwork is really hard.” Most of the time, children and teens find this validating rather than shaming – finally someone sees that their struggle is not their fault, not because their brain is wrong or bad, not because they are not trying hard enough. They just need more of the right kind of practice.

Knowing their strengths and their weaknesses, it is much easier to shape the game plan for the future. I tell children and teens that the good news is that we know what strategies can help make that weaker area even stronger. So choose your metaphor: coaches have different plays or practices, music teachers have different pieces for someone to play, artists can try out a new medium or set of supplies, or gamers practice different strategies and read tips and tricks from other gamers. By choosing a relatable experience for your child or teen in that moment, we can make the information both relevant and accessible. Your neuropsychologist can speak with you about how you as a parent can share this information with your child, or they can arrange a time to share the information directly from neuropsychologist to client. It is helpful for you to listen, too, so you can hear the language used by the neuropsychologist. Be prepared that these meetings are not very long to suit a child or teen’s attention span. Children and teens need time to process the information the same way adults do. You might expect a child to return to you a few days later with questions, or for the topic to more organically arise when your teen faces a challenge. Feedback is a unique chance for your child to feel validated, encouraged, and empowered!

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit 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.

Avoiding Burn-out

By | NESCA Notes 2022

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

We have hit our third calendar year of COVID. It’s season 3 of this drama series during our Junior Year of COVID. As my colleagues in front line health care discuss ways to avoid burn-out in this lengthy experience, it’s inspired me to think of ways for our kids and teens to avoid burn-out. Typically, we define burn-out as a stage of chronic and overwhelming stress in the workplace. It is the full time job of our children and teens to attend school. So what do we do to support our children who may themselves be experiencing signs of burn-out?

First, let’s understand some signs of burn-out, including:

  • A sense of fatigue or low energy to engage with school or personal activities
  • A sense of “distance” from school, which can include statements such as, “I don’t care,” or withdrawal from activities
  • Negative feelings about school or academic achievement, which can sometimes look like irritability and hatred of school
  • Doubts that school is “worth it” or a sense that what is learned in school is never applicable to real life
  • Reduced efficiency so that tasks take far longer than usual

Given the constant stress of close contact notifications, masking requirements, fears of infection, and disappointment about canceled activities (to name a few), it is not surprising that kids may feel this sense of burn-out. Let’s consider 5 tips to support children and teens with a sense of burn out:

  1. Give it a name. It might feel like a relief to recognize and label the experience for children and teens. Giving the experience the name of “burn-out” can provide some distance from the problem, rather than feeling consumed by it.
  2. Practice mindfulness. It can be easy to get caught up considering the “before-COVID” good old days. It can also be hard to imagine the uncertain future and when one might get to the other side. Practice focusing on this moment of this day. Encourage children to notice any physical signs of stress in their bodies. These moments can pass as the sensation is not permanent. Using meditation and deep breathing can help children to stay rooted in the present moment.
  3. Manage the calendar. It is easy to feel overwhelmed by due dates, projects, and additional activities. As a parent, this may mean that you will have to take over as the “gate keeper” of the calendar. Help to prioritize the necessary and eliminate what is not needed. Protect personal time carefully so that school tasks do not consume all areas of the weekend.
  4. Practice self-care. Self-care can look different for everyone – from vigorous physical activity for one teen to a day of relaxation for another. Encourage discussion about what your child might need and consider ways to change up the ordinary. For example, consider assigning a “home spa day” of relaxation or a warm bath. Consider outside activities for the active child who needs to run or exercise to feel good. Sleep, exercise, and good nutrition are critical ways to care for our bodies when facing chronic stress.
  5. Leave room for the fun. When school feels boring or challenging for children, it can be hard to motivate children and remain committed. Work with your child to identify a staff member or friend who they look forward to seeing. Consider an after-school activity that sparks joy so there is something to look forward to at the end of the day.

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit 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.

Boredom: The Good, the Bad, and the Ugly

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

According to the APA Dictionary of Psychology, boredom is defined as:

A state of weariness or ennui resulting from a lack of engagement with stimuli in the environment. It is generally considered to be one of the least desirable conditions of daily life and is often identified by individuals as a cause of feeling depressed. It can be seen as the opposite of interest and surprise

In an APA podcast called Speaking of Psychology, Erin Westgate, PhD, a psychologist who studies boredom, suggests that boredom is an unpleasant emotion similar to anger, sadness, fear, and pain. In her efforts to understand and define boredom, Dr. Westgate explored the ways in which attention and meaning affect emotions and explain boredom. She opines that boredom may result from one’s inability to sustain attention, which may occur either when a task is too easy or too hard. It may help to understand why students describe a less preferred subject (e.g., math) as boring. Boredom may also be due to a sense that what we are doing lacks meaning. In both instances, the mind wanders and we are faced with that sense of being alone with our thoughts. Dr. Westgate notes that some thoughts are more engaging than others, and there are certain conditions under which people enjoy or do not enjoy their own thoughts. It has become increasingly difficult for people to sit and think, and consequently they search for ways to escape or avoid the boredom that results. However, boredom is not all bad. Like many things in life, it depends on how we manage it.

Similar to other negative emotions, boredom alerts us that something is wrong in our body, and it is human nature to want to escape or avoid it. When escape and avoidance become the only method to cope with boredom, individuals may begin experiencing chronic boredom, which can be detrimental to emotional and physical wellbeing. When boredom becomes chronic, it no longer works as a useful signal. Boredom can be more impactful than loneliness and is often mistaken for loneliness. When boredom is not well managed, it can lead to depression and self-destructive behaviors, such as self-harm and addiction. As alluded to above, the ability to sit with our thoughts and feelings without trying to avoid or escape them has become increasingly difficult. Perhaps related to the ease with which they can be avoided; for example, when our body sends out the first signal of discomfort, we can distract ourselves by reaching for our phone. An article in TIME magazine stated:

We’re trying to swipe and scroll the boredom away, but in doing that, we’re actually making ourselves more prone to boredom, because every time we get our phone out we’re not allowing our mind to wander and to solve our own boredom problems, Mann says, adding that people can become addicted to the constant dopamine hit of new and novel content that phones provide. Our tolerance for boredom just changes completely, and we need more and more to stop being bored.

Relying on electronics is only one example of a way to avoid and escape the discomfort of boredom. It is highly reinforcing because, in the short-term, it works. However, when it is one’s only tool in the toolbox, it may quickly undermine their ability for learning to manage uncomfortable thoughts and feelings and use them for creating positive change. Therefore, it is necessary to find a positive, opposite behavior to replace the maladaptive behavior. This often leads to an increased sense of purpose and agency, and improved self-esteem and self-concept.

Children and adolescents often complain about being bored, and while boredom is uncomfortable, it can also help to develop skills, creativity, and boost self-esteem. Once boredom sets in, it can be difficult for children to shift their attention to find meaning when confronted with the discomfort of boredom. According to an article published by the Child Mind Institute, boredom can be a great way to teach children how to manage frustration and regulate emotions when things are boring or not going their way. It is not that boredom teaches the skills, but rather it is what they do when faced with boredom. There are many strategies outlined in the article to help parents nurture skills when their children are bored. In general, be aware that behaviors may be attention-seeking, and therefore, should not be reinforced. Otherwise, boredom offers an opportunity for children to do something meaningful that benefits them and those around them. When properly managed, it spurs creativity and innovation. Along the way, it is important to be realistic and recognize that there will be failure, and learning to manage the discomfort of failure is an added bonus.

 

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.

 

Assessing Work Motivation and Values

By | NESCA Notes 2021

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

Over the past few months, my colleague Tabitha Monahan and I have dedicated several of our blog entries to vocational assessment as a critical tool for helping students learn about employment and set career goals for themselves. Previous blogs have provided an overview of vocational assessment as well as an in depth look at career interest inventories, vocational aptitude testing, and real-life experiences, such as informational interviews and job shadows. However, there is another type of vocational assessment that we have not yet discussed that can be an invaluable tool for helping students to learn about their “vocational selves” and ultimately choosing occupations that are a good fit—a work motivation or work value assessment.

Work motivations or values are the qualities, principles, or standards that really matter to a person as a worker. Essentially, if you are going to get out of bed every day and go to a job, what are the characteristics that your job needs to have in order for you to feel that going to work is worthwhile? Certainly, money can be an important characteristic of a job, but is that more important to you than helping others, creativity, or recognition? Each of us has a different set of values that will drive us to make choices and take action in our lives, and having an occupation that satisfies those values is just as important as having a job that aligns with our interests and skills.

Similar to career interest inventories, work motivation and value assessments come in many shapes and sizes, some formal (e.g., lengthy and standardized) and some informal (e.g., short checklists or rating scales). Also, similar to career interest inventories, it can be helpful to administer or self-administer more than one of these assessment tools to get a sense of how clear one’s work motivations and values are (i.e., how often an individual responds to assessments with a similar pattern of expressed values). Additionally, it is recommended that students not just take assessments, but that educators and career counselors engage students in qualitative conversations about their results so that students have the opportunity to clarify their values as well as more quantitative exercises, such as comparing work values with career interests.

While there are many different work motivation and value classification systems, I’m choosing to highlight the four work motive categories and eight value constructs from one of my favorite assessment tools, the Work Motivation Scale below.

Fulfillment Motives: The need for work that provides the individual with opportunities to reach their maximum potential. Creativity, curiosity, foresight, and competence are attributes that are often observed in individuals with high fulfillment motives. Fulfillment motives are comprised of the following work value constructs:

  • Success Orientation: Individuals scoring high on this construct are motivated toward accomplishing career goals and reaching their full potential through their work. Passionate about their work, they are willing to endure periods of hardship to be successful.
  • Mission Orientation: Individuals scoring high on this construct are oriented toward seeing the big picture and tend to be less concerned with details. Goal directed, they recognize how their current work fits into and contributes to the overall direction of the organization.

Self-Esteem Motives: The need for achievement, responsibility, and challenging and meaningful work tasks. Links between leadership and achievement are usually present for individuals with high self-esteem motives. Self-esteem motives are comprised of the following work value constructs:

  • Managing Others: Individuals scoring high on this construct value opportunities to direct and supervise the work of others. They willingly take responsibility for worker  performance and the productivity of a work unit, department, or work function.
  • Task Orientation: Individuals scoring high on this construct are oriented toward completing tasks. Planning their work, making the most of resources, and maintaining their focus are important to them. They may hesitate to perform functions outside of those tied to a specific job description.

Affiliation Motives: The need for the acceptance and support of coworkers and supervisors. Cooperation and collaboration toward meeting work goals are sought by individuals with high affiliation motives. Affiliation motives are comprised of the following work value constructs:

  • Supervisor Relations: Individuals scoring high on this construct feel that cooperating with and relating to their supervisor are important. They strive to meet their supervisor’s expectations and highly appreciate their supervisor’s recognition and support.
  • Coworker Relations: Individuals scoring high on this construct feel that relating to peers is important. They prefer to be actively involved in employee related organizations at work and outside of work. They highly value collaboration and teamwork.

Survival and Safety Motives: The need for employment with an adequate livable wage and a safe and secure work environment. The need for favorable benefits packages is also valued by individuals with high survival and safety motives. Survival and safety motives are comprised of the following work value constructs:

  • Working Conditions: Individuals scoring high on this construct believe that a good work environment and creature comforts (climate control, privacy, adequate lighting) are important. They value having the materials, equipment, and resources to do their work effectively and efficiently.
  • Earnings and Benefits: Individuals scoring high on this construct value salary, raises, health insurance plans, pensions, and retirement planning. Vacation, sick leave, personal days, and family leave policy are important considerations in their employment choices as well.

Definitions provided by/taken from the Work Motivation Scale Administrator’s Guide.

Understanding which of these constructs and categories matter most to a student, and a student understanding this about themselves, can have a huge impact on helping a young person to find fulfilling work.

To read more about vocational assessment, check out the following blog entries:

For more information about vocation assessment and transition assessment at NESCA, visit our transition services page and our transition FAQs.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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