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

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

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2

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.

4

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.

10

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.

10

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.

 

36

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.

1

How to Tame Holiday Stress

By | NESCA Notes 2021

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

The holidays are supposed to bring joy, but they also bring a lot of pressure, expectations, and stress. Planning and preparing can take months, and balancing this planning with school events, holiday parties, and our every day demands can be a lot to handle. That said, there are some basic things that we can to do manage holiday stress and focus on the things that matter most, including the following:

Identify and prioritize your values. Reflect and decide ahead of time what is most important to you this holiday season. Whether it is being with family, following through with traditions, giving back to others, or something else, knowing what you care most about will help you know where to put your time and energy.

Simplify where you can. Once you know your priorities, cut out things that are not in line with these. We tend to go a bit above and beyond at the holidays, and we often find ourselves doing things just because we always have done so, not because we want to. Invest your time where it matters most. This year, I cut out holiday cards. While cute, they are time consuming and the majority likely go straight to the trash. Creating cute waste is not my priority. Sorry, grandparents – maybe next year.

Take focus off of gift giving as much as possible. Overindulgent gift giving is not only financially burdensome and time consuming, but it is also likely not in line with your intrinsic holiday values. Streamline your gift giving where able. For example, adults draw names instead of buying for everyone, set a limit for the number of gifts per person, or buy group gifts and experiences. In our house, when buying for the kids, we try to stick with: one thing you want, one thing you need, one thing to wear, and one thing to read. Sometimes we stray a bit, but it helps keep our priorities focused and manage the children’s expectations.

Communicate expectations. Tell your family or friends what they can expect from you this holiday season. This should include talking with your children about how your family will celebrate the holidays, and how it may be different from what others do. If you know you’ll be invited to three holiday dinners, or if someone may expect your visit to be longer than you desire, get ahead of it and tell them your anticipated schedule and plans.

Pick your battles. The holidays are overwhelming for everyone, including children. They may try to manage their stress by exerting control, including pushing back against holiday traditions or expectations. Before asking things of them, remind yourself of your priorities and values. If you don’t really care whether your child wears slacks versus sweatpants during Christmas dinner, don’t pick that battle.

Provide familiarity. To help manage the uncertainty and stimulation of holiday festivities, do what you can to provide children with some familiarity, such as having some preferred foods in the dinner buffet or giving them a designated break away from the chaos to play alone without the pressure to socialize.

In sum, holiday stress is a given, but identifying your holiday values and priorities will allow you to make decisions and create expectations that will help mitigate some of this stress and allow you and your family to enjoy the season.

 

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.

37

Vocational Aptitude Testing

By | NESCA Notes 2021

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

Over the past month, my colleague Tabitha Monahan and I have been dedicating 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 and real-life experiences, such as informational interviews and job shadows. Many of these tools provide opportunities for students to learn more about the world of work and types of jobs that match with their interests and things that they know they like. Today, I am going to share information about a different type of assessment, vocational aptitude testing.

It is not uncommon for middle and high school students to have job aspirations that do not fully align with their physical and cognitive strengths or even their general preferences for daily work (e.g., being seated, indoors, casually dressed, etc.). When you have had very little exposure to employment and you spend most of your time in a structured educational environment, it is hard to picture yourself as a worker and fully appreciate the skills, knowledge, education, abilities, and experience needed for a particular job. Vocational aptitude testing is formal testing of a set of abilities known to impact an individual’s potential for success and satisfaction in a variety of occupations.

Similar to intelligence or cognitive assessment tools, vocational aptitude tests vary in format, activities, and the defined abilities or factors that are tested. For instance, at NESCA three of the most common vocational aptitude tests we use are quite different from one another—an online computer-based assessment tool that is designed for self-administration, a paper-based assessment tool that is formally administered in an office or classroom with both a test booklet and scantron answer sheets, and a functional hands-on set of performance activities that simulate actual work activities (e.g., sorting mail by zip code, alphabetizing post cards, assembling pipes, tightening screws, etc.). However, most vocational aptitude tests include tests designed to evaluate the following aptitude factors (i.e., abilities):

Verbal Aptitude – The ability to understand and use words effectively, to comprehend verbal concepts and language, and to express ideas clearly in words. People who score highly generally do well in school, particularly in subjects where verbal concepts are important.

Numerical Aptitude – The ability to do arithmetic and other numerical computations quickly and accurately. People who score highly on this aptitude may do well in such school subjects as math and physics.

Spatial Aptitude – The ability to visualize two-dimensional objects in three-dimensional space, and to mentally manipulate objects through different spatial orientations. People who get high scores have the aptitude to perform well in school subjects and work involving drafting, art, architecture, clothes designing, and so on.

Perceptual Aptitude – The ability to compare and discriminate words, numbers, symbols, or other graphic material to see if slight differences exist between them. People who score highly in this area should do well in proofreading, copyediting, and nonverbal tasks that require attention to detail and rapid visual discriminations.

Manual Dexterity – The ability to coordinate eye and hand movements and perform manual tasks rapidly and accurately. High scores indicate the ability to manipulate tools and objects with speed and precision.

General Ability – The ability to learn and achieve in training or academic situations. People who get high scores “catch on” quickly in new situations, and are proficient in making judgments and in grasping underlying principles and solving problems. (This is often computed through summing or averaging an individual’s verbal and numerical aptitudes.)

Definitions provided by/taken from the Occupational Aptitude Survey and Interest Schedule Aptitude Survey (OASIS-3: AS) Examiner’s Manual.

If a student has participated in other kinds of standardized testing over time, especially intelligence testing and occupational therapy testing, it is likely that quite a bit of information is already known regarding the students’ aptitudes for employment. However, there are many vocational aptitude tests that are bundled with interest inventory tests, enabling a quick and clear comparison of the student’s vocational aptitudes and interests. For example, the OASIS-3 Aptitude Survey mentioned above is part of a testing kit that includes the OASIS-3 Interest Schedule and an Interpretation Workbook for easily comparing jobs within a student’s interest areas with their current career abilities.

Career aptitude testing can give a student a clear sense of their relative strengths and areas of challenge as well as a sense of how their current abilities compare with the abilities required for jobs of interest. However, it is important to caution that career aptitude testing does not predict the kind of work that a student should do. Results of career aptitude testing may differ considerably based on many factors, including new learning and work experiences. Results of testing should change as a student gains education and work exposure and can certainly be used to help us understand what skills might need remediation for a student to have a better chance of participating in certain kinds of employment.

One final thought regarding career aptitude testing is that while it can sometimes be an option to administer standardized testing with accommodations, I would encourage only providing accommodations that would reasonably be provided on a work site. For example, offering a student who has comprehension or processing speed difficulties the opportunity to take aptitude testing with unlimited time may not help the student to get a sense of how their aptitudes truly match up with the demands of a particular job. The reality is that most employers are not able to give employees unlimited time to do their jobs. Using text-to-speech during computer-based administration of a test may be far more relevant as long as test results are interpreted with the need for this accommodation in mind.

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.

9

When the Honeymoon Period Is Over: Signs of School Refusal

By | NESCA Notes 2021

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

As we reach the end of our second month back to school, many of us may be reaching the end of that glorious honeymoon period – the phase when kids are excited to see friends, optimistic for the school year, and reviewing material they likely already know. For some, the return did not start this rosy; the bloom is falling off the rose and kids are getting tired. You and your child are not alone in this. My goal for today’s blog is to share with you some warning signs that your child may be struggling and ways to get support before they grow to become bigger problems. The biggest problem I want to avoid: school refusal.

Have you heard this yet? – “My tummy hurts. I have to stay home.” Or, “I hate school. Please don’t make me go.” Or, “I’m not going!” Or perhaps these messages are communicated more subtly with covers over their heads in the morning, difficulty getting out the door on time, tantrums or disruptive behaviors in the mornings, missed buses, or the overwhelming frustration of homework that erupts into nightly battles. According to researcher Christopher Kearney, these are signs to pay attention to as they can evolve into what he terms “school refusal behavior.” School refusal is an umbrella term used to describe behaviors that interfere with a child being in school for their expected and scheduled time. This is a problem that can impact anywhere between 28-35% of students! While there are the more extreme cases for children or teens who are out of school for months at a time, my purpose here is to address the smaller, but more likely, problems. When we address smaller problems, we can keep them small.

Risky signs that your child is struggling with school:

  • Consistent statements of hating school, their teacher, or specific peers. A casual mention of a bad day is not cause for alarm. We all have bad days. If the statements keep coming and they get louder and stronger, then parents should pay attention.
  • The outward behaviors are getting bigger in the mornings before school or over homework. Behavior is a way for children to communicate with us how they are feeling. So, explosions over homework or tantrums in the morning that lead to tardiness are warning signs. The occasional homework meltdown or rushed morning is normal; we are all human! But, the problem is in the pattern.
  • Avoidance rears its ugly head. While some kids show on the outside that they are uncomfortable through their explosions, others communicate very clearly through their withdrawal. Some kids and teens struggle to get out of bed, are constantly tired, not completing work, falling asleep in class, or sharing every somatic complaint or symptom available on Google. If medical causes are ruled out, anxiety can be a culprit.
  • Consider the role of a major transition. According to Kearney, the riskiest time for a child to develop a pattern of school refusal is during times of significant transition – like starting kindergarten or changing schools from middle to high school. In addition to the social and emotional jump that these transitions bring, there is also a massive leap in demands for academic independence. It is very common for kids to struggle with the leap initially.

Oh no. So now what?

  • First and foremost, keep calm. It is far easier to keep small problems small when we have a clear-headed approach. Pull in anxiety management techniques like deep breathing, sleep, and exercise to support your own anxiety as a parent.
  • Reach out to your child’s teacher or school psychologist. Let them know your child is struggling with homework or coming to school. This is a great chance to gather information on what is going on in your child’s day and put your child on their teacher’s radar. This is critical as the only effective approach to remedy a problem with school refusal is a team approach.
  • Talk to your child honestly about what is going on. This has to include a chance for kids to talk about what might be happening to make them feel stressed or why they dislike school. Don’t shortcut this step. If your child has trouble explaining what is going on (which can be especially true for younger kids), try this approach: you and your child are both going to be detectives to learn together what is making school feel hard. We can’t solve a problem until we understand it. By joining with your child in gathering information, you are demonstrating great empathy and validating that their feelings are real.
  • Be careful of your language and conversation about school. It can be tempting to go too far in validating a child to give the message that the assignment really is stupid or their teacher really is unreasonable and mean. It’s best to stick to the feeling (“that must feel so frustrating”) without reinforcing negative messages about school.
  • Hold the line. As you gather more information, it is really important to maintain the message that it is your child’s job to go to school. It might feel conflicting to both validate the feelings of hating school and give the message to attend school. It might feel something like this: It’s either “I love and support my child OR I’m going to force them to go to school even when it’s hard.” Let’s change that OR to AND. Reframe the thought to: “I love and support my child AND they have to go to school AND they can do hard things.”

For more information, please check out:

Kearney, C.A. (2007). Getting your child to say “yes” to school: A guide for parents of youth with school refusal behavior. New York: Oxford University Press.

 

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.

5

Meet NESCA Pediatric & Adult Neuropsychologist Miranda Milana, Psy.D.

By | NESCA Notes 2021

By: Jane Hauser
Director of Marketing & Outreach

This September, NESCA welcomed a new neuropsychologist to its team. Learn more about Pediatric & Adult Neuropsychologist Miranda Milana, Psy.D., in my interview with her below.

Where did your interest in neuropsychology come from?

I knew from an early age that I wanted to work with children. I initially thought I would work with children in the medical field, but I ended up being fascinated by child psychology, which led to my focus on the clinical aspect of therapy with kids and their families.

I then started to notice the importance of neuropsychological reports in schools, treatment planning, formulating diagnoses and determining the tools needed to help kids be successful. I knew I wanted to do that! I saw my fair share of unhelpful reports and wanted to take the opportunity to write truly beneficial ones.

Over time, I’ve gotten to work with families and have been able to offer evaluations to the adults as well as young adults.

Who do you evaluate??

I really enjoy working with all kids, but have a particular intertest in early elementary-aged kids – toddlers through early elementary schoolers. I love to get to know kids whose parents, caregivers or educators are questioning whether they may have an autism spectrum disorder (ASD) or some kind of learning challenge. It’s exciting to start to work with a child as they are entering school and continue to watch them progress throughout their education.

Additionally, I have a particular interest in working with older adolescents and adults who feel there may be a “missing piece” in their understanding of themselves, or who seek greater insight into their personal profile to inform appropriate therapies, access relevant services, and enhance self-awareness.

Tell me about your clinical experience prior to joining NESCA.

Before coming to NESCA, I was a post-doctoral fellow at Boston Children’s Hospital, which provided me with great exposure to a wide variety of kids and the challenges they were experiencing. My case load there exposed me to a vast range of educational and developmental concerns and presentations. Working with children aged 2 through 17 who showed a wide-ranging array of presentations really helped me to become a flexible thinker.

It was a great opportunity to work with all types of clinicians, families and children. Also, having such a diverse case load afforded me the opportunity to become part of so many teams within the hospital, including the Down Syndrome, Adoption and Teenager teams, among others. It was rewarding to be able to learn from each one of them.

What drew you to NESCA?

I wanted to continue to work in a collaborative environment, where it wasn’t just me contributing to a child’s evaluation and plan. I really wanted to learn and collaborate with a team of psychologists and other providers in a group practice, outside of the hospital setting. Being part of a child’s trajectory in school is exciting, and NESCA allows me to do just that!

Joining NESCA also allows me to work with a more diverse group of individuals based on age. While I love working with children and adolescents, I also welcome the opportunity to work with more adults, parents, or young adults who are trying to secure adult services and supports.

What are some of the more rewarding experiences you’ve had as a neuropsychologist?

Getting kids who are closed off to share their experiences with me is very rewarding. With these kids, we have to be creative in how we approach them, get them to share and play. Having anxious, resistant children feel comfortable opening up to me in conversation or who allow themselves to be vulnerable by sharing personal information, is such a rewarding part of what I do. To know you have built that kind of trust with a child is so fulfilling.

Working with adults has also been rewarding, as it allows me to provide meaningful insights and answers to individuals who have often spent years seeking clarity without success.

What’s your secret sauce in building that trust with a child who is anxious or resistant?

I am kind of a kid at heart, so I use that in testing children to engage them and create a more fun environment. I take pride in getting to know a child beyond the test scores and collected data. Finding common ground and relating to them is so important. I also like to make sure they know I am part of their team who will support them as they move forward in school and in life. It’s a personal challenge to me to get the most resistant kids to engage and maybe even crack a smile during the evaluation!

 

About Miranda Milana, Psy.D.

Dr. Miranda Milana provides comprehensive evaluation services for children, adolescents, and adults with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a individual’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a person’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

 

To book an evaluation with Pediatric Neuropsychologist Dr. Milana or one of our many other expert neuropsychologists or therapists, 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.

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