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46

Why is it so hard to develop Executive Function skills for college as a high school student?

By | NESCA Notes 2024

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

Students with disabilities often have challenges with executive function skills. These may include difficulties with organization, planning and prioritization, time management, task initiation, attention and effort, working memory, self-regulation, self-monitoring, and mental flexibility. Being successful as a college student often depends on using and integrating these skills. Therefore, it’s no surprise that most of the IEPs I read when working with teenage and young adult students have goals or objectives aimed at remediating executive function (EF) skills. However, many students on IEPs have these “EF” goals for years and still don’t effectively develop the skills they need to successfully manage executive functioning tasks as college students.

One of the reasons for the remaining skill gap when students matriculate to college is because high school student responsibilities are pretty radically different from college student responsibilities. While research indicates that individuals can continue developing executive function skills throughout the lifespan, this requires a very particular set of activities. Executive function skills develop through a combination of direct instruction and opportunities to practice using the learned skills with and without support. But there often are not opportunities for practicing the skills needed for college as a high school student.

Below is a list of executive function supports that exist in high school, but often disappear in college:

  • Classes are small and always taught by teachers
  • Class material is centralized in books or on the board in the classroom
  • Time is structured by the school
  • Students are told what they need to learn from homework
  • Students are reminded of assignments and due dates
  • Completed homework is checked by teachers
  • Reading is discussed in classes
  • Studying is limited to a few hours per week
  • Testing is frequent and covers small amounts of material
  • Teachers approach students who need help
  • Schools are required to find students with disabilities who need specialized instruction and accommodations
  • Parents and teachers will remind students of their responsibilities
  • Parents and teachers will help to set priorities (or simply set them for the student)
  • Parents and teachers will correct students when behavior is unexpected

In college, students may have large classes taught by other students or experts in their fields who aren’t experts on teaching. They have to use syllabi, manage their own schedules (with large swaths of unscheduled time), integrate academic materials from a wide range of sources, and self-direct long hours of reading and studying. They also have to be responsible for advocating for themselves, knowing when they need help, and knowing what they are responsible for (academically, socially, and in their dorms) and getting those things done without parent and teacher reminders. For students who have strengths with executive functioning, often the transition to college still presents a steep learning curve. But for those who have vulnerabilities in these areas, it can be critical to recognize that the gaps are large between these two learning environments, and sometimes additional support and instruction is necessary while students are taking college classes. Some students will still need to build effective academic and executive function skills, and practice and master those executive function skills, while they are in college and managing this new set of demands.

NESCA offers many services designed to help students bridge the transition from high school to college, including executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our coaching services, visit: https://nesca-newton.com/coaching-services/ . To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/ .

Reference:

Many of the bulleted items of executive function supports that exist in high school are adapted from this high school versus college comparison by King’s College: https://www.kings.edu/admissions/high_school_vs_college

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

To schedule an appointment with one of NESCA’s transition specialists, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

9

Sibling Stress: How to Support the Siblings of a Child with Emotional Needs

By | NESCA Notes 2024

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

A child with significant mental health or developmental needs impacts the whole family system. The impact is multifaceted – from the way that a child interacts in the home environment to the challenging logistics of coordinating outpatient care and appointments. Families have to make sacrifices with their time, attention, and financial resources to address the mental health needs of one (and sometimes more than one) child. Families may also arrange schedules, including planning vacations or social events, for the family in order to accommodate treatment. It can add more stress when parents stop to consider: how is this impacting the other kids in the family?

To buffer siblings against negative impacts from being in the home with someone struggling with mental health:

  • Create an environment of safety and predictability. Talk in a family meeting about basic safety needs for the household – things like being safe with your body, being safe with property, and maintaining basic travel safety (e.g., staying buckled in the car). It is important that all siblings hear the rules and the consequences for violating the rules. If there is an episode of dysregulation, it can be very helpful to return to this conversation again.
  • Create a plan for when there is dysregulation. Remind your child/children without mental health concerns that the job of the parent is to re-establish safety, and where your other child/children should go while you address a problem. This can be their bedroom, basement playroom, or other identified place in the home. Take a moment to identify Plan B for where the safe place is if the dysregulation is happening in a common space. Talk to your child about what activities may distract and distance them from the commotion.
  • Remind your child what adults are available for them. If you are in a two-parent household, one parent can address dysregulation, and the other can stay with the sibling(s). If you are in a one-parent household (or a partner is not home), remind your child that they can call the other parent, aunt, uncle, grandparent, or identified friend or neighbor if they need some reassurance.
  • Put on your “oxygen mask” first. After an incident of dysregulation, check in with yourself as a parent to regulate emotionally before approaching your other child/children. Take a few moments for deep breaths or progressive muscle relaxation to calm your own nervous system. Once you are re-regulated, your message that safety has been re-established will be more soothing and believable.
  • Set aside time in each day to connect with each child. The focus can often be on positive connection with the child struggling. But, all children need the positive connection, praise, and child-driven interactions. This can help ensure that all children receive the attention they need to thrive.
  • Hold the frame. It can be easy to relax the rules with a sibling whose struggles and behavior may seem mild by comparison. It’s important to establish standards that work for each child’s unique skills and needs. It’s worth a candid conversation with each child about what the expectations are and why.
  • Use the village. Establishing a support system is critical to buffer the entire family from the overwhelming stress that can accompany emotional health issues. Enlist the support of other family members, neighbors, teammates’ families, or school personnel. If you feel that your support system is small, start with your child’s pediatrician or school to connect to community resources.
  • Reach out for help. It’s important to closely monitor siblings for signs of increased anxiety, stress response, low mood, or atypical behaviors. If you see classic signs of anxiety (fight/flight/freeze), reach out to your child’s school or pediatrician to evaluate symptoms and initiate treatment.

Additional resources to support siblings:

 

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. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

18

Transition Goals: What are they and why do they matter in the IEP process?

By | NESCA Notes 2024

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

As an evaluator and consultant, I spend a lot of time in team meetings. Usually, I expect to be invited to more of these at the beginning of the school year when teams meet to review assessments or important changes that have occurred during summer months. But May and June are also times when teams cram in meetings, especially for high school students who may be close to exiting public education. Therefore, it seems timely to write my blog on transition goals and their role in the IEP process.

For all students with individualized educational programs (IEPs), teams are accustomed to writing and implementing annual goals. But, for students 16 and older (or students who live in states where transition planning starts earlier such as students 14 and above in Massachusetts), their IEP process also needs to include transition goals. What is confusing about transition goals is that we commonly used this verbiage to describe a few different components of the IEP for transition-aged students.

In my opinion, the most important transition goals, are the measurable postsecondary goals, that are included in the IEP. These describe the outcomes that a team expects for the student to achieve after exiting public education and are based on the student’s own strengths, preferences, interests and vision. Every IEP across the country must include measurable postsecondary goals. In Massachusetts, postsecondary goals are documented in the student’s vision statement at the start of the IEP. For transition-aged students, the vision statement needs to include explicit statements about the outcomes that are expected for the student in transition planning areas. Postsecondary goals for education and/or training as well as employment are required for all students on IEPs, and many students will also have independent living and community participation goals. However, postsecondary goals and transition services are document differently in many states and it is important to familiarize yourself with the location of a student’s postsecondary goals in your own state’s IEP.

Below is a formula for writing a postsecondary goal that is adapted from the National Technical Assistance Center on Transition: The Collaborative (NTACT:C):


Within 2 months of graduation, Joseph will participate in supported employment training and community-based training with assistance from MA Department of Developmental Services. A few examples of measurable postsecondary goals are included below:

  • After earning her diploma, Sarah will attend a four-year college in Massachusetts or New Hampshire (and major in education or child development).
  • After graduation, Tom will work part-time at TJ Maxx with support from his coworkers and supervisor.
  • After high school, Joseph will use public transportation (e.g., subway, bus) to get to and from his apprenticeship.

Unlike annual goals, measurable postsecondary goals are not goals that will be achieved in the calendar year or even while the student is on an IEP. However, there is another type of “transition goal” that is closely related. Once an IEP team has clearly defined a student’s postsecondary goals, they are required to identify transition services that the student will need to make progress toward these goals. When the IEP is developed, the IEP must include annual IEP goals that clearly and directly relate to the student’s postsecondary goals and transition service needs. For example, a student who wants to attend college may need annual goals related to building executive functioning, self-advocacy and college-level academic skills; while a student who wants to use human service supports for community-based employment may need to build communication, self-regulation and work readiness skills. Annual IEP goals should be based on the student’s disability-related needs and also their postsecondary goals—Given the student’s disabilities, what skills does the student need to build this year to be able to attain their postsecondary goals in the future?

Special education is about preparing students for future education, employment, independent living and community engagement. Measurable postsecondary goals are how we make sure that special education is individualized for each student, and transition-related annual IEP goals are how we make sure we are progressing toward the postsecondary goals. When we know what the student wants for their adult postsecondary life, we can use the IEP process to help the student build academic and functional skills that can support the student in achieving that vision.

The next time you look at an IEP, take a look at the vision statement (or the section where your state records measurable postsecondary goals). Can you clearly tell what the student wants to do after high school? Are there both employment and education or training goals included? What about independent living and community engagement? These measurable postsecondary goals are the goalposts that provide direction for the IEP process and ensure that the team is working together to facilitate the student’s progress toward a meaningful adult life.

This link to a presenter’s guide for a presentation on Indicator 13 from NTACT:C is also a great resource for understanding the role of postsecondary goals and annual goals in the IEP process as outlined in IDEA: https://transitionta.org/indicator-13-presenter-guide/

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. However, please note that the IEP will be changing in Massachusetts in Fall 2024 and postsecondary goals will be written on the first page of the document.

 

About the Author:

Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. Since 2013, Ms. Challen has served as Director of Transition Services at NESCA, where she provides an extensive array of services including individualized transition assessment, planning, consultation, pre-college coaching, training, and program development services. She is particularly skilled in providing transition assessment and consultation for students with complex profiles who may not be able to engage easily with traditional and standardized testing tools. Ms. Challen received her Bachelor of Arts in Psychology as well as a Minor in Hispanic Studies from The College of William and Mary. She pursued her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. Ms. Challen has been actively involved in the MA DESE IEP Improvement Project, is a member of the Association of Autism and Neurodiversity (AANE) Program Committee and has mentored multiple transition specialist candidates in the Transition Leadership Certificate Program at UMass Boston. She is also 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: Innovations that Enhance Independence and Learning. She is also the mother of two children and two puggles who continually help with her inventive and flexible thinking!

To schedule an appointment with one of NESCA’s transition specialists, please complete our online intake form.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

14

Why Do So Many Girls Get Diagnosed with ASD Later in Life?

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

In the 15 years that I have been doing neuropsychological evaluations, I have made countless diagnoses of Autism Spectrum Disorder (ASD) in females who are already in high school or even in college. Many times, the diagnosis comes as a surprise to the girls and the families alike, because no one has ever suggested it previously and/or their perceptions are colored by the stereotypes created in the media about autistic individuals. However, a discussion about what ASD is and how it manifests in females as opposed to males usually helps my clients and their families understand the nuanced and comprehensive nature of the ASD diagnosis. They often pivot to feelings of relief and gratitude for having a label for what they have been struggling with for a long time. Many of my clients learn to embrace this new diagnosis and use it as a framework for celebrating their strengths and looking for supports to address their vulnerabilities. They often say, “It totally makes sense!”

Autism Spectrum Disorder is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. When autism was first introduced by Dr. Leo Kanner in 1943, he described children (boys) who showed little interest in other people, insisted on routines, and displayed unusual body movements, like rocking back-and-forth and flapping their hands. Many of the children could talk but they rarely used their speech to communicate with others, and they had a variety of pervasive learning difficulties. For the most part, this continues to be the image that is conjured when people mention autism. However, with advances in research, especially within the last few decades, we have come to recognize the various manifestations of autism in children and adolescents who are higher functioning, have better communication skills, and have fewer learning issues. Thus, the newer conceptualization of autism as a spectrum with a wide range of capabilities and communication skills. More recently, researchers have also discovered that the presentation of autism varies in boys versus girls. This has made the diagnosis of ASD in girls difficult.

In their book Girls Growing Up on the Autism Spectrum, ASD researchers Shana Nichols, Ph.D., Gina Moravcik, MA, CCC-SLP, and Samara Pulver Tetenbaum, MA, outlined some preliminary findings of differences between males and females on the spectrum. They reported that:

  • The play of boys with ASDs is more restricted in range and more repetitive when compared to girls with ASDs who have stronger pretend-play skills.
  • Girls have stronger communication skills.
  • Sex-related social difficulties emerge over time – boys have more impairments early on (thus leading to earlier diagnoses), whereas for girls, the difficulties appear more in early adolescence.
  • Boys are more easily distracted when compared to girls.
  • Girls with mild difficulties may not be included in research samples.

They added that these differences could impact the assessment and diagnosis of ASD. They wondered if girls with ASD are being missed or overlooked during an evaluation because their presentation does not fit how professionals currently characterize ASD based on a male prototype. Other researchers have suggested that girls with ASD may be better able to compensate for symptoms despite having persistent core deficits associated with ASD, which might contribute to greater social “camouflage” or what is called “masking” (an individual hides or suppresses symptoms, behaviors, or difficulties). Indeed, as I have been learning more and working with girls diagnosed with ASD, I have been keeping in mind these potential sex differences. For example, I often compare my client’s social and communicative abilities to what is considered normative for girls their age and cognitive ability. I have been avoiding comparing my female clients with what has been the prototypical profile of autism in males. I also think about other manifestations of repetitive behaviors and interests in girls with ASD that are more socially acceptable, for example, an obsession on reading or running as opposed to preferred topics of males on the spectrum (e.g., trains, schedules, calendars, etc.).

Researchers have speculated that these differences in the manifestation of ASD in girls versus boys stem from how girls are socialized at an early age to pay attention to social cues/actions as opposed to boys. There is also research that suggests that girls are more able to follow social actions by delayed imitation. They observe and copy other children more effectively than do boys. This could lead to the phenomenon of masking and to milder presentations when compared to boys.

Sources:

Evans, S., et. al. (2019). Sex/gender differences in screening for autism spectrum disorder: Implications for evidence-based assessment. Journal of Clinical Child Adolescent Psychology, 48 (6), 840-854.

Nichols, S., Moravcik, G. & Tetenbaum, S. P. (2009). Girls growing up on the autism spectrum. London: Jessica Kingsley Publishers.

Ozonoff, S., Dawson, G. & McPartland, J. (2002). A parent’s guide to asperger syndrome and high functioning autism. New York: Guilford Press.

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

To schedule an appointment with one of NESCA’s pediatric neuropsychologists, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

12

College Myth Buster – Your Child’s 504 from High School Does Not Apply in College

By | NESCA Notes 2024

By: Kristen Simon, M.Ed, Ed.S
Transition Specialist; Psychoeducational Counselor

There can be a lot of confusion for students who have received special education services or accommodations in high school about what stays the same and what changes in college. Some high school families and staff know that if a student has received IEP services throughout school, the IEP does not travel with them to college. This is because an IEP is a document that is developed in accordance with IDEA, a special education law that affords protections to students with disabilities up until they graduate or age out of their local high school. When a student transitions to work or a college or university, this law is no longer relevant and the IEP essentially “expires.”

There is often greater confusion for families around whether colleges are required to follow 504 plans (i.e., accommodation plans) developed in high school. While it’s true that students with disabilities are protected by Section 504 of the Rehabilitation Act, it’s important to understand that high school 504 plans also effectively “expire” once a child graduates. Students can still receive accommodations under Section 504, but they are unlikely to hear the term “504” or to have any written “plan” related to their disability or those accommodations. There are some important differences between Section 504 mandates under subpart E (which covers postsecondary institutions) and those that fall under subpart D (which covers secondary schools). The key differences are described below:

  • Eligibility: Colleges and universities will have their own process for eligibility, and students have to be determined eligible by their university – even if they had been deemed eligible for accommodations in high school. Students will usually need documentation from a doctor or a psychologist that demonstrates the presence of a disability as well as how that disability substantially limits learning.
  • Available Accommodations: Colleges don’t have any obligation to provide the same services and accommodations that students may have received in high school, and not all of the accommodations provided by high schools are available at the college level. Moreover, different accommodations may be available at different colleges because the law mandates that the college provides accommodations which are “reasonable” and effective, not the best or most expensive.
  • Shift in Delivery: Professors will not automatically provide an accommodation as was the case in high school. Students have to seek out accommodations and can register for them after they are officially enrolled. At the college or university level, the expectation is that the young adult knows what support is available to them and that they self-advocate for the accommodations they need. Also, even if a student qualifies for an accommodation, they have to make the choice to actively use that accommodation – if they don’t advocate, they won’t get it.

Students should also know that while accommodations help, they can only go so far (e.g., if you don’t understand the content, having extra time on the exam won’t help). Students should be sure to connect with disability services to hear about tutoring options, academic coaching, writing centers, counseling supports, and anything else that is offered.

Resources:

U.S. Department of Education: Students with Disabilities Preparing for Postsecondary Education

Elizabeth Cohen Hamblet Learning Disabilities Consultant website: College Disability Accommodations Information – Elizabeth C. Hamblet (ldadvisory.com)

 

About the Author

Kristen Simon, M.Ed, Ed.S, has worked with transition-aged youth as a licensed School Psychologist for more than a decade. She has extensive experience working with children and adolescents with a range of learning and social/emotional abilities. Kristen’s strengths lie in her communication and advocacy skills as well as her strengths-based approach. She is passionate about developing students’ self-awareness, goal-setting abilities, and vision through student-centered counseling, psychoeducation, social skills instruction, and executive functioning coaching. Mrs. Simon has particular interests working with children and adolescents on the Autism spectrum as well as individuals working to manage stress or anxiety-related challenges.

Mrs. Simon is an expert evaluator and observer who has extensive working knowledge of the special education process and school-based special education services, particularly in Massachusetts. She has been an integral part of hundreds of IEP teams and has helped to coordinate care, develop goals, and guide students and their families through the transition planning process. Mrs. Simon further has special expertise helping students to learn about their diagnoses and testing and the IEP process in general. She enjoys assisting students, families, and educators in understanding a student’s disability-related needs as well as the strategies that can help the student to be successful in both academic and nonacademic settings. Mrs. Simon has often been a part of teams in the years when students are initially participating in transition services, and she has helped countless students to build the skills necessary to be part of their first team meetings. She is committed to teaching students—as well as parents and educators—how to participate in student-centered team meetings and the IEP processes.

At NESCA, Mrs. Simon works as a transition specialist and psychoeducational counselor. She works with adolescents, their families, and their school communities to identify and build the skills necessary to achieve their postsecondary goals. Mrs. Simon provides transition assessment (including testing, functional evaluations, and observations), program observations and evaluations, case management and consultation, and individualized counseling and skills coaching.

 

To schedule an appointment with one of NESCA’s transition specialists, please complete our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

11

Navigating Screen Time: Understanding the Impact on Child Development

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

At school, we have had increasing difficulty with children refusing to leave their car at drop-off because they are on their tablets and do not want to stop what they are doing to go to school. Screen time has long been discussed regarding how much is too much and recommendations offered for limiting screen time. Now, with mobile devices, screens can be taken anywhere. Furthermore, there is never a shortage of entertaining options to engage with, from games like Minecraft, Roblox, and Fortnite to YouTube, all of which draw children in and make it difficult to stop. This article aims to provide a nuanced exploration of the impact of screen time on child development. While screen time is not inherently negative, it requires thoughtful management and consideration, particularly in the context of the developmental needs of children.

Screens are pervasive in daily life and have become integrated into the fabric of 21st century family dynamics, mostly due to the numerous ways of engaging with screens. According to the American Academy of Child and Adolescent Psychiatry (AACAP), children between the ages of eight to 12 spend at least four to six hours a day watching or using screens. According to Common Sense Media, children between birth and eight spend an average of two and one-half hours per day, with children two and under spending approximately 49 minutes on average. While screens can teach and entertain, too much may lead to problems.

Excessive screen time can have a variety of effects on child development. These effects can be physical, cognitive, emotional, and social, and vary depending on the content and purpose of screen time. The is largely due to what children are not doing when they are using screens. Extended periods of screen time can lead to a sedentary lifestyle, which can lead to obesity, poor posture, and disrupted sleep patterns. In terms of cognitive development, overuse of screens with fast-paced and visually stimulating content can overwhelm a child’s developing brain and potentially affect attention span, impulse control, and the ability to concentrate.  It can also impede the development of language and communication skills. When children spend too much time in front of screens, they may have fewer opportunities to engage in real-life conversations and interactions, which are crucial for language development. And, while educational content can have benefits, excessive screen time can still disrupt the learning process. It may lead to reduced engagement with traditional forms of learning and limit a child’s ability to exercise critical thinking and problem-solving skills.

It is important to note that not all screen time is detrimental. Age-appropriate and high-quality content, as well as supervised and interactive screen time, can have educational and social benefits. Additionally, technology can be a valuable tool for learning and creativity when used in moderation and with parental guidance. Parent and caregivers can help mitigate the potential negative effects of screen time by setting limits, monitoring content, and encouraging a balanced lifestyle that includes a variety of activities, such as physical play, reading, and face-to-face interactions. Sometimes the best conversations happen in the car.

References:

 

About the Author

Dr. Cynthia (Cindy) Hess conducts neuropsychological evaluations as a pediatric neuropsychologist at NESCA. Dr. Hess enjoys working with children and young adults with complex emotional and behavioral profiles. She is skilled at evaluating social and emotional challenges as well as a range of learning profiles. Her experience allows her to guide families in understanding the supports and services their child requires to be successful in school.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

3

The ABCs of Challenging Behavior

By | Nesca Notes 2023

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

When a child or adolescent is exhibiting challenging behaviors, it is helpful to understand why the behaviors are occurring. The first step is to analyze the situational factors surrounding the behaviors:

A: Antecedent. What is happening right before the behavior occurred?
B: Behavior. What is the specific behavior that the child/adolescent exhibited?
C: Consequence. What happened right after the behavior occurred?

By looking at the ABCs of a particular behavior, we can start to understand the function of the behavior. That is to say, why is the child/adolescent engaging in the behavior? How is the behavior being reinforced?

Let’s look at an example:
Tom is in 6th grade. He arrives to math class, and the teacher distributes a worksheet. Tom rips up the math sheet and throws it on the floor. The teacher sends him to principal’s office.

A: Math class, being given a worksheet
B: Ripping up the paper
C: Being sent to the principal/leaving the class

In this example, the aversive situation might be math class itself, it could be the worksheet, or it could be the specific concept being worked on (e.g., multiplication is hard for Tom). Alternatively, something might have happened right before math class that upset him.

The consequence is that Tom is allowed to avoid the problematic situation. Thus, the teacher is inadvertently reinforcing the behavior. Tom has learned that if he refuses to do the work, he gets to leave class.

The more effective intervention would be to understand why he refused the work. In this case, it would be important to have a conversation with Tom. Was the work too hard? Does he need extra explanation of the concepts being covered in the worksheet? Did something happen before math class that Tom was still upset about? If the teacher is not able to engage him in this type of conversation, perhaps it would be better to send him to the school counselor as opposed to the principal.

As you think about your own children, it might be helpful to consider the ABCs of any challenging behaviors that are occurring. What was happening right before? If you can identify antecedents, you might be able to make some concrete environmental changes in order to avoid the behavior. What happened right afterward? Did your reaction to the behavior somehow reinforce it? Could you do something different next time the behavior occurs that would be more effective?

Resources
The Explosive Child by Ross Greene
How to Talk So Kids Will Listen & Listen So Kids Will Talk by Adele Faber and Elaine Mazlish
The Behavior Code Companion by Jessica Minahan

 

About the Author

Erin Gibbons, Ph.D., evaluates children presenting with a range of attentional, learning, and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

6

Loving Individuals with Executive Function Challenges: Real-world Examples of Flexibility and Adaptability

By | Nesca Notes 2023

By Jasmine Badamo, MA
Educational Counselor; Executive Function Tutor

Last week I discussed how being flexible and adaptable is a great way to support individuals with executive function struggles. Today I’d like to give you a few examples of how that would look in real life!

Scenario #1
You are the parent from the nighttime routine debacle from last week. Instead of bedtime being relaxing, it fills you with anticipatory dread. Bedtime is in 15 minutes, and you are scrambling to get your child ready. After prompting your child for the 27th time to pick a pair of pajamas and put them on – something they have to do literally every night and should come as no surprise to them, you walk into your child’s room to see the contents of their backpack strewn all over the floor as they look for their favorite plushie to pack for school tomorrow. Pajamas are not on, teeth are not brushed, and now there is a room to clean. You feel your frustration boil over as you realize that it will be yet another night of everyone going to bed late and stressed out. You think to yourself, “This shouldn’t be this difficult! My kid should be able to do a simple nighttime routine and get to bed on time!”

→ Examples of Flexibility and Adaptability: You stop constantly prompting (or as your child calls it, “nagging”) and start providing external supports that help them foster more independence. After sitting down together and learning that visual reminders are helpful, you posted a nighttime routine checklist on the wall. In your discussion, you also realized that your little one runs out of steam about 15 minutes in, so you simplified the nighttime routine to the bare minimum. You even started shuffling some of the nighttime tasks to earlier in the day when everyone has more energy. It’s a little unconventional to put on pajamas before dinner, but it’s one less task to do later, and it makes dinner fun.

Scenario #2
You love your partner dearly, but for the life of them, they are incapable of arriving to any family event even remotely on time. The lead-up to walking out the door and into the car is always filled with shouting and frustration, and while you arrive together, you arrive late and grumpy.

→ Examples of Flexibility and Adaptability: You started traveling separately to family events. Yeah, it confuses some of your relatives, you’re using double the gas, and your partner shows up way later than they would if you drove together, BUT you both arrive at the family gathering in great moods and enjoy your time with everyone, which is your actual priority. It’s also helped your relationship because it’s removed a lot of the push-pull dynamic that was created by rushing to get somewhere together on time. You also notice how it has opened the door to more conversations around your spouse’s neurodiversity and ways to support them. But really, the best part of this new flexible arrangement is that you can get there on time before all the tasty food runs out, and when you’re feeling generous, you even save your partner a plate!

Scenario #3
No matter how hard you try, your fridge is a warzone. Vegetables rot before you can cook them; you have multiple bottles of hot sauce because you keep forgetting you already have some; and a pack of mushrooms stares judgingly at you every time you pass over it because you still haven’t bought the other ingredients for the mushroom soup you plan(ned) to make.

→ Examples of Flexibility and Adaptability: You let go of how you thought a fridge needed to look, and organized it in a way that makes sense for your brain and eating habits. Vegetables now go in the fridge door where you’ll have a visual reminder to eat them before they go bad. Condiments are on a lazy Susan so you can quickly check what you have and don’t have. You also started shopping for only 1-2 dishes at a time, and now keep all the ingredients needed for a dish together in bins so they’re ready to go when you cook. Yes, you know pasta doesn’t need to be in the fridge, but you know what, this is your life, and this makes sense for you. And while it’s true that this new organization system is suboptimal in terms of space usage, you’ve noticed that you’re actually using more of what you do have in the fridge, which is your priority.

Want to explore this topic more?
Here are a few social media accounts that are modeling a more flexible and adaptable approach to executive function demands:
@thecenteredlifeco
@strugglecare (along with her Podcast “Struggle Care”)
@divergentcoachkelly
@adriabarich

And, if you would like to explore additional solutions to executive function challenges, NESCA’s team of expert executive function coaches is available to work with you and/or your family. We have coaches who can work in-person or remotely. Let us know how we can support you.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

6

Reduce Your Frustrations: How Being Flexible and Adaptable Helps You and Your Loved One with Executive Function Challenges

By | Nesca Notes 2023

By Jasmine Badamo, MA
Educational Counselor; Executive Function Tutor

The Dreaded Nighttime Routine
Hey parents, tell me if this rings a bell. Instead of bedtime being relaxing, it fills you with anticipatory dread. Bedtime is in 15 minutes, and you are scrambling to get your child ready. After prompting your child for the 27th time to pick a pair of pajamas and put them on – something they have to do literally every night and should come as no surprise to them – you walk into your child’s room to see the contents of their toy bin strewn all over the floor as they look for their favorite plushie to pack for school tomorrow. Pajamas are not on, teeth are not brushed, and now there is a room to clean. You feel your frustration boil over as you realize that it will be yet another night of everyone going to bed late and stressed out. You think to yourself, “This shouldn’t be this difficult! My kid should be able to do a simple nighttime routine and get to bed on time!”

In my experience, so many of us have found ourselves in a similar situation with a child, a partner, or even ourselves. While you might like for me to launch into tips and tricks for achieving a seamless nighttime routine for your family (does that exist?!), instead I’d like to explore the idea of challenging our “shoulds,” and discuss how being more flexible with ourselves and others can help reduce our frustrations.

Yep, I’m Talking about Letting Go!…Again!
If you or a loved one struggle with executive function demands, it’s important to get more comfortable letting go of how things “should” be, and start being flexible around how things could be. I really love Dr. Russell Barkley’s shepherd analogy for parenting a child with ADHD, as it can be applied to a wide range of relationships and situations involving individuals with executive functioning challenges. He tells us that parents are not engineers, and they do not get to design their children to be the way they’d like them to be. Instead, he pushes parents to accept that they are “a shepherd to a unique individual,” and while “no shepherd is gonna turn a sheep into a dog,” parents do have the power to “pick the pastures in which the sheep will graze and develop and grow.”

Whether you are shepherding a child, a loved one, or yourself, this approach helps us let go of who a person “should” be, how the routines of daily life “should” go, or what tasks “should” be easy. Trying to turn a sheep into a dog (aka trying to shove a round peg into a square hole) only leads to frustration, and worse yet, often sets neurodivergent people – and those who love them – up to fail. Instead, start focusing on how daily life could be, and channel your efforts into shaping your environment and tasks accordingly.

Flexibility and Adaptability are the Tools for Letting Go
The best way to start shaping the environment to better suit the needs of an individual with executive function struggles is to be flexible and adaptive. Below is a list of strategies for being more flexible and adaptive:

Adaptivity Killers Adaptivity Enhancers
-All-or-nothing thinking

-100% optimization and productivity

-Shaming in order to motivate action

-Rejection or deprivation of needs

 -Growth mindset (progress over perfection)

-Selective effort and investment

-Positive self-talk and celebrating small successes

-Self-reflection and compassion

Notice how the Adaptivity Enhancers above align with practices that will dissipate frustrations or at least help you weather them with more ease. Take a look at how each would play out in real life:

  • “I may not be the most athletic human in the world, but I’m really interested in doing more physical movement. I bet if I practiced, I could increase my athletic ability and start to enjoy physical activity more.” (growth mindset).
  • “I know I can’t go from 0 to 100, and that I only have so much expendable energy in the day. I’m going to focus my efforts on lifting weights: starting with small weights and lifting just twice a week.” (selective effort & investment).
  • “Today I lifted for less than my target time, but I’m really proud of myself for coming all the way to the gym after I had such a crummy day at work. I’m also proud that I lifted weights for as long as I did.” (positive self-talk; celebrating small successes).
  • “I notice that I’m usually cranky on Wednesdays after work, and it’s a drag to get myself to the gym – which is totally understandable. Maybe I can better support myself by going on Tuesdays when I tend to have more energy.” (self-reflection and compassion).

Stay tuned for next week’s blog for more real-life examples of how being flexible and adaptable can help you navigate everyday executive function demands.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

5

Neurodevelopmental Evaluations for Children under Age 5

By | Nesca Notes 2023

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Many families are curious about neurodevelopmental testing. Neuropsychologists who specialize in working with young children are often asked about when it is appropriate to pursue an evaluation, what the evaluation process entails, and where to go.

Why Would a Young Child Need an Evaluation?

There are developmental milestones across several domains that children are expected to achieve within certain timeframes. When children are showing delays in achieving those milestones within expected age ranges, seeking an evaluation may be warranted. From birth to 5 years of age, the areas of development that are especially important to monitor include:

  • Speech and Language (e.g., use of single words/phrases, following directions)
  • Social Skills (e.g., eye contact, social smile, interest in others, imaginative play skills)
  • Motor Skills (e.g., crawling, walking, using a pincer grasp)
  • Cognition/Early Problem Solving Skills (e.g., matching shapes and objects, completing simple puzzles)

If delays in any of the areas listed above are observed, pursing an evaluation sooner rather than later is recommended, as research has shown that early diagnosis and intensive treatment are the most important factors in determining rapid progress and long-term prognosis.

What Does a Neurodevelopmental Evaluation Entail?

Within a comprehensive neurodevelopmental evaluation, the child is administered tests that look at the developmental areas listed above. Information should also be collected from parents, teachers, and other caregivers who know the child well. These evaluations help to provide a better understanding of the child’s developmental profile, including areas of relative strength and weakness. In other words, the evaluation can provide more information about where the child’s skills currently fall when compared to their same age peers. Such information can provide diagnostic clarification, as well as help to inform recommendations for services if needed.

Where to Go

There are several options for where families can pursue evaluations, each with their benefits and drawbacks:

  • Early Intervention (EI): EI is meant to support families of children birth to three years of age who have developmental delays or are at risk of developmental delays. The goal of the Massachusetts EI program is to collaboratively promote skill acquisition based on the family’s priorities and child’s individual needs. Evaluations are typically conducted within the home setting to determine the child’s eligibility for EI services. While these evaluations can provide valuable information about the child’s strengths and weaknesses, a diagnosis will not be provided.
  • Hospital-based Setting: These evaluations are structured differently depending on the hospital system. In most cases, these evaluations are interdisciplinary, meaning that they involve a team of providers from different disciplines (i.e., psychologist, medical provider (pediatrician, nurse practitioner) speech and language pathologist, occupational therapist, etc.). While outcomes of these evaluations can include diagnosis and recommendations for services when appropriate, waitlists are often long, and reports tend to be brief.
  • Independent Setting/Private Practice: Independent evaluations usually involve several visits with a pediatric psychologist or neuropsychologist, rather than with a team of providers. Similar to the hospital-based evaluations, independent evaluations can result in diagnosis when appropriate. Specific recommendations based on the child’s individual profile are offered. These evaluations tend to be more detailed and comprehensive than those conducted by EI and within hospital-based settings. Clinicians also have the option to observe the child in other settings (e.g., daycare, preschool, elementary school), as well as attend school-based meetings.

Relatedly, NESCA is currently providing evaluations for children 12 months to 3 years of age who are showing early signs of an autism spectrum disorder (ASD). The wait time is 1 month or less – by design –  so children who meet criteria for an ASD diagnosis can access the appropriate interventions for them. If you are interested in learning more about ASD Diagnostic Testing through NESCA’s ASD Diagnostic Clinic, please visit our website at https://nesca-newton.com/asd-diagnostic-clinic-2/ and/or complete our online Intake Form.

Related resources and links to help track developmental milestones:

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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