NESCA is currently booking for in-person Real-life Skills and Executive Function Coaching in the Newton, MA office! Our experienced occupational therapists work alongside individuals to achieve their personalized goals, which often address functional life skills that allow them to thrive in their homes, schools, and communities. For those not local to Newton, MA, remote services are also offered. Click here for more information. To inquire about our coaching services, complete our Intake Form.


reading comprehension

Understanding and Identifying Organizational Challenges

By | Nesca Notes 2023

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

When clients come for neuropsychological assessment, a domain of skills that is commonly assessed is executive function. Executive function is a complex set of cognitive and self-management skills that allow for efficient, goal-oriented problem solving and task completion. These skills do not speak to how smart someone is, or whether or not they will achieve a goal. Instead, they speak to the ease with which one works toward their goal – Is their path a nice straight road from beginning to end? Or was it a zig-zagging route filled with stops and starts, redos, and confusion?

Executive function is a broad domain containing many different skills, such as planning, working memory, self-monitoring, impulse control, and organization. This last skill – organization – is one that can be commonly misunderstood. That is likely because people often focus on behavioral organization, meaning whether someone keeps their things in order. While a tidy bedroom and neat locker make it easier to find things, there are other aspects of organization that can have a much greater impact on learning, task completion, and daily functioning. From a neuropsychological standpoint, there are three aspects of organization that should be of focus, including:

  • Behavioral Organization. As noted above, this is the aspect of organization with which people are most familiar. It can be thought of as your “organization of stuff” skills. At home, this may be keeping an organized bedroom, putting things away when done, and knowing how to find things when you need them. At school, this may involve keeping a neat locker or desk, having color-coded binders for your classes, or turning in assignments once you’ve completed them. Individuals who struggle in this area may often lose their belongings, fail to turn in completed tasks, or frustrate their parents with their messy rooms.
  • Organization of Information. This is the organizational skill that is often of most focus within neuropsychological assessment. This is a cognitive aspect of organization, meaning others cannot necessarily observe when someone struggles in this area. This aspect of organization speaks to one’s ability to process information in a manner that appreciates both the details and how they integrate into a “big picture.” This skill is very important for learning, allowing you to consolidate information into memory in a manner that is connected and organized, which makes it much easier to remember and retrieve later on. Think of this as the filing cabinet of the brain. Organization of information and ideas is also important for reading comprehension as well as written expression, including prioritizing ideas and pulling them together in a cohesive manner. Individuals who struggle in this area may be overly detail-focused, missing main ideas or struggling with abstraction. They may also become easily overwhelmed by information, not knowing what is most relevant, which may result in difficulty planning, executing, and drafting writing assignments.
  • Organization of Time. A.K.A. – time management. This organizational skill requires you to both recognize the end goal while also being able to break the task into smaller steps that can be accomplished over a short or long span of time. It requires a recognition of how long each step may take and how to balance such requirements within life’s other time constraints. Individuals who struggle in this area may appear to procrastinate, though the true challenge may lay in difficulty estimating time or understanding how to break things down and create the road map from “here to there.” This is often a person who may be misunderstood as lacking motivation, given their difficulty initiating and completing tasks, though their lack of execution actually stems from difficulties organizing information and time.

Quite often, individuals with organizational challenges do not struggle in all three of the above areas. A child may appear fastidiously organized, with an impeccably organized room and diligent notes; however, they may be relying on this excessive behavioral organization as a means for compensating for hidden challenges with informational organization. They may not know what is most important, so they study excessively for tests or over-include information in their essays. To the observer, they look astute; however, they are cognitively over-extending themselves. As already noted, organizational challenges may also present as the “unmotivated” student, as long-standing difficulty knowing how to break down tasks and manage time may have resulted in helplessness. This is why neuropsychological assessment is often an important tool for understanding and supporting these students – as the underlying challenges may not be behaviorally observable. Positively, executive function skills can be taught to address any of the above concerns, but interventions will always be most effective when the areas of need are clear.


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 or call (603) 818-8526.

Literacy-based Speech Therapy: Winter Edition

By | NESCA Notes 2021

By: Abigael Gray, MS, CCC-SLP

NESCA Speech-Language Pathologist

Books are a great speech-language therapy tool. They can be used to target many different goals for a variety of ages and profiles. With books, children are given context for learning vocabulary, concepts and important story elements. Literacy-based therapy is not only more fun, but research also supports its use in teaching children with speech and language disorders:

  • Teaching story elements has been shown to improve oral language production and reading comprehension.
  • Teaching within a narrative context can make language learning less demanding, more meaningful and more authentic.
  • Students’ comprehension and story retelling/generation skills improved more with contextualized (literacy-based) intervention than decontextualized intervention.

Books can easily be incorporated into life at home, if they are not already a part of the daily routine. Just grab your or your child’s favorite book, or find a YouTube read aloud of it, and have your child help you read it! Be sure to pause throughout the book to talk about the pictures, make inferences about why events are happening and ask a few questions. Don’t be afraid to change the words to match your child’s level of understanding or interests.

My top three favorite winter books to use in speech-language therapy are:

  1. Sneezy the Snowman by Maureen Wright

A story about a cold and sneezy snowman who melts several times while trying to get warm. His human friends help him by rebuilding him and sharing their winter clothes.


YouTube Read Aloud:

Skills that I target and can be incorporated into shared book reading at home:

  • Producing subject-verb-object or complex sentences to talk about what is happening.
  • Predicting what will happen before and throughout reading (e.g., “Sneezy is drinking hot chocolate, what do you think will happen?”).
  • Answering detail (what, where, who, when) and inferential (why) questions.
  • Discussing story parts (e.g., characters, setting, problem, solution) and retelling the story.
  • Writing using different prompts, such as “My snowman melted because…” or “When I’m cold, I…”.
  1. The Mitten by Jan Brett

A traditional story about a boy whose grandmother knits him new mittens. He loses one mitten when he is outside playing, and many different animals climb inside to stay warm.


YouTube Read Aloud:

Skills that I target and can be incorporated into shared book reading at home:

  • Sequencing events by talking about the order of animals that climbed into the mitten.
  • Creating a craft by printing a mitten and animals, coloring the animals and putting them inside the mitten as you retell the story.
  • Watching a different rendition of The Mitten on and comparing and contrasting the two stories using a Venn diagram.
  • Producing past tense verbs to describe what happened.
  • Making inferences about characters’ emotions and motivations.
  1. The Snowy Day by Ezra Jack Keats

A Caldecott Medal-winning book about a boy’s adventures in the snow when he puts on his snowsuit and goes outside to play.


YouTube Read Aloud:

Skills that I target and can be incorporated into shared book reading at home:

  • Telling an original story together by covering up the words on the pages.
  • Finding words that contain the child’s target speech sound (i.e., if your child is working on producing the “R” sound, find all the words that contain “R” and practice those).
  • Describing character traits of Peter, the main character.
  • Discussing cause and effect (e.g., cause: Peter smacked a snow-covered tree, effect: snow fell on Peter’s head).
  • Writing using different prompts, such as “On a snowy day, I like to…” or “I can save a snowball by…”.



Davies, P., Shanks, B., & Davies, K. (2004). Improving narrative skills in young children with delayed language development. Educational Review, 56, 271 – 286.

Gillam, S. L., Gillam, R. B., & Reece, K. (2012). Language outcomes of contextualized and decontextualized language intervention: results of an early efficacy study. Language, speech, and hearing services in schools43(3), 276–291.

Tomasello, M. (2003). Constructing a language. A usage-based theory of language acquisition. Cambridge, MA: Harvard University Press


About the Author

Abigael Gray has over six years of experience in assessment and treatment of a variety of disorders, including dysphagia, childhood apraxia of speech, speech sound disorder, receptive and expressive language disorder, autism spectrum disorder and attention deficit hyperactivity disorder. She has a special interest and experience in working with children with feeding and swallowing disorders, including transitioning infants to solid foods, weaning from tube feeding, improving sensory tolerance, developing chewing skills, increasing variety and volume of nutritional intake and reducing avoidance behaviors during mealtimes.




To book an appointment or to learn more about NESCA’s Speech & Language Therapy, please fill out our online Intake Form, email NESCA’s Director of Clinical Services Julie Robinson or call 617-658-9800.

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