Tag

social functioning

Why the Autism CARES Act Matters

By | NESCA Notes 2019

 

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

The CDC estimates that 1 in 59 children are diagnosed with an autism spectrum disorder (ASD), and studies by Autism Speaks also found that children with autism have a nearly four times greater chances of having unmet health care needs compared to children without disabilities. With those sobering statistics in mind, it’s important for us to take a closer look at recent legislation to help the growing number of people with an ASD diagnosis.

On September 30, 2019, President Trump signed the Autism CARES Act of 2019, which was due to expire on the same day. Originally called the Combating Autism Act, which was established in 2006. It was reauthorized in 2011, and again in 2014 when the name was changed to the Autism (Collaboration, Accountability, Research, Education and Support) CARES Act. This Act is the primary source of federal funding for autism research, services, training and monitoring

Because of this important Act, the 2014 legislation dedicated over $3.1 billion for autism programming. President Trump renewing this Act in 2019 allowed for an extension of the current primary autism law and authorized $1.8 billion in spending on the developmental disorder over the next five years.

The Autism CARES Act of 2019 renews federal support for existing autism research and programs, but also expands these activities, placing an increased emphasis on reducing health disparities and improving services throughout the lifespan. More specifically, the funding provides:

  • Autism research grants awarded by NIH, focusing on advancing scientific understanding of autism, expanded efforts to develop treatments for medical conditions often associated with autism and address the needs of people affected by it. The NIH also works to foster collaboration among research centers to increase the effect of their efforts.
  • Ongoing support for programs across the country focused on ensuring high-quality services for people with autism. This includes funding 52 Leadership Education in Neurodevelopmental and Other Related Disabilities (LEND) programs and 12 Developmental Behavioral Pediatric Training Programs. These programs allow for the continuation of education, early detection and intervention activities through the training of future leaders and healthcare professionals.
  • The continuation of Collaborative programs like Autism Intervention Research Network on Physical Health (AIR-P), which helps to translate research into improved care and tangible resources for families and clinicians.

The Act also calls for the Department of Health and Human Services to once again produce a report for Congress on the health and well-being of individuals with autism. In 2014, this important report to Congress emphasized the needs of individuals with autism as they transitioned out of school-based services and into adulthood. The 2019 Act has placed an increased emphasis on the needs of individuals with autism “across the lifespan,” highlighting a need to understand challenges faced by individuals of all ages. As noted by Autism Speaks President and CEO Angela Geiger, “this legislation ensures sustained funding to better support people with autism across the spectrum and at every stage of life.”

Indeed, as a neuropsychologist, working side-by-side with NESCA’s team of Transition Specialists, I have the privilege of following many individuals with autism spectrum disorders from early childhood throughout their transition to young adulthood.  I find that families begin to scramble as special education funding runs out and they struggle to understand how these young people will continue to get their needs met. For many years, the focus of funding and research was on children, but as these individuals aged out of school-based services, their needs did not end. Yet,  the funding was and continues to be well below what is necessary. While there have certainly been improvements, there continues to be many more needs than are able to be supported. Research remains essential in understanding the longitudinal needs throughout the lifespan, and I am encouraged that our country continues to support these efforts.

 

Reference:

Autism Speaks

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, 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.

 

 

In Defense of the Lowly Questionnaire

By | NESCA Notes 2019

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

When gleaning information about a child’s areas of strength and challenge, neuropsychologists gather information from multiple sources, including parent and child interviews, conversations with teachers and mental health professionals working with the child, clinical observations, structured testing and questionnaires.

In my work with families, I sometimes hear complaints from parents about the myriad questionnaires that I saddle with them as part of the evaluation process – that some questionnaires might appear to be geared toward more challenged children than their own or that they are unsure how to respond to some of the questions (e.g., Is this behavior exhibited “sometimes” or “often?”).  While those are valid complaints, I find data from questionnaires to be particularly valuable in my work.

For instance, simply relying on clinical observations to glean information about a child’s attention span and degree of distractibility would be often misleading.  While the distraction-reduced, one-to-one, highly-structured testing setting is an ideal context in which to administer standardized assessments, within such a setting, even students with moderate attention disorders can often remain on task to an extent they are not able to demonstrate in less-structured, real-world contexts.

Similarly, children with mild social communication or autism spectrum disorders might be able to demonstrate reasonably-intact social skills within the context of a structured, one-to-one setting with an adult, while they struggle in their interactions with peers in less structured settings.

Conversely, children who might present with moderately high levels of test anxiety might appear so wound-up in a testing setting that, without additional information about their emotional state outside of the testing context, they could mistakenly be diagnosed with a generalized anxiety disorder.

In addition, relying exclusively on results of standardized testing to glean information about a child’s learning profile can be equally misleading.  For instance, children who might well present with executive function challenges can often fare well on specific tests of executive function, as those tests provide a level of structure not present in daily contexts.  Further, the nature of those standardized tests is such that specific executive function skills are measured in isolation (e.g., how well is a child able to brainstorm or switch gears or see the big picture), as opposed to in real life, when a child needs to make use of multiple different executive function skills in concert to complete given tasks.

Of further importance, I often find that a comparison between a child’s responses on a self-report questionnaire and those of parents or teachers yields critical information.  More specifically, it is often the case that from the parent perspective a child is running into pronounced executive function challenges, while from the child’s perspective they have minimal challenges in that domain of functioning.  That discrepancy can provide useful information about a child’s level of self-awareness or self-acceptance, information that can, in turn, illuminate an important area to address moving forward.

Again, a thorough, comprehensive, integrated neuropsychological evaluation draws on multiple sources of information.  As part of a thorough assessment, questionnaire data is a critical data source, not only in confirming observations made during the testing and results of structured assessments, but also in providing an additional perspective as to how a child might present outside of the structured testing setting.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

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

 

The Use of Adaptive Behavior Rating Scales in Neuropsychological Assessment

By | NESCA Notes 2019

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

In my work as a neuropsychologist, much of my practice involves assessment geared toward transition planning – the move from high school to college or from high school to the working world. For these cases, I find the use of measures of adaptive behavior skills – day-to-day skills associated with self-care, communication, community navigation, home living, socialization, use of leisure time, and functional academics – to be a critical part of the neuropsychological testing battery.

Historically, adaptive behavior rating scales were developed and primarily used for assessment of intellectual disability. While adaptive behavior has taken rightful prominence in the assessment and diagnosis of intellectual disability – overtaking the importance of intelligence testing – the use of adaptive rating measures also proves quite important to help with transition planning for individuals with a wide range of psychiatric and neurodevelopmental presentations, including those with exceptionally strong cognitive skills.

These measures (e.g., Adaptive Behavior Assessment System – Third Edition; Vineland Adaptive Behavior Scales – Third Edition), which take the form of parent/caregiver or teacher questionnaires/structured interviews, yield detailed information about an adolescent’s readiness for their upcoming transition out of their family’s home. Particularly for bright adolescents with strong academic skills who might, say, present with attention and executive function challenges but have largely been successful in school, an assessment of adaptive behavior skills is often overlooked. However, over the course of my career, I have heard multiple stories of students who have seemed “college-ready” in the traditional sense of the word (i.e., strong academic and cognitive skills) but have suffered “failure to launch” experiences, as they had not learned to take their prescribed medications consistently, never learned to self-regulate their sleep schedule, or were well behind in their capacity to strike a balance between work and leisure activities.

Although the scores obtained on these measures can be a helpful guide, I find that a closer look at the specific components that may point to a need for additional skill development can help generate a sort of “to-do” list for transition planning work. Thus, while at times simply confirming an adolescent’s suspected transition readiness, the administration of an adaptive measure often proves to be a valuable tool to help determine what skill areas need to be targeted prior to the transition and/or supported during the transition.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

To book a consultation with Dr. McCormick or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

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

 

Child Feedback Sessions: How and Why We Explain What Testing Means To Kids

By | NESCA Notes 2019

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

“Who get’s the results of the testing, me or my parents?” As a neuropsychologist, clients of all ages ask why they are being tested and who is going to get the information from the testing. Sometimes these questions come from a place of nervousness, while others are asking because they have a general curiosity.

Neuropsychological evaluation is an intensive process where students are trying out all sorts of skill sets, some activities that are familiar (e.g., math problems), and some activities that they will only ever do in the context of an evaluation process (e.g., putting pegs in a pegboard, drawing weird rocketship shaped patterns from memory). Even children as young as elementary school are often curious about the results of the assessment (e.g., how did I do? what were you testing? what is the report going to say?). These are such important questions and I am always excited when the children I am working with are curious about what this all means.

At NESCA, a neuropsychology and integrative treatment practice founded in Newton, MA, we conclude our testing with a parent feedback session where results and preliminary recommendations are clearly presented to parents. This is a conversational format so that we can ensure that there is good understanding and a shared picture of what we have learned about the child. Even with a lengthy conversation, parents often question about how to share the findings with their children because it often results in changes for the child like working with new people or getting more/less or different services at school.

Importantly, we offer child/adolescent feedback sessions for children of all ages. These mini-feedback sessions are presented in a developmentally appropriate manner to share the findings of the evaluation. Often with older children and adolescents this conversation includes discussing any diagnosis that came out of the evaluation. For all individuals the conversation always includes a strengths-based approach highlighting the things the child/adolescent did wonderfully using examples from the testing to explain these strengths and how they might show these skills in real life. Then we move on to also talking about some of the activities that were more challenging and how we envision teachers, providers, or other supports helping them to make progress. For example, a child might do extremely well on tasks of visual problem solving such as recreating block designs or on verbal tasks that ask them to define words, but have greater challenges on tasks that assess processing speed. These findings suggest a child is able to think and problem solve at a high level, yet processes information more slowly and might need more time to show off their strengths when they are expected to produce output. This important difference is so essential to explain to even younger children. Children often value speed over all else, and explaining to them that working slow but producing amazing ideas is a real asset. The same type of careful explanation can be taken when explaining learning disabilities, attentional issues, social difficulties and emotional vulnerabilities. There is a calculated effort to include the child/adolescent in a conversation about their own ideas on how to improve areas of need and I feel this really empowers them to work for the change and positive growth. Plus, these sessions are a great way to gain closure over the experience of testing and allow them to understand what was accomplished and learned through all of their hours of hard work.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

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

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, 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.

 

 

A Tale of Two Social Styles: Classical and Jazz Socializers (Republished from Nov. 27, 2017)

By | NESCA Notes 2018

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

I work with a number of parents concerned about the quality of their child’s social life.  Lamenting that their child has no true friends, many parents I see note that that their child doesn’t “hang out” with peers.  However, when asked about how their child does spend time with peers, many parents report that their child is involved in several different structured after-school activities, such as a church youth group, scouting, or a gaming club.  In other words, while not getting together with peers in less structured settings, these students often do, despite parent misgivings, have satisfying social lives.

I find it useful to think about socializers as lying in one of two camps: Jazz and Classical.  Jazz socializers are all about improv.  They’ll head downtown with a friend and see where the afternoon takes them, invite a friend over with no particular plan or agenda, or wander the mall in a herd.  They care little about predictability and in fact relish spontaneity and surprise.  Classical socializers, by contrast, are most comfortable with structure.  They crave predictability, wanting to know the specific parameters of a social activity, including the start and end times, the purpose, and the rules of engagement.  Classical socializers, then, tend to do best with organized social activities.

It’s important to note that one type of socializing is not better than the other; it’s about a match.  I say that as many parents of Classical socializing children worry that their children will grow up to be friendless and alone.  To those concerns, I observe that there are plenty of socially-satisfied Classical socializing adults: they have their book club the first Monday of every month, poker night every other Thursday, weekly chorus practice, and bar trivia on Wednesdays.

Thus, rather than trying cram to their Classical socializing child into a Jazz paradigm – which in fact runs the risk of leading to more social isolation due to anxiety stemming from the mismatch – I encourage parents to embrace the kind of socializer that their child is.  For parents of Classical socializers, that means supporting their child’s social satisfaction and growth through the encouragement of their participation in a variety of structured after-school activities (of course without over-scheduling).  In addition to giving their children a chance for a rich and rewarding social life now, participation in such activities serves as an important practice and preparation for adult life, as in college and as adults in the working world, that is how Classical socializers will be most socially satisfied.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, MA, 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.

 

School Observations

By | NESCA Notes 2018

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

One of my favorite activities as a neuropsychologist is getting to conduct school observations. Many parents ask why would I need a school observation? And the answer is simple, they provide a wealth of information about your child and their everyday experience at school. For so many, understanding the comings and goings of a child’s day at school is something most parents do not have the opportunity to explore. You ask your child, “how was your day?” and for many, all you get is a “fine” or “okay” with no elaboration of what actually happened. Understanding a child’s experience of the school day is important for all families, but especially important if your child is having difficulties at school such as learning, social or emotional stressors.

After conducting a neuropsychological assessment of a child, I am able to get a good understanding of the child’s learning profile and a good grasp of the child’s strengths and needs. With this information, I am able to conduct school observations with a lens towards what the children I am seeing might need and how they interact with their environment. For the majority of the children I observe at school they are already getting specialized services and for one reason or another, their parents are concerned.

During the observation, I am able to gain a better understanding of a child’s social functioning within the context of their peers at school. I often purposefully schedule observations during a combination of structured class time as well as less structured time such as art or gym, and finally during an unstructured time such as lunch or recess. This combination of environments allows me to see the child interact with peers in a variety of settings. I am able to answer questions about where a child does best and what types of environments might be more challenging. Are they a rock star during group lessons or are they leading a group of peers across the playground? For other children they may fade into the background, refusing to participate during large group instruction but become more animated during one-on-one time with their teacher. Or maybe they are a child that cannot handle the unstructured recess time and hide in the corner isolating themselves. Gaining a better understanding of a child’s social successes and then relating that information to their neuropsychological profile can help to explain why a child is struggling and how best to support them.

Beyond looking at a child’s social functioning during the school day, I am also able to observe the delivery of instruction and how the child responds. I am always watching how a teacher deliveries information to the class and then seeing how the child is able to respond. Does the child follow the direction the first time they are heard or do they need them repeated and modeled by watching other students begin the activity first? I also look at how a child interacts during whole group instruction or discussion versus a small group or more individual work. I also love the opportunity to speak with teachers during the observation to understand what curriculums they are using as well as answering questions about how they see the child interacting in the classroom. If a child is on an education plan I am also paying close attention to how accommodations and supports are being integrated into and across the child’s school day.

In addition to being a fun and engaging part of my job, observations also provide such valuable information from which I can create very specific and targeted recommendations for a child based on their own school environment. There is definitely not a one-size-fits-all recipe for helping a child with a particular profile because an environment is so influential on a child’s successes and challenges. An amazing relationship with one teacher can go a long way toward helping a child take chances and make progress, just as the opposite is true. With a school observation, there is the opportunity to gain more clarity into a child’s everyday school life to help foster their strengths and support their vulnerabilities.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, 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.