To accommodate requests for neuropsychological evaluations after the start of the new school year, NESCA has added evaluation dates in its Newton, MA office. Immediate openings are now available for scheduling. Please complete our Inquiry/Intake Form for more information or to start the scheduling process.

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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.

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.

9

Going South: NESCA Announces New Hingham, MA Location

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to announce that it is opening a Hingham location to serve clients on the South Shore of Massachusetts. NESCA is currently booking appointments now for Neuropsychological and Psychological Evaluation Services commencing on November 1, 2023. Learn more about what is being offered by our Hingham-based staff from my interview with Hingham Director; Pediatric & Adult Neuropsychologist Moira Creedon, Ph.D.

What prompted NESCA’s expansion to the South Shore or Massachusetts, and how can clients benefit from our Hingham location’s services?
NESCA is expanding our in-person services to Hingham on the South Shore to widen the breadth of neuropsychological and educational evaluation and consulting services offered within the state. We know that families have options as they partner with neuropsychologists, and we want to be in close proximity to communities we hope to serve. This is an exciting opportunity to support students in elementary, middle, and high school as well as adults, as they navigate the complexities of their daily lives. It is our priority to continue providing detailed, client-centered, thorough evaluations that highlight a client’s areas of strength and vulnerability. I am also excited to strengthen relationships with local care providers and schools, and to build new relationships as a new clinician within the South Shore community.

What services do you offer?
At this time, NESCA’s South Shore-based practice will offer Neuropsychological Evaluations and Projective Assessments. The goal of these services is to build a complete picture of a client’s functioning, including their intellectual, academic, and social-emotional profile. Team members are also available to participate in team meetings at school (IEP meetings), conduct school observations, and offer consultation to parents and team members. Sometimes, a child has already participated in evaluations in other settings (schools, hospitals), and a family needs help to review these documents and make meaning of the findings.

What types of clients will NESCA serve in its South Shore location?
NESCA’s South Shore-based practice is similar to our other locations and will serve children, teens, and adults with a range of presenting issues. The focus is in working with students in elementary, middle, and high school as well as young adults. I can see clients with diagnostic questions, including Autism Spectrum Disorder (ASD), Learning Disorders (e.g., dyslexia, dysgraphia), Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, depression, and complex psychiatric diagnoses.

A specialty we have at NESCA – including in Hingham – is working with clients who have multiple diagnoses or who don’t fit neatly into a singular diagnostic box. I also see clients who are high functioning and curious about their learning style, how to improve their study skills, and how to plan for their academic future based on their unique profile.

Where are you on the South Shore? Are services in-person or remote?
We are practicing in person in an office at 99 Derby Street, Suite 200, in Hingham, MA. Hingham is uniquely positioned to serve the South Shore/Southcoast, and the Cape and Islands. For those traveling for appointments, most clients schedule testing in two longer (2.5 hour) blocks of time so the commute is reduced for families. I am also available to participate in IEP team meetings and conduct student observations in person on the South Shore, which is an exciting way to collaborate and build strong relationships with families, schools, and organizations.

What is different about what NESCA offers on the South Shore compared to other organizations or services available locally?
NESCA is highly respected in the community for providing detailed, comprehensive evaluations of students that speak to their strengths as well as their needs. Compared to some practices, your child or teen will be assessed directly by a neuropsychologist rather than a technician. You can depend on your neuropsychologist to bring their own expertise as well as the “village” of NESCA, as I am always collaborating with NESCA’s team of innovative neuropsychologists, transition specialists, educational consultants, speech and language pathologists, occupational therapists, and therapists. We work routinely with special education attorneys, advocates, therapists, and school personnel in collaborative relationships to support children, teens, and adults. At NESCA, we live our core values everyday: being creative problem solvers, being collaborative and building lasting relationships, and caring deeply for students, their families, and the community.

Does insurance cover your services in Hingham?
Several NESCA providers take both Blue Cross Blue Shield and private pay for services. I am paneled with BCBS. Some families are able to obtain some coverage or reimbursement through other insurance agencies, and we can provide those families with brief billing information to submit to their insurance company. We can never guarantee insurance reimbursement, so it is important that families check with their insurance plan regarding covered services.

What if I am unsure if I should refer my child or client for an evaluation?
Give us a call! Our administrative team is happy to support you in navigating this process. We are also planning some community events to provide information to our community about a variety of topics, including who we are and how to recognize signs that an individual may need additional support. There is also a ton of information on our website.

How do people get more information about NESCA’s South Shore services?
You can fill out our online intake form, call 617-658-9800 to speak with an intake coordinator, or reach Hingham-based Pediatric Neuropsychologist Dr. Moira Creedon directly at mcreedon@nesca-newton.com.

 

About the Author

Hingham Director; Pediatric & Adult Neuropsychologist Dr. Moira Creedon has expertise in evaluating children, teens, and adults 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 (coming soon), 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

NESCA Offers Vermont-based Transition and Coaching Services

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA recently announced that it is now offering transition services and coaching services in the Greater Burlington, Vermont region. Learn more about what is being offered by our Vermont-based staff from my interview with Vermont-based Program Manager Dr. Lyndsay Wood, OTD, OTR/L.

Why did NESCA expand to Vermont and how can clients benefit from your services?

NESCA is expanding our in-person services to Vermont to widen the breadth of transition services offered within the state. Through research and conversations with local professionals and parents, we recognized that there is an opportunity to bolster local transition services for students to meet their personal postsecondary goals and to live fulfilling lives post-high school. Through our variety of services, our goal is to empower teens and young adults to create their own vision for the future and build the skills necessary to achieve it. This is important for students currently in public middle and high schools as well as local college students and young adults new to the world of work. At NESCA, we take a relational approach with to build a strong foundational relationship between ourselves and the clients we support. Our priority to is create a safe, inclusive, and welcoming environment within our sessions.

What services do you offer?

At this time, NESCA’s Vermont-based practice will offer transition assessment, real-life skills coaching, executive function coaching, transition consultation, and functional community-based occupational therapy evaluations. All Vermont-based services are delivered by experienced occupational therapists and transition specialists with expertise in developing functional and relevant goals. For more information on each of these services, please visit our website and view our Post-Secondary Transition Services and Coaching Services links: https://nesca-newton.com/our-services/. Many folks are unfamiliar with transition assessments, so to learn more, see the following blog written by our Director of Transition Services Kelley Challen, Ed.M., CAS: https://nesca-newton.com/transition-assessment-what-is-it-anyway-how-is-it-different-from-neuropsychological-evaluation/.

What type of client does NESCA serve in Vermont?

NESCA’s Vermont-based practice primarily works with teens and young adults with autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), mental health diagnoses, specific learning disabilities, executive function (EF) challenges, and other complex cases based on the expertise of our providers. A specialty at NESCA is working with clients who have multiple diagnoses or who don’t fit neatly into a singular diagnostic box.

Where are you in Vermont? Are services in-person or remote?

Coaching services will be offered in the home, school, or community within the greater Burlington area. Services can also be delivered remotely if deemed appropriate for the client. Transition assessment is typically conducted within the client’s school setting.

What is different about what NESCA offers in Vermont compared to other organizations or services already available?

NESCA will be a premier independent transition assessment provider in Vermont. We are happy to collaborate with school districts or work with families directly. Additionally, we are unique in providing one-on-one occupational therapy services that specifically address life skills within a client’s home and community setting. Working within the home and community, and not only within the school setting, is incredibly important for the generalization of life skills as well as social skills, functional academic skills, and executive functioning skills.

Does insurance cover your services in Vermont?

NESCA is primarily a private pay service provider. Some families are able to obtain some coverage or reimbursement for our real-life skills coaching service with their health insurance, but it is vital that folks first check with their insurance provider to ensure our services would be covered.

How do people get more information about NESCA’s Vermont services?

To learn more about NESCA, please visit our website at: https://nesca-newton.com/.

If you would like to fill out an intake form, follow this link: https://nesca-newton.com/intake.

If you have more specific questions, do not hesitate to call: 617-658-9818

Additionally, you can contact our Vermont-based Program Manager Dr. Lyndsay Wood, OTD, OTR/L, directly at: lwood@nesca-newton.com

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

 

To book coaching and transition services at NESCA, complete NESCA’s online intake form. 

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

42

Transition Assessment: What Are You Testing that Hasn’t Already been Tested?

By | Nesca Notes 2023

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

Transition planning is a complex process centered around helping students, typically who receive special education services, to set goals for their postsecondary adult lives and to engage in learning, services, and experiences that will help them to ultimately reach those goals. Assessment is a critical aspect of this process, both as a means for collecting baseline information about the student and measuring progress throughout the planning process. Transition planning is federally mandated for students at age 16. However, some states require schools to start the process earlier. For instance, transition planning is required as part of the IEP process for students turning age 14 in Massachusetts.

Transition assessment is therefore required in middle school or early high school for most students in the United States. By this point in time, students on IEPs have often participated in lots of testing. Students may have had academic testing, psychological evaluation, speech and language testing, occupational and physical therapy assessments, functional behavioral assessment, and even home or health assessments. They have participated in so much previous testing, that some parents or professionals may ask, “What could a transition specialist be testing that has not already been addressed through other evaluations?”

The answer is, “A lot!” There are many areas that can and should be evaluated as part of an informed transition planning process, but which are not frequently evaluated when creating earlier IEPs. This is because initial IEPs and early reevaluations focus on helping students to access education and school life, but transition planning is about helping students to develop necessary skills for accessing learning, living, community, and employment as an adult. The following tables are based on on the Transition Assessment Planning Form developed by the Transition Coalition at the University of Kansas in 2008. These highlight many areas of assessment that can and should be considered as part of a comprehensive transition assessment and planning process. These also indicate which areas have usually not been considered for evaluation prior to a thorough transition assessment process.

Please note that every student on an IEP is an individual with unique strengths and disability-related needs and so these tables are offered as a general picture of what has been observed at NESCA in the majority of cases. Additionally, while all of the areas above are considered as part of a comprehensive transition assessment and planning process, they may not need direct assessment depending on student profile, postsecondary goals, and existing evaluation or report data.

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

 

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

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

11

Understanding Behavior as Communication

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

School is out for many, and it is no surprise to many that it was a challenging year for teachers, parents, and children. One word that captures the experience of the 2022-2023 school year is stress. Teachers were stressed as their students continued to contend with the academic and social deficits that resulted from the pandemic. Many students have struggled to adapt to post-pandemic learning, and incidents of acting out behavior have increased precipitously. How do we make sense of children’s behavior while helping them develop and effectively manage the academic, social, and behavioral expectations of an ever-changing world?

Ross Greene, Ph.D., states, “Children want to do well and would if they could.” Behavior is not just random or meaningless. It serves as a way for children to express their needs, feelings, and experiences, especially when they have not yet developed strong verbal or communication skills. When the demands of the environment exceed a child’s capacity to manage them, they are apt to become stressed, increasing the likelihood that they will act out. Stress is a complex concept that is a response to perceived or anticipated demands or pressures that exceed an individual’s coping abilities.

When stressed, the adrenal glands release cortisol, a stress hormone that helps mobilize energy reserves for the fight-or-flight response. Fear and anxiety also increase individuals’ vulnerability to responding with fight or flight. So, while fear is focused on a specific threat, physiologically, it feels much the same as stress. Behavior is, therefore, a way of communicating that something is amiss. For instance, a child who acts aggressively may express frustration, which is stressful. And a child who becomes withdrawn might feel overwhelmed or anxious, triggering a stress response. Behavior is a natural way for children to communicate their needs, emotions, or reactions to the environment.

Our job as adults is first to check our own emotional status, because if we are tired or stressed, it will likely influence how we respond when children behave badly. Observing and interpreting behaviors with a curious and open mindset is important. By paying attention to patterns, triggers, and context, adults can gain insights into what a child might be trying to communicate through their behavior. Our job is not to manage the behavior but to understand, per Dr. Greene, what skills are lagging or what problems need to be solved, build relationships, and work collaboratively with children to solve problems and change behavior.

Resources:

The Explosive Child, Ross Greene, Ph.D., 2021

Beyond Behaviors; Mona Delahooke, Ph.D., 2019

Podcast: Two Sides of the Spectrum; episode dated April 5, 2023; “Safety as the Foundation for Everything

 

About the Author

Dr. Cynthia Hess (Cindy), a licensed psychologist, worked as an elementary counselor and school psychologist for 15 years before starting her doctorate. In this role, she developed extensive expertise and aptitude for working with individuals and groups struggling with a wide range of emotional and learning challenges.

She completed her pre-doctoral internship with Rochester Institute of Technology in Rochester, N.Y., where she trained at Hillside Family of Agencies in a therapeutic residential school. At Hillside, she worked with youth ages 5-17 who had experienced complex developmental trauma.

She earned her Psy.D. in Counseling and School Psychology from Rivier University in 2018. Having a strong interest in the impact of social media on children and our culture, her doctoral dissertation studied the impact social media has on social skills development in fourth- and fifth-grade children.

Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England, where she provided psychotherapy and family therapy to children ages 5-18 and young adults.

Dr. Hess joined NESCA’s Londonderry, N.H. office in 2019, where she completed a second two-year fellowship in pediatric neuropsychological assessment. Dr. Hess now conducts neuropsychological evaluations as a pediatric neuropsychologist and has a particular interest in working with children and young adults with complex emotional and behavioral profiles. Her experience allows her to guide families in navigating the complicated options for school and other support services.

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and the greater Burlington, Vermont area, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

39

So, You Are Taking a Leave of Absence from College—Now What?

By | Nesca Notes 2023

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

Over three-quarters of college students (76%) reported moderate to severe psychological distress during the 2022-2023 school year (National College Health Assessment, American College Health Association, Spring 2023). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. My appointment calendar is often made up of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

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

 

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

3

Neuropsychological Evaluations at Different Stages of Childhood & Adolescence

By | Nesca Notes 2023

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

Having been at NESCA for more than 11 years, I have been fortunate enough to follow many clients throughout their childhood. In some cases, I have conducted two or three neuropsychological evaluations on the same student at different points in their life. After their first experience with an evaluation, parents will often ask, “Will we need to do this again?” or “How often should we get evaluations?”. As is the case for most things, the answer is different for every child depending on their needs. When determining how often to seek an evaluation, it might be helpful to think about what information you are trying to gather depending on the child’s age.

Preschool (2-5)

  • Concerns about developmental delays (not meeting milestones)
  • Concerns about autism spectrum disorder (ASD)
  • Transition from Early Intervention into preschool
  • Transition from preschool to kindergarten

Elementary School (5-10)

  • Concerns about academic skills – assess for dyslexia, dysgraphia, dyscalculia, or other specific learning disability
  • Why is the student not making expected progress in school?
  • Concerns about attention and executive functioning (possible attention-deficit/hyperactivity disorder (ADHD)
  • Concerns about ASD (if not already diagnosed)
  • For children who already have an identified disability – need to monitor progress
  • Plan for transition to middle school

Middle School (10-14)

  • If this is the first neuropsychological evaluation – it is usually because the child did okay in elementary school but is now struggling with increased demands in the areas of academics, executive functioning, and social
  • For students with a previously identified disability – need to monitor progress
  • Plan for transition to high school

Early High School (14-16)

  • Monitor progress – how is the student managing increased demands of high school?
  • Mental health – emerging concerns about anxiety and/or depression
  • Start planning for postsecondary transition
    • Is the student on track to graduate in 4 years?
    • Does the student need programming beyond 12th grade?

Late High School (16-18)

  • Heavy emphasis on postsecondary transition planning
  • Do we need to work on vocational skills?
  • If the student is college-bound – determine whether any accommodations will be needed
  • If the student is not going to college – what is next?
    • Remain at high school with ongoing special education services
    • Gap year
    • Young adult transition program for students with disabilities
  • Consult with transition specialist to help with planning

Early Adulthood (18+)

  • If the student is in college – do they need additional supports?
  • If the student is still accessing special education services – where should we be putting the emphasis?
    • Academics
    • Vocational
    • Life Skills
  • For students with developmental disabilities, need to plan for adult services
    • Should the parents seek guardianship?
    • Is the student eligible for DDS or other adult service agencies?
    • What resources are available to the family?
  • Combine with transition specialists to help navigate adult services

 

About the Author

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

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

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

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

41

Age of Majority: Preparing Students to Make Special Education Decisions as Adults

By | Nesca Notes 2023

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

One of the exciting aspects of being a transition specialist who evaluates and provides consultation to students and schools across the country is that transition services are dictated by the Individuals with Disabilities Education Act (IDEA 2004), a federal law. Students have similar rights across all 50 states regarding how their IEPs must prepare them for postsecondary learning, living, and employment experiences. However, there are additional rights and responsibilities related to special education that are dictated by state laws and regulations. Age of Majority and the Transfer of Rights to students is one of these issues that varies from state to state.

At the Age of Majority, or the age of legal adulthood, in each state, young adults are granted certain legal rights (e.g., voting, marrying, opening a credit card, signing contracts). Each state determines which rights will transfer to young adults within their state. IDEA 2004 gives states the right to transfer educational decision-making rights to students who have reached the Age of Majority—this means that all of the educational rights previously accorded to parents/guardians may transfer directly to the student. The Age of Majority is 18 in most, but not all, states.

In states that transfer educational rights at the Age of Majority, school districts are required to provide notice to parents and students ahead of time so that families are not surprised that the parents’ rights will transfer to the student. Additionally, at least one year before the student reaches the Age of Majority, the student’s Individualized Education Program (IEP) needs to include a statement indicating that the student was informed of their rights under IDEA.

There are exceptions to the Transfer of Rights when a student has been determined to be “incompetent” under state law—this often involves a parent/guardian taking partial or complete guardianship of the student. Students may alternatively have a Power of Attorney drawn up so that a parent can continue to represent their educational interests. States may also have their own processes for electing decision-making when the student reaches the Age of Majority. For example, in Massachusetts, students who have turned 18 are presented with a choice to take over decision-making, share decision-making with a parent or other willing adult, or delegate decision making to their parent or another willing third party; They sign a document indicating their elected choice on or after their 18th birthday.

There are many educational rights that a student may assume when they reach the Age of Majority. Some of these include receiving notice of IEP meetings, consenting to evaluation, placement, and/or an IEP, deciding to drop out of school, or deciding to accept a diploma and end eligibility for transition services. Parents and educators can help students prepare for the Age of Majority and Transfer of Rights ahead of time. Pacer’s National Parent Center on Transition and Employment has put together a handout with tips for doing this important work. Some of the tips are included within my longer list of preparatory activities below:

  1. Start building choice-making and decision-making skills as young as possible.
  2. Teach students about the IEP process in elementary or middle school.
  3. Encourage students to observe and participate in IEP meetings.
  4. Allow students to invite preferred educators, family members, and community members to IEP meetings for support.
  5. Role-play IEP meetings prior to participation.
  6. Begin talking about Transfer of Rights when students first begin attending IEP meetings.
  7. Prior to reaching the Age of Majority, talk about how the student thinks they will want to make decisions across areas of life—What decisions do you want to make totally alone? What decisions do you want to make in collaboration with others? What decisions do you want other people to make for you?
  8. Help students to develop good working relationships with school personnel and team members.
  9. Stay involved in the IEP process even after a child reaches the Age of Majority—but allow the student to be the primary participant in the development of their IEP.

For parents or guardians who suspect that a child will not be competent to handle educational decision-making, it will be important to consult with clinical and legal experts well in advance of the child reaching the Age of Majority. It is also important to keep the IEP team informed regarding any legal proceedings or arrangements that may impact educational decision-making. With that said, many students who are not competent to manage complex medical or financial decisions can be strong participants in their educational processes and transition services. For tools that you can use to help educate students regarding the IEP process, please check out the video and document resources from imdetermined.org. For tools that you can use to explore decision-making and supported decision-making as students approach adulthood, please review these resources from Charting The Lifecourse.

 

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

 

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

39

So, You Are Taking a Leave of Absence from College—Now What?

By | NESCA Notes 2022

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

Almost 75% of college students reported moderate to severe psychological distress during the 2020-2021 school year (National College Health Assessment, American College Health Association, 2021). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. In the weeks leading up to Thanksgiving, my appointment calendar consisted primarily of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

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

 

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

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