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14
Filled backpack ready for the first day of school

How to Prepare Students with Autism for the New School Year

By | NESCA Notes 2024

Filled backpack ready for the first day of schoolBy: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

I know that summer is about to end here in New England when I see posts on Facebook from my West Coast friends about their children’s first day of school and when every other commercial on TV is heralding back-to-school sales. A little sense of panic sets in, because of all the preparations needed for children going back to school. In my work with children with special needs, one group that often struggles with transitions such as these is children with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. One of the symptoms of ASD is difficulty with transitions. Some children with ASD get really upset with even slight changes in routines or plans. This is the reason why the start and end of the school year is often difficult for them. Here are some strategies for helping children with ASD transition back to school. They can also be used for any child to prepare for any transition, major or minor.

Visit the new school/classroom – A lot of schools are already doing this, but a visit to a new school or classroom a few days before the official start of school could help your child get acclimated to their new environment or teacher. Teachers usually report for work the week before the first day of school to prepare their rooms. Set a time to meet with the new teacher and let them provide your child with a tour of the room and other areas, such as the library or cafeteria. Show the child their desk and cubby. Tell them about the schedule posted on the board. This will ease some of your child’s fears and anxieties about the first day of school.

Use social stories – Social stories are written or illustrated stories that present information about social situations. Developed by educational consultant, Carol Gray, they instruct students about what to do or say in social situations, for example, the first day of school, together with information about other people’s motives or expectations. Using pictures from the school visit above, you can create a social story about the first day of school that talks about what to expect, directives about what your child can do or say, and the reason behind these actions. Here is an example of part of a social story for the first day of school:

  • This is Ms. Smith, my new teacher. She is very nice.
  • My mom and I walk to my classroom.
  • Smith is there to greet me. I look at her and smile.
  • I say goodbye to my mom and give her a big hug. She will come back at the end of the day to pick me up.
  • I enter the room and place my bag in my cubby. I find my desk and take my seat.
  • I look at the kid next to me and say, “Hi.” I want other kids to like me.

For help with creating social stories, you can go to https://carolgraysocialstories.com/social-stories/what-is-it/ or https://www.autismspeaks.org/templates-personalized-teaching-stories.

Use video modeling – In my work with children with autism, I often find that they are visual learners; they have better developed abilities in thinking and reasoning with pictures. And with the popularity of technology, such as iPads and smartphones, they are usually attracted to videos. Speech and language pathologist Linda Hodgdon, M.Ed., CCC-SLP (www.usevisualstrategies.com) has developed a strategy of using videos to teach skills/competencies for children and adolescents with ASD. In video modeling, you can bring your child to the new school/classroom a few days early with a video camera. You can record walking the hallways from class to class, opening the locker, going to the cafeteria or the gym, and other things they would need to do when school is in session. While you are filming, you can add dialogue explaining each item or place of interest. Then, your child/teenager can watch the video at home to prepare for the first real day of school when students will be there. Video modeling can also be used to prepare for other transitions/novel situations, such as preparing for a holiday or a new experience (e.g., riding a train, watching a movie, visiting a new restaurant).

Transitions are difficult because they require us to leave a place or state that we have been accustomed to and enter something that is unknown or unpredictable. Preparing ourselves for transitions by demystifying some of the unknowns can help us cope better with the anxiety that is inherent in these situations. I hope the suggestions above can help you and your child transition back to school.

 

About the Author

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

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

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

 

12

How the Pandemic Changed In-Person Learning

By | NESCA Notes 2024

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Among the parts of my job that I find most meaningful are the conversations I get to have with parents during intake and feedback sessions. During an intake, much of the emphasis is on history taking. Some of it isn’t very exciting; trust me, I get that it can be tedious to review information like how much your child weighed at birth, how many ear infections they had, and when they learned to walk. Yet so often the information parents are able to share about a child’s history is crucial. There’s a quote attributed to Michael Ventura that says, “Without context, a piece of information is just a dot. It floats in your brain with a lot of other dots and doesn’t mean a damn thing. Knowledge is information-in-context… connecting the dots.” The history parents share provides essential context that helps us piece together and make sense of the data we get from doing an assessment in the office.

In recent years, we’ve added questions about COVID-19 to help us understand how that experience has impacted the children and teens we work with. I regularly ask parents, “How old was your child when COVID-19 hit? What grade were they in and how long did remote learning go on? When did they return to in-person instruction?” During a recent intake with a parent, I got an answer I wasn’t expecting. A very thoughtful and perceptive mom gave me some dates and ages then paused for a moment and added, “But even though they’re back in school, I don’t think learning has ever been the same since COVID.” I asked her to tell me more, and we had a wonderfully thought-provoking conversation. As so often happens, I learned a great deal from a parent. Since that time, I’ve extended the discussion to include some of my very insightful colleagues, who have also shared their thoughts. The consensus is that “in-person learning” in 2024 doesn’t mean the same thing it did in 2019. So, what’s changed?

Yes, students are, for the most part, sitting at desks inside classrooms rather than connecting remotely from their desks (or kitchen tables or couches) at home, but what happens in the classroom and beyond is different in some important ways.

  • Technology: In speaking with parents and colleagues in different fields, I’ve repeatedly heard that pandemic-related school closures “accelerated the use of technology” and “online learning platforms” in education. There was certainly a need to use online learning platforms during the pandemic, and the extent to which schools incorporated technology speaks to ingenuity and flexibility in the face of an unexpected and incredibly challenging situation. Moreover, technology is a wonderful tool that can be used to enhance learning in many ways. That being said, many parents and colleagues have observed that schools never went back to “how information and tasks were managed pre-COVID.” That is, technology and online platforms have remained a part of the learning experience. The challenge for some students is that even within the same school system, there can be a great deal of variability between the specific platforms individual teachers use and how they make use of them. Especially for students who struggle with anxiety or executive functioning weaknesses, keeping track of and switching between different platforms and applications for different classes can be overwhelming.
  • Different Teaching Methods: One of the trends I’ve observed directly and have gotten feedback on from others has to do with how teachers provide instruction in the classroom. Compared to “the before times,” the post-pandemic years have seen a rise in independent learning, even within the context of the classroom. More often, teachers have students work independently, whether that means reading through Google slides at their desks or completing worksheets and tasks on their own. There seems to be less direct teacher-led instruction and an increased reliance on independent learning, which often incorporates use of technology, such as Chromebooks, in the classroom. While some students thrive when given the freedom and flexibility to learn on their own, many students learn best when provided with instruction using more direct, structured, and an interactive approach.
  • The Boundaries are Blurred: Working adults will relate to this phenomenon. Back before COVID-19, many of us had pretty clear boundaries separating our work lives from our personal lives. We commuted to an office or other workplace, worked for a set time period, then went home. That all changed when many non-essential employees pivoted to working from home at the start of the COVID-19 lockdown. Suddenly our kitchens or bedrooms were transformed from private living areas to undefined spaces that housed both our personal lives and our work lives. And our work and home lives bled into each other as we tried to fit in work when we could, especially if we were also home-schooling or caring for children all day. Though many employees are back to the office at least to some extent, the boundaries remain somewhat blurred. The same phenomenon has happened for students. There is a “24-7 connectedness” that technology enables, which has both pros and cons. Because a lot of schools still use online platforms for assigning, submitting, and grading homework, teachers can post assignments at any time. One parent described a sense of assignments popping up online “like Jenga blocks, one layered in after another.” Similarly, students can turn in assignments at any hour of the day or night. One of my colleagues has observed that this has negatively impacted sleep habits for some students. Another colleague astutely pointed out that, not only can this be overwhelming for students, but it may also be contributing to some of the burn-out many teachers are experiencing.

Education has been perhaps permanently altered by the pandemic, just as many of us have been. The changes that have occurred bring benefits and challenges that our students and teachers are still adjusting to. I don’t have answers or solutions, but I know that I’m going to be adding to the questions I ask parents about COVID-19, education, and the impact on their student. It’s still important for me to learn when a student resumed “in-person learning,” but I’m no longer going to assume that phrase means the same thing it’s always meant. Instead, I’ll be asking parents to tell me what in-person learning looks like now, because the reality is that none of us has gone back to life circa 2019. Just like all of us, our students are living in the “new normal,” and we need to understand it so that we can support them in benefiting from the opportunities it brings and in navigating the challenges it poses.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

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

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

10

Understanding the Neuropsychological Evaluation Process When an Autism Spectrum Disorder is Suspected

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In January, Dr. Folsom published a blog post detailing the reasons why so many females on the autism spectrum are misdiagnosed in childhood. Here at NESCA, we are continuously working to improve our testing practices and administration protocols to ensure that we accurately capture one’s diagnostic picture when they come in for a comprehensive neuropsychological evaluation regardless of gender identity, age, or diagnostic presentation. As clinicians, tailoring an appropriate testing protocol is only one piece of the puzzle when working with our clients. From the moment we review your intake paperwork and questions/concerns, we work diligently to make sure we are teasing apart each component of a child’s neuropsychological profile to ensure clarity and accuracy for diagnoses and tailored recommendations. Here is a look into some of what that process looks like:

Initial Paperwork: Before your first intake appointment, your clinician will thoroughly review all of the intake paperwork and supporting documents you have submitted to us. We make sure to read all of your questions and concerns, while also making our own notes of questions that we will have for you during the intake appointment. All neuropsychologists here at NESCA are trained to identify “red flags” or areas of potential concern that we want to know more about through our interviews with you, your child, teachers, and our testing protocols.

Intake Appointment: During this appointment, we will ask you more in-depth questions about your responses and questions from the intake paperwork you provided. This is an opportunity for us to explore any concerns we may have. For many diagnoses, there are overlapping diagnostic features that are important to tease apart. For example, inflexibility and rigidity (not handling transitions well, struggling with changes in routine) may be related to an anxiety diagnosis, a mood disorder, an autism spectrum diagnosis, and/or executive functioning weaknesses.

Speaking with Collaterals: Oftentimes, clinicians will ask for permission to speak to other caregivers who have knowledge of your child, such as teachers, therapists, and pediatricians. Because we only see your child for a “snapshot” in time, it is important for us to also consider the perspectives of those who have longstanding relationships with them in a variety of contexts and environments.

Developing a Testing Battery: After the intake appointment, clinicians put together a tentative list of assessment measures that we may want to utilize. Tentative is the key word because oftentimes testing batteries change throughout the course of the assessment as a diagnostic picture becomes clearer or when specific areas of deficit become more apparent.

At NESCA, we have access to multiple testing tools that allow us to tailor our testing battery to capture any nuanced constellation of symptoms or diagnostic profile. For example, when thinking about how to accurately diagnose someone who is “high functioning” or “masking” areas of vulnerability related to an autism spectrum diagnosis, clinicians have access to the following batteries:

  • Autism Diagnostic Observation Schedule—2nd (ADOS-2): The ADOS-2 is one of the most well-known assessments for autism as it utilizes a semi-structured format to assess social communication skills as well as restricted interests, repetitive behaviors, sensory sensitivities, and rigidity. The ADOS-2 relies on standardized observations to capture any difficulties in the aforementioned categories.
  • Childhood Autism Rating Scale—2nd (CARS-2): The CARS-2 is another measure that involves a standardized rating scale based on direct observations of the child. While playing and interacting with your child, the clinician is able to fill out this rating scale to assess symptoms associated with an Autism Spectrum Disorder. The CARS-2 also includes a parent questionnaire to allow for qualitative parent observations.
  • Monteiro Interview Guidelines for Diagnosing the Autism Spectrum—2nd (MIGDAS-2): The MIGDAS-2 assesses qualitative observations of language and communication skills, social relationships, emotional responses, as well as sensory interests and/or sensitivities. The MIGDAS-2 can be particularly helpful for children and adolescents who are “high-functioning,” or do not fit the presentation of the “male prototype” described in Dr. Folsom’s blog.
  • Social Language Development Test (SLDT): The SLDT measures social communication skills such as the ability to make inferences, interpret social situations, and navigate peer conflicts.

In addition to the above measures, clinicians may also choose to administer subtests related to social thinking, perspective taking, and/or emotion identification. Examples of these subtests include:

  • Affect Recognition and Theory of Mind from the NEPSY-II
  • Inferences, Meaning from Context, Idiomatic Language and Pragmatic Language on the CASL-2

For older children and adolescents, clinicians may ask them to fill out/answer questions about their own perceptions of their lived experiences. This can be done through an unstructured interview or by one of the following:

  • Camouflaging Autistic Traits Questionnaire (CAT-Q)
  • Ritvo Autism Asperger Diagnostic Scale—Revised (RAADS-R)
  • Autism Spectrum Quotient (ASQ)

Parent Questionnaires: Whenever there are any questions or concerns related to social communication and interpersonal relatedness, your clinician may ask you to fill out rating scales assessing your perception of your child’s ability to interact with others, engage in age-appropriate play, be flexible in their responses to change or new environments, and have a variety of interests. These questionnaires include:

  • Social Responsiveness Scale—2nd (SRS-2)
  • Social Communication Questionnaire (SCQ)
  • Autism Diagnostic Interview—Revised (ADI-R)
  • Gilliam Autism Rating Scale—3rd (GARS-3)
  • Gilliam Asperger’s Disorder Scale (GADS)
  • Autism Spectrum Rating Scales (ASRS)

As you can see, we have a wide variety of measures available at NESCA to look at symptoms of an Autism Spectrum Disorder. Based on the discretion of your clinician, one or more of these may be used to further assess social communication concerns. While you may have heard of some of these being referred to as “the gold standard,” your clinician will use their knowledge, experience, and training to tailor a testing battery for the individual needs of your child. There is never a one size fits all approach to neuropsychological testing!

 

About the Author

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

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

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

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

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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, New York (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.

 

15

Creating a Kinder, Gentler New Year

By | NESCA Notes 2024

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Counseling Services, NESCA

We use the start of every new year as motivation to set goals for ourselves, and we often ask children to do the same thing. A New Year’s Resolution is a tradition, in which we set our mind, heart, and spirit to change an undesired trait or behavior, accomplish a personal goal, or otherwise improve ourselves in some tangible way. We may set a goal to lose weigh, exercise more, eat less sugar, meditate daily for five minutes, do homework without a fuss, help out with chores around the house, or walk the dog when my parents ask, etc. Often, we make New Year’s Resolutions, but we don’t usually accomplish them. Within a month or so, we start slipping back into our old ways. Habits are hard to change, and we are resistant to change – it is partly due to our wiring. So, if you are one of these people who has good intentions and sets New Year’s Resolutions then fails, know you are not alone. Hopefully, this fact can help you feel less shame and guilt when you “fail” at keeping them.

I’d like to suggest that if you decide to set a New Year’s Resolution, you do it with yourself and other people in mind. There is so much angst and strife in the world right now that if we resolve to be kinder, gentler, and more patient with ourselves and each other, the world would be a better place.

One idea is to make group resolutions that impact the functioning of the collective. For instance, we could consider Family New Year’s Resolutions or Classroom New Year’s Resolutions. With this in mind, here are some sample suggestions for New Year’s Resolutions for families, classrooms, parents, teachers, and children. Keep your resolution(s) manageable – i.e., only pick one that you are truly committed to working on and putting the energy into changing, as your brain is partly “against you” changing! As they say, “May the Force Be With You!”

General New Year’s Resolutions

  • Sleep – It’s important for everyone, so try to set bedtimes for everyone and stick to them (parents included). Bedtimes should be different depending upon the ages of each child. Getting more sleep may afford us the ability to be more patient with others.
  • Unplug – Take time to unplug from your devices for an hour or more every day. Go for a walk, talk to each other, get the kids involved in preparing the dinner, play a board game. (i.e., take part in old fashioned “family time”). Unplugging affords us the opportunity to be more connected with each other, and being with others (Social Engagement) has been proven to improve one’s quality of life.

For All of Us:

  • Develop patience and compassion when you mess up, as you will mess up.
  • Develop patience and compassion with others because they, too, will mess up.
  • Develop a calming practice if you do not currently have one. Stress happens and is a “silent killer” (i.e., higher blood pressure, poor eating habits, etc.). We have smart watches that can remind us to take a breath…set it to remind yourself. Come back to your breath in moments of stress. Just a few minutes a day mindfully breathing can lower your heart rate and, over time, lower your blood pressure and reduce cortisol (a stress hormone) in your body.
  • Listen more/Talk less.

For Classrooms:

  • Encourage each student to identify one area related to Personal Growth (i.e., ask more questions in class, volunteer to help another classmate, remain calm when challenged academically, etc.). I will ___Settle Down___ when asked by the teacher by the end of the count; show ___Kindness___ to others in my class by___; Ask more questions; volunteer to ___.

For Teachers:

  • Start the New Year off with renewed energy and reimagine equity in your classroom.
  • Talk about fairness – Fair doesn’t mean equal; it means everyone gets what they need to succeed.
  • Talk about school-based stressors/triggers for students (i.e., a certain subject/activity type, tests/quizzes, speaking in front of the class, etc.). Teach them that stress is a normal part of life, then teach them simple stress-reduction techniques (i.e., mindfulness, deep breathing, yoga poses, etc.) they can weave into their day.
  • Teach students about perseverance, grit, and effort and how they are all entwined. Involve students in identifying when they are using them.

For Parents:

  • Self-care – Priority #1 for parents. Just like the airlines say, “Put your own oxygen mask on first.” Define what this means for you and make a plan to stick with it. One small step at a time.
  • “Be Present” with your kids. Often, we are “with” our kids a lot, but are we truly present in mind and body? Usually not; we are doing something else when they are talking to us (i.e., cooking, paying attention to our phones, packing lunches, etc.), so our attention is split. Try taking 10 minutes every day with each of your kids to be truly present in mind and body with your attention solely on them in the moment.
  • Talk with your children about home/life stressors/triggers (i.e., not getting to do what they want, having to do something they don’t want to do, moving from a preferred to non-preferred activity, etc.). Teach them that stress is a normal part of life, then teach them simple stress-reduction techniques (see above) and work together to weave them into the day. Model practicing them yourself!
  • Show gratitude for their words and actions.

Here’s to hoping we are blessed in 2024 with more peace in our hearts and a kinder, gentler, and more compassionate family, classroom, and world!

Resources on these topics:

Keeping Resolutions

Family Resolutions

Stress & the Body

Awesome Year by Kid President

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert clinicians, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant/service in the referral line.

 

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.

 

148

Five Tips for Promoting Fine Motor Development in the Home!

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach

  • Writing on a vertical surface is a great way to promote proper hand/wrist positioning and fine motor growth – try taping paper to an easel or to the wall and allowing them to try writing on this plane.
  • Skip the fat pencils for our little learners. While specific adapted writing utensils for children with fine motor needs can be best assessed by an occupational therapist, for the majority of our young learners, the rule “the object promotes the grasp!” is applicable. If we want our learners to be building strength and learning proper hand positioning, I suggest trying either a standard number 2 pencil or a mini golf pencil.
  • Let your children peel off and stick on their own stickers! In reality this could end up with some ripped stickers or extra time spent on a project, but peeling off stickers promotes a pincer grasp, bilateral coordination and visual motor integration. If your child is too young to find the edge and begin to peel, consider starting the sticker and then letting them finish peeling it off independently.
  • Use scissors to cut anything and everything! While supplies of construction paper and worksheets sent home from school may be dwindling, consider letting your children cut up junk mail (make sure it’s sanitized), old magazines, newspapers and scraps of old cloth. Some of our kids will want to use these scraps to create a collage or other art projects, while others will simply enjoy the act of shredding. You can make this activity accessible for really young kids by simply having them tear the paper with both hands.
  • Bring out the tool box! Twisting a bolt onto a screw, using a wrench to tighten a hex-nut and using a hammer to pull nails out of a block of wood all help with fine motor and increasing strength. For more of a visual perception task, considering mixing all of the screws, nails and bolts together and having your child sort them into different bowls or containers.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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

 

149

Remote Real-life Skills Coaching: How Does it Work?

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach

What is life skills coaching?

Coaching services in general aim to target functional life skills and help our children and adolescents to slowly build the ability to independent. While some of these skills, such as taking Uber, riding the T, or ordering in a restaurant, cannot be targeted using an online platform, the majority of these skills can absolutely be built with the help of a dedicated remote coach. Currently, many of our coaches are helping students through the great task of processing a huge life change in response to the COVID19 virus.

What skills can be worked on with a remote coach?

Hard skills are often thought of as specific, functional abilities that one can develop and perform. (In employment, these are often thought of as technical skills.) Options that can be worked on with a remote coach include cooking based on a specific recipe, ordering groceries on-line, calling to refill prescription, setting up a medication management system, typing, using Google classroom or Microsoft suite, electronic calendar management, etc.

Soft Skills include more abstract and broad abilities that are necessary for employment, academic success, and community independence. NESCA coaches work on executive function, social communication, and self-determination skills necessary for long-term independence at home, in school, and at work. Example skills taught include creating daily schedules, goal setting, preparing for interviews, organizing the home environment in order to be productive, reading and understanding IEPs and assessments, using technology to support memory, customer service skills, research skills, and more.

With the current pace and routine of life changing dramatically, NESCA coaches are working to help our clients establish healthy routines and habits. Coaches are available to help develop functional morning and evening routines, set up weekly to-do lists, develop a system to meet deadlines, use online resources for virtual learning, etc.

Who can benefit from this service?

Almost all adolescents and young adults could benefit from building life (and career or college readiness) skills, increasing independence, and practicing executive function; however, our neurodiverse population often has particular difficulty with changes in routine and greatly benefits from having a relational support to build structure and navigate change. All of our coaches have extensive experience working with adolescents and young adults with a wide range of learning, developmental, physical and social-emotional needs. NESCA is committed to helping young people who are struggling with this transition as well as families who are eager to use this unique situational opportunity to focus on skill building at home that is often difficult to fit in simultaneous to normal school demands.

What is a recommended coaching schedule?

Due to the individualized natural of coaching, the schedule and frequency can be incredibly personalized for each individual client. All of our coaching sessions begin with an intake process that includes input from both the adolescent and their family. Schedules are often developed in collaboration with the teen or young adult, the family, and the coach to best meet the client’s needs. Some example schedules that are used by current NESCA clients include:

  • Weekly Skill Building. Clients who are looking to target specific skills often choose to do a weekly session focus on learning and repetition.
  • Monday, Wednesday, Friday 30 Minute Check-ins. This model allows for a student to receive some guidance creating their own scheduling, while simultaneously holding them accountable.
  • Monday Motivation/Friday Follow-up! These sessions range from 1-2 hours and include weekly goal setting, check-ins regarding a weekly to-do list, and personal scheduling. For many clients a Friday follow-up session is an important opportunity to practice self-monitoring and review the previous week.

As somebody who coaches students in person and remotely, what differences do you notice?

I find that the main difference when coaching students remotely is when and how skills are targeted. In person, much of my coaching focuses on community integration, using our transit systems, and navigating the complex social interactions that are necessary when out in the community. Remote coaching can still target pieces of each of these skill areas but the process is in many ways more intrinsic. We may focus on learning to use the internet to find community opportunities, learning to create schedules for travel or complete applications for para-transit, using video learning to “try out” travel, employment, and community activities, and bolstering social media skills. We focused on building global skills in new ways that will help in the future, across environments. For instance, social communication by phone and video conferencing is a skill that will support social and employment success in the future.

In terms of the personal connection and opportunity to build rapport, I find that some teenagers are incredibly adept at communicating over a digital medium. Those who are not, tend to learn quickly. I am continually impressed by their ability to focus, discuss real-life topics, and build skills remotely.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, Transition Services, or Virtual Coaching Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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

 

149

School-based Occupational Therapy at Home

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach

While school districts and government officials work to plan for the current “new normal,” no concrete decisions have been made about the delivery of special education and provider services. As parents take on the huge task of educating within the home, it is important to consider how we can bolster some of the skills that are continuously targeted in the school setting. As an occupational therapist, I have provided direct services and worked with teachers who are adeptly teaching a class of 20, while simultaneously making sure that their two students with OT needs are being provided appropriate accommodations and motor practice. Here are some activities that can be done in the home to keep the development and learning going!

If your child’s occupational therapy (OT) evaluation mentions difficulty with fine motor coordination, consider incorporating these activities into your day.

  • Sort marbles, pompom or coins. Using fingers to pinch and pick up small objects helps to build strength and solidify grasp and grip patterns. Increase the difficulty of this activity by having kids push pompom and marbles through small holes or manipulate coins through slits in a tub or box.
  • Play with playdough or putty. Make shapes using cookie cutters, push beads into putty and pull them all out, roll playdough into a snake and use different pinches to create patterns from head to tail. Pinches to consider include: thumb and index finger, thumb and index+middle finger and thumb against the side of the index finger (lateral pinch).
  • String beads, cheerios or pasta with holes. This activity promotes bilateral coordination, fine motor control and grasp patterns. Scaffold this activity by starting with threading on pipe cleaners, moving to dry spaghetti and finally working to thread onto string.
  • Practice using tweezers to pick up small objects.

If your child’s OT evaluation mentions difficulty with visual perception or visual motor integration, try these!

  • Puzzles! Doing a puzzle requires multiple visual perceptual skills, as well as the fine motor precision to fit pieces together.
  • Word searches. Word searches require horizontal and vertical tracking, letter discrimination and visual figure ground ability. Consider scaffolding this activity by finding word searches that only have horizontal words, have both horizontal and vertical, or have horizontal, vertical and diagonal words.
  • Sorting activities. Objects can be sorted by color, shape, size, texture and a plethora of other characteristics. Consider using objects found in the home, such as pens, buttons, silverware or simply items in a junk drawer for sorting activities.
  • Mazes, Hidden Pictures and Spot the Difference activities can all be found online.
  • Copying activities. Draw pictures using horizontal, vertical and diagonal lines, circles, squares, triangles and crosses and have your child try to copy them exactly. This activity works on visual motor integration specifically.

If your child’s OT evaluation mentions difficulty with endurance, postural stability or core strength, try these!

  • Draw or play while lying on the ground. Tummy time is often thought of as an activity to help our newborns, but lying on your tummy and using the muscles needed to keep the upper body and head stable can be beneficial for building strength in most of our kids.
  • Yoga! Incorporate an online video or movement break into your daily routine.
  • Pretend to be different animals! Walk like a bear, slither like a snake, hop like a frog or trot like a horse. Mimicking these animals is a great activity to do while listening to music and uses all different muscles.

While it can be difficult to target our children’s specific needs without direct access to therapists and our usual resources, building in small activities throughout the day can help to maintain strength, skill development and the foundational abilities needed for academic growth.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in educational OT and functional life skills development. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as a part of the Real-life Skills Program within NESCA’s Transition Services team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. Having spent years delivering direct services at the elementary, middle school and high school levels, Dr. Bellenis has extensive background with school-based occupational therapy services.  She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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

 

172

Making the Most of COVID-19 School Closures

By | NESCA Notes 2020

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach

COVID-19 was recently declared a pandemic by the World Health Organization (WHO), and it is quickly becoming a pervasive force that we are all attuned to. As our healthcare providers, scientists and officials focus their energy on social distancing recommendations and public health measures, it seems as if time spent at home with our families – whether self-imposed or mandated – is inevitable. With our hardworking community members and officials focused on large-scale responses and issues, let’s take some time to discuss how we can create positive and productive environments in our own homes with our children while so many schools are closed.

  • Create Routines – Our children thrive on routine. Consider keeping their regular bedtime and morning routines, sitting down for lunch at the same time as they do at school, and writing out a daily schedule so that they know the plan for the day. Keeping these small things consistent can help our kids to feel regulated, calm and make a potentially scary situation feel much more predictable.
  • Request Work from Classroom Teachers – Most teachers will be sending home classwork to keep children engaged while they are out of the classroom. Make sure to request passwords to online learning sites used at school (raz-kids.com, IXL.com, etc.), have access to books at an appropriate reading level, ask about sites that provide printable worksheets, and, if still in school, bring home worksheets that could be completed during time off.
  • Schedule Recess/Playtime – While home is often seen as a place to relax and have fun, scheduling recess or play/downtime may help kids to feel like there is more of a routine. An average day at elementary schools fluctuates between time spent on learning, time to process and reflect, and time to have some fun. With an extended stay at home, it may help to touch on all of these activities. Scheduled recess allows for a child to predict when they will have a break to move their bodies and decompress.
  • Use Screens Wisely – Many parents will no doubt be working from home and have significant to-do lists of their own. While watching movies and favorite TV shows is likely an inevitable – and in many ways beneficial – tool to pass the time, consider exploring some more educational screen-based options as part of your child’s day. Resources such as National Geographic Kids, PBS KIDS.org, ScienceDaily.com, educationworld.com, TIME For Kids, Smithsonian Tween Tribune, among others can help to provide more academic content, including Social Studies, Science, Current Events and more. Commonsensemedia.org is also a great resource for finding age appropriate options.
  • Move Your Body – While getting outside for some fresh air is the ideal way for our children to move their bodies, this may not be an option. Thankfully, there are some creative ways to make sure our kids get in time for gross motor movement. Consider options such as GoNoodle.com, Cosmickids.com and Gaia.com for whole body movement and yoga videos. If you are looking for options other than video-based activities, consider building a pillow fort, keeping balloons off of the ground, having a dance party or setting up a home-made obstacle course.
  • Bolster Life Skills Education – As Kelley Challen, NESCA’s Director of Transition, so aptly explained in her blog post, the process of teaching our kids to become functional adults starts at birth. Consider spending this time teaching some skills in the home: have kids help with the process of doing a whole load of laundry from start to finish, work through a recipe for dinner together or clean surfaces around the house while explaining how to safely use different cleaning products. All of these experiences help a child to understand their future role as independent adults.
  • Work on the Broader Executive Functioning (EF) Skills – EF includes skills such as problem solving, time management, goal setting and organization. Provide sorting activities, have a child create their own schedule, set a daily goal, practice telling time or play some problem-solving games such as Heads-up, Charades or Guess Who.

 

About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.
To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email info@nesca-newton.com or call 617-658-9800.

 

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