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Monday, April 23, 2018

First Recommendation: Take up Golf

NESCA Founder/Director

A five-year old boy, whom I will call Marcel, was referred by his parents for evaluation to determine if he had Autism Spectrum Disorder (ASD) because he isolated himself socially. With a great deal of effort, I got Marcel through the neuropsychological evaluation process and observed him at his pre-school. Results of the evaluation revealed a significant communication disorder but no other symptoms of ASD. He was socially isolated because he didn’t have the language skills to interact easily with others. Although his verbal abilities were limited, Marcel’s visual-spatial skills were superior, based on testing results. During my school observation, I was struck by his ability to focus intently, seemingly immune to distraction, on building an extensive highway system for his cars for more than an hour.

In thinking about treatment for Marcel, my top priority was to conceive of a plan for luring him out of his “own world” where he retreated much of the time to avoid the communication demands inherent in engaging his surroundings. Because the language skills of young children develop most rapidly in social contexts, increasing Marcel’s opportunities for interaction with others would be expected to improve both his language skills and his social confidence. Since people can be most readily induced to change by leveraging their strengths, I asked myself, “What activity requires superb visual-spatial skills, and the ability to concentrate for hours on visual stimuli?”, both conspicuous strengths for Marcel. I also wanted an activity that would provide ample opportunities for interactions with others but not demand it.

Deciding that Marcel was too young to become a pool shark, I recommended golf to his parents, explaining my reasoning. I told them that, in addition to using Marcel’s natural strengths to build a skill that would enhance his self-esteem, golf would provide a “controlled social arena”. Marcel could get away with socializing primarily about the game, which would require him to use a limited vocabulary (e.g. birdie, bogey, slice) whereas socializing in less controlled environments involves a broader range of topics and associated language demands.

Marcel excelled with golf, quickly mastering the game and often playing more than 36 holes during weekends, such that he was interacting with others throughout the day, instead of engaging in solitary pursuits, but still “having a break” from other people while he focused on his game. He and his family were rightfully proud of his tournament trophies and Marcel established relationships with his teammates and coaches. As he spent more time interacting with others, Marcel’s communication skills and self-confidence blossomed.

When I saw him recently for his two-year follow-up evaluation, Marcel told me that he wanted to switch from golf to tennis “because its more social”.

Leveraging a child’s strengths can be one of our most potent tools for remediating weaknesses.

About the Author 

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

Monday, April 16, 2018

Transition Planning: Let’s Talk about Graduation Dates for Students on IEPs

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

On March 26, the Massachusetts Department of Elementary and Secondary Education (DESE) sent out an important administrative advisory regarding transition services and graduating with a high school diploma (Administrative Advisory SPED 2018-2: Secondary Transition Services and Graduation with a High School Diploma). This much-needed advisory clarifies when and how students with IEP's should be issued a high school diploma and also touches on best practices for planning both student graduation and appropriate secondary transition services.

As a transition specialist who is often contracted by schools and families, it is not uncommon to be asked to help determine whether a student is ready to graduate. The challenge in answering this particular question is that there is no universal set of skills or level of knowledge that deems a student on an IEP "ready" to graduate. In fact, students on IEP's, just as with mainstream students, graduate all the time without being ready for many adult activities (e.g. apartment hunting, changing jobs, applying for a bank loan, comparing health insurance plans).

The truth is, there are a number of skills that we need for "adulting," but do not need in order to graduate with a high school diploma. As this important advisory points out, the special education process is not simply about completing local graduation requirements. It is also about transition planning and services that uniquely equip a student for reaching their goals after leaving public education. Therefore, we need to rethink the question, “Is my child/student ready to graduate?” And instead, the critical question to ask when a student approaches the end of 12th grade is, “Has the child/student received a free and appropriate public education (FAPE)?”

As I discussed in a previous blog (Transition Planning: The Missing Link Between Special Education and Successful Adulthood), FAPE as guaranteed by the Individuals with Disabilities Education Act of 2004 (IDEA 2004) includes transition planning and services. Under IDEA 2004, a federal law, transition planning must start by the time a student turns 16. Here in Massachusetts, we have even stronger regulations, and secondary transition services may begin “no later than the age of 14.” This means that the IEP has to be carefully constructed to help students build skills "in a stepwise and cumulative manner" toward completing their high school program while also making progress toward their desired post-secondary learning, working, and independent living activities including community engagement.

The foundation for this process is an individualized and coordinated transition assessment process that carefully evaluates a student’s needs, strengths, preferences, and interests beginning before the age of 14. Just as with all IEP goals and services, assessment informs the team’s discussion and decision-making; it helps the team to know how to plan for the long-term, prioritize for the coming school year, and to track progress.

In each annual meeting for a transition-aged student, the IEP team needs to explicitly discuss whether the student is progressing towards their measurable postsecondary goals and whether the educational program and related transition services are calibrated in such a way that the student will continue to make progress. Anticipated graduation date (listed on the top of the Transition Planning Form and recorded in the Additional Information section of the IEP) is a critical part of this discussion each year. When a student, parent, teacher, or other team member is uncertain about a student’s ability to complete local requirements and receive appropriate transition services “on time,” this needs to be discussed directly.

If there is confusion or disagreement about the graduation date, additional assessment may be needed to clarify the student’s needs. However, if the team starts the transition planning process when a student is 14, and carefully plans out the instruction, community experiences, and employment related activities necessary for progressing toward the student’s post-high school goals, and closely tracks the student’s progress, then students, parents and educators will rarely need to ask whether the student is “ready to graduate.” Instead, they will know if the student has received FAPE because the student’s IEP has included well-calculated transition services and there will be clear measures of the student’s progress with annual goals and transition-related services indicating whether this particular student requires support beyond the traditional 12 years of education.

I am grateful for the recent administrative advisory from DESE and have found each of their advisories on the topic of transition to be tremendously helpful in supporting a shared understanding of the transition planning process among families, schools, and the professionals supporting them. At NESCA, we have seen great progress in the delivery of individualized transition services across the state of Massachusetts since the Massachusetts Legislature approved the amendment to the Massachusetts special education statute in 2008 to require transition planning services “beginning age 14 or sooner” and DESE put out Technical Assistance Advisory SPED 2009-1: Transition Planning to Begin at Age 14. With the recent advisory, I am certain that we will continue to see more teams embrace the transition planning process early. Students, families, and districts will experience less confusion and distress as a student approaches the end of 12th grade, because there will be a clear plan for exiting or continuing special education based on effective transition planning and a collaborative and communicative team process.

Transition Resources and Advisories from MA Department of Elementary and Secondary Education 
· MA DESE Secondary Transition Page - http://www.doe.mass.edu/sped/secondary-transition/default.html
· Administrative Advisory SPED 2018-2:Secondary Transition Services and Graduation with a High School Diploma - http://www.doe.mass.edu/sped/advisories/2018-2.html
· Technical Assistance Advisory SPED 2017-1: Characteristics of High Quality Secondary Transition Services - http://www.doe.mass.edu/sped/advisories/2017-1ta.pdf
· Technical Assistance Advisory SPED 2016-2: Promoting Student Self-Determination to Improve Student Outcomes - http://www.doe.mass.edu/sped/advisories/2016-2ta.pdf
· Technical Assistance Advisory SPED 2014-4: Transition Assessment in the Secondary Transition Planning Process - http://www.doe.mass.edu/sped/advisories/2014-4ta.html
· Technical Assistance Advisory SPED 2013-1: Postsecondary Goals and Annual IEP Goals in the Transition Planning Process - http://www.doe.mass.edu/sped/advisories/13_1ta.html
· Technical Assistance Advisory SPED 2009-1: Transition Planning to Begin at Age 14 - http://www.doe.mass.edu/sped/advisories/09_1ta.html

While this blog includes some specific content that applies only to families of students in IEPs in Massachusetts, the requirement of transition services for students on IEPs is a federal mandate. For families living in New Hampshire, guidance from the New Hampshire Department of Education can be found at https://www.education.nh.gov/instruction/special_ed/sec_trans.htm. The NH DOE has additionally helped develop a web site with resources for increasing the college and career readiness of NH Students that can be found ahttps://nextsteps-nh.org.

If you are interested in working with a transition specialist at NESCA for consultation, planning, or evaluation, please complete our on-line intake form: https://nesca-newton.com/intake-form/.

About the Author

Kelley Challen, EdM, CAS, is NESCA’s Director of Transition Services, overseeing planning,  consultation, evaluation, coaching, case management, training and program development services.  She 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 also 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. While Ms. Challen has special expertise 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. 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.

Monday, April 9, 2018

The Role of Pediatric Occupational Therapy

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach

In order to fully understand the role that occupational therapy can play in pediatric health and wellbeing, it is first important to understand the term “occupation.”  The World Federation of Occupational Therapy (WFOT) defines occupations as, “the everyday activities that people do as individuals, in families, and in communities that occupy time and bring meaning and purpose to life.”  As we know, these activities look different at every age, and our routines, habits, and responsibilities are continually growing and changing. 

During childhood, the development of these skills moves more quickly than any other period of life. For example, a two-year old little girl, Katie, is learning to put on her shirt independently, kick a ball, and sort by color.  Within ten short years, Katie may be getting herself ready for the bus, writing a three-paragraph essay, and learning to play the saxophone.  The transition to adolescence comes with even more new experiences and expectations.

So where does occupational therapy come in?

Occupational therapy focuses on the child, the activity at hand, and the environment around them.  By considering all of these factors, OTs work to determine the correct modifications, adaptations, and strategies that may be necessary for success.

What is the goal?

Due to the fact that occupations are incredibly personalized, the goal of OT is often to simply increase independence and participation in valued activities.  One child may be working on learning to independently tie his shoes, while another may need help developing a morning routine to consistently follow.  These goals are only worth focusing on and problem solving if they are important to the child and his or her family.

How do we get there?

Consider the child’s strengths and limitations. These may include physical, emotional, cognitive, sensory abilities, and much more.  A child’s particular interests, level of motivation, and understanding of themselves all play a role in their ability to engage in the things that are important to them.

Consider the environment. The environment in which a child lives and grows is physical, spiritual, social, and cultural. It is this individuality that makes it nearly impossible for an environment to be a “good fit for all users.”  Occupational therapists often work to modify the environment, or help individuals understand the role that the environment plays.

Consider the activity itself. The list of childhood occupations is seemingly never-ending.  From brushing your teeth, getting dressed, and doing chores, to maintaining friendships, navigating the digital world, and learning to take the bus, these skills all require numerous steps and different abilities.  These activities often must be broken down into small steps to determine how to help a child be successful.

My work at NESCA

At NESCA, I am currently working as a community-based skills coach, using occupational therapy to create experiential learning opportunities, and develop functional living skills.  I love having the ability to work with tweens, teens, and young adults in their own environment to collaborate on creating lasting strategies for participation and independence.

Dr. Bellenis works with a small caseload of clients aged 12-26 who have recently participated in neuropsychological evaluation and/or transition assessment at NESCA. If you have questions about working with Dr. Bellenis for Community-Based Skills Coaching, please email Kelley Challen, Director of Transition Services, at kchallen@nesca-newton.com.

About the Author

Dr. Sophie Bellenis is 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 motor skills must be taken into account to create comprehensive educational programming. 

Monday, April 2, 2018

Modern Parenting - Part 3: Sarahah, WhatsApp, Snapchat, Oh My! Navigating the Wide World of Apps

By: Jacki Reinert, Psy.D., LMHC
Pediatric Neuropsychology Post-Doctoral Fellow

I recently had the opportunity to co-evaluate a young woman in high school who was recently suspended from school due to ongoing peer conflicts with classmates on a social media app called Sarahah. What initially started as an innocent question soon escalated into an online battle, fueled by a misunderstanding and magnified by an impulsive decision to post a verbal threat. Since that time, Sarahah has popped up in my social media feeds, particularly among parents, educators, and therapists on Facebook. Well-intentioned adults are scrambling to learn more about the app, how they can protect their children, clients, and students from the dangers of yet another social media platform which promotes anonymous bullying. This phenomenon highlights the significant and misguided, albeit well-intentioned, approach adults use to conceptualize social media and adolescent usage. It is March 2018, and Sarahah has been unavailable for download on iTunes for approximately two months. Teens have already begun to move on to the next app, while adults are only more recently learning about the obsolete app.

Some common misconception adults have about social media is that they need to know each of the apps that teens are using, an impossible feat considering the speed with which they become popular, trend on iTunes, and quickly become a relic of the past. As digitally competent adults, we are better served by understanding the types of social media apps teens use, how to talk to kids about which apps they should steer clear of and why.

Generally, there are four types of social media apps that are currently trending, moving adolescents away from typical texting to new social platforms. The first are new texting platforms, which include WhatsApp, KikMessanger, Telegram, and GroupMe. These types of apps allow teen to group chat for free in virtual “private chat rooms." Live streaming group chats are also popular because they allow multiple people to participate in a group “FaceTime” experience. Apps that offer these experiences are HouseParty, Live.ly, and Live.me.

Microblogging is another popular social media platform which allows teens to quickly post relevant information. Examples of this are classified into platforms such as Twitter or Tumblr, which allow teens to share text, GIFs, and videos, and photo-based microblogging, such as Snapchat, Instagram, and the now-defunct Vine. Of these, photo and video-based apps are more popular.

Lastly, there has been a huge shift from identifiable users to anonymous platforms, which include Yik Yak, Saraha, Spillit, Secret, Whisper, and AskFm, as well as meet-up and online dating apps. These apps include Monkey, Meet.me, Omegle, Yubo, and Tinder. Apps that promote anonymity are arguably the most dangerous, primarily because people (adults and adolescents) are more likely to say things online that they would never say to someone face-to-face, increasing cyberbullying. In a nationally-representative sample of 5,700 middle and high school students, the Cyberbullying Research Center found that over the last ten years, 27% of students had been cyberbullied at some point in their life. Further, anonymous social media apps and increased incidents of cyberbullying have been linked to multiple teen suicides around the globe.

As I mentioned in a previous post (http://www.nesca-news.com/2018/03/modern-parenting-part-2-what-are.html), talking to teens about their digital footprints is the first step in opening a social media dialogue about expected behaviors when using social media as a member of an online community, and the ramifications associated with engaging with others online. As a social media consumer, I have found CommonSense Media to be the best spot to access relevant information about not only apps but also other types of media, including movies and video games.

Research conducted by CommonSense Media highlights misconceptions about age-appropriateness for apps; they often compare what parents think is an appropriate age for specific apps, what kids think, and what the specialists think. For example, Snapchat is one of the most popular apps currently used by teens. Parents think it is appropriate for kids ages 14 and up, while kids think ages 12 and up is okay. CommonSense Media recommends users ages 16 and up. What about Instagram? Parents, 14 and up, kids say 12 and up, and CommonSense Media? Ages 15 and up.

So, who’s right? When is it appropriate for a kid to use Instagram? A one-size-fits all approach is likely to mismatch kids, particularly those who may have complex cognitive or social-emotional profiles, with the appropriate social media platforms. Join me next week to learn more about how to start social media conversations with kids, pitfalls adults can make, and when to seek advice from a professional.

Read the rest of this series:

Modern Parenting: A Heartfelt Series of Social Media Tips - Part 1

About the Author:

Dr. Jacki Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and will join the Londonderry office in March 2018. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma.