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Monday, May 28, 2018

Education for Life: Social Emotional Learning

By: Nancy Roosa, Psy. D.
Pediatric Neuropsychologist

The agonizing discussion around the tragedy of school shootings – happening on a weekly basis in this country -- too often devolves into a polarized argument about whether the main problem is guns OR mental health. The argument seems moot, since BOTH access to a firearm and mental health problems have to come together – in one troubled individual - to result in one of these large-scale school massacres. Therefore, while the discussion about gun control is an important one, I’m going to leave that for another forum. In this blog, in my role as a psychologist, I’d like to focus on how we can improve the mental health of our children.

There is no clear answer as to why some students choose to go on a deadly rampage against members of their own community – the peers and adults they spend time with every day – although clearly something has gone very wrong for them in that community. Some research does link bullying and social isolation to school shootings. The U.S. Secret Service and the U.S. Department of Education in a 2004 report found that “almost three-quarters of the (school shooting) attackers felt persecuted, bullied, threatened, attacked, or injured by others prior to the incident. In several cases, individual attackers had experienced bullying and harassment that was long-standing and severe. In some cases, the experience of being bullied seemed to have a significant impact on the attacker and appeared to have been a factor in his decision to mount an attack at the school.”

I do not want to blame the victims, by somehow implying that the social environments at Columbine, Sandy Hook, Parkland and Santa Fe – and all the other sites of horrific massacres - were particularly cruel or harsh. We know that some students at every school feel ostracized and alone, and some are also coping with other serious life stresses, i.e. living in families stressed by poverty, addiction, and/or mental health challenges. But just because this is commonplace doesn’t mean we should accept it. Our society needs a stronger safety net, so that all children are safely housed, well fed and emotionally nurtured in their families, outside of school.

In addition, schools are increasingly recognizing their part in raising the next generation of emotionally mature and secure individuals, and many are attempting to include “social-emotional learning (SEL)” in the curriculum. But while everyone might agree that SEL is a good idea, few people seem to know how to teach it. A recent study by the nonprofit organization CASEL (Collaborative for Academic, Social, and Emotional Learning) found that 83% of principals believe that social-emotional learning is important and a full 95% say they are committed to developing their students’ social and emotional skills. However, only 38% of them had a plan for implementing such learning. Clearly the importance of SEL has been recognized, but doing it well – or doing it at all – still leaves many educators at a loss. Implementing an effective SEL program does require substantial resources – time, money and expertise. Teachers and staff must be trained and then spend time and energy every day implementing the plan. How can we expect schools to find those additional resources when they are already underfunded for the many tasks they are currently charged with? Adding SEL effectively will require that we provide adequate funding to our schools.

Yet, some research shows that the resources invested in SEL bring a hefty payback, not just in social emotional health, which is clearly hard to measure, but also in students’ academic achievement. In 2011, a meta-analysis published in the journal Child Development found that students who participated in a well-implemented SEL program showed an 11 percent gain in academic achievement. In 2015, a study in the Journal of Benefit-Cost Analysis found an $11 benefit for every $1 spent on a rigorous SEL program.

Here in Boston, we have our own success stories involving SEL. One local school, the Mildred Avenue K-8 School in Mattapan, was, 5 years ago, one of the district’s lowest performing schools, at risk of a takeover; now it’s classified as a “level 1” school, the highest category, based on student achievement. Last fall, they were awarded the coveted School on the Move prize by the nonprofit organization Edvestors, which has, for the past 12 years, awarded this prize to a school within the Boston public school district that has made the most progress, based on quantifiable data about student achievement. This school, as well as the other two finalists at this year’s award ceremony in November, highlighted that one important factor was implementing social-emotional learning across the curriculum. They also spoke about the importance of teacher empowerment and creating a sense of an inclusive community in their schools.

Clearly SEL works. Let’s look a bit more closely at what it involves. The cornerstone of SEL learning is gaining five essential skills and competencies, according to CASEL.
1. Self-awareness: recognizing and labeling one’s feelings and accurately identifying one’s strengths and limitations.
2. Self-management: regulating emotions, delaying gratification, managing stress, motivating oneself, and setting and working toward achieving goals.
3. Social awareness: showing empathy, taking others’ perspectives, and recognizing and mobilizing diverse and available supports.
4. Relationship skills: clear communication, active listening, cooperation, nonviolent and constructive conflict resolution, knowing when and how to be a good team player and leader.
5. Responsible decision making: making ethical choices based on consideration of feelings, goals, alternatives and outcomes, and planning and enacting solutions with potential obstacles anticipated.

This is an ambitious list, and we don’t expect these skills to be mastered by 10th grade along with the ability to write a 5-paragraph essay. These are skills that one can—and should!—spend a life time learning. But just pondering this list for a few minutes makes me realize that these are the qualities I value in the people I interact with—my colleagues, friends, and family members—and they are the main qualities that determine whether one lives a productive, satisfying life … much more so than one’s MCAS score.

Will implementing SEL in our schools stop all mass shootings? Sadly, probably not. But will it allow more of the next generation of Americans to grow into socially and emotionally competent individuals? I’d suspect that answer is yes. So let’s start the conversation about this – in every home, in every neighborhood, in every school. Let’s keep our Eyes on this Prize: educating every child for life.

There are a plethora of programs claiming to promote SEL, and a few important guides to distinguish among the programs. Anyone interested in learning how to implement an SEL program could start with one of the following guides.
· The 2015 CASEL Guide: Effective Social and Emotional Learning Programs (CASEL.org).
· How to Implement Social and Emotional Learning at Your School, by Maurice J. Elias, Edutopia, March 24, 2016.
· Selecting the Right SEL Program, by Leah Shafer, June 20, 2017. Harvard Graduate School of Education.

About the Author 

Nancy Roosa, Psy.D. has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems.

Dr. Roosa’s evaluations are highly-individualized and comprehensive, integrating data obtained from a wide range of standardized assessment tools with information gained from history, input from parents, teachers and providers, and important observations gleaned from interacting with the child. Her approach to testing is playful and supportive.

Her evaluations are particularly useful for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box.

Monday, May 21, 2018

Modern Parenting: Moving Beyond the Standards of Screen Time

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

Content is king. Not all content is created equal.

Recently I received a sweet, hand-made Mother’s Day gift from my son. On small pieces of paper, he meticulously filled in a series of incomplete sentences, ranging from “My mom can do many things. I think she’s best at making art” to “Did you know that my mom is a sicalligist (psychologist)?” and “My mom is super smart! She knows that kids should have two hours of screen time.”

“Two hours of screen time” has been successfully drilled into each adult responsible for monitoring a child’s technology use thanks to a successful media push by the American Academy of Pediatrics (AAP). Beginning in October of 2013, AAP held a firm stance on screen time, indicating that children over the age of two should be limited to two hours of screen time. Over time, the guidelines once again shifted in 2016 to ensure that no child under the age of 18 months should have access to screen time, referencing research that indicated technology could have a profound effect on brain development.

Despite these significant implications, screen use among 0 to 8-year-old children continues to grow. In a large-scale study of screen use in the United States, researchers at CommonSense Media (2017) found that on average, children under two spend approximately 42 minutes per day on “screen media use”. Of that time, approximately 58 minutes is spent watching television, 17 minutes are spent watching DVDs, 48 minutes are on a mobile device, 10 minutes on a computer, and 6 minutes on a video game player. For kids ages 2 to 4, total screen media use clocks in at 2 hours and 39 minutes; for 5 to eight-year old’s, 2 hours and 56 minutes.

AAP has once again shifted their policy regarding media, permitting use of video-chat, such as FaceTime and video conferencing to facilitate social communication with family members living far away. They encourage adults to provide the social context for little ones. Further, an emphasis on type of content has been further reinforced; Sesame Street is different than Power Rangers,

Finding a balance is key; you should feel comfortable putting on a 20-minute show while you prepare dinner, whereas allowing kids to binge before bedtime is heavily frowned upon by pediatricians. According to parents surveyed in the research conducted by CommonSense Media, nearly half of all children 8 and under often watch television or play video games during the hour leading up to bedtime. While outcomes vary, researchers have found that using any device at bedtime is associated with a statistically significant increased use of technology in the middle of the night, compromising sleep quantity and quality (Fuller, Lehman, Hicks, & Novick, 2017). Further, research also suggests that excessive television viewing in early childhood has negative implications on cognitive, language, and social/emotional development (Conners-Burrow, McKelvey, & Fussell, 2011).

So how do we provide the structure and balance for kids, particularly for our youngest viewers? One of the best ways is to track current usage to better inform decision-making. One easy-to-use application is the “Media Time Calculator” developed by HealthChildren.org. This application allows adults (in English and in Spanish) to calculate the amount of time your child spends on various activities, such as school, reading, homework time, unstructured time, chores, etc. to better inform how much “extra time” is permitted in a child’s day for media time. https://www.healthychildren.org/English/media/Pages/default.aspx#calculator

Most importantly, decide what is most appropriate for your family and stick with your plan. Avoid using technology as a bartering tool for compliance or tacking on “extra time” for good behavior.

Another easy way to determine what content should be emphasized first is to have discussions with kids about what should “count” towards screen time. In our household, playing a movement-based game on the Wii, such as Wii Sports, doesn’t count towards the daily “two hours,” neither is playing a chess app on the iPad or solving math problems on Prodigygame.com. Armed with this information, you can then develop a Family Media Plan for both adults, teens, and children in the home: https://www.healthychildren.org/English/media/Pages/default.aspx#wizard 

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 Londonderry office. 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 providing individual and group therapy. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma. Dr. Reinert has extensive experience providing intensive in-home family treatment, family outreach and care coordination for adolescents served by the Massachusetts Departments of Mental Health and Children and Families. She provided similar services for children who had been adopted internationally or through the foster care system through a program funded by the New York Office of Children and Family Services.

Monday, May 14, 2018

How Language Difficulties Impact Math Development

By: Alissa Talamo, Ph. D.
Clinical Neuropsychologist

Did you know research shows that 43-65% of students diagnosed with Dyslexia also struggle with math at a level that meets criteria for a Specific Learning Disability in Math? This is in comparison to the general population, where 5-7 % of the population meet criteria for a Specific Math Disability (Dyscalculia – difficulties with number sense, number facts, or calculations). 

I recently attended a lecture given by Dr. Joanna A. Christodoulou, assistant professor in the Department of Communication Sciences and Disorders at Massachusetts General Hospital and leader of the Brain, Education, and Mind (BEAM) Team in the Center for Health and Rehabilitation Research at MGH. The topic of discussion? How language difficulties can negatively impact math development.

How do language difficulties impact math development?

When asked to learn math, a student with language problems may:
· Have difficulty with the vocabulary of math
· Be confused by language word problems
· Not know when irrelevant information is included or when information is given out of sequence
· Have difficulty understanding directions
· Have difficulty explaining and communicating about math including asking and answering  questions 
· Have difficulty reading texts to direct their own learning
· Have difficulty remembering assigned values or definitions in specific problems

It is helpful to have an understanding of typical math development in children. With this information, a parent can monitor their child’s development relative to grade level expectations.

Math difficulties often looks different at different ages. It becomes more apparent as children get older but symptoms can be observed as early as preschool. Here are some things to look for:

· Has trouble learning to count
· Skips over numbers long after kids the same age can remember numbers in the right order
· Struggles to recognize patterns, such as smallest to largest or tallest to shortest
· Has trouble recognizing number symbols (knowing that “7” means seven)
· Unable to demonstrate the meaning of counting. For example, when asked to give you 6 crayons, the child provides a handful, rather than counting out the crayons 

In grades One to Three, a child should:
· Begin to perform simple addition and subtraction computations efficiently
· Master basic math facts (such as 2+3=5)
· Recognize and respond accurately to mathematical signs
· Begin to grasp multiplication (grade 3)
· Understand the concept of measurement and be able to apply this understanding
· Improve their concept of time and money

Clearly, as a child continues through school, demands to understanding abstract math concepts increases. For example, in middle school, a child will be expected to understand concepts such as place value and changing fractions to percentiles, and when in high school, a child will be expected to understand increasingly complex formulas as well as be able to find different approaches to solve the same math problem.

What should I do if I suspect my child has challenges with math?
If you suspect your child is struggling to gain math skills, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

What if I am not sure whether my child needs a neuropsychological evaluation?
When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child's academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child's profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA's online intake form. Indicate "Consultation" and your preferred clinician in the referral line.

Sources used for this blog:
- Dr. Joanna A. Christodoulou
- www.understood.org 

About the Author 

With NESCA since its inception in 2007,  Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.  

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders and emotional issues. She is also interested in working with highly gifted children.

Monday, May 7, 2018

When it Comes to the College Transition, Sweat (some of) the Small Stuff

By: Jason McCormick, Psy. D.
Pediatric Neuropsychologist

As a neuropsychologist who specializes in working with adolescents and young adults, I have had many years of experience assessing students who are gearing up for the college transition. Having also the vantage point of working regularly with college students, I see up close what kinds of skills help students make a smooth landing and, conversely, what types of skill deficits throw a monkey wrench in this transition.

In assessing readiness for a four-year college, it is of course important to consider a student’s cognitive profile, academic functioning, executive functioning, and information processing skills. However, in addition to those important areas of functioning, it is also critical to consider a student’s degree of independence with life skills.

With multiple priorities in a student’s high school career, the development of independence with life skills is one area that often gets shuttled to the side. Among those skills are the abilities to self-regulate sleep schedules, set alarms to wake up without parental assistance, do laundry, and take prescribed medication consistently and with full independence (including monitoring when medicines are running low and taking care of prescription refills).

A common refrain when I bring up these issues to parents in testing feedback sessions is that those are skills that their student will be able to figure out when they get to college. Whether or not that is the case, the important question here is not just if a student has the cognitive and executive function capacities to figure out these tasks, but have they done those tasks enough that they are habits, thus allowing the student to follow through on them with automaticity.

Even under the best of circumstances, the college transition brings with it a number of stressors, including navigating roommate issues, branching out socially, managing academic demands, and making effective use of the large swaths of unscheduled time without the built-in oversight and structure of living at home.

Understanding that this is a major life transition, the more needed skills a student can master before that transition, the easier that transition will be. In this regard, I like to think about this topic in terms of conservation of energy. If, for instance, a student not only has the ability to do their own laundry, but the ability to take care of that chore on autopilot, they will be more likely to follow through on that (socially-important) task when they are stressed, fatigued, or under the weather.

Thus, while in many cases I endorse the adage, “Don’t sweat the small stuff,” in this regard sweating the small stuff makes the bigger stuff more manageable.

About the Author 

A graduate of Massachusetts School of Professional Psychology (MSPP), Dr. McCormick completed a two-year, postdoctoral neuropsychological training program at Children’s Evaluation Center following a one-year internship. He has been working in the service of children and adolescents for over ten years.

Dr. McCormick, a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder, a mild form of autism, and has volunteered at the Asperger’s Association of New England (AANE).