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Showing posts with label anxiety. Show all posts
Showing posts with label anxiety. Show all posts

Monday, June 4, 2018

The Struggle is Not Only Real, It is Necessary


By: Angela Currie, Ph.D.
Pediatric Neuropsychologist

From an early age, we are subliminally taught that stress is a bad thing. Whether frustrated because your LEGO tower broke or confused about which two paint colors to mix to get green, you were more likely to hear “Calm down – no reason to get stressed,” than you were to hear “Let’s use your stress to help us make a plan for how to solve this problem.”

For most adults, the natural, well-meaning response to a child’s expression of stress, or most any unwanted feeling, is to try to fix it, make it go away, avoid it, or make it seem like it isn’t such a big deal. We do this by saying things like:

“Don’t be sad.”
“No need to worry about it.”
“It’s not as bad as you think it is.”
“Just try thinking about something else.”
“Let me do that for you.”

We all say and do these things, and the good intention is clear. Nobody likes to see a child struggle or experience discomfort. Unfortunately, manageable stress and discomfort is necessary for growth. When we minimize, distract, or dismiss a child’s emotional reaction, we are sending the message that feelings are unimportant, untrustworthy, and bad. This means that we are also missing the opportunity to teach the child about why we have feelings, and how even the unwanted ones are incredibly useful.

Stress and anxiety are at an all-time high nowadays. It is important to think about small things that we can do each day to help children feel more confident and competent in their ability to navigate this stressful world. One of the best ways we can help them to become more resilient is by creating an environment where emotions are acknowledged, accepted, and used in a functional manner. To start doing this, here are some basic things to keep in:

1) Feelings are information. They are telling us that something is important and may require our attention.
2) Feelings are never bad or “negative,” though they may be unwanted.
3) Stress is often a good thing – without it we would not prepare for tests, show up to work, or care about our relationships. Life without stress would be pretty unfulfilling.
4) The goal is not to control stress or other unwanted feelings – the goal is to recognize, use, and cope with them.
5) Acknowledging and accepting unwanted emotions is one of the best ways to reduce their impact.
6) Regular, casual discourse about wanted and unwanted feelings is healthy and normal. If we talk about the day to day feelings, it will make it easier to talk about the “big ones.”
7) Let children struggle sometimes. Don’t feel the need to fix things right away. Help them express how they're feeling, gently guide them toward problem solving, and praise their persistence in the face of challenge.

About the Author 

Dr. Currie specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

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, March 12, 2018

Intensive Cognitive-Behavioral Therapy (CBT) for Anxiety


By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

Deciding to enroll your child in mental health treatment is a big step in and of itself. Before initiating the process, there is often a trial and error period of interventions to improve the situation, whether at home or in school, and then coming to terms with the fact that they might not be enough to sufficiently address your child’s needs. Finding the right therapy and therapist match for your child can also prove challenging. Not only are there numerous therapeutic approaches available, but there are also varying levels of care depending on the severity of your child’s symptoms and amount of support he or she requires. This ranges from once weekly outpatient therapy to day treatment programs to inpatient hospitalizations for more acute psychiatric issues that may require crisis stabilization (i.e., suicidality, self-harm, etc.)

One type of treatment that has garnered considerable empirical support for treating youth anxiety and depression (conditions we regularly treat at NESCA) is Cognitive-Behavioral Therapy (CBT). CBT focuses on the intersection between our thoughts, emotions, bodily sensations and behaviors. The goal of CBT is to better manage overall emotional distress and reduce physiological symptoms by changing negative thoughts or unhelpful thinking patterns, ineffective coping strategies, and maladaptive behaviors that might be reinforcing uncomfortable feelings. CBT aims to teach children and their parents new, adaptive coping skills while providing opportunities both in and between sessions to practice these skills. CBT is a short-term, targeted treatment that promotes “approach” behaviors (as opposed to “avoidance”) through “exposures,” or exercises designed to practice facing fears gradually, in a safe environment. CBT might also include learning mindfulness, emotion regulation, and distress tolerance; techniques that have been shown to enhance treatment outcomes.

While some youth make progress in meeting with a therapist once per week, others benefit from a condensed, “intensive” format where they receive CBT treatment daily and over a shorter period of time. The accelerated nature of these types of programs, offered in both outpatient and hospital-based settings, allows for quicker acquisition of strategies, substantial exposure practice, and generalization of newly learned skills to other settings in a child’s life. Think of it as a crash-course in CBT.

You may want to consider an intensive therapy program for your child if:
  • Your child’s symptoms are greatly interfering with his or her life, such as attending school or school performance, family life, and friendships.
  • Your child has tried different therapies in the past but there has been minimal carryover from session to session and/or you haven’t noticed much progress overall.
  • Your child is experiencing distress but other commitments during the school year have hindered attending therapy on a consistent basis, making school breaks or the summer an ideal time to work on it.
At NESCA, we are pleased to offer a highly specialized and immersive therapy experience through our 2-Week Summer Intensive CBT Program for anxiety. We work with children and adolescents who present with all types of anxiety, including generalized anxiety, separation anxiety, social anxiety, specific fears (e.g., dog phobia, vomit phobia, etc.) and obsessive-compulsive disorder (OCD).

What does NESCA’s 2-Week Summer Intensive Program consist of?
  • Intake evaluation – A meeting is held with the child and parents to gain a comprehensive understanding of the child, provide an assessment of symptoms and discuss goals for treatment, all of which will inform the treatment plan.
  • 1:1 therapy sessions – Individual CBT therapy sessions with the child or teen are conducted 5 days/week for 90 minutes. Homework will also be assigned between therapy sessions to reinforce skills learned.
  • Parent involvement – Parent participation is vital in treating childhood anxiety. Parent sessions are held 5 days/week for 30 minutes. During these meetings, parents will be educated about their child’s anxiety, receive progress updates and also acquire tools to better support their child. Parents might also be asked to help children practice the new skills they are learning.
  • Discharge planning – Families will be assisted in determining follow up support that will be helpful in order to maintain treatment gains.
  • Treatment summary – Following the conclusion of the program, families will receive a written summary that reviews the course of treatment, progress made and discharge recommendations.
There are circumstances in which the frequency, duration and/or structure of the program can be modified to best fit your child’s needs.

For more information about NESCA’s Summer Intensive CBT Program or to find out if the program is appropriate for your child, please contact Dr. Ryan Ruth Conway at (617) 658-9831 or [email protected].

About the Author:

Dr. Ryan Ruth Conway is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal. 

Monday, March 5, 2018

Mindfulness In Schools


By: Ann-Noelle McCowan, MS, RYT
Therapeutic Yoga Instructor, NESCA

Open Google and type in Mindfulness in Schools and you are presented with a buffet of resources. What was once seen as an alternative idea has become mainstreamed. But what is Mindfulness and why is it something that deserves a place in schools?

Mindfulness was originally developed as part of the 8 Fold Path of Buddhism. With mindfulness your attention would be turned inward and also impact your relationship with the world through mindful actions and behaviors.  Now it is scientifically studied and found in locations like professional locker rooms, jails and hospitals to fortune 500 companies like Nike, Google and Apple. Advancements in brain imaging show that a regular mindfulness practice creates increased activity in the areas of the brain associated with working memory, executive function, emotional regulation, perspective taking and empathy, with decreases in the areas of the brain associated with depression, PTSD and stress (correlated with a decrease in amygdala size).

Mindfulness’ increased popularity may be due to the fact that it is an adaptable, take with you anywhere antidote to a society that is increasingly fast paced and technology focused. In a global world it helps us feel both connected to ourselves and grounded where we are. More adults and kids are feeling stressed, anxious and depressed, and mindfulness can help soothe our worries without negative side affects.

Schools are responsible for teaching children skills and information across many content areas, yet how often are children taught the best way to pay attention, or how to use attention?  Attention is the lens through which all of our experiences are filtered through, yet it is rarely directly and specifically taught! Mindfulness is at its core simply focusing on a single thing at time, in a particular way, without evaluation. It is an invaluable life skill for helping children be successful students as well as happy well adjusted and connected children. An informal survey of my colleagues and friends found that yoga and mindfulness is being adapted to various school settings.  From class transitions that begin with listening bells, rounds of belly breathing before assessments, calming scented oils on cotton balls in the nurse's’ office,  books clubs with teachers, introductions to mindfulness apps in health class and  mindfulness or yoga activities and clubs.  mindfulness is staking its place in schools. 

When introducing mindfulness in classrooms and schools the following steps help outline ways to weave mindfulness into classrooms and schools.

1. Learn More. 

Starting with this blog post the internet is full of articles and videos to explore.
     How Meditation Can Reshape Our Brains: Sara Lazar at TEDxCambridge 2011
     https://www.nytimes.com/guides/well/mindfulness-for-children
     Kids getting lessons in mindfulness in school - Today's Parent

2. Model Mindfulness and Practice Yourself. 

You can’t teach what you don’t know. Practicing mindfulness will help you be aware of your own reactions if at first your students are squirmy or resistant. Keep in mind that students may not use the words you expect to describe their experience, listen for what is behind their words.

3. In an age appropriate way, explain how mindfulness is beneficial for them. 

My teens love learning about how their brain works and that mindfulness is a form of training for their brain. 

Some videos for younger  kids:

4. Teach about the monkey or animal mind. 

Children of all ages enjoy the practice of noticing how many places their thoughts go and how quickly thoughts connect to others. There are fantastic books for younger kids such as Moody Cow Meditates and  Mindful Monkey, Happy Panda.  Teens understand how if walk into class and see their friend laugh with a peer after a glance towards them their thoughts immediately race.... “ “what did I do” ...“ they are mad”...“I’m not going to have a partner for this project”... “ there goes my secrets, begin the rumors”... “I’ll be left out of the weekend plans” … “I’ll be alone forever”.  Teach them to acknowledge the chatter but not get caught in it.

5. Start small. 

Begin with 1-3 minutes at the start of class directing kids to feel their seat in their seat, their feet on the floor, their hands on their lap and intentionally take 5-10 long inhales and exhales. Other ideas:

  • Practice silent snack one day a week, take a mindful walk as a class and have them focus on their senses and record it in their own journal ( words or visuals) when back in the classroom. Create a mindful space in a corner of your room with coloring books, pencils, cushions as a safe break place.
  • For kids it may be hard to focus on a single item at a time, so use manipulatives. A Hoberman Sphere, Pinwheels or feathers to demonstrate breath.  Build Worry Jars, adapt Chutes and Ladders or other familiar games with mindful exercises. Use one of the many Yoga Card Decks. 

6. There’s an App for this!

Ironic perhaps to use technology but most kids love technology and it offers choice and control. Try  “Calm.com”, “Stop, Breathe and Think”, “Smiling Mind” or the “Insight Meditation Timer” (after medications my kids love to check out the world map and see all the locations where people are meditating!).  Try a classroom program such as http://www.innerexplorer.org/

7. Be consistent.

Greater benefits and habits are created when mindfulness is done repeatedly. Colleagues who practice mindfulness daily, even for a few minutes notice the impact is greater than if  done sporadically. 


Mindfulness is good for us and our children and has a natural place in our schools. Benefits abound like enhanced attention, self-regulation, social competence, as well as greater kindness and compassion. After I have practiced mindfulness with my students or clients they look different, calmer and relaxed and ask for it again. I too notice the rest of my day feels more manageable and my smile is broader. Enjoy adding mindfulness to your classroom or express your hope to your child’s teacher or school leaders that mindfulness be a part of your child’s school experience. 

Thursday, March 1, 2018

Continuing Education Opportunity: Late, Lost, and Anxious! – Technology to Support Executive Function


An exciting continuing education opportunity for psychologists, occupational therapists, speech-language pathologists, educators and related professionals!!!

Presenters:

Angela M. Currie, Ph.D., Pediatric Neuropsychologist at NESCA
Heather Gray, M.S., CCC-SLP, ATP, Gray Consulting and Therapy
Jennifer Stylianos, M.S., OTR/L, Gray Consulting and Therapy

About the Workshop:

Students nowadays are confronting significantly greater levels of stress and anxiety than ever before. Often times, this stress occurs alongside executive function and attentional difficulties that make it difficult for the student to manage increasing academic demands. In this workshop, we will discuss how executive function, attention, and stress intersect and ultimately impact a student’s academic motivation. We will then discuss assistive technology as a tool to support these challenges, addressing how to identify appropriate supports and how to develop an effective plan for their implementation. 

At the conclusion of this workshop, participants will be able to:
  • Define and understand executive function as a complex set of self-regulation skills 
  • Understand how attention and anxiety intersect with executive function, resulting in motivation 
  • Identify 3 factors necessary to effectively implement an assistive technology plan 
  • Describe key features of assistive technology needed for executive functioning 
4.5 continuing education credits or professional development units will be offered for this workshop.

When and Where: 

May 17th, 2018 9:00am – 2:30pm
Brookstone Park, Derry, NH

Registration: 

Registration is $119 and includes continental breakfast and lunch. Registration deadline in May 11th. Please register by calling or emailing Stephanie MacInnis at 603-818-8526 or [email protected].

Cancellation Policy: 

Cancellations received prior to May 10th will receive full refund. Cancellations received after that date will not be refunded.

This event is Co-Sponsored by Neuropsychology & Education Services for Children & Adolescents (NESCA). NESCA is approved by the American Psychological Association to sponsor continuing education for psychologists. These credits are also accepted by the State Board of Mental Health Practice for all NH licensees. NESCA maintains responsibility for the program and its content.

Monday, February 19, 2018

Sleep Hygiene and Sleep Debt


By: Rebecca Girard, LICSW, CAS
Licensed Clinical Social Worker, NESCA

For many students, teachers, and families in Massachusetts (and several other states throughout the country), this week marks a vacation and a time for rest. In that spirit, this week on NESCA News & Notes, we are highlighting the importance of good sleep hygiene for children, a vital element of wellness, mental health, and learning. Check out this short TEDx talk by Roxanne Prichard of the University of St Thomas about the importance of sleep for children. Highlights of the talk include:
  • Sleep is an essential for a healthy brain
  • United States school children are ranked 1st among nations with academic problems directly attributable to sleepiness
  • A 2014 Sleep in America poll found that fewer than 1 in 5 teens is getting the minimum amount of recommended sleep

Benefits of a good night’s sleep include:
  • Better regulated vital systems including growth and immune responses
  • Better memory and ability to retain new information
  • Boosts mood

Tips for good sleep health (according to the CDC):
  • Be consistent. Make sure your child goes to bed at the same time each night and gets up at the same time each morning, including on the weekends (as much as possible)
  • Make sure the bedroom is quiet, dark, relaxing, and at a comfortable temperature
  • Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
  • Avoid screens 30 minutes before bedtime. Promote reading, drawing or another quiet, non-screen activity to wind down
  • Avoid large meals, caffeine, and sugar right before bedtime
  • Make sure your child is getting some exercise. Being physically active during the day can help a child fall asleep more easily at night.

So how much sleep does a child need?


For more information on Dr. Roxanne Prichard as well as sleep hygiene, visit the following web sites:
About the Author:

Rebecca Girard, LICSW, CAS is a
licensed clinical social worker specializing in neurodivergent issues, sexual trauma, and international social work. She has worked primarily with children, adolescents, adults with Autism Spectrum Disorders and their families for over a decade. Ms. Girard is highly experienced in using Cognitive Behavior Therapy (CBT) as well as Socio-dramatic Affective Relational Intervention (SDARI), in additional to a number of other modalities. She is excited to provide enhanced psychotherapy to children with ASD at NESCA as well as to provide therapeutic support to youth with a range of mood, anxiety, social and behavioral challenges. Her approach is child-centered, strengths-based, creative and compassionate.


Monday, February 12, 2018

Acupuncture and its Role in Treating Anxiety


By: Holly Pelletier, L.Ac.
Licensed Acupuncturist, NESCA

Whether or not you’re familiar with acupuncture, you may be wondering what role it could possibly play in the field of mental health. Most people associate acupuncture with the treatment of pain conditions, and although it has gained recent popularity and prevalence in our little corner of the world, it is often only given a portion of the credit it deserves when it comes to the scope of treatment possibilities. 

Acupuncture is a branch of Chinese medicine based upon a meridian system that runs throughout the entire body. On the meridians, there are acupuncture points that can be accessed through different means such as needling, acupressure, or by using a warming herb called mugwort. The purpose of using these points is to move blockages of energy, blood, or fluids (i.e. lymph) in the body. By using different needling techniques and various point combinations you can either add to a deficient area or move an excess one. 

How does acupuncture work with anxiety and other mental health concerns? To explain fully, we can look at it from two different perspectives: 

The first is a more traditional “western” approach where we look at things on a biochemical level. Acupuncture points are specific areas beneath the surface of the skin that have high concentrations of nerve endings, mast cells, lymphatic vessels and capillaries. When an acupuncture needle is inserted into a point, it stimulates the sensory receptor, which in turn stimulates the nerve and transmits impulses to the brain. In this sense, it can be viewed as a “feedback loop” that directly affects your brain, your hormones, and your glands. So, the relaxed feeling you get after an acupuncture session is real, it is not just a placebo or “in your head”. The needles directly adjust imbalances in the body and allow the person to begin the healing process with a “blank slate." This unique aspect, specific to acupuncture, is extremely powerful because it allows the body to access its own, innate power to heal itself. 

The second approach is the stance of Chinese medicine, which frames anxiety as a symptom of something out of balance. If everything was functioning as it should, there would be no symptoms, we would live pain and stress free every single day of our lives. When something is “off”, tiny sensations start surfacing that at first may seem like nothing at all - a foggy head, fatigue, or tight shoulders. But as time goes by, symptoms worsen and the imbalance becomes larger, making it harder to reverse. 

Zooming in even closer to examine just the anxiety is helpful as well. Anxiety comes in all forms. If you have only seen or felt it one way in yourself or your child, it may surprise you that there is a wide array of symptoms that can show up when someone experiences anxiety. Some may have digestive upset while others get headaches or a racing heart, and others may have trouble breathing or dissociate from the world around them. Often, a person is treated for anxiety and given the same medication as someone else, regardless of their symptoms. Rather than treating someone for anxiety and having one specific point protocol or herbal approach, acupuncture treats those symptoms associated with the anxiety instead. For instance, the headaches, or the palpitations that signal stress to the body. Therefore, each person is looked at individually and each case/course of treatment is completely unique. 

As mentioned above, acupuncture is only a part of a much larger system of medicine. Other branches of the system include nutrition, meditation, herbs, and Qi Gong to name a few. Incorporating these other aspects allows the patient to not only feel better temporarily, but to possibly relieve the anxiety fully. 


If you have any questions about acupuncture and want to see if you or your child would be a good candidate, please contact our acupuncturist, Holly at: [email protected]

To read Holly’s Blog with simple ways to incorporate Chinese Medicine in daily life, visit: http://holisticallyinspiredblog.blogspot.com/

About the Author:

Holly Pelletier, L.Ac. is a licensed acupuncturist who practices part-time at NESCA. Holly Pelletier has been working with children of varying ages, in many different capacities since 2004. Prior to treating kids with acupuncture, she worked as a teacher, coach, and mentor. She exceptionally enjoys working with children and acupuncture because of their speedy response time and genuine excitement about this form of medicine. Holly has a very gentle technique and has specific training in non-insertive acupuncture styles, which does not require needling directly into the skin. In additions to working with children, Holly is also very passionate about working with issues involving women’s health, nutrition/herbs, neurological disease, and psychological challenges such as anxiety and depression.

For more information on our acupuncturist, Holly visit: http://www.hpelletieracu.com/


Monday, January 22, 2018

Mindful or Mind Full? Can You and Your Child Be More Present?


Mindfulness Activities For Caretakers and Youth

Pediatric Neuropsychologist
NESCA

Mindfulness is an area of psychology that continues to gain popularity in our culture and in therapeutic practice. By definition, mindfulness is the practice of being conscious or aware of our current state without judgement. That is, focusing our awareness on what is happening in this very moment related to our feelings, thoughts, and bodily sensations. We ignore what was happening in the past and what could happen in the future by being present in this moment. While this seems like a simple concept, in our distracted world of technology and instant gratification this can be difficult to put into practice. Too often we lose sight of the present and our current experiences, as our mind races and analyzes what just happened or what could happen, giving rise to anxiety. 

Research suggests that the benefits of mindfulness include improved emotional regulation by decreasing rumination and improving attentional capabilities. There is also emerging evidence that mindfulness can decrease emotional reactivity which can have a positive impact on interpersonal relationships. Other positive benefits include improvements in sensory processing as well as sensitivity to internal stimuli. 

Below is a list of mindfulness-based activities that can get you and your child started on the journey of being more present in the moment and begin reaping the benefits of a mindfulness practice. For more information or to explore therapeutic options at NESCA that utilize mindfulness strategies please read about our therapeutic services

  • Breathing: Have the child breathe in for three seconds, hold their breath for three seconds, and then breathe out for three seconds. For younger children, the very act of focusing on this activity will ground them to the moment. For older children and teens, there might be more instruction like having the child focus on how the breath feels coming in, holding it in their lungs, and finally blowing out through their nose or mouth. 
  • Seeing the world: Ask the child to spend a minute looking around the room while being silent with the goal of finding things in the room that have never been noticed before. After one minute, the child should be asked to share the most interesting thing that they see now but have not noticed before. 
  • Feeling objects: Provide the child with an object or series of objects and ask them to spend a minute just noticing what the object feels like in their hand. Guiding them to attend to the texture, temperature, size, shape, etc. Afterwards, ask the child to share what they noticed. 
  • Listening: Ring a bell or other chime-like noise that provides a long trailing sound. Ask the child to indicate when they can no longer hear the sound. After the ringing ends, ask the child to listen to any other sound they hear for the next minute. 
  • Emotional acceptance: Young children tend to be more "in the moment" than most when it comes to emotional experience. When a child is expressing an emotion, rather than tell them “You’re okay,” validate their emotional experience and let them know it is okay to be angry, sad, etc. Then follow with asking your child how their body feels when they are in this emotional state. This process can help children to be more in touch with their bodies and begin to recognize how their emotions feel in their body to create greater emotional awareness. 

To learn more about mindfulness and practice techniques, check out:
About the Author:

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

Tuesday, January 2, 2018

Understanding Motivation in Children and Teenagers, and Where We Went Wrong



By: Angela Currie, Ph.D.
Pediatric Neuropsychologist
Director of New Hampshire Operations

As parents and teachers, we hear, and say, these things all the time:

“Why doesn’t he just do it?”

“How many times do I have to ask you?”

“Why don’t you care about your work?”

“She just doesn't have the drive.”

Be it schoolwork, chores, or social events, some kids seemingly just aren’t motivated to do things. We punish. We nag. We fight. But even with all of this, sometimes things do not change.

It is easy to become frustrated, but in this state of frustration, we often forget to ask ourselves why finding motivation is so difficult for the child.

There are two types of motivation – intrinsic and extrinsic. Intrinsic motivation is an internal desire or drive to do something based strictly on the resulting feeling of satisfaction or enjoyment. Extrinsic motivation relies on external rewards, such as money, good grades, stickers, toys, or other things. Intrinsic motivation has long-lasting effects, while behavior based on extrinsic motivation is fleeting.

Some children seem to develop intrinsic motivation naturally. For other children, we attempt to gain compliance or task completion through extrinsic motivation – behavioral charts, rewards, punishments, etc. Sometimes this works in the short term, but as soon as the rewards or punishments are gone, so is the behavior. Other times, even extrinsic motivation seems absent and behavior still does not change, no matter how big the reward or punishment.

Frustration ensues and we often find ourselves feeling or saying the above things – the child does not have the motivation, therefore the work or task does not get done. But where does this leave us? The adults are defeated, the child feels blamed, and the situation worsens.

So where’d we go wrong?

Our understanding of motivation is often backwards – motivation exists, therefore successful behavior occurs. This is wrong. We are not born inherently knowing how to motivate ourselves. We learn it through successful experiences in the world. So, what really happens is: successful behavior occurs, therefore motivation develops.

Lesson #1: Motivation is the effect, not the cause.
In reversing the relationship, we can now ask ourselves: “What is causing the lack of motivation?” If we are able to identify and address the underlying challenges, the child can begin to experience the successes that are necessary for motivation to develop over time. Further, in accepting that motivation is learned through experience and not inherent, we accept that the term “intrinsic” is somewhat misleading.

Lesson #2: Intrinsic motivation is not naturally intrinsic – it becomes intrinsic after feelings of success are internalized.

By identifying and addressing skills deficits, we can help children to experience more successes and increase their willingness and ability to “try harder.” Academic deficits, attention problems, anxiety, low self-esteem, social challenges, executive function weaknesses, among other things, can all interfere with motivation. Challenges in any one of these areas can, and will, interfere with motivation. As such, motivation is not a single thing. It is a complex skill that can only develop once other, more basic, skills have developed.

Lesson #3: Motivation is not one thing – it is the coordination of many skills.

Now viewing motivation as something that is learned over time as other, more basic, skills develop and a child experiences successes in life, we are better able to develop a plan for how to intervene.

Take home message: All children and teens can be motivated – it is our job to teach them how.

When motivation seems absent or fleeting, we must become detectives, working to figure out what underlying challenges or deficits are present. This may be aided through conversations with the child’s teachers or other support providers. Other times, a comprehensive evaluation may be necessary in order to specifically identify the child’s strengths and challenges, as well as receive individualized recommendations for how to address their needs.

Dr. Currie will be offering a free webinar about motivation and self-regulation this Spring. Stay tuned for sign-up information. 

About the Author:


Dr. Angela Currie conducts neuropsychological and psychological (projective) assessments out of NESCA’s Londonderry, NH and Newton, MA offices, seeing individuals with a wide range of concerns. She enjoys working with stressed-out children and teens, working to tease apart the various factors that may be lending to their stress, including assessment of possible underlying learning challenges (such as dyslexia or nonverbal learning disability), attentional deficit, or executive function weakness. She also often conducts evaluations with children confronting more primary emotional and anxiety-related challenges, such as generalized anxiety, obsessive compulsive disorder, or depression. Dr. Currie particularly enjoys working with the seemingly “unmotivated” child as well as children who have “flown under the radar” for years due to their desire to succeed.

Friday, December 22, 2017

Special Holiday Edition: 'Tis the Season for Self-Care



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

As a child, the idea of Christmas meant cookies, presents, time with family, and of course, giving up TGIF’s Full House in favor of holiday movies. Everything from Scrooged to A Miracle on 34th Street to Home Alone, and every clay animated favorite served as the framework for my formulation of what the holidays truly meant; “It's Christmas Eve. It's the one night of the year when we all act a little nicer, we smile a little easier, we cheer a little more. For a couple of hours out of the whole year we are the people that we always hoped we would be." Frank Cross’s commentary on Christmas set expectations high, and year after year, we hoped to top the magic and splendor of the previous year’s festivities. 

As a parent, the holiday season conjures up warm memories of childhood, ignites aspirations to establish new traditions, and creates opportunities to share experiences with our loved ones, particularly our children. The magic of the holidays can also cultivate high expectations; to act nicer, smile easier, and to cheer more. These expectations more often than not exceed our capacity to truly encapsulate the hopes and aspirations we drum up in our heads. High expectations can pave the way for increased levels of perceived stress. 

The American Psychological Association recently released its annual review, Stress in America (November, 2017), which indicates the United States has reached its highest stress level yet. Acute arousal stress in isolation can activate and enhance mobilization, sharpening our concentration and preparing our bodies to engage in challenging tasks, such as wrapping those last two presents and baking another round of cookies. This basic human reaction known as the “flight-or-fight” response has served us well, priming our bodies to flee or combat unsafe situations; however, our bodies can also overreact to simple, non-threatening situations, such as holiday pressure, financial difficulties, and increasing family demands. 

Chronic stress has far more lasting and serious complications, particularly when it exceeds our ability to cope and leads to emotional and physical dysregulation. Stress is negatively related to our coping potential and our perception of control, which decreases use of problem-solving coping strategies and increases negative coping strategies, such as alcohol consumption and avoidance tactics (Rui Gomes, Faria, & Gonçalves, 2013). Individuals who experience elevations in stress and engage in maladaptive coping strategies such as drinking more alcohol, complaining, sleeping less, and consuming unhealthy foods which increase chances of becoming physically and mentally run down.

For parents, the added stress of the holidays and high expectations can have a significant impact on not only themselves, but those around them. Research suggests that adults are more likely to find family responsibilities stressful than they have in the past (APA, November, 2017). High expectations can make capturing the perfect holiday, particularly when parenting a child with special needs, a stressful time, leading to feelings of resentment (“I’m doing all of this and no one is helping me”), frustration (“I have no time to fit this all in”), and disappointment (“It seems like they didn’t have a good time”).

This year, I encourage you to lower your holiday expectations, increase self-care and self-compassion. While practicing self-care may be the furthest thing from your mind, the following may offer some reprieve from the hustle and bustle of the holiday season. 

1. Expect that things will go wrong, and that’s okay. Someone will get sick, you might burn a dish, and yes, that’s okay. Avoid catastrophic thinking, a common cognitive distortion where we imagine and worry about the worst possible situation, either consciously or subconsciously. For example, your ability to prepare the perfect holiday dinner for twelve people is an act, not a representation of how good of a person you are. You are not the sum of how well-executed things are, how perfectly the house looks, how your children act. 

2. Practice self-regulation and utilize coping skills. The easiest way to understand the subtle difference between these two concepts is to imagine yourself in a car, driving down I-90 into Boston and someone cuts you off. To access a coping skill to manage your anger, you would first need to pull off the highway, put the car in park, and throw on your hazard lights. Conversely, if you were utilizing a self-regulation skill, you could continue driving and manage your thoughts and feelings in the moment. Self-regulation is the ability to modulate our emotions and impulses, to keep ourselves in check, whereas coping is a process or actions that help you manage difficult emotions. Examples of self-regulation skills include diaphragmatic breathing (learn more here: https://www.youtube.com/watch?v=hFcQpNr_KA4&t=140s) and box breathing (https://www.youtube.com/watch?v=dP4Jxxhhzl0). Coping skills can include meditation (https://www.youtube.com/watch?v=4Bs0qUB3BHQ), and progressive muscle relaxation (https://www.youtube.com/watch?v=1nZEdqcGVzo). 

3. Practice micro-moments of positivity. Research suggests that rather than pursue the perfect gift to demonstrate your love for a family member, seeking out opportunities to be present and make a meaningful connection have a more lasting effect (Heshmati, Oravecz, Pressman, Bathcelder, Muth, & Vandekerckhove, 2017). Crawling into bed and reading a holiday book with your children, or complete a small craft together can have a more lasting impact that securing a sloth Fingerling for them. You can read more about micro-moments here: https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence

4. Opt outside! Research suggests that spending time in nature can have significant effect on mood (https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence) and can increase sun exposure and the benefits of Vitamin D. Locate a winter wonderland hike here: http://www.bostonmagazine.com/health/2016/01/11/winter-hiking-massachusetts/

5. Finally, don’t forget about self-care. Self-care is a deliberate act to support and nurture your physical and mental health. Taking care of yourself not only helps you but those around you. There are several TED talks highlighting the benefit of self-care: https://www.ted.com/playlists/299/the_importance_of_self_care


From the clinical team at NESCA, we wish everyone a happy holiday season!

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.

Wednesday, November 22, 2017

Lynn Lyons, LICSW, Anxious Kids, Anxious Parents: Strategies to Interrupt the Worry Cycle

If you have not previously attended the Dr. Charles P. Conroy Speaker Series at Dr. Franklin Perkins School, next Thursday's presentation provides an excellent reason to attend their first session:

Anxious Kids, Anxious Parents: 
Strategies to Interrupt the Worry Cycle
Speaker: 
Lynn Lyons, LICSW

Date: 
Thursday, November 30, 2017

Time: 
6 pm to 8 pm

Where: 
Charles P. Conroy Auditorium
Perkins Janeway Education Center
975 Main Street, Lancaster, MA

Lynn will provide an overview of managing anxiety and will then delve deeper into how to manage anxiety in both adults and children. She will explain why it is much more important to answer "how" questions than "why" questions in managing the fears that lead to anxiety. She will offer productive solutions and strategies. Lynn Lyons is a licensed clinical social worker and psychotherapist in Concord, New Hampshire, specializing in the treatment of anxiety disorders in adults and children. Lynn has traveled globally as a speaker and trainer on the subject of anxiety and its roles in families and the need for a preventative approach in the home and in schools.

Learn more about Lynn Lyons and her work:



While the sessions are FREE, please register by e-mail to [email protected] or call 978-365-7376 during regular business hours (8:30am-4:30pm, Monday through Friday). Parking is plentiful but seating is limited, so please be sure to register!

Monday, November 20, 2017

Community-Based Skills Coaching: What is it? Is it the right intervention for my son or daughter?


Transition Specialist

What is Community-Based Skills Coaching?

Community-Based Skills Coaching is an individualized service delivered by seasoned professionals to support the needs of transition-aged youth and young adults. It is an intensive 1:1 coaching model provided in the young person’s community. It can include any area of need and is tailored to the young person’s age and stage of development. 

Community-Based Skills Coaching is empowering to the young person because the coach meets them where they are at emotionally, socially and developmentally. It allows the individual to learn practical living skills across multiple real-life environments. The first step in Community-Based Skills Coaching is an evaluation period where the young person works with the coach to identify strengths and areas for improvement. Through a collaborative process, the coach and young person tailor each session to allow for direct in-vivo teaching. This can include, but is not limited to, independent living skills, career planning and work readiness skills, financial literacy skills, travel skills, social pragmatic skills and self-advocacy skills. 

Coaches meet with individuals in their home communities in order to determine how to best problem solve around any barriers or obstacles that the young person may encounter. It allows for the individual to develop and generalize learned and new skills across settings and in real-time. With frequent opportunities to practice skills in authentic environments, the individual begins to develop a level of confidence and automaticity that can only be learned outside of a classroom or office. 

Many transition-aged young adults are at a developmental stage of individuating away from parental support. Community-Based Skills Coaching provides an experienced and trained adult to serve as a coach and mentor in order to guide the young person. This coach becomes an important "expert" and a qualified and trusted team member who can support the individual through the lengthy process of transitioning from high school to post-secondary adult life including learning, working, daily living, and community-based leisure activities.

How do I know if this is the right support for my son, my daughter, or myself?

Coaches work with young people aged 12-26 with varying skill levels. Coaches most often work with transition-aged youth who have a diagnosed learning, emotional, and/or developmental disability and transition related skill development needs. However, our coaches are also experienced in working with young people who are struggling with forward progress unrelated to a specific learning or medical diagnosis. Coaching utilizes a strength-based approach and supports youth and young adults to learn about themselves while experiencing life outside of school and home. 

The student or young adult drives the process by choosing an area of interest and need. The coach provides guidance and immediate feedback and support to practice and improve upon skill areas. The coach builds rapport with the individual and is able to re-frame and teach in the moment. An inquiry based approach is used to allow the young person autonomy over the mastery of the skill. The coaching can occur weekly or more often, if necessary. Feedback to parents and designated team members typically occurs on a weekly or monthly basis, often beginning with student input.

To learn more about our Community Coaching at NESCA, please feel free to contact Kathleen Pignone, M.Ed., CRC at (617) 658-9800 or email at [email protected]

Who provides coaching at NESCA?

Kathleen Pigone, M.Ed., CRC, brings a wealth of knowledge and experience to her role as a Transition Specialist at NESCA. She received her undergraduate degree in Sociology from Boston College and her master of education in Rehabilitation Counseling from the University of Massachusetts Boston.

Ms. Pignone was the Career Development Director at Bay Cove Academy for 15 years, providing students with classroom and real-world employment skills training, community job placement and on the job employment-training. She supervised the Career Development Program, developed individualized transition plans for students, created innovative programming for tracking and assessing long-term employability and career success for students. She also trained staff in the areas of career development and transition services.

Ms. Pignone joined NESCA in March 2016, bringing her unique expertise supporting vocational assessment and employment planning for adolescents and young adults as well as local school programs. In addition to supporting NESCA’s premier transition assessment services, Ms. Pignone engages in person-centered planning with teens and young adults, consultation and training for parents, providers and schools, and community-based skills coaching.

Sophie Bellenis, OTD, OTR/L, is Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. For the past five years her work has primarily been split between children and adolescents with ASD and related profiles in the United States, and marginalized youth in Tanzania, East Africa.

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. 

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. She is joining NESCA in order to offer community-based skills coaching services as well as social skills coaching to students and young adults.

Kelley Challen, Ed.M., CAS, is Director of Transition Services at NESCA and oversees Community-Based Skills Coaching as well as transition assessment, planning, consultation, case management, program development, college supports, trainings, and professional development offerings. 

Ms. Challen received her Master's Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. Initially trained as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling. She began facilitating social, life, and career skill development programs for transition-aged youth in 2004.

Prior to joining NESCA, Ms. Challen founded an array of programs for teens and young adults at MGH Aspire, and spent time as Program Director of the Northeast Arc's Spotlight Program, where she often collaborated with schools to develop in-district social skill and transition programming. She is also co-author of the chapter "Technologies to Support Interventions for Social-Emotional Intelligence, Self-Awareness, Personal Style, and Self-Regulation" for the book Technology Tools for Students with Autism.

While Ms. Challen has special expertise in working with students with Asperger's Syndrome and related profiles, she provides transition assessment, consultation, planning, and programming support for individuals with a wide range of learning and developmental needs.

Monday, October 23, 2017

The Great Masquerader

Anxiety and School Refusal


By: Ryan Ruth Conway, PsyD

Everyone experiences anxiety at some point in life. It is a normal, adaptive human emotion that helps us prepare for important events and optimizes performance – think upcoming tests, ballet recitals, sports playoff games – and alerts us to danger in situations that threaten our safety. However, some individuals experience anxiety so intensely and so frequently that it becomes impairing, hindering their daily functioning. In fact, according to the National Institute of Mental Health (NIMH), it is the most common mental health disorder in the United States among adults and children. In my work with children and teens, I have seen anxiety become such a powerful force that it gets in the way of having sleepovers at friend’s houses, limits social engagement, results in marked physical discomfort, impairs concentration in class, and even contributes to flat out refusal of school.

Anxiety is an inward focused feeling, meaning that we experience it internally. As a result, it is often unrecognizable to parents and teachers and can go easily undetected for a long time until it becomes a problem. Children might be ashamed to talk about it, try to push it away to avoid distress or be limited in their ability to fully articulate what is happening. Behaviorally, anxiety causes a fight-flight-freeze reaction. It leads to acting out and aggressive behaviors (i.e., “fight”) as well as running away and escaping (i.e., “flight”). Anxiety can also be an underlying source of noncompliance, disguised as unwillingness to engage and shutting down in overwhelming situations (i.e., “freeze”).

In a recent New York Times Magazine article (see link below), writer Benoit Denizet-Lewis takes a closer look at the increasing prevalence of adolescent anxiety as well as a residential program, Mountain Valley Treatment Center, that provides services for more severe cases. In an information age, many teens, parents, educators and mental health professionals are citing social media as partly to blame for the uptick in anxiety. The constant comparing to peers through social media is problematic in that it makes teens feel like they aren’t good enough, which can greatly impact their self-esteem. In my clinical work I see an overreliance on smartphones due to the reinforcing function they serve – whether it be a text back to hang out or a “like” on an Instagram post – and I will often work with youth on self-reinforcement and finding alternatives that are intrinsically rewarding to them.

Many of the students interviewed for the New York Times Magazine article who attended Mountain Valley had histories of significant difficulty attending their regular school due severe anxiety and/or depression, a presentation known as school refusal. School refusing behaviors exist on a spectrum, from the mild (e.g., missing gym class every now and then due to fears of changing in front of classmates) to the more severe (e.g., missing entire weeks of school due to persistent worries about having panic attacks). Early intervention is key. The longer the child or adolescent is out of school, the more pressure they feel about “catching up” academically. The more they feel like they are falling behind, the more depressed and anxious they become. The more upset and stressed they are, the more difficult it is to get back to school. And the cycle continues.

Understanding this cycle, NESCA offers a special program for youth who refuse school because of emotional distress, called Back to School (BTS). In this program, clinicians use a comprehensive evidence-based treatment approach and work closely with parents and school faculty to figure out the most effective plan that will help the student reenter school.

  • Given the importance of catching school refusal early, here are some warning signs to look out for:
  • Test-taking anxiety
  • Peer bullying
  • Ongoing visits to the nurse despite no apparent signs of illness
  • Frequent requests to phone or go home during the school day
  • Somatic complaints without a medical explanation (e.g., stomachaches, headaches, etc.)
  • Absences on significant days (e.g., tests, speeches)
  • Sleep problems or resistance to leave bed in the morning
  • Changes in mood – anxiety, irritability, sadness 
If you have any questions about the BTS Program or NESCA’s therapy program in general, please contact Dr. Ryan Ruth Conway at [email protected] or 617-658-9831. Dr. Conway will additionally be speaking at several workshops this fall on the subject of School Anxiety, School Phobia, and School Refusal. Information regarding upcoming NESCA events can be found on our web site at http://www.nesca-newton.com/events.html.

Article: 
Denizet-Lewis, B. (2017). Why Are More American Teenagers Than Ever Suffering From Severe Anxiety? The New York Times Magazine. Retrieved from https://www.nytimes.com/2017/10/11/magazine/why-are-more-american-teenagers-than-ever-suffering-from-severe-anxiety.html.


About the Author:

Dr. Ryan Ruth Conway is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.