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Showing posts with label early childhood. Show all posts
Showing posts with label early childhood. Show all posts

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, February 26, 2018

Neurodevelopmental Evaluations - Where and When to Start


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

Parenthood is a daunting task to say the least. Not only must we worry about keeping our children healthy and safe, but we are constantly bombarded with information about potentially harmful foods, chemicals, toys, etc. Many parents also have concerns about whether their children are meeting developmental milestones on time and/or whether they should worry about certain behaviors their children are displaying.

When concerns arise about older children, parents are often advised to seek a neuropsychological evaluation to rule out possible attention, learning, or developmental challenges. However, parents of children under 5 are often urged to “wait and see” or might be told it is “too early” to seek an evaluation. The truth of the matter is that it is never too early to have your child evaluated when you are worried about his or her development.

Where do I start?

If you have concerns about your child’s development, it is always a good idea to start with your pediatrician. Describe what you are seeing at home and any difficulties you have noticed. Your pediatrician might recommend that you seek a comprehensive neurodevelopmental evaluation to assess for any developmental delays.

What is a neurodevelopmental evaluation?


This is a comprehensive set of tests designed to assess all aspects of your child’s development, including cognition, language, motor, and social skills. This type of evaluation is conducted by a pediatric neuropsychologist. First, you will be asked to provide information about your child’s developmental and medical histories. Your child will then be asked to participate in a series of activities over the course of 2 or 3 hours. For example, he/she will have to solve simple puzzles, label pictures, or play with different types of toys.

Why is a neurodevelopmental evaluation useful?
After completing the evaluation, the neuropsychologist will analyze all of the information and develop a comprehensive picture of your child’s developmental profile. In addition to helping you understand your child’s strengths and weaknesses, the neuropsychologist will also identify any developmental delays that require intervention.

What happens next?

An evaluation will identify developmental delays that need to be treated in order to help your child catch up with peers. Some examples include speech/language therapy, occupational therapy, physical therapy or applied behavior analysis (ABA).

For children under 3, this means they can start receiving Early Intervention services right away. Early Intervention is a system of services for babies and toddlers who have developmental delays or disabilities and is available in every state in the US.

For children over 3, parents can seek services privately, or can work with their local school district to develop an Individualized Education Program (IEP) for their child. Having an independent evaluation completed prior to your child’s transition to public education is extremely useful as it provides the district with the child’s type of disability and informs the process of developing necessary services.

Where can I go?


Neurodevelopmental evaluations are available at many local area hospitals as well as private neuropsychology clinics. Parents can also contact their insurance company for a list of providers or search through the Massachusetts Neuropsychological Society: https://www.massneuropsych.org/i4a/pages/index.cfm?pageID=3309

At NESCA, we are proud to offer neurodevelopmental evaluations for children ages 1-5 and will provide parents with a comprehensive report, extensive recommendations for services, and ongoing consultation through the years. Our clinicians are able to do observations of children in their natural environments (e.g., day care, preschool) to gain a full picture of the child and provide environmental recommendations that would be most supportive. Moreover, we are available to attend meetings with early intervention specialists and special educators to help a child's team fully understand their individual learning and service needs.

If you are interested in scheduling a consultation or evaluation at NESCA, please complete our on-line intake form: https://nesca-newton.com/intake-form/.

About the Author:

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