By Leslie Baer Cohen, Ph.D.

 With summer right around the corner, many parents are actively exploring summer programs for their children.  As a child psychologist, one of the more common questions that I hear from parents during this process is, “What, if anything, should I tell my child’s counselor/camp about his/her neurobehavioral problems?”   For many parents, a tension exists between wanting to make their child’s camp experience a positive one and at the same time worrying that telling a camp about their child’s vulnerabilities will somehow be stigmatizing.  Although one size never fits all in the world of children with neurobehavioral difficulties, the following guidelines may serve as useful pointers:

1. Be proactive — Ask questions

Before making a final selection on a camp, you should be prepared to ask very specific questions about how the camp is run. Find out who will be working with your child, how old they are, what kind of training they have had and how behavior problems are handled.  The following questions also are helpful to ask: How much structure does the camp provide? What is their daily routine? What is the adult: child ratio? How many children share a cabin together? Has the camp worked successfully in the past with children who have had similar difficulties?  What kinds of options exist for a one-on-one aide?  What is the camp’s philosophy? Is it competitive?  If camp personnel are unable to answer these questions to your satisfaction, it is probably not the best place for your child.

2.  Define the problem

Most good camps will want to know as much as possible about your child’s strengths and vulnerabilities.  Generally speaking, knowledge is empowering.  Give the staff a true and honest account of your child’s special needs (e.g., level of inattention/hyperactivity; motor problems; language problems; trouble with peers; sensory issues; previous experience with camp, medications). Make sure they know this is something you consider to be important. You can help educate the staff by spending time with them and answering and asking questions before you drop off your child.  Rather than simple giving a label that is open to interpretation, it is often more helpful to provide specific behaviors that your child is likely to exhibit.  For instance, instead of just saying “My child has ADHD,” it may be more helpful to say, “My child has ADHD, which means that his ability to pay attention for extended periods is not as strong as others his age.”

3. Offer ideas

When discussing your child’s special needs, offer some easy to implement strategies that you have found to be helpful.  Enlist help from your child’s teachers and other specialists (e.g., speech/language, therapist, psychologist, occupational therapist).  At the same time, provide some predictions about what types of activities at camp may be the most challenging for your child (e.g., unstructured time, overstimulating activities, getting dressed after swimming, lunch) so that the counselor can take a proactive stance.  Remind the counselor about the importance of positive reinforcement, close supervision, and appropriate boundaries and consequences. 

4. Provide references

Don’t assume that camp staff will understand exactly what your child’s neurobehavioral disorder entails. Provide some simple and direct printed information stating what the problem is and how it may manifest at camp. (Staff at RNBC can help you with this information.) It is considerably more likely that teenage counselors will read a one-page summary than a book and a mountain of papers.  If your child is taking medication and will be attending sleep-away camp, be sure to provide the phone number of the child’s prescribing physician.  In addition, provide the staff with a list of emergency phone numbers and email addresses, and make sure they know how to reach you at all times during your child’s camp stay. You may even want to sign a release for your child’s specialist to speak with particular camp staff, such as his/her therapist.

5. Keep in touch

Check in with your child’s counselor on a regular basis to see how things are going. Give them permission to tell you about any problems right away, and work collaboratively with them to resolve the situation. If counselors are willing, send a report form that lists desirable behaviors that can be checked off and returned to you each day. Be sure to read any information sent home from camp and respond promptly with questions.

The following list includes some camps that offer specialized programs for children with neurobehavioral difficulties:

Camp STAR  www.jcys.org/campstar

Camp Hug the Bear (autism spectrum disorders-NSSRA)

Cove/Hyde Park Day School-summer reading and math programs

Camp Neeka (Josselyn Center, IL)

Julie Herr & Associates (Chicago) www.julieherr.com

Camp Firefly www.campfireflyjcfs.com

Hidden Valley Camp (Maine) www.hiddenvalleycamp.com

The Learning Camp (Vail, CO) www.learningcamp.com

Camp Buckskin www.campbuckskin.com

Wolfeboro: The Summer Boarding School www.wolfeboro.org

Summit Camp (Pennsylvania) www.summitcamp.com

SOAR (North Carolina) www.soarnc.org

Global Works www.globalworkstravel.com

Outward Bound www.outwardbound.com

Talisman Programs www.talismancamps.com

 Rush University Medical Center also maintains a web-based resource which includes camp information.  The direct link to the summer camps is http://www.rush.edu/rumc/page-1234554460333.html

Disclaimer

There may be camps other than those identified in this article that would be suitable for this patient population. None of the camps identified in this article are owned by, affiliated with, related to or agents of Rush University Medical Center.

Jacy’s first became exposed to the importance of developing executive function skills when she was in a Montessori early childhood classroom.  The children were learning social and academic concepts that were often reserved for older children.  They were excelling in these areas due to the intentional focus on developing executive functions.  Later, when Jacy earned her MS from Erikson Institute, she was able to add another layer of understanding to the importance of these skills.  She strongly believes they form the foundation of life-long learning, as well as provide an avenue for a better quality of life. 

As a part of the McCormick foundation’s grant for 8 Big Shoulder Fund Catholic Schools, Jacy is helping to guide teachers in learning about executive functions through In-service sessions, modeling lessons in the classroom, and is revising the Primary and Intermediate Executive Functioning Curriculum Notebooks.  She will also be engaging with students in one-to-one tutoring sessions focused on developing executive function skills.

In the school setting, Terese works to incorporate RNBC’s Executive Functions Curriculum into the school curriculum. By supporting teachers with their implementation of Executive Functioning lessons in the class, students receive skills needed to be successful in their academics.  

As an Executive Functions tutor, Terese assists in the coordination and implementation of the tutoring program for RNBC.  In doing so, she helps students to incorporate skills that are necessary for success in their school work and beyond.

Terese received her Master of Arts degree in Curriculum Development from De Paul University. As an educator in the Chicago land area for over 16 years, her professional experience includes teaching at the Middle School, High School and Post-Secondary level. She has assisted in developing intervention plans for both ESL and at risk students. Her primary goal as an educator is to assist students to become lifelong learners. Terese is excited to be part of the extraordinary team of professionals here at RNBC.

“His mom tells him to get ready for bed, and she finds him sitting on the floor, half dressed, building something with Legos. His teacher says she gave the class an assignment, and he lifted the lid of his desk to get out some paper, and found his library book, and just sat there reading, with the desk lid up, while everybody else got to work. My question is: if he has an attention deficit disorder, why is he able to pay so much attention to the stuff he likes?”

This is a question I often hear from parents whose children seem to have an endless ability to concentrate on the things they care about, but no steadiness of purpose when it comes to what is required of them.

“The role of motivation is huge when it comes to attention,” I told Mr. Drake. “And to help James we’re definitely going to have to use that. One way is to say no screen time until after homework, for example. But you’re right. It seems paradoxical that a child who has trouble paying attention can literally spend hours playing a video game. It’s one of the reasons that some neurobehavioral experts think that instead of talking about Attention Deficit Disorder; it would be more accurate to say that some children have attention regulation issues, and both over-focus and under-focus. They have trouble fine-tuning it to the appropriate level.”

An assessment showed that James did indeed have attentional issues of two kinds: he had trouble sustaining interest and had difficulty switching from one activity to the next.  I suggested that he receive a combination of behavioral therapy and medication. His parents were hesitant about the meds and so we worked on ways, in addition to his therapy, that James could learn to maintain focus. Instead of giving James chores to do, his parents did household tasks with him. They created a homework routine that James gradually learned.  He did improve, although he still tended to zone out at school, particularly in math. His father had gained a lot of insight over the course of the year and now said sympathetically, “James finds math particularly difficult. I know it’s hard to focus on what you don’t understand and feel bad about.” Thinking about what might motivate James, his father rephrased all his son’s story problems in terms of Harry Potter. It actually helped a lot.

His parents and teachers had made good efforts to motivate James and his issues with attention had improved noticeably. But going into fifth grade meant moving to a system where children changed classrooms for different subject areas. James completely fell apart. He lost things, forgot things, started to slip behind academically, and called himself “stupid” when he made mistakes. At this point, his parents decided to try medication. 

But this in no way meant that behavioral therapies and changes at home and in the classroom hadn’t been useful. His parents had learned to make the effort required to help James become more focused, and James appreciated it. They felt much closer. And because he had worked for the better part of a year on improving his performance, he valued the effectiveness of his medication. “I concentrate better, so I learn more, so it’s more interesting, so it’s easier to concentrate,” he told his mom. “It’s a vicious cycle – but for the good.”

While supporting your child with nightly assignments it is important to monitor the amount of time needed for assignment completion.  If you feel that the time is excessive or that your child clearly does not understand the assignments or requires total supervision in order to complete them, share your concerns with the classroom teacher(s).  If your child already has and IEP or a 504 Plan, homework accommodations can be added.  Suggestions for accommodation are: set a limit on the time spent completing nightly assignments, modify the length of assignments, break lengthy assignments into manageable steps, provide a check-out to make sure all assignments are written down and that necessary materials needed for completion are taken home.

Below is a list of recommendations which may help your child complete homework more effectively, efficiently and independently and hopefully provide some added time for leisure activities. 

Organization Strategies

• Teach prioritizing of assignments, i.e., completing those that a most difficult first, completing assignments that are due tomorrow before working on a long-term project.
• Model HW time management, i.e. ask your child to estimate the time it will take to complete an assignment, set a timer, compare the estimated time with the actual time.
• Teach task analysis of long term assignments.
• Prepare a locker list reminding your child what needs to be taken home.

 Support for Reading

• Use books on tape.
• Enlarge print.
• Purchase an extra set of textbooks for home so that your child can write notes and highlight in text.
• Review post-reading assignment expectations prior to doing the reading assignment.
• Pre-teach reading concepts to be covered.
• Relate concepts in the story to your child’s personal experiences.
• Create “purpose for reading assignment” sheet, i.e., as you read look for, highlight or jot down personality traits of the main character.

Support for Math

• Copy problems from the book for your child.
• Copy problems on a lined piece of notebook paper turned so that the lines are vertical.  Use the vertical lines as a grid, writing one number in each space.
• Give adequate space to complete problems and limit the number of problems written on page.
• Draw a box around each problem.
• Use different colored pencils for addition, subtraction and multiplication signs.
•  Break down multi-step problems.
• Write each step on a sequence card and have your child use the sequence cards to complete HW.
• Use manipulatives to represent numbers.
• Use a number line.
• Use a multiplication chart.
• Use a calculator.
• When completing story problems; review math vocabulary i.e. addition, plus all together, in all; highlight relevant information, i.e., only numbers needed to complete problem and process required; use visual representation i.e. drawing pictures

 Support for Spelling

• Present one spelling concept at a time (long “A” sound)
• Review and pretest one spelling concept at a time
• Write words in a tray filled with salt or shaving cream
• Use clay or Play Doh to write words

 Support for Vocabulary

• Limit number of new vocabulary words presented at one time.
• Highlight vocabulary words on worksheets.
• Give page numbers to help your child locate and find meaning of vocabulary words.
• Ask your child to draw pictures that define vocabulary words.
• Ask your child to act out new vocabulary words.

Support for Written Expression

• Use jot lists, outlining and webbing.
• Create graphic organizers (ideas can be found on-line).
• Use computer graphic organizers, i.e., Kidspiration, Inspiration
• Use a tape recording when formulating ideas.
• Allow your child to dictate ideas.
• Write questions to be answered in a different color and then provide adequate space for your child to respond.
• Tell your child how many sentences are necessary for each answer or paragraph (write 3–4 sentences).
• Create rubrics to make expectations clear.
• Create a checklist of elements on the rubric or assignment requirements.
• Provide a sequence of tasks for the proofreading and editing process, i.e., Are all words capitalized at the beginning of each sentence?  Does each sentence end with a period?
• Encourage use of computer.
• Expect use of spell check and grammar check.

Support for Test Preparation and Test Taking

• Request prior notice for all tests and quizzes to avoid “cramming” at the last minute.
• Create study guides with necessary names, dates, concepts, etc.
• Use index cards for individual concepts and group similar concepts.
• Create acronyms when memorizing lists.
• Create pretests.
• Remind your child to read and highlight instructions before beginning tests.

Strategies to Support Inattention

• Reduce the number of extraneous materials present in the homework area.
• Create a private key word, e.g., “focus”, that can be used as a cue.
• Physically refocus attention, e.g. touching the shoulder.
• Break down instruction into separate parts and use fewer words.
• Give one instruction at a time.
• Write down multi-step instructions.
• Ask your child to repeat and rephrase directions in order to confirm that he/she has heard, understood and retained the information.
• Break down complex tasks into smaller, more manageable components.

Improvement of Self-Esteem

• Remind your child that everyone makes mistakes and that nobody is perfect.
• Acknowledge efforts that your child makes to complete an assignment.
• Base comments on the effort being made and not on the result.
• Model making mistakes in front of your child in order for him/her to see that a person can survive when making an error or when a project comes out less than perfect.
• Model how to handle difficult tasks.  For example, when experiencing difficulty with a task say aloud “This is hard, but I’m going to keep trying.” 
• Monitor for signs of frustration and be aware of whether the signs may be secondary to anxiety and insecurity over perceived task difficulty.
• Highlight and praise your child’s many abilities in other areas.

 Ms. Resnick serves as RNBC’s School Liaison.  She supports families through interpreting evaluations and IEP’s, developing educational programs including suggestions for goals, accommodations and teaching strategies, working with school system to secure appropriate services and providing alternative school placement recommendations.

Sandra dutifully Nate prepared for the new experience. They bought a backpack and talked about reading books from the school library and bringing a book home in his backpack. She told him about all the new kids he would meet and how they could play after school at each other’s houses. When they heard that Nate’s teacher would be Mrs. Anderson, Sandra learned about her from other parents and told Nate that his teacher had a Scottie dog and two grown up sons, and drove a cool old car that she repaired herself. Nate and his mom even got to meet Mrs. Anderson the day before school started.

All the preparation paid off. Sandra walked Nate to the door of his classroom, where Mrs. Anderson was waiting to greet them. Mrs. Anderson showed Nate a cubby with his name on it, where he could put his backpack. Then Nate glanced around the room, decided what he wanted to play with, saw a friend from summer art camp, and said, “Bye!” to his mom over his shoulder as he headed over to say hello. 

In a way, Nate’s mom was startled, even hurt, that he’d separated from her so easily. Then she decided she was relieved.  Was this really going to be so simple? 

Apparently so. Nate came home and said the teacher read the class a book called Dinosaurs Beware that was really funny. Nate had drawn a picture of one of the dinosaurs going down a slide headfirst. They had eaten tiny graham crackers. They had had partners and walked around the school. They met the gym teacher Mr. Conway. “School was good,” Nate said. “I liked it.”

So his mom felt upbeat when she woke him the next morning with a cheery “Time to jump out of bed and go to school!”

Nate sat up and gaped at her, absolutely astonished. “Again?” he said.

I loved Sandra’s story because Nate’s “Again?” puts the emphasis right where it belongs—on establishing a rhythm, and making a challenge easier through familiarity and repetition. In planning, adults focus on unique events, like the first day of school, but success actually depends on a matter-of-fact, day-in-day-out establishment of habits that carry a child through, on good days and bad days. This may sound strange coming from me, because I often talk about creating a learning environment uniquely tailored to a child’s needs, but that doesn’t mean that everything is up to the child. Children also need to learn that some things in life don’t depend on how you feel about them or what you want, they just have to get done.

For that reason, it’s vital to create good routines, because making decisions afresh each day is hard. Doing what you’ve always done is much easier. That’s why Sandra’s creating a framework of familiarity and good habits for Nate will make all the difference.

For ten years, all through grade school and high school, we worked on Greg’s organizational skills. He had executive function support for his homework. He learned to make lists and to create a schedule for when each part of a long-term project was due. Much of his life was organized by his mom who woke him up, reminded him when he had to be some place, and helped him keep track of his stuff. His friends on the lacrosse team made sure he got to practice. His girlfriend planned their time together and organized events like starlight bowling with friends and team barbecues.

By the age of 18, Greg had grown into a slender, crew cut kid with decent grades and a very manageable life. A strong social network helped Greg function at a high level.

He got into the college he’d hoped to attend and we talked about the organizational challenges he might confront freshman year. Nevertheless, when we met during winter break after his first semester, he let me know there was trouble. “I don’t have my grades yet,” he said. “But they’re not going to be good.”

“How do you know?” I asked.

He shrugged. “I forgot a lot of work I should have done,” he said. “I never woke up for my first period biology class, and when you miss the lab, you can’t do the assignment. I had a lot of stuff to do like laundry, but I never got around to it. I brought it all home at Thanksgiving and the back of my car is full of it again. I feel like I’m slipping. I’ve missed team practice. I don’t remember to do assignments. I find myself studying for tests at the last minute and staying up all night. I don’t understand it. I was doing a lot better in high school.”

“In high school you learned to structure your schoolwork, but at college you have to structure your whole life— waking up, working out, homework, classes, social life, self maintenance like haircuts and laundry and meals,” I said. “A lot of kids have a hard time managing at first.”

Because I didn’t want Greg to feel overwhelmed, I suggested he choose two things to work on. Wisely, he chose homework and getting up on time. When Greg and his family had been selecting a college we had made sure that each possibility offered a resource center with special tutoring for students with learning difficulties. Greg knew his school’s Study Center existed but had resisted going there, hoping to do everything on his own.

Now I reminded him that there was a place on campus that would help him get organized. “There’s nothing shameful about using it,” I said. “They didn’t build the center just for you. There are a lot of people who do better because of it.”

Greg agreed. “Half gone, half good,” he said cheerfully, meaning that the first half of the year might have been wasted, but the second half would be better.

His optimism was justified. He got a friend to wake him every morning, and stopped missing classes. He went to the campus learning center—and bumped into a girl who lived two doors down in the same dorm. He’d been wanting to get to know her. Suddenly going to tutoring became a social thing.

Gradually Greg created the same social network that had enabled him to flourish in high school. At the end of his first year he sent me a card with a photograph of two men and a bear, pushing on the back of truck stuck in the mud. Underneath it was a quote from Ashleigh Brilliant: “The best thing about needing help is that it’s a good way to meet people.” Once again, this great kid had overcome his difficulties by building on strengths.

What is school-based anxiety and school refusal?

Anxiety disorders are one of the most common problems among children and adolescents with rates varying from 10% to 20%. While a little worrying is normal, anxiety is defined as excessive worrying that is irrational or out of proportion to the feared stimulus. Symptoms of anxiety can interfere with everyday functioning as well as interpersonal relationships and school achievement. School can be an especially daunting place for children with anxiety because of the enormous interpersonal and academic demands. School-based anxiety is defined as a developmentally inappropriate reaction to the perceived consequences associated with school (e.g., failing a class, fears of getting picked on). School refusal behavior, also known as school phobia, occurs when the anxiety becomes so distressing that children and adolescents miss days, weeks, or months of school. The most common age of school refusal is 10 to 13 years, but can occur at any point in development. Parents are also more likely to see anxiety and avoidance behaviors occur during transition years (e.g., from elementary to middle school).

How does anxiety and school refusal impact youth?

Children with excessive anxiety present with a range of behaviors. Some children withdrawal from social activities or avoid difficult tasks for fear of failing or being embarrassed. They may appear inattentive, forgetful or unmotivated to engage in classroom discussions. Academic performance starts to suffer and teachers may interpret their behavior as defiant, disorganized or lazy. Socially, children may isolate themselves to avoid participation in peer interactions. They may have a poor self-concept and believe they lack the skills to initiate and sustain a friendship, which leads to further worries about being rejected by peers. Over time, children are more likely to develop sadness and develop a stable pattern of anxious thinking. Avoiding school or minimizing academic and social activities offer youth effective, short-term relief to reduce anxious feelings, but over time have serious negative consequences. Additionally, families are affected by this problem. Parents often feel blamed by the school given the common misperception that the issue is simply a matter of discipline. In reality, parents struggle to manage conflicting feelings around empathic desire to comfort their children and exasperation associated with the battle to get them to school.

 Warning Signs and Symptoms

Some warning signs that your child might be experiencing increased anxiety or school refusal include:

-       Excessive reassurance-seeking behavior

-       Clinging to an adult

-       Temper tantrums, crying

-       Sleep difficulties

-       Depressed mood, irritability

-       Difficulty concentrating

-       Complaints of physical problems that are absent on weekends or breaks

-       Frequent tardiness or absences

-       Absent on important days (tests, presentations)

-       Frequent trips to the nurse’s office

-       Frequent requests to call or go home

-       Refusal to get out of bed or go to school

-       Running away from home or school

What You Can Do

If you are concerned that your child is experiencing an increase in stress and anxiety or you have observed changes in his/her behavior that lead to school-based problems, it’s important to take steps to indentify the problem and develop an intervention plan. Parents may wish to consider one or more of the following actions:

 Medical and Psychological Evaluation

Having a routine medical check-up might be a good place to start, especially if you child is complaining of physical problems (e.g., headaches, stomach aches). Many of the symptoms commonly seen in children with anxiety can also have a medical explanation. Ruling out physical problems is critical before taking further action. On a related note, there are also a number of psychological conditions that could better explain the kinds of problems associated with school refusal. For example, a mood disorder such as depression may also cause a child to withdraw from school or lack motivation to go to school. Also, conduct problems, attention deficits and learning disabilities might manifest as school refusal and poor classroom connectedness. Finally, many children are unfortunately the targets of bullying, which can make school very unpleasant and lead to unwillingness to attend. In these cases, intervention efforts would take a different form. A comprehensive psychological evaluation would identify these or other potential contributors to your child’s school difficulties as well as guide treatment decisions.

School-Based Interventions

Parents are strongly encouraged to work closely with the school in developing an intervention plan. In order to be successful, the plan should start with a school refusal assessment that identifies the target behaviors, as well as antecedents and consequences (i.e., what happens before and after the behavior) at home and school. For example, if the child’s refusal seems to occur on days when there are tests, the school might implement a plan providing accommodations and support around test taking. Other common school-based interventions include structured behavior plans with rewards and consequences, social work support, reduced time spent at school, reduced or modified work expectations, or a systematic re-entry plan.

Home-Based Interventions

Parents play an important role in their children’s treatment plan. Successful interventions will include ongoing, consistent communication with the school and specific ways of handling anxiety and school refusal at home. Parents may be guided on how to respond to children’s complaints of feeling sick or temper tantrums. Forcing your child to go to school when the child is having a meltdown is one of the hardest things parents face. The result is feelings of guilt and frustration; parents may feel compelled to let the child stay home. This response inadvertently reinforces the anxiety and makes the problem worse. Establishing a contingency plan that involves the school will be helpful in guiding your decisions during these intense moments.

There are a number of other things parents can do to support anxious children, in general. Being supportive and consistent in discipline as well as providing a structured, predictable routine can alleviate anxiety symptoms. Be patient and avoid being overly critical or punitive. Praise effort over outcomes and be prepared to listen and encourage expression of feelings. Also, be mindful of your own anxiety and make efforts to model relaxation strategies such as positive self-talk and deep breathing

Other Considerations

Seeking outside help is strongly recommended if the problem persists and continues to impact the child’s ability to attend school or engage in daily activities. Individual or family therapy can be very helpful to reduce anxiety and support parents. Cognitive-Behavioral Therapy is a well-supported treatment approach that teaches children to manage anxiety using a combination of physiological, behavioral and thinking strategies. For extreme cases, parents may consider enrolling their children in partial– or full-hospitalization programs designed specifically to treat school refusal. Also, anti-anxiety or anti-depressant medication may also be a component of treatment.

If you have concerns about your child experiencing anxiety or school refusal and would like an evaluation and/or treatment through our Stress and Anxiety Clinic, please call 847–933-9339 to schedule an appointment.

 1. Diagnostic Clarity

Does Joe have ADHD? A learning disability? Executive functioning problems? Anxiety? Depression? A combination of things? These are all potentially valid hypotheses.  Children are complicated and a host of factors may account for a similar behavioral presentation.  For instance, children who look like they are not paying attention often have undiagnosed learning disabilities.  The reverse is also true in that children who have attention deficit disorders may appear to have learning difficulties because they cannot consistently produce academically.  Similarly, children who are anxious or depressed may have difficulty concentrating or be unavailable for new learning. One major goal of a comprehensive evaluation is to determine which problem areas are primary and which are secondary, and ascertain whether the data are suggestive of a specific diagnosis.  Often, there is a combination of factors which need to be understood.

 2. Learning style

In addition to diagnostic clarification, another major purpose of a comprehensive evaluation is to understand how a child like Joe learns the best.  One size does not fit all.  Testing provides a profile of a child’s unique strengths and weaknesses across multiple areas of functioning and sheds light on how a child processes information.  Such information is invaluable for teachers and other professionals who are working with children on a daily basis and may be unclear about how to most effectively intervene.

 3. Road Map

A comprehensive evaluation should provide a road map for parents, teachers and other pertinent professionals about how to address their child’s needs. Such interventions may include tutorial support, medication, psychotherapy, speech/language therapy, occupational therapy, social skills groups or school-based learning resource support.  Sometimes, a change in school placement is recommended.  Regardless of the type of intervention, once a full evaluation has been completed, the best combination of supports and specific goals for each is more readily understood.

 4. Monitoring Tool

Comprehensive evaluations provide concrete data about a child’s level of intellectual, academic, social/emotional and attentional functioning at a snap shot in time.  Nonetheless, children are moving targets.  As such, children like Joe need to be monitored over time to determine whether in fact they are progressing, hitting a plateau or falling behind.  Periodic evaluations are a very helpful tool in this monitoring process.  Interventions often need to be updated or changed to accommodate children’s continual development.  As such, 2–3 year re-evaluation intervals are typically recommended for school-aged children, while annual re-evaluations are ideal for children under age 5.

 If you have questions about psychological/neuropsychological evaluations at RNBC, please contact our office at (847) 933‑9339

Many of the kids I treat really do count the days. The effort to produce academically when there’s a difficulty with learning or regulating behavior can push children to the limit. The relief of being free of school, of no longer being judged on the basis of activities that often make these children feel they are at a disadvantage, creates a sense of buoyancy and lightness. Everything in daily life gets easier over the summer for the children, but also for their parents. Or it can, if you keep a few simple guidelines in mind.

1. Don’t recreate the pressures of school at home. Some parents are so focused on the challenges of the school year that they forget to create an atmosphere in which a child can relax and feel good about himself or herself. Even kids who benefit from tutoring over the summer should have at least one week of every four when there’s no work to do. This is the time to travel, play, pursue a hobby or sport, sleep late, and see friends.
2. Monitor screen and phone time. A couple hours a day of computer time, video games, or talking on the phone can be a pleasure for a child and is often a social experience. But too much time in front of a screen interferes with the chance to focus on a personal passion – an activity that the child really loves or a skill that a child could develop.
3. Monitor your own screen and phone time, too! If you have a chance to be with your child—pushing a stroller, driving a car pool, or spending an evening at home—stay off the computer and/or phone and talk to your kid about what you’re both seeing, feeling and thinking. Discuss movies, books, a game you’ve seen. Make a meal together and eat it at leisure.
4. Relax! Not every moment should be purposeful and productive. Don’t pack your child’s schedule or your own. Leave time to think and take walks. Give in to (positive!) impulses. If your child comes down to breakfast talking about dinosaurs, draw dinosaurs together, jump in the car and go to the Field Museum,  head for the library to get dinosaur books, or together do a computer search on dinosaurs.
5. Model the behaviors you want your children to learn. Sign up to clean a beach or deliver meals on wheels. Build something for Habitat for Humanity with your teenager.
6. Foster relationships with your extended family. A visit to grandparents, a week playing with cousins, going to museums with a favorite aunt, or learning to fish with a favorite uncle, can make a child’s summer memorable.
7. Let children help to plan and organize trips and activities. All too often children who lack organizational skills are asked to develop them around activities they don’t enjoy such as homework or tutoring. They’ll have a lot more incentive to strengthen their skills planning a trip to Great America or scheduling things to do during a cousin’s visit.
8. Let summer be a time to experience new possibilities. Children—particularly those who struggle during the school year – need to know they’re not boxed in by the status quo. One of the activities they try for the first time this summer—horseback riding, painting, SCUBA diving—could become a long-term passion, a source of self-worth, and a connection to the world.