By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

Many of my clients find NESCA after experiencing years of difficulty, whether at school, at home, or in the community. They have often been evaluated previously but still do not clearly understand what underlies their challenges. When clients struggle for years, they have often received a variety of diagnoses. The DSM-V provides diagnostic criteria that label a person’s experience due to developmental concerns, learning differences, or psychiatric problems. In essence, diagnoses are a simplified way to describe complex, ever-changing, multi-layered differences and are difficult to pin down with a single term. One of the most challenging diagnoses for a neuropsychologist to make, and a person to live with, is attention-deficit/hyperactivity disorder (ADHD).

ADHD is diagnosed when an individual displays difficulty directing and sustaining their attention to the extent that it negatively affects functioning across multiple domains. They may be distracted by internal processes resulting in daydreaming or struggle to filter incoming sensory information in the environment. For example, sounds, lights, and feeling too hot or cold. Because the regulatory part of their brain is not fully developed, they are more likely to become distracted. ADHD can be tricky, though, because there are many other explanations for why someone struggles with attention that may seem like ADHD but are not. This article focuses on similarities and differences between ADHD and anxiety in children.

When a child is anxious or stressed, whether about getting a good grade, disappointing a teacher or parent, or how he/she is getting home after school, this takes her mind off instruction, work, and social interactions. The result is inattention, but not due to ADHD. Individuals with anxiety may hyperfocus on worry, limiting attention to other information. Furthermore, it is common for children with ADHD to experience anxiety; however, it is most often a consequence of poor attention regulation rather than a cause of inattention. Both conditions can be associated with procrastination, but the basis for delaying work differs. The child with ADHD may struggle with initiating a task, while the child with anxiety may be preoccupied with anticipation about how well she will perform. At times, anxiety and ADHD present so similarly that it can be difficult to distinguish one from the other.

As you can see from the graphic below, there is a tremendous overlap in symptoms between ADHD and anxiety, making a comprehensive evaluation necessary to make an informed diagnosis.

Humans are complex, and a single diagnosis rarely captures their emotional and behavioral challenges.

References:

Essentials of ADHD Assessment for Children and Adolescents, First Edition, by Elizabeth P. Sparrow and Drew Erhardt, Wiley, 2014

About the Author

Dr. Cynthia Hess graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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

Reading 20 minutes per day has been shown to have many positive benefits. Did you know…?

• Children who read 20 minutes a day/5 days a week are exposed to 1.8 million words in one school year. Compare this to students who read 5 minutes per day – they will be exposed to 282,000 words per school year.
• Reading helps foster empathy – a child experiences “walking in someone else’s shoes.”
• Children are exposed to different ideas and cultures.
• Reading also improves critical thinking.
• Reading increases knowledge of correct syntax and grammar, along with robust vocabulary knowledge, resulting in improved writing skills.
• Students who read 20 minutes per day score significantly higher on standardized tests of reading.
• Reading with your child, or having them read independently before bed, can help them to relax and wind down from their day.

It is important to recognize that despite all our good intentions, sometimes students are reluctant to read on their own. This reluctance can come from different reasons, such as difficulty reading, not yet knowing the types of books they would enjoy, or even that they would simply rather be playing video games or be on social media. To help make reading more attractive to your child, there are several things you can try:

• Let the child choose what they are reading – help them find books that are about an area of high interest to them (anything from sports to fashion to history – all is fair game!).
• If the book they are interested in is above their reading level, you can read to them (model the page) and then have them read it back to you.
• Allow them access to audio books, and they can follow along with the text.
• Encourage different types of reading material (comics, graphic novels, magazines, traditional books, etc.).
• Look for book series – once they enjoy one, they will often want to read the rest!

Getting your child to read is not always easy. However, allowing them to read high interest material, asking them questions to help them interact with the text, and modeling that reading can be fun is a great start!

If your child demonstrates difficulties improving their reading skills, reach out to their teacher and discuss if there are any underlying concerns (visual issues, such as difficulty tracking; reading challenges, such as reduced phonemic awareness, etc.). If you continue to have concerns, consider having your child evaluated by a reading specialist or pediatric neuropsychologist to ensure that such an important skill is supported and developed as your child continues through school and beyond.

Sources

https://www.honorsgradu.com/importance-of-reading-20-minutes-a-day/

The Surprising Benefits of Reading 20 Minutes a Day

https://www.k12reader.com/why-read-20-minutes-a-day/

https://www.understood.org/articles/en/14-ways-to-encourage-your-grade-schooler-to-read

About the Author

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

According to the APA Dictionary of Psychology, boredom is defined as:

A state of weariness or ennui resulting from a lack of engagement with stimuli in the environment. It is generally considered to be one of the least desirable conditions of daily life and is often identified by individuals as a cause of feeling depressed. It can be seen as the opposite of interest and surprise

In an APA podcast called Speaking of Psychology, Erin Westgate, PhD, a psychologist who studies boredom, suggests that boredom is an unpleasant emotion similar to anger, sadness, fear, and pain. In her efforts to understand and define boredom, Dr. Westgate explored the ways in which attention and meaning affect emotions and explain boredom. She opines that boredom may result from one’s inability to sustain attention, which may occur either when a task is too easy or too hard. It may help to understand why students describe a less preferred subject (e.g., math) as boring. Boredom may also be due to a sense that what we are doing lacks meaning. In both instances, the mind wanders and we are faced with that sense of being alone with our thoughts. Dr. Westgate notes that some thoughts are more engaging than others, and there are certain conditions under which people enjoy or do not enjoy their own thoughts. It has become increasingly difficult for people to sit and think, and consequently they search for ways to escape or avoid the boredom that results. However, boredom is not all bad. Like many things in life, it depends on how we manage it.

Similar to other negative emotions, boredom alerts us that something is wrong in our body, and it is human nature to want to escape or avoid it. When escape and avoidance become the only method to cope with boredom, individuals may begin experiencing chronic boredom, which can be detrimental to emotional and physical wellbeing. When boredom becomes chronic, it no longer works as a useful signal. Boredom can be more impactful than loneliness and is often mistaken for loneliness. When boredom is not well managed, it can lead to depression and self-destructive behaviors, such as self-harm and addiction. As alluded to above, the ability to sit with our thoughts and feelings without trying to avoid or escape them has become increasingly difficult. Perhaps related to the ease with which they can be avoided; for example, when our body sends out the first signal of discomfort, we can distract ourselves by reaching for our phone. An article in TIME magazine stated:

We’re trying to swipe and scroll the boredom away, but in doing that, we’re actually making ourselves more prone to boredom, because every time we get our phone out we’re not allowing our mind to wander and to solve our own boredom problems, Mann says, adding that people can become addicted to the constant dopamine hit of new and novel content that phones provide. Our tolerance for boredom just changes completely, and we need more and more to stop being bored.

Relying on electronics is only one example of a way to avoid and escape the discomfort of boredom. It is highly reinforcing because, in the short-term, it works. However, when it is one’s only tool in the toolbox, it may quickly undermine their ability for learning to manage uncomfortable thoughts and feelings and use them for creating positive change. Therefore, it is necessary to find a positive, opposite behavior to replace the maladaptive behavior. This often leads to an increased sense of purpose and agency, and improved self-esteem and self-concept.

Children and adolescents often complain about being bored, and while boredom is uncomfortable, it can also help to develop skills, creativity, and boost self-esteem. Once boredom sets in, it can be difficult for children to shift their attention to find meaning when confronted with the discomfort of boredom. According to an article published by the Child Mind Institute, boredom can be a great way to teach children how to manage frustration and regulate emotions when things are boring or not going their way. It is not that boredom teaches the skills, but rather it is what they do when faced with boredom. There are many strategies outlined in the article to help parents nurture skills when their children are bored. In general, be aware that behaviors may be attention-seeking, and therefore, should not be reinforced. Otherwise, boredom offers an opportunity for children to do something meaningful that benefits them and those around them. When properly managed, it spurs creativity and innovation. Along the way, it is important to be realistic and recognize that there will be failure, and learning to manage the discomfort of failure is an added bonus.

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By: Tabitha Monahan, M.A., CAGS, CRC
NESCA Transition Specialist/Counselor

It’s become somewhat of a New Year’s tradition for me to make my first blog of the year about goal setting. Last year, the blog focused on the creation of an attainable SMART goal and breaking up a larger goal or vision into smaller chunks. However, creating a SMART goal is just the first step. Once you have a goal, you need to create your action plan. Before sharing some of my favorite strategies for creating (and following through) on action plans, let’s refresh ourselves as to what SMART goals are:

Specific – The goal should be specific. I’ll increase the distance I run is vague. Will you increase the distance by 20 feet, 2 miles? Are you planning for a marathon? How will you increase your distance? Will you increase it randomly? Will you increase the number of days you run each week, the length you run each time, or a combination of both?

Measurable – There’s a good chance that if your goal is not specific enough, it will be hard to measure if you have succeeded in that goal. So, let’s make our exercise goal both specific and measurable. I’ll increase the distance I run from 1 mile to 3.2 miles (5k).

Attainable – Attainable is the hard one for many students who are still building awareness of their strengths and challenges. Let’s say a person who has never run wants to run in the Boston Marathon. This is likely not an attainable goal, even if it is specific and measurable.

Relevant – If I am trying to increase my social circle and group leisure skills, running is unlikely to get me there. However, if, like many people, we’re trying to improve our health at the beginning of the new year, increasing the distance we run certainly will help get us there. Many young adults may need to bounce ideas off someone to ensure the goal is relevant to the area at hand.

Time-bound – Attainable and time-based work tightly together. If you do not give yourself a deadline, the goal may still be there at the end of the year. Humans work best with deadlines. We need the motivation to complete a plan, and often motivation needs a sense of urgency. When determining a deadline, it is also important to circle back and ensure that the goal is still attainable given the end date. Increasing a person’s distance from 1 mile to 3.2 miles may not be reasonable in 2 weeks but may be attainable in 3 months.

So now that we have our SMART goal:

I will increase the distance I run from 1 mile to 3.2 miles in one setting by increasing the distance I run by ¼ mile each week by April 15, 2023.

Once my students have created their SMART goal, the next step I have them do is determine the “action steps” they need to achieve to make progress towards their goal. Before the students create their action steps, I ask them to list the strengths and challenges impacting their goal progress. Using their strengths and considering their challenges allows the student to build awareness of how to select action steps and determine their frequency. For some goals, the first action step may be gathering materials (i.e., if they want to get their driver’s permit) or benchmarks they should make along the way (i.e., trying to run a 5k). Each action step should have its own deadline and be similarly measurable as the original SMART goal.

The creation of action steps allows for one of the most important and challenging aspects of achieving one’s goal: the follow-up. Periodic follow-up is essential to ensure that one is progressing as needed to achieve the goal in time. The follow-up also provides the best opportunity for skill building for current and future success. When a person is checking the status of their goal, they are asking themselves:

• What is going well?
• What unexpected challenges have occurred?
• Is there anything I should do differently?
• Do I need to add or change any action steps?
• Am I still on target to meet my goal deadline?

Being able to ask and answer these questions can make all the difference in goal achievement.

About the Author

Tabitha Monahan, M.A., CAGS, CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She 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.

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

There can be a great deal of confusion about what kind of testing you want for your child. No wonder when we have so many options – neuropsychological testing, psychoeducational testing, speech and language testing, occupational therapy testing, personality testing, and psychological testing. The part that can be incredibly challenging is that these labels often involve overlapping test measures, meaning that the assessor may choose the same specific tasks that might fall into most or all of these categories. Take cognitive assessment using IQ tests which can be used by a psychologist conducting psychological, neuropsychological, or psychoeducational testing. Another layer of confusion is added for parents when one considers that many professionals in schools or medical practices are also confused and interchangeably use these labels. In an effort to demystify the process, I want to tackle a common question: what is projective testing and why might my child need it?

Projective testing provides psychologists with very specific and unique insight about a person’s thinking habits and processing. Unlike cognitive or academic tests, projective tests do not have a “right answer.” So, projective testing is not going to ask a child to solve a math problem or define a word. It is not going to test how quickly they can name vegetables or see how skilled they are at shifting between sets of the rules. The overall goal of projective testing is to figure out how a child, teen, or adult responds to an ambiguous situation. This means, we ask people to project their brain habits (thinking style, way of interpreting the world, way of processing emotions, way of viewing self and others) onto a situation when it is not clear that there is a “right” or “wrong” answer. A person must use their problem-solving and emotion regulation skills in action. Examples of projective tests include the Rorschach inkblot test, story-telling tasks (e.g., the Thematic Apperception Test or the Roberts Apperception Test), drawings, and incomplete sentences. Projective tests take additional time to administer and usually longer to score, so they are scheduled as separate visits at NESCA.

Why might you use a projective test? There are some situations where projective testing is incredibly useful, such as when a diagnosis of a thought disorder (e.g., psychosis) is in question. It is also very useful for questions of trauma, attachment, anxiety, or mood disorder. Projective testing is also incredibly useful when psychiatric symptoms are confusing. Take the example of someone who is a perfectionistic or very guarded about their symptoms. A person with this profile is very likely to read a question that says, “I am very anxious,” and answer no. However, projective testing can see if there are themes of anxiety by considering how a person responds to an ambiguous situation. Take another example of someone who leans in the other direction and reports many symptoms that overlap with many diagnoses. In this case, many symptoms are endorsed as “yes.” Projective testing can help to provide clarity to narrow down the list, especially without an obvious answer. In both of these cases, it is helpful to access a person’s unconscious brain habits as a key to understanding a person’s functioning.

When would you not use projective testing? I do not use projective testing when my referral question does not need it. For example, a question of a learning disability or ADHD does not require projective testing. Using projective measures would be inappropriate, time consuming, and potentially stressful for a person when it is not needed. Similarly, projective testing is not often used in individuals with Autism Spectrum Disorder as there is little research about how neurodivergent populations respond to the ambiguous stimuli. I also do not use projective testing if neuropsychological testing suggests that a person has an intellectual disability or struggles in their visual processing skills (e.g., NVLD) since many of the projective measures (e.g., Rorschach, story-telling, drawings) use a visual stimulus card. In those cases, it would be inappropriate to assume that a response reflects a person’s emotional processing when it would really be about their visual processing.

Projective testing is incredibly informative and, like other neuropsychological tools, should only be utilized by professionals who are trained to administer and interpret these tests. Since it is not as simple as a correct single answer on an answer key, it is critical that these procedures are administered by psychologists with the advanced training to use and interpret the information. And, like all of our measures, the results gathered using projective measures are data points that are combined with other data points. The performance on one test or demand does not dictate the entire conclusion. A strong and comprehensive assessment will use projective test data as part of a larger understanding of your child. Information gathered in projective testing can highlight important strengths for your child and contribute helpful information to drive treatment.

NESCA has several clinicians who are highly trained and skilled at administering projective testing. If you have questions about projective testing and whether your child needs it, let us know by filling out our online Intake Form.

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

During the first few years of life, parents and caregivers are often tracking baby’s exciting first milestones, such as their first steps or first words. Routine well-child visits at the pediatrician’s office will often include the doctor asking what new skills you have noticed since baby’s last visit—Are they sitting unsupported yet? Crawling? Saying Mama or Dada? It can be stressful when your child is not yet meeting their milestones. It can be especially challenging when you notice they may be behind their peers at childcare or when around same-aged children at family functions.

The Centers for Disease Control and Prevention is a great resource to utilize as reference for what is expected of children by age. You can access more information here: https://www.cdc.gov/ncbddd/actearly/milestones/index.html or through their developmental milestone checklist.

What are age-appropriate milestones?

At a glance, several notable milestones listed by the CDC are as follows:

6 months:

• Recognize familiar caregivers
• Reach for toys/objects of interest
• Roll from their belly to their back

9 months:

• Respond when you call their name
• Smile/laugh in response to interactive games, such as peek-a-boo
• Babble (mama or dada)
• Bang objects together
• Sit on their on

1 year:

• Call their parent by name (e.g., mama or dada)
• Pull themselves up to stand
• Walk while holding on to furniture

18 months:

• Point to show you something interesting
• Following one-step directions
• Imitating your actions (e.g., putting on makeup, vacuuming, hammering)
• Walking unassisted
• Climbing on and off couches and chairs without support

2 years:

• Look to you for your reactions in new situations
• Putting two words together, such as “more milk”
• Using gestures like nodding/shaking their head
• Running
• Eating with a spoon

Should you have any concerns regarding your child’s development, talk to their pediatrician! Your baby may qualify for a referral to Early Intervention (EI), which can help them to gain the appropriate skills in a way that supports you, your child, and your family.

What is EI?

EI is a federal grant program that was established in order to identify children at risk for developmental delays and to help families meet their children’s needs and maximize their potential. EI serves children ages 0-3 and provides a multitude of services depending on a child’s needs. Referrals for EI can be made by caregivers and/or providers for children who are exhibiting delays in their developmental milestones OR for children who have a medical condition that places them at risk for a developmental delay. EI referrals can be made as early as birth for medical conditions, such as prematurity, low birth weight, and Down syndrome. Many children receive referrals for EI from their parents, pediatricians, and/or childcare providers when there are observable delays in meeting speech milestones, motor milestones, speech milestones, and/or social milestones.

Who qualifies for EI?

Once referred to EI, your child will likely undergo a developmental evaluation. They will qualify for services if they have a diagnosed medical condition with a risk for developmental delays OR a delay in one or more areas of development of at least 30% OR a delay in one or more areas at least 1.5 standard deviations below the norm OR there is a questionable quality of skills based on the informed clinical opinion of the multidisciplinary team. Children can also meet criteria if there is a risk for delays due to four or more child or family risk factors (e.g., NICU stay, feeding challenges, chronic illness of a caregiver, lack of social supports for the caregiver).

At the end of the day, you know your child best. If you have concerns, reach out to their pediatrician. You can also reach out to a local EI provider on your own. In MA: https://www.mass.gov/info-details/ei-program-contact-information. In NH: https://www.dhhs.nh.gov/family-centered-early-supports-services.

About the Author

To book an appointment with Dr. Miranda Milana, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

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

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Counseling Services, NESCA

During this holiday season, life for most people gets a bit more hectic. Many of us feel more stressed, busy, and overwhelmed with everyday life as well as preparing for the holidays. Our children are stressed as well, as they feel our stress. Older students feel the end of semester stress of papers being due and final exams looming.

A client, who is a college student, called me the other day and said, “I am just so stressed and angry, I couldn’t wait ‘til my appointment. I am angry at nothing and everything. I am being hard on myself and others.” I reflected on these feelings, and we discussed that, at this time of year, many people feel more stress and have a “shorter fuse.” I reminded him that being angry at himself for being angry wasn’t the solution/remedy; that just intensifies the feeling. Instead, we talked about normalizing his feelings, remembering to focus on his breath, and have compassion. When we focus on our breath, we shift our attention away from the thoughts and feelings that make us spiral. This client plays video games, so introducing him to stress management apps/games was a “no brainer.” I reminded him to use the app at least once a day for a few minutes, especially during this holiday season. This practice helps him and can help all of us to establish a new habit of stress reduction to help us remember how to focus on our breath and shift our attention.

Since most adults and children are using technology daily, let’s focus on spending some of that screen time for managing our mental health and stress levels. Experiment with free versions of apps and find one that resonates with you or your children, then practice it every day. Make it a part of your daily routine for at least 5 minutes. Pick the time that works for you. It is something that can even be done as a family. We establish routines for reading at night, let’s establish a routine of stress management at night, whether it’s an app or another method. Prioritize the time; it will make all your lives better! This habit and skill development will ultimately help us develop stress management skills and be able to use them when we are stressed. The development of these skills also helps us feel less stressed in general. Instead of feeling stress during the holidays, let’s feel the joy, love, and gratitude that abounds.

Listed below are a sampling of several stress management apps related to mindfulness, emotional recognition and regulation, and anxiety/depression to help you and/or your children manage the stress of the upcoming holiday season. Hopefully one of them will resonate with you and your children so that you all may experience more resilience and peace when stress does happen.

Headspace (Children through Adult) is a mindfulness/meditation app that helps people reconnect with their breath. Headspace for Kids focuses on five areas: Calm, Focus, Kindness, Sleep, and Wake Up.

Calm (Children through Adult) is an app that focuses on mindfulness, yoga, guided meditation, breathing programs, improving focus, calming and relaxing music, and more.

Insight Timer (Children through Adult) is an app that includes lessons/classes, talks, music, and more on a variety of topics, such as mindfulness, stress reduction, achieving better sleep, anxiety, yoga, and other areas.

Super Better (Age 13 through Adult) is an app that uses games to build resilience, change mindset, emotional control, mental flexibility, achieve goals – even with challenges – and helps with anxiety, depression, chronic pain, and more.

Mindshift CBT (Teens through Adult) is an app that focuses on anxiety reduction, including worry, perfectionism, social anxiety, panic, phobias, and more.

Breathe2Relax (Teens through Adult) is an app that focuses on diaphragmatic breathing and stress reduction.

Smiling Mind  (Ages 7 through 18) is part of a broader collection of tools/curriculum that focuses on mental health for children and adults (teachers and parent). It focuses on mindfulness, deep breathing, body scan, gratitude, and more.

Positive Penguins (Ages 4 through 11) is an app that helps children understand how their feelings and thoughts are connected and to develop more positive thinking.

Resilient Family, Happy Child (Ages 4 through Adult) is an app that uses simple mindfulness- based movement to support the development of resilience and self-regulation.

Mightier (Ages 6 through 14) is a biofeedback tool that uses a heart sensor to help children understand their emotions and teaches them calming strategies.

HeartMath (Ages PreK through Adult) is a company that has many tools, games, music, curriculum, books, and more that focu on stress reduction. They have biofeedback apps and desktop computer versions for single users, classes, or multiple clients. They all use a heart sensor. Inner Balance is the app it uses within the program.

DreamyKid (Ages 9 through 18) is an app that uses guided visualizations, meditations, and affirmations related to mindfulness.

WellBeyond Meditation for Kids (Ages 4 through 8) is like DreamyKid but is geared towards younger kids with guided meditations, visualizations, and breathing exercises.

Breathe Think Do Sesame (Ages 2 through 5) is an app that helps children learn deep breathing, problem solving, an emotional vocabulary, positive thinking habits, and more through guided meditations, visualizations, stories, breathing exercises, and more.

Mindful Powers for Kids (Ages 5 through 10) Through play, games, stories, and more, kids learn about emotions, mindfulness, positive thinking, body scanning, and more. It uses Acceptance and Commitment Therapy (ACT) as a guiding principle of its platform.

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By: Lyndsay Wood, OTD, OTR/L
NESCA Transition Specialist & Occupational Therapist

Procrastination is affecting a lot of us these days. There is a wide variety of reasons that people put things off until the last minute. In a previous blog, I discussed tips for anxiety-based procrastination which you can read here. Today I would like to talk about procrastination related to low motivation.

Have you ever had a day where you cannot get off the couch, and you want to keep binge watching your favorite show? Or, maybe you have noticed your child cannot seem to get off TikTok to do their homework. These are all examples of procrastination as a result of low motivation.

It can be extremely challenging to find the motivation to do things we don’t want to, especially when it means transitioning away from the things that bring us joy. You may have noticed this getting worse as the weather turns colder and the sun sets earlier each day. Many people find that their mood and motivation hit a low during these fall and winter months. So, how do you overcome this feeling?

Here are five strategies to get over the procrastination hurdle when motivation is low.

1. Momentum Stairs – Do you remember learning about Newton’s Laws of Motion? The Law of Inertia says an object at rest will stay at rest, and an object in motion will stay in motion. Makes sense, right? If you have been sitting still and engaging in an activity you enjoy (I’m looking at you, Netflix), it can be extremely difficult to transition to the task you have been putting off.

Sometimes, the best thing to do is to start with an activity that is more enjoyable just so you can get moving. For example, if you need to write a paper, but you can’t get off the couch, build your momentum by making yourself a cup of tea. That gets you off the couch and away from the TV, and once you are up, maybe you complete a small chore that isn’t too difficult (watering your house plants, wiping the counter, etc.) then you can move on to start writing your paper.

To initiate that movement, it is easiest to start with something easy and work your way toward the task that you have been procrastinating. Some folks find it helpful to picture a set of stairs; the activity they enjoy is at the top and the uninteresting task is at the bottom. You must take small steps down the stairs to build momentum toward the activity at the bottom of the stairs.

2. Habit Stacking – Habit stacking is a great strategy to help build routines out of existing habits and overcome low motivation. Once a routine is in place, it takes a lot less energy and motivation to complete those regular activities since they have become automatic.

The principle behind this strategy is that you slowly add to existing habits until you have formed a routine. For example, let’s say you eat breakfast every morning, but have not been good about taking your vitamins. By habit stacking, you could start taking your vitamins every day as soon as you finish breakfast, thereby accomplishing two things much more easily than having to remember to take your vitamins separately later in the day.

It may be helpful to place your vitamins in your pantry so there is always a visual reminder when you are making breakfast. Stacking habits in this way can make it much easier to form new routines that help you get past low motivation and accomplish bigger goals.

3. Reduce Barriers – Another helpful strategy for low motivation is to reduce the barriers needed to start the activity. Sometimes it can feel overwhelming to think about cooking that homemade meal you have been wanting to try, or to deep clean an area of your house that you can never get to. That results in low motivation, and the best way to overcome it is to reduce any barriers to initiating the activity.

One suggestion is to take all the materials you will need to complete the task out the day or night before. That can help reduce the barriers to getting started when you are feeling tired later in the day. You could also create checklists for yourself to reduce the cognitive load for certain chores. For example, a house cleaning checklist. Follow this checklist each time you have to clean so that you do not need to use as much brain power. When you can reduce the barriers to starting an activity, it will be so much easier to get up the motivation to complete it.

4. Pairing – Try pairing an activity you must do with something you enjoy doing. When motivation is low, sometimes the only way we can get ourselves up and moving is by combining the activity we have been putting off with something enjoyable. The key to making an effective and lasting pair is to ensure you only engage in the specific fun activity while completing the unpreferred task.

For example, if one of your goals it to take a daily walk to improve your health, but you cannot find the motivation to do it each day, it might help to pair it with a new audiobook that you are really excited about. Only allow yourself to listen when you are walking because that will transform the walk itself into a reward, and you will likely stop dreading it.

5. Five-minute Max – The five-minute max strategy is excellent for low motivation – and it’s easy to accomplish. Set a five-minute timer and start the activity you have been putting off. Tell yourself that you can stop the activity after five minutes. More than likely, once you start, you will be able to keep going, but you have the option to stop after just five minutes. Knowing that you only have to work for five minutes can help when motivation is low and make a task seem a lot less exhausting.

There is no perfect strategy that works for everyone in every situation, but adding these strategies to your toolbox can help you experiment with which methods work best for you. See if you can find just one tool to help you in those moments when low motivation is impacting your ability to get moving.

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

To book coaching and transition services at NESCA, complete NESCA’s online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

One of the most common referral questions I see in my work as a neuropsychologist is, “Does my child have ADHD?” When a child has trouble focusing, Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the first things that comes to mind, and for good reason. However, ADHD is only one potential underlying cause of inattention. In fact, there are many cases in which attentional difficulties are present as part of another underlying issue. Some of these include:

1. Anxiety—On a physiological level, anxiety involves activation of the “fight or flight” response. This adaptive process is designed to alter attention in order to prioritize survival. When the brain senses a threat, it tunes out everything else so it can focus on dealing with the danger at hand. This is extremely useful when the threat is something like a wild animal chasing you. In that case, you need to momentarily shift all of your attention to survival. It’s the worst possible time to be distracted by anything that could divert your attention from escaping a dangerous situation. But when students are anxious, especially for extended periods of time, the same process can make it difficult to focus on day-to-day tasks, including learning.
2. Learning Disorder—Students who lack the academic skills to engage with the curriculum can appear to be simply not paying attention. If a student’s reading skills, for instance, are several grade levels below expectations, they won’t be able to actively engage with written assignments or materials in class.
3. Communication Disorder—Deficits in receptive and/or expressive language often manifest in ways that mimic inattention. If a child cannot grasp what is being communicated, they will have significant difficulty following verbal instructions, answering questions, and retaining important information. This can easily be misinterpreted as a sign of an attentional issue when, in reality, the underlying problem has to do with communication.
4. Autism Spectrum Disorders (ASD)—Many individuals on the Autism spectrum tend to be more attuned and focused on internal experiences (e.g., their own thoughts and specific interests) than to the external environment. As a result, they can miss important information, ranging from social cues to expectations communicated at home or within the classroom.
5. Other neurocognitive disorders—Weaknesses in other cognitive functions, particularly those we refer to as “cognitive proficiency” skills (e.g., processing speed) and executive functions (e.g., working memory, organization) can also result in apparent inattention. Students who cannot process information quickly are sometimes unable to keep up with the pace of instruction, which causes a diminished ability to comprehend and retain information. Similarly, students who cannot hold information in working memory or organize ideas and concepts can demonstrate reduced comprehension.

There is a range of other issues that can contribute to children or adolescents appearing inattentive. Some of these include trauma, absence seizures, hearing impairments, thought disorders and/or hallucinations, and Tourette’s Syndrome. It is important to thoroughly evaluate the potential causes of inattention and to consider an individual’s full history and presentation.  Because different underlying issues will necessitate different treatment approaches, getting to the root of the issue can be tremendously important.

About the Author

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

A recent New York Times article described a trend, noticed by many mental health professionals, where adolescents and young adults have been exploring mental health on social media. The article references the explosion of TikTok videos in which individuals disclose their psychiatric diagnoses and symptoms. For young people searching on social media, these videos are shown at an increasing rate, based on algorithms. Young people are finding a great deal of validation and connection by watching these videos. Many begin to seek out mental health support, often entering the therapeutic relationship with a clear idea of what their diagnosis will be.

As a mental health professional, I see a great deal of complexity coming from this trend. Certainly, the dissemination of information about mental health and reduction in stigma seems to be positive. Allowing individuals to more readily learn about psychiatric conditions will hopefully reduce fear, embarrassment, shame, and avoidance of mental health care. In addition, promoting self-understanding is important, particularly for young people who are in a developmental stage of identity exploration.

However, there are also concerning implications. First, self-diagnosis can be problematic in mental health, as it is in the medical field. There is a fine balance between being an informed health care consumer and a patient unwilling to listen to the expert opinion of their physician. Entering a physician’s office, unwavering in certainty of your diagnosis, can lead to friction and frustration. In contrast, entering with relevant personal and family history, a thoughtful list of your current symptoms, and readily accessible notes on recent changes in your lifestyle can be invaluable in partnering with your doctor to determine the origin of the problem. This is paralleled in mental health. Entering a therapeutic or evaluation process with information and an open mind is vital to the partnership between clients and clinicians.

The other implication of this trend involves the necessity of a formal diagnosis. I hear from many individuals, after a comprehensive neuropsychological evaluation is completed, that they feel relief at “finally knowing what is wrong.” This validation is entirely understandable, and is not restricted to times when I have provided a diagnostic label. An in-depth exploration of neurocognitive strengths and weaknesses can provide invaluable information that can help individuals understand themselves, access what they need, and plan for their future. Sometimes, a client’s symptoms are best captured by a diagnostic label. However, other times, a person’s comprehensively evaluated profile does not warrant a formal diagnosis. The latter does not mean that a person’s symptoms are any less valid or impactful. Formal diagnoses generally require multiple symptoms, occurring within specified timeframes, and occurring in the presence or absence of other important factors. There are many instances where a symptom is clearly impactful and interfering for a client, without the client’s profile meeting the full range of criteria necessary for a diagnosis. At other times, a symptom that appears, on the surface, to indicate one diagnosis, may in fact indicate a very different diagnosis after a person’s full neuropsychological profile is explored.

As a wise mentor once told me that, in the evaluation process, we must “hold our hypotheses lightly.” We enter a therapeutic relationship, either as a client or a clinician, with a sense of what we might discover or be told. Our initial sense can be entirely accurate, or shockingly incorrect. Therefore, it is vital for all of us to hold our ideas about what may come from an evaluation lightly.

About the Author

To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

By Olivia Rogers, MA., CCC- SLP
Speech-Language Pathologist, NESCA

A written language disorder is an impairment in fluent word reading (i.e., reading decoding and sight word recognition), reading comprehension, written spelling, and/or written expression (Ehri, 2000; Gough & Tunmer, 1986; Kamhi & Catts, 2012; Tunmer & Chapman, 2007, 2012). As written language disorders are quite complex, appropriate assessment and treatment often incorporates many members. Members of the interprofessional practice team may include, but are not limited to, reading specialists, occupational therapists, special educators, learning specialists, and more.

When you think of a speech-language pathologist (SLP), a few words probably come to mind; terms like articulation, language, or fluency. Often, SLPs are associated with spoken language only. Most people don’t think of reading or writing when they think of SLPs. However, in addition to the diagnosis and treatment of spoken language disorders, it is well within the scope of practice of a SLP to diagnose and treat written language disorders. In fact, spoken and written language have a reciprocal relationship; each builds on the other to result in general language competence. Children with spoken language problems frequently have difficulty learning to read and write, and children with reading and writing problems frequently have difficulty with spoken language. Children with speech and language deficits are at a higher risk for reading and writing difficulties. Higher rates of all forms of written language disorders have been documented in children with speech and/or language impairments. Take a look at these findings:

1. Comorbidity between literacy difficulties and speech and language deficits occurred in as high as 50% of cases (Stoeckel et al. (2013).
2. By the end of kindergarten, more than 25% of children with language impairment were reported to also be poor readers (Murphy et al., 2016).
3. Approximately 20%-28% of children with speech sound disorders (SSD) have literacy difficulties (Overby, Trainin, Smit, Bernthal, and Nelson, 2012).

No matter the age, SLPs can assess and treat spoken and written language difficulties. SLPs bring knowledge of communication processes and disorders, and language acquisition to the literacy table. Additionally, SLPs are skilled in dynamic assessment and have clinical experience in developing individualized programs for children and adolescents. Here are just a few written language skills that SLPs work on:

Reading: Pre-reading Skills

Before a child can decode, or read, they must have an understanding that words are composed of smaller units and how these units operate separately and together. SLPs incorporate the following skills into sessions:

• Rhyming (e.g., “flag and stag”)
• Syllable segmenting (e.g., “student: stu/dent”)
• Blending sounds into words (e.g., “sh/i/p says ‘ship’”)
• Segmenting words into their sounds (e.g., “leg: l/e/g”)
• Deleting sounds in words (e.g., “cup without the c is up”)
• Substituting sounds in words (e.g., “change the ‘B’ in bat to an ‘M’”)

Reading: Language Comprehension

This is the biggest one for SLPs. To target language comprehension, we work on smaller goals, such as:

• Grammar
• Story Grammar Elements
• Visualizing and Verbalizing
• Vocabulary
• Active Reading Strategies
• Themes

Writing: Organization/Planning

Before writing, it is important to plan out what you will write. Many children with language disorders have trouble with these skills. Here are just a few ways that SLPs help children plan and develop their writing by:

• Using visuals for story grammar components
• Make and practice using graphic organizers
• Teaching sentence, paragraph, and essay construction

Spelling

Yes, spelling! SLPs are equipped to work on spelling. After all, it is just another language skill. Some ways to target spelling include:

• Working on phonological awareness and phonemic awareness
• Teach students about morphology (the study of words and their parts)
• Incorporation of working memory strategies, such as chunking, visualization, or mnemonics

If you have concerns about your child’s pre-literacy or literacy skills, or would like to support your child’s written language skills, please contact NESCA’s Olivia Rogers at orogers@nesca-newton.com or fill out our Intake Form, noting an interest in speech language pathology.

Sources:

Overby, Trainin, Smit, Bernthal, and Nelson, 2012) Preliteracy Speech Sound Production Skill and Later Literacy Outcomes: A Study Using the Templin Archive.

American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents [Position Statement]. Available from www.asha.org/policy.

Catts, H.W. & Weismer, S.E. (2006). Language Deficits in Poor Comprehenders: A Case for the Simple View of Reading. Journal of Speech, Language, and Hearing Research, 49, 278-293.

About the Author

To book an appointment with Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Coaching Program Manager

Halloween is here, and it’s important to take a moment to consider the small steps we can take to be inclusive and promote a successful experience for all children and adolescents. While Halloween is a holiday meant to bring communities closer together, trick or treating can sometimes be overwhelming, wrought with difficulty, or just a bit too spooky.

Over the past several years, significant efforts have been made to ensure that we are being inclusive of all children. Leading the charge is Food Allergy Research & Education, or FARE, a non-profit organization focused on providing education about childhood food allergies. In 2012, FARE started the Teal Pumpkin Project, which encourages families to put a teal pumpkin on their doorstep and offer non-food alternatives, such as small toys or puzzles. A newer movement among families is to carry a blue pumpkin trick-or-treat basket to signify that they are on the autism spectrum. As a nation, we are starting to understand the need to make Halloween enjoyable for everyone.

While these clues may prompt those handing out treats to be a bit more patient or understanding of a child’s actions on their doorstep, I hope we can approach Halloween with the goal of being understanding and patient with all the children in our communities. One way is to refrain from saying things, such as:

• “Oh no! Why aren’t you wearing a costume? You need a costume to get some candy!”
• “You look pretty old to be dressing up! Are you sure you should still be trick-or-treating?”
• “Only take one! Put those back!”

The child without a costume may have sensory defensiveness that makes it too difficult to put on a costume without feeling physically uncomfortable. The adolescent who is dressed up may have been looking forward to Halloween for months. The holiday could even be a special interest. Let’s let these adolescents have their day, too. And the five-year-old grabbing four pieces of candy in his little fist may have fine motor delays making it difficult for him to pick up just one small piece at a time.

Simply put, let’s have a fun AND compassionate Halloween by allowing each child or adolescent to be unique and being more sensitive to everyone’s needs.

 

About the Author

Dr. Sophie Bellenis is Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA full-time in the fall of 2019 to offer transition assessment, occupational therapy assessment and treatment services as well as to oversee the Real-Life Skills Coaching program as part of NESCA’s transition team.

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

By: Jane Hauser
Director of Marketing & Outreach

I recently had the opportunity to learn more about Pediatric Neuropsychologist Ferne Pinard, Ph.D., who joined NESCA in this August. We are thrilled to have her on board and hope you learn more about her background and specialty areas in today’s blog interview.

How did you choose pediatric neuropsychology as a profession?

I’ve had an interesting journey to get to where I am today professionally. I started working with adolescents in the West Indies as a high school teacher. There I quickly learned that meant not just teaching to the curriculum, but also looking at each student as a whole person – often along with their parents – providing counseling to them and additional academic support as needed to meet their needs. That sparked my initial interest in working to support children.

That spark turned into a deep interest in psychology. In college I decided to major in psychology. I became involved in research examining various aspects of child development and learned about statistical methods.

In graduate school, I worked with my mentor on research projects that involved administration of neuropsychological tests and examining how performance on these tests were related to various outcomes (e.g., academic performance, externalizing behaviors). I enjoyed doing assessment as part of the research project and other training experiences. Although I toyed with the idea of becoming a therapist – as I was trained to provide therapy and conduct assessment – I decided to further my knowledge in the brain/behavior relationship

How have your previous work experiences prepared you to be a neuropsychologist with NESCA?

I spent the last 11 years at Boston Children’s Hospital, first as a post-doctorate fellow and later as an attending neuropsychologist.

As a fellow at Boston Children’s, I had the opportunity to work in various specialty clinics, gaining exposure to patients with a range of medical and genetic conditions, including neurofibromatosis, cancer, etc.

Later, I went on to gain specialty experience in the Pediatric Neuro-immunology and Learning Disabilities programs. As an attending neuropsychologist, I worked with, trained, and supervised pre-doctorate psychology interns and post-doctoral fellows.

As part of the neuroimmunology program, you assisted with research on the impact of post-acute sequelae of COVID-19 (PASC) – also known as Long Haul Covid – on children and their education. Tell us about that.

Yes, I had the opportunity to provide consultation to a previous colleague examining the cognitive impact of Long Covid. I also conducted a few assessments of adolescent struggling with persistent symptoms after being diagnosed with Covid. Difficulties with attention, mood, executive functioning (e.g., working memory and slow processing speed), and fatigue are commonly reported among individuals with Long Covid. These students also experienced disruption in school due to their illness then ongoing symptoms and understandably find it difficult to keep up and meet academic expectations. So many young people were sadder and more anxious throughout Covid…layer Long Haul Covid on top of that, and it’s a huge problem.

How do you see your previous work experiences translating to the families we work with at NESCA?

I bring a lot of knowledge and evaluation experience to NESCA, but most importantly, I bring expertise and compassion in working with families – creating and maintaining relationships with them. The greatest thing I can do for a family is to listen to their concerns, let them feel heard, and allow them to express their feelings about what they and their child are going through. This helps the parents and the child’s school gain a better understanding of the child.

How do you tailor your evaluations for different children, say an anxious child?

Patience and validation are key. I think it is also important to include the child and their caregiver in the discussion. Perhaps I add additional structure to the evaluation (e.g., use of a checklist, breaks at predetermined times), integrate strategies to reduce anxiety (e.g., deep breathing, use of fidgets), or modify the evaluation to take place over three sessions instead of two. Sometimes, the child is allowed to have the parent in the room with them throughout the evaluation. There are different approaches that can be taken based on each individual, and it’s my role to work with the child and caregiver to identify what would work best for the child.

You’ve had a lot of experience evaluating medically complex children and children who are dealing with medical conditions that many think only affect adults. Tell us about that.

It’s true. I’ve worked closely with children who have gone through cancer treatments, including chemotherapy, radiation, and surgery. These are always very touching experiences. These children have been through so much medically that sometimes the medical experiences lead to mental health challenges. They may have gotten through the cancer itself, but there can be residual and sometimes long-term fears of a reoccurrence. Often, there is an intensely emotional component to these assessments because of what the children and their families have endured. I’ve heard the fear in the voices of both the children and their parents’ voices. It’s my job to listen and provide them with a safe space.

Some of the children seen may not be able to maintain engagement for a typical evaluation due to fatigue related to their medical condition and treatment, for example. In these cases, the evaluation will need to be carefully tailored to address the referral question (s). And again, the approach to the evaluation would have to be modified to meet the child where they are.

I’ve also worked with children who have been diagnosed with Multiple Sclerosis and other autoimmune conditions. With these children, I always factor in the amount of stress they are experiencing in life and school as well as the fears they have about how MS may impact them later in life. The stress they feel, whether at school or based on their diagnosis, can have a negative impact on their symptoms. There’s a cascading effect from the brain and all of its thoughts and worries, and that is what we help them deal with. I am always eager to advocate for these children who bear such a heavy load.

What is the most rewarding part of your job as a neuropsychologist?

I feel that I have added value to a child’s life, when I can provide them and their families with a meaningful and comprehensive understanding of their profile—one that includes strengths, not just a focus on weaknesses. I think this is essential as it enables the family and child to advocate for their needs.

Why did you want to be part of NESCA’s team?

Initially, I was really drawn to the integrative approach to care for the children who are with NESCA. Coordination of care, whenever possible, and consultation among professionals involved in a child’s care leads to better outcomes. I was also excited to work with the professionals who specialize in different areas than I am accustomed to working with, such as postsecondary transition. The team here is very willing to collaborate so we can all teach and learn from each other. While I know I will gain great knowledge from the group, it really best serves the families with whom we work.

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

Dr. Pinard provides comprehensive evaluation services for children, adolescents, and young adults with learning disabilities, attention deficit/hyperactivity disorders (ADHD), and psychiatric disorders as well as complex medical histories and neurological conditions. She has expertise in assessing children and adolescents with childhood cancer as well as neuro-immunological disorders, including opsoclonus-myoclonus-ataxia syndrome (“dancing eyes syndrome”), central nervous system vasculitis, Hashimoto’s encephalopathy, lupus, auto-immune encephalitis, multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and acute transverse myelitis (ATM), and optic neuritis.

To book a neuropsychological evaluation with Dr. Pinard or another expert neuropsychologist at NESCA, complete NESCA’s online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By: Ann Helmus, Ph.D.
NESCA Founder/Director; Clinical Neuropsychologist

While supporting a friend who was recently diagnosed with bipolar disorder, I have come to appreciate how challenging it is for people with this disorder to maintain a stable mood state. One of the most helpful resources I discovered in my search for information to help me support my friend was a TEDx talk by Ellen Forney, an author who has successfully managed her bipolar disorder for two decades by following SMEDMERTS, an acronym for: Sleep, Medication, Eat Well, Doctor/therapy, Mindfulness/Meditation, Exercise, Routine, Tools (coping), and Support System. I was struck that only 25% of the solution for managing her mental illness involves the mental health system: medication and doctor. The bulk of her treatment system relates to lifestyle choices.

While attention to SMEDMERTS is important for all of us, especially in these stressful times, consistent focus on these lifestyle choices is particularly critical for the many children and adolescents who we see at NESCA presenting with anxiety, mood disorders, ADHD, and behavioral issues. Most of us struggle to achieve our daily goals for sleep, diet, meditation, exercise, sticking to a routine, practicing adaptive coping strategies, and nurturing our support system, even though we know how much better we feel and how much better our children function when we are focused on SMEDMERTS in our daily life. While the impact of medications and doctors on functioning is largely outside of our control, we can control our lifestyle choices, which are critical to the success of managing any mental health issue.

How can we help the children in our lives to embrace SMEDMERTS?

• Modeling it for them. As Robert Fulgham said, “Don’t worry that your children never listen to you; worry that they are always watching you.”
• Praising their efforts. Offer positive feedback, such as, “Great idea to get up early to go for a run,” or, “I like how you called a friend when you were upset to get some advice.”
• Enlisting the help of a coach. NESCA offers real-life skills coaching, executive functioning coaching, and health coaching to help children, adolescents, and young adults build and maintain habits to support positive lifestyle choices.

Health coaching is available to parents of NESCA clients who are seeking support in developing positive health habits, such as exercise, diet, stress management, and meditation.

If you are interested in coaching services at NESCA to support your quest for SMEDMERTS, please contact Crystal Jean: cjean@nesca-newton.com or fill out our intake form at www.nesca-newton.com.

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.

To book an evaluation with one of NESCA’s many expert neuropsychologists, complete NESCA’s online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

According to the International Dyslexia Association (IDA), “Dyslexia is a language-based learning disability. Dyslexia refers to a cluster of symptoms, which result in people having difficulties with specific language skills, particularly reading. Students with dyslexia usually experience difficulties with other language skills such as spelling, writing, and pronouncing words. Dyslexia affects individuals throughout their lives; however, its impact can change at different stages in a person’s life. It is referred to as a learning disability because dyslexia can make it very difficult for a student to succeed academically in the typical instructional environment, and in its more severe forms, will qualify a student for special education, special accommodations, or extra support services.” Also, it is important to recognize that dyslexia is not due to either a lack of intelligence or a lack of desire to learn, and with appropriate and sufficient teaching methods, students with dyslexia can learn successfully.

Fortunately, there are effective strategies to help students with dyslexia. However, some common approaches to teaching reading (e.g., guided reading, balanced literacy) have not been found to be effective enough for the struggling reader. What research has found to be most effective is Structured Literacy. Structured Literacy instruction includes specific elements that are necessary for a dyslexic reader to make reading progress. Such elements include phonemic awareness (the ability to notice, think about, and work with individual sounds in words, such as separating the spoken word “cat” into three distinct phonemes), phonological awareness (the ability to recognize and manipulate the spoken parts of sentences and words), sound-symbol association (e.g., identify printed letters and what sounds they make), syllable instruction, morphology (smallest unit of meaning in the language), syntax (e.g., grammar), and semantics (meaning). In order to be most effective, students with dyslexia need to be taught using an explicit instruction method, with a teacher trained in a program that meets that student’s specific needs, the instruction needs to be taught in a logical order (basic concepts before more difficult ones), and each step needs to be based on previously learned concepts (cumulative).

According to the IDA, a comprehensive evaluation to assess for dyslexia, as well as to assess for any other potential language challenges or learning disabilities, should include intellectual and academic achievement testing, as well as assessment of critical underlying language skills that are closely linked to dyslexia, such as receptive and expressive language skills, phonology (phonological awareness, phonemic awareness), and rapid naming (e.g., quickly reading single letters or numbers). Additionally, a full evaluation should assess a student’s ability to read a list of unrelated real words as well as a list of pseudowords (made up pretend words to assess a child’s ability to apply reading rules), in addition to a student’s ability to read in context (e.g., stories). If a student is found to demonstrate that they meet criteria for a diagnosis of dyslexia, a specialized program should be developed by the school in order to provide appropriate services and accommodations.

Sources:

https://dyslexiaida.org/dyslexia-basics-2

https://dyslexiaida.org/effective-reading-instruction-for-students-with-dyslexia

www.readingrockets.org

About the Author

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Real-life Skills Program Manager and Coach, NESCA