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The Path to Eligibility

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist

A child’s pediatrician is often the first professional who hears a parent’s concern that their child is struggling in school. It is comforting to know that The American Academic of Pediatrics has recently provided guidelines to pediatricians that outline the important role they can play when a child is struggling in school. The guidelines refer to pediatricians’ involvement in prevention (e.g. avoiding brain injuries, good nutrition, etc.), early recognition, diagnosis, treatment, advocacy/monitoring and referral. Regarding referral, pediatricians are asked to consider involvement of a number of subspecialties, including neuropsychologists, child psychologists, speech and language pathologists and others.

In my prior work as a Special Needs Advocate and now as a pediatric neuropsychologist, I understand how the referral to a neuropsychologist for a comprehensive evaluation can assist a parent in the Special Education eligibility process, but it is still too often an unknown for many others. To be eligible for Special Education services, a child must meet three basic criteria (1) present with a qualifying disability; (2) demonstrate a lack of effective progress in the general education setting; and (3) require specialized instruction or related services (e.g. Speech Therapy, Occupational Therapy, Psychological Services, etc.). The determination of eligibility is made by the school team that includes the parents. The school will conduct its own assessments which may provide the information needed to make a determination of eligibility. A private neuropsychological evaluation provided by the parents can also help to inform the process, by providing a diagnosis(es) as well as a deeper and more integrated look at the child’s cognitive, academic and social/emotional profile.

School evaluators do not typically provide what are considered medical diagnoses, such as ADHD, Autism Spectrum Disorders or Dyslexia. A neuropsychologist can make such a diagnosis, and a comprehensive neuropsychological evaluation should also provide an understanding of how the disability is impacting the child’s academic, social and/or emotional development. The neuropsychologist can then relate the diagnosis to the appropriate educational disability category for the school’s consideration. A neuropsychological evaluation can also assist in determining if a child is making effective progress within the general education setting. Data obtained through standardized testing, teacher reports and observation of the student in the school setting can provide information needed to determine if the child is making progress commensurate with their potential. Finally, delineation of specific skill deficits identified in an evaluation can provide information necessary for selecting appropriate specialized methodologies or the related services the child requires to make progress.

We often hear the phrase, “It takes a village.” It certainly “takes a village” of professionals to provide the coordinated and comprehensive care that a child who is struggling in school requires. With pediatricians providing the first line of support and referrals for parents, the outside professionals, including neuropsychologists, can work with the pediatrician and in conjunction with the school staff to provide the struggling student the range of services needed to foster their academic, social and emotional development.


About the Author

Combining her experience and training in both pediatric neuropsychology and educational advocacy, Dr. Reva Tankle has particular expertise in working with families who are navigating the IEP process. Having participated in numerous team meetings over the years, Dr. Tankle is especially knowledgeable about the many ways that schools can support and accommodate students with special learning needs, information that she clearly communicates in her evaluation reports and in team meetings, if needed. She also has a great deal of experience in articulating the reasons that a student may need a program outside of the public school.

Dr. Tankle evaluates students with ADHD, learning disabilities, high functioning autism spectrum disorders, and neurological conditions, as well as children with complex profiles that are not easily captured by a single diagnostic category.


To schedule an appointment with Dr. Reva Tankle in Plainville, MA, or any of our 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 or call 617-658-9800.


Having a Seat at the Table

By | NESCA Notes 2019

By Dot Lucci, M.Ed., CAGS

Many people come to NESCA because their child/children or they are struggling in some aspect of their life, school or work. They come to be evaluated, counseled or to access our integrative services. Often, they are hoping to gain insight into what is amiss and ultimately receive recommendations to help develop a “roadmap” toward improving their lives. The roadmap provides them with a greater understanding of themselves or their child/children, including strengths, challenges and possibilities. Through the neuropsychological evaluation, a diagnostic label is often provided, if warranted, that conceptualizes their learning and psychological profile. This label typically implies a difference from the “norm” – a disability. So, is getting a label of a disability a relief, a shock, a curse, a dream shattered or an “ah ha” moment? It may be all of these, and these feelings may change over time. Is a disability a “bad thing” or a “good thing” or both? I like to say, “It just is.” It is a piece of who we are, but it isn’t everything – nor does it define us in our totality.

Did you know that 60 million Americans have a disability? That’s 20% of our population. Many of us will enter this category of disability as we age; therefore, all of us will know someone with a disability or will develop one ourselves. As Jay Ruderman, disability advocate, says, “It’s the only minority group almost all of us are guaranteed to join at some point in our lives.” If we look at it this way, wouldn’t we all be better off if we embraced people with disabilities across all aspects and stages of life? Wouldn’t it be nice to know that there’s a place for us at the table and one that we didn’t have to fight for?

It’s been 30 years since the Americans with Disabilities Act (ADA), the civil rights law that prohibits the discrimination against individuals with disabilities in all areas of life (work, schools, housing, etc.), was passed. It states that people with disabilities should have the same rights and opportunities as everyone else, meaning they belong at the table and should be included. But do individuals with disabilities truly have the same rights as non-disabled people? On paper, yes, but in practice, not necessarily. While people with disabilities do have many more rights today than they did before the ADA was passed, barriers still exist – people are still marginalized and fighting for equality. The law says everyone is equal, yet people are still discriminated against in profound and subtle ways every day.

Compared to 30 years ago, public education, communities and businesses are doing a much better job at recognizing individuals with disabilities and providing opportunities for them. We now have universal design principles utilized in architecture, community planning, schools and businesses. However, there is still much to be done! Data from the National Center for Education Statistics shows that in 2017, 63% of students across all disability categories spend 80% or more of their school day in classrooms with typically developing peers. That’s a dramatic increase from pre-ADA years. Yet in contrast, only 17% of students with intellectual impairment and 14% with autism spend their time in general education classrooms.

When disabled students age out of the educational system, they are not faring as well as their nondisabled peers in opportunities for housing, community and employment inclusion. Data from the Department of Labor Statistic states that the employment to population ratios in 2018 are still lagging for persons with a disability. In fact, 20.8 % are employed, whereas 69.2% of “non-disabled” persons are employed. Why is that? This is an untapped workforce. What holds back employers, communities and housing authorities from hiring and including people with disabilities? Is it fear? Is it a belief that they can’t do the job, or that it will cost more to hire/include a person with a disability? The reasons/excuses cited are endless, and unfortunately inhibit us from including people with disabilities from being truly valued and contributing members of society.

So, even 30 years later, there is much work to be done to improve outcomes for individuals with disabilities. We have to look inside ourselves and ask, “What are we doing to create an inclusive society?”. How have we fostered an inclusive community at school, work, as we walk down the street or at a café? How have we overcome our own biases and fears, or helped to alleviate the fear of other people? How have we helped to change the hearts, minds and beliefs of others so we have true inclusion and true equality? Much like the civil rights movement did – it’s taking a stance and doing what’s right for everyone. Inclusion is about creating a better world, where everyone belongs, is valued and honored for who they are and what they contribute to our society.

Remember, in the word “disability” is “ability.” This should be the guiding principle. See the ability before you see the disability in people. Everyone has abilities, interests and strengths that can be used to better our world. Recognize the abilities and strengths of individuals who learn and work differently, for it is what makes the world a better place. We hope that after coming to NESCA for an evaluation, counseling or integrative services, our clients leave with a better understanding of themselves or their child/children, recommendations for next steps, an acceptance of who they are and hope for the future.

For additional resources, please visit:

Commit to Inclusion

National Center for Educational Statistics

Disabled World


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.


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


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 or call 617-658-9800.


In Defense of the Lowly Questionnaire

By | NESCA Notes 2019

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

When gleaning information about a child’s areas of strength and challenge, neuropsychologists gather information from multiple sources, including parent and child interviews, conversations with teachers and mental health professionals working with the child, clinical observations, structured testing and questionnaires.

In my work with families, I sometimes hear complaints from parents about the myriad questionnaires that I saddle with them as part of the evaluation process – that some questionnaires might appear to be geared toward more challenged children than their own or that they are unsure how to respond to some of the questions (e.g., Is this behavior exhibited “sometimes” or “often?”).  While those are valid complaints, I find data from questionnaires to be particularly valuable in my work.

For instance, simply relying on clinical observations to glean information about a child’s attention span and degree of distractibility would be often misleading.  While the distraction-reduced, one-to-one, highly-structured testing setting is an ideal context in which to administer standardized assessments, within such a setting, even students with moderate attention disorders can often remain on task to an extent they are not able to demonstrate in less-structured, real-world contexts.

Similarly, children with mild social communication or autism spectrum disorders might be able to demonstrate reasonably-intact social skills within the context of a structured, one-to-one setting with an adult, while they struggle in their interactions with peers in less structured settings.

Conversely, children who might present with moderately high levels of test anxiety might appear so wound-up in a testing setting that, without additional information about their emotional state outside of the testing context, they could mistakenly be diagnosed with a generalized anxiety disorder.

In addition, relying exclusively on results of standardized testing to glean information about a child’s learning profile can be equally misleading.  For instance, children who might well present with executive function challenges can often fare well on specific tests of executive function, as those tests provide a level of structure not present in daily contexts.  Further, the nature of those standardized tests is such that specific executive function skills are measured in isolation (e.g., how well is a child able to brainstorm or switch gears or see the big picture), as opposed to in real life, when a child needs to make use of multiple different executive function skills in concert to complete given tasks.

Of further importance, I often find that a comparison between a child’s responses on a self-report questionnaire and those of parents or teachers yields critical information.  More specifically, it is often the case that from the parent perspective a child is running into pronounced executive function challenges, while from the child’s perspective they have minimal challenges in that domain of functioning.  That discrepancy can provide useful information about a child’s level of self-awareness or self-acceptance, information that can, in turn, illuminate an important area to address moving forward.

Again, a thorough, comprehensive, integrated neuropsychological evaluation draws on multiple sources of information.  As part of a thorough assessment, questionnaire data is a critical data source, not only in confirming observations made during the testing and results of structured assessments, but also in providing an additional perspective as to how a child might present outside of the structured testing setting.


About the Author:


Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.


To book a consultation with Dr. McCormick or one of our many other 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, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email or call 617-658-9800.


When is it Actually Bullying?

By | NESCA Notes 2019

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

Autumn holds excitement for many students – heading back to school to see old friends, meet new teachers and learn new skills. However, for some, a new school year holds more apprehension than enthusiasm. Students worry that their teacher will be mean, their math homework will be hard or that their recess time cut short by bad weather. One fear that is described more and more often by parents and children is the fear of bullying.

What is bullying?

There is no single definition of bullying, but most researchers describe the following necessary and sufficient characteristics:

  • unwanted, intentionally aggressive behavior that is aimed at harming another person
  • carried out repeatedly
  • in a relationship where there is a power differential

The quintessential example of this is the hulking, five-foot-five elementary schooler who pushes, shoves and steals the lunch money of a short, scrawny younger child every day. Luckily, this kind of aggression is rare; however, the rarity of “classic” bullying requires us to be somewhat more mindful of what childhood behaviors are (and, are not) considered bullying.

First and foremost, behavior must be unwanted and intended to harm. This means that the rambunctious children rough-housing on the playground is generally not a bullying situation. Playful acts, or acts with the intent of friendly, physical play, are not bullying. Certainly, there are times when children may misunderstand the intent of their peers or friends and perceive an action as hurtful. In that case, a frank discussion of intended message versus experienced consequence is required, but there is no immediate concern for bullying. If a child did not intend to hurt their peer, bullying is not the issue.

When researchers use the term “aggressive behavior,” it should be clarified that aggression is not always physical. Aggression comes in three forms: physical, verbal and relational. Physical aggression is exactly what you are imagining – punching, kicking, hitting and similar behaviors. This kind of aggression occurs in very young children (think: toddlers), most often as a means of communication due to their limited verbal skills. By early childhood, kids rarely use physical aggression to communicate, as most children are able to talk and verbalize their wants, needs and feelings.

The second type of aggression is verbal aggression. This can involve things like yelling, screaming, swearing, threatening and name-calling. This kind of aggression occurs throughout childhood and adolescence, with the frequency decreasing as children mature.

The last form of aggression is the most complex. It is called relational aggression. Researcher Nicki Crick defined relational aggression as any act that uses the social relationships, social standing or social experiences of an individual to harm them. The stereotypical examples of relational aggression come from films like Mean Girls. Gossip, social exclusion, humiliation, embarrassment, rumor spreading and intentional ignoring are all examples of behaviors that fall into the category of relational aggression. This frequency of relational aggression generally increases as children develop, as relational aggression requires more sophisticated verbal and social skills to carry out. In addition, relational aggression is rarely noticed by adults and often does not carry the same disciplinary consequences as physical or verbal aggression. Children learn quickly that refusing to play with a peer or spreading a nasty rumor is unlikely to get them “in trouble,” making this type of aggression far more effective for older children and adolescents.

It is important to note that both boys and girls engage in aggressive behavior. Girls tend to start using relational aggression younger, and use it consistently throughout their lives. Boys tend to start out using physical aggression, and shift to relational aggression as they mature. However, both boys and girls engage in aggressive behavior at all developmental stages.

Back to our definition of bullying – the next element is “happens repeatedly.” Bullying is not a one-time occurrence. The behavior, or harm caused by the behavior, must happen over and over. Two children who are angry and get into a fight in the cafeteria may well be intending to harm one another. However, if the fight is a one-time occurrence, there is no immediate concern for bullying. One challenging aspect of this part of the definition is how we handle online or cyberbullying (i.e., bullying that happens through electronic media such as text or social media). Because posts to social media, texts and images online can be viewed multiple times by multiple people, a single act carried out online may meet the definition of bullying. For example, posting a message that conveys a nasty rumor about a peer to one classmate’s profile can have untold impact on the victim’s social relationships depending on how many times that post is forwarded, tagged, “liked,” discussed or otherwise shared across the social network.

The last part of the definition of bullying is that it occurs “in a relationship where there is a power differential.” Power differentials exist in many relationships – parent/child, teacher/student, employer/employee, landlord/renter, therapist/patient and so on. In children, power differentials may exist when a child is:

  • older
  • physically larger
  • more popular
  • more socially skilled

While this is not an exhaustive list, these are the most common situations where we find power differentials in children. Without a power differential present in the relationship, bullying is not an immediate concern. It is not uncommon for children to have challenges in their friendships, such as teasing, unwanted horseplay, sitting with other friends at lunch and choosing to work with a different partner on a project. However, these challenges typically do not meet the “power differential” criterion of bullying. They are better defined as normal, healthy obstacles in relationships that, when worked through productively, can help children develop more sophisticated social problem-solving skills.

What to do when it is bullying

We’ve discussed many examples of what is not bullying, so what should happen when behaviors are best characterized as bullying? First and foremost, assess your child’s safety. If physical aggression is part of the bullying, consider immediate action, such as talking to your child’s teacher or school administrator. Note that bullying is now a legal matter in many states, including Massachusetts. When talking to your child, remember that bullying comes with plenty of shame and anxiety, so make every effort to ask simple, clear, direct questions with as calm a tone as possible.

If your child’s safety is not a primary concern, ask your child if they want your help to solve the problem. If so, consider helping your child map out the social dynamics of what is happening. Who is saying what? To whom? Is it just you who is the victim, or are the bullies doing the same thing to other children? Does the teacher notice? If so, do the bullies get in trouble? Depending on the answers, help your child work toward a strategy to solve the problem. Younger children may require more adult intervention, such as a parent reaching out to the teacher. Older children and adolescents may be able to try out problem-solving strategies independently, with your support at home.

If your child does not want your help, consider letting them try to solve the problem on their own. Remind them that you love and trust them, and have confidence in their ability to figure out tough situations. Encourage your child to participate in other social activities where they experience more positive interactions, such as martial arts, Girl or Boy Scouts, team sports or clubs outside of school. Having strong, positive friendships is one of the most important resiliency factors when a child is the victim of bullying.

It may help to know that upwards of 90% of adults report having been the victim of bullying at least once in their lifetime. Interestingly, over 70% also report having bullied someone else.


About Pediatric Neuropsychologist Dr. Yvonne Asher:

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.


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 or call 617-658-9800.


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


Accommodations for Computer-based Testing

By | NESCA Notes 2019

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-based Skills Coach

As a school-based occupational therapist, I found myself beginning each academic year by focusing on what my students needed to learn, the skills they needed to develop, and how I could best use my time to help them be successful in the classroom. Despite it being September, every year this inevitably led me to consider standardized testing – one of the many academic themes of springtime.

My third graders not only needed to know the foundational mathematics skills being assessed, but how to navigate the computer screen in front of them. They needed to practice the fine motor precision to move a mouse and click on small boxes or multiple-choice bubbles. My sixth graders not only needed to understand how to plot points on the x and y axes, but they needed to have the visual perceptual skills to plot these points on a computer screen that scrolls up and down.

This demand for computer literacy skills within testing was noted as early as 2003, when Thompson et. al noted the inherent disadvantage for students who lack access to computers. However, as we continue to move further and further into the digital age, it is clear that computer-based testing has become our nation’s go-to method for assessing its students’ grasp of academic content and subject mastery. Computer-based testing allows for more efficient administration, quicker result times, built-in accommodations, and other positive benefits that make commitment to this practice worthwhile. For many students, computer-based testing is hugely preferred, and the option to type an essay is far less daunting than writing pages and pages by hand.

However, the National Center on Educational Outcomes claims that, “Despite the fairly dramatic increase in attention to CBT (computer-based testing), accessibility challenges continue to have the potential to reduce the validity of the assessment results and to exclude some groups of students from assessment participation” (Thurlow, Lazarus, Albus, & Hodgson, 2010).

So, what happens when this manner of assessment is more difficult for our students with disabilities? How can we help? What can we do?

As is often noted by test creators and administrators, most computer-based tests have relatively comprehensive built-in accommodations. Options such as enlarged font, speech-to-text, and line masking are often built into the platform. Despite this, computer-based accommodations may not be enough. When it comes to being truly accessible, the assessment of skill areas, individualized accommodation, and significant practice of testing systems are all necessary to arrive at an accurate assessment of academic skills.

Consider Charles, a fourth-grade student who has been receiving occupational therapy for decreased fine motor precision, visual perception, and low visual and fine motor endurance. He has difficulty with visual memory and gets easily overwhelmed by visual clutter. As a student in the general education setting, it is initially assumed that Charles will take his standardized tests in the computer format. At his team meeting, Charles’ mother raises her concern that he will fatigue quickly due to the visual demands of staring at a computer screen for the testing period. The team offers to provide Charles with a paper-based version of the test so he can avoid having to look at a computer screen. But Charles has decreased fine motor precision and endurance! How do we accommodate his needs?

This one case displays the importance of considering the whole child, trialing different options, and working collaboratively. Charles could potentially be allowed to take the assessment on the computer with access to a paper copy. He could use a scribe to help him type or write while he takes a computer or paper version. Maybe Charles feels confident using the computer-based test and his mother’s concerns about visual fatigue were unwarranted. Realistically, the team does not know what is best for Charles until they try a few distinct options and get his input.

Computer-based testing tools are here to stay, and fortunately our children are becoming more and more comfortable with digital methods. As we continue to make this transition, it is important to maintain the commitment to be individualized. Each student has different needs, and I urge teams, related service providers, educators, and parents to consider these needs early in the school year and early in the student’s academic career.


Thompson, S., Thurlow, M., & Moore, M. (2003). Using computer-based tests with students with disabilities (Policy Directions No. 15). Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes. Retrieved [9/09/2019], from the World Wide Web:

Thurlow, M., Lazarus, S. S., Albus, D., & Hodgson, J. (2010). Computer-based testing: Practices and considerations (Synthesis Report 78). Minneapolis, MN: University of Minnesota, National Center on Educational Outcomes.


About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.
To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email or call 617-658-9800.


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 or call 617-658-9800.


What is a Nonverbal Learning Disability?

By | NESCA Notes 2019

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

There is often lack of awareness or confusion about what a Nonverbal Learning Disability (NLD or NVLD) is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management.  As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning. On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception. In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration. Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills. Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive Functioning. Executive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning. With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges. Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD? The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. Some available options include Pamela Tanguay’s Nonverbal Learning Disabilities at Home: A Parent’s Guide and Nonverbal Learning Disabilities at School: Educating Students with NLD, Asperger Syndrome and Related Conditions, and Kathryn Stewart’s Helping a Child with Nonverbal Learning Disorder or Asperger’s Disorder: A Parent’s Guide.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at


About the Author:

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 or call (603) 818-8526.

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2019


By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

I recently attended the International Dyslexia Association Conference in Atlanta, GA ( Among the conference attendees were researchers, teachers, speech-language pathologists, psychologists, and parents of children with dyslexia. One recurring key point was the importance of early identification of reading difficulties, as early provision of appropriate interventions and services leads to better outcomes.

It is important to remember that unlike seeing, hearing, and eating, reading is not something humans do naturally. Reading must be learned and it is not easy (Maryanne Wolf, Proust and the Squid).

As a parent, your early observations are important as there are many developmental indicators that may signal a risk for reading difficulties such as:

  • Experiencing repeated early ear infections
  • History of speech delay and/or pronunciation problems
  • Slow vocabulary growth, frequent difficulty finding the right word, use of less specific words such as “the thing,” “the stuff,” or “that place.”
  • Your child struggles to recognize words that start with the same sound (e.g., cat and car) or end with the same sound (rhyming).
  • Difficulty learning letter and number symbols when in preschool
  • Family history of reading problems

During first grade, you can watch for these warning signs as you listen to your child read aloud:

  • Does not know the sounds associated with all of the letters
  • Skips words in a sentence and does not stop to self-correct
  • Cannot remember words; sounds out the same word every time it occurs on the page
  • Frequently guesses at unknown words rather than sounding them out
  • If you ask your first grader to read aloud to you and he/she is reluctant and avoidant


Early identification of reading issues is extremely important for outcome. If children who have dyslexia receive effective phonological awareness and phonics training in Kindergarten and 1st grade, they will have significantly fewer problems learning to read at grade level than children who are not identified or helped until 3rd grade.

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

To learn more about evaluations and testing services with Dr. Talamo and other clinicians at NESCA, you may find the following links helpful:

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

Sources used for this blog:


About the Author:

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

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

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School Students.”

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

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.


To book a consultation with Dr. Talamo or one of our many other 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, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email or call 617-658-9800.


This blog was originally published in 2017.

Parenting Orchids and Dandelions

By | NESCA Notes 2019

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

I recently evaluated a 15-year-old boy, who we’ll call Sam, whose parents brought him in due to some concerning new behaviors, including failing classes, disobeying his parents’ rules – particularly around curfew and technology use – and smoking marijuana on a daily basis. When meeting Sam, I was amazed at how engaging, polite and good-natured he was. It was hard to imagine this young man disobeying his parents and staying out all night, which he was also doing frequently.

Sam had grown up in an affluent and supportive family, the third of four children. The other three were, like their parents, easy-going, adaptable and successful – academically, socially and athletically. They were on the path to becoming independent and successful adults. Sam had always been a bit different. He was the child who had colic as an infant, sleep disturbances throughout childhood, separation anxiety at preschool, and extreme sensitivity to sensory stimuli. His parents cut tags out of his clothes, bought him loose-fitting pants, and avoided birthday parties at Chuck E. Cheese’s – or almost anywhere there would be crowds of loud children, as these situations could reduce Sam to tears.

When evaluating Sam, I was impressed by his intelligence, quick reasoning and solid academic skills.  There was nothing obvious that standard neuropsychology tests uncovered. But Sam was also open and articulate about his difficulties. He explained that he was easily overwhelmed – “jangled,” he called it – in social situations, in a fast-paced classroom or on an athletic field. When he started ninth grade in a challenging parochial school, he was faced with more stressful situations, academically and socially. He became extremely anxious about tests and lengthy homework assignments, so he fell behind academically and developed pretty serious school anxiety. Given his sensitive nature, he was particularly likely to struggle in a class where the teacher was, in his words, “too strict,” or even “mean.” He wasn’t successful enough socially or athletically to sustain his self-esteem in these areas, particularly compared to his talented siblings. He found himself becoming angry and anxious, and he started using marijuana to calm himself. As he described it, getting high was the only time he felt happy and relaxed.

Sam was clearly struggling, easily meeting criteria for an anxiety disorder and a substance use disorder.  But I wanted to explain some of the “why” behind his struggles, so, in talking to his parents, I relied on the explanation put forth by Dr. W. Thomas Boyce, in his book, Orchids and Dandelions: Why Some Children Struggle and How All Can Thrive. He explains that most children are like dandelions, born with sturdy, resilient temperaments so that they, like dandelions, grow and thrive wherever they land –  assuming there’s some minimal level of appropriate conditions. But about 20% of children are more like orchids. They are born with a very sensitive nervous system, which is highly attuned to all the stimulation in the world around them. Dr. Boyce found that for these children, lower levels of stress precipitated a full-fledged anxiety response, involving the release of stress hormones that create a Fight, Flight or Freeze response – an appropriate response for a life-threatening situation, but not much help when facing, say, a strict teacher or a hard test. These children are therefore much more likely to develop full-blown anxiety disorders. On the positive side, their high level of sensitivity to the world around them means they are typically very empathic and emotionally attuned. Like an orchid with careful nurturing, they will develop into exceptional adults.

Fortunately, many orchids do naturally gain resilience as they grow, according to Elaine Arons, Ph.D. In her book The Sensitive Child, she cites studies that find most children who are shy as preschoolers – suffering social and separation anxiety – will develop coping strategies and not appear shy by the time they reach school age. These orchids gain resilience without losing their sensitivity.

But this positive evolution requires good parenting. While dandelions do fine with the average “good-enough” mother, as famously defined by psychologist Donald Winnicott, orchids need parents to be just a bit better.

How does one do this? How can a well-meaning, good-enough parent help these orchids become better able to manage the squalls, large and small, that occur in any one’s life?

Fortunately, there is a wealth of research – contained in books and articles – on building resilience in children. Most emphasize that we need to allow children to struggle with challenges, even to the point of sometimes failing, so they learn that they can cope and succeed in the face of adversity. This message is clear from the title of several such books: e.g. The Blessing of the Skinned Knee: Using Timeless Teachings to Raise Self-Reliant Children, by Wendy Mogel and The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed by Jessica Lahey.

We also have a neurobiological explanation for this process. We know that continued exposure to a stressful situation allows the body to habituate and the terrible feelings – such as fear and panic – that accompany a stress response gradually recede. As this happens, the previously scary situation becomes routine, and the child’s self-confidence and willingness to tackle new risks grows. Every preschool teacher knows this. The crying child who is being left by his parents in an unfamiliar preschool will eventually calm down and start to enjoy himself. The process goes more quickly if parents calmly and confidently reassure the child, then leave. The parent who is also anxious, who hovers over the child, attempting to sooth his fears, only increases the child’s anxiety by sending the message that this IS a scary situation. This phenomenon was dramatically illustrated in a study by Susan Crockenberg and Esther Leerkes (Development and Psychopathology, 2006). They found that 6-month-old children had different levels of reactivity – or startle – in response to unfamiliar stimuli. These infants also showed differences in how much they tried to avoid the situation, versus distracting themselves while staying in the presence of the stimuli. Children with high reactivity and a tendency to withdraw from novel stimuli, along with parents who were less sensitive, were more likely to show high anxiety at 2.5 years of age. Exposure to challenge causes the body to habituate and builds resilience. Trying to avoid stressful situations only exacerbates fears.

However, this can be counterintuitive for parents of very sensitive children. In fact, the more attuned a parent is to his/her child’s sensitivity, the harder it becomes. Sam’s parents had always coddled him a bit more than their other children. Knowing that he didn’t like loud birthday parties, his mother tended to decline these invitations. When he became upset and started to cry at a soccer game, his father felt so sorry for him that he didn’t insist that Sam return the next week. This avoidance did not allow Sam to grow and master new situations, but instead narrowed his world.

This is not to say that Sam’s parents should have been less emotionally attuned. Rather, it’s important for parents of children like Sam to walk a fine line between exposing the child to moderate challenges that he can manage but do not overwhelm him. It’s also important that they stay calm themselves, empathizing with the child’s fears but reassuring him at the same time. Not an easy task.

Fortunately, Sam has many strengths, not the least of which are his sensitivity and his intelligence, as well as great artistic gifts. He also has a solid relationship with his parents, even though it has been quite strained of late. After our evaluation, Sam and his parents decided to place him in a therapeutic wilderness program so he could withdraw from daily pot use in a safe place and learn skills from therapists there, as well as learn from peers who were going through similar struggles. This coming year, he will not return to the challenging parochial school he attended for ninth grade and will instead start at an independent school that offers some academic supports and a flourishing arts program. Sam’s roots are well-established, and with a bit more awareness of the gifts and challenges inherent in his sensitive nature, he is expected to grow into a self-confident and resilient young man.


About the Author: 

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

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 or call 617-658-9800.

How High School and College Differ for Students with Disabilities

By | NESCA Notes 2019

By: Dina DiGregorio Karlon, M.A.
Transition Specialist, NESCA

Today, more students with disabilities are opting to attend college. As students plan to pursue college, it’s important for them to understand the increased expectations in college in the areas of academics, independence and social environments. For example, while in high school, the responsibility to get the students the services needed to be successful fell on parents and teachers; however, college students must advocate for themselves in post-secondary education. Below are some important ways in which the college and high school settings differ for students with disabilities, as well as some suggested strategies to prepare them.

Applicable Laws – In high school, students with disabilities are covered under the Individuals with Disabilities Act (IDEA), which mandates a free, appropriate public education for students with a disability (3-22 years of age). Some students in high school are covered under Section 504. In college, schools must comply with the Americans with Disabilities Act (ADA) and Section 504 – both laws are based on civil rights and prevent discrimination for people with disabilities. In short, IDEA is about success; ADA is about access.

Required Documentation – In high school, the school district is responsible for providing an evaluation at no cost to the student; this documentation focuses on whether a student is eligible for services under specific disability categories. Colleges are not responsible for the documentation. Students must get an evaluation at their own expense (if documentation is not current). Most colleges will accept current testing (within three years). This documentation must provide information about how the disability impacts the student and demonstrate the need for accommodations. Colleges will list on their website the type of documentation needed.

Modifications vs. Accommodations – In high school, if necessary, classes and materials may be modified, and the school is responsible for those accommodations and modifications. Some modifications may include reduced assignments or readings, adjusted grading to weigh a student’s daily work equal to semester tests. However, in college, there are no modifications to assignments or the curriculum; there are only accommodations. School is no longer responsible for arranging accommodations; rather students must advocate and arrange accommodations  for themselves.

Self-disclosure and Self-advocacy – In high school, teachers and parents support the student’s needs, with teachers approaching students if they believe assistance is needed. In college, the student is primarily responsible for arranging accommodations and advocating for their own needs. This is a significant shift—not just for the student, but for the parents, too. Parents no longer have access to the student’s records. The high school cannot disclose to a college a student’s disability—only the student can choose to disclose.

Disclose or Not to Disclose…That is the Question – Choosing to disclose that a student has a disability to a college is a deeply personal decision. As discussed, it is up to the student to disclose. If the student decides to disclose a disability, they need to understand not only the name of the disability, but also be able to communicate and describe how the disability impacts them and their learning. This is critical in determining what types of accommodations will be written into their 504 plan. While in high school, the student should be honest and realistic about the types of accommodations actually used and which of those were helpful. Helping your child practice discussing their disability and how it impacts them is very useful in preparing them to meet with the Office of Disability to share their needs. If a student decides not to disclose, they will not receive accommodations. However, all colleges have some type of tutoring and/or writing center to help students improve their academic skills. If a student chooses not to disclose and does not do well, they can still meet with the Office of Disability at any time to look into a 504 plan. However, their 504 plan will not be retroactive for the semester. Instead, accommodations will start from the date of the plan.

What Can Parents Do?

Preparing your child with a disability is critical to helping them be successful. Specifically, they will need self-determination skills. Self-determination is the understanding of one’s strengths and limitations together with a belief in oneself as capable and effective. These skills enable a person to participate in goal-directed, self-regulated, independent behavior. A person with self-determination skills is more likely to be independent and successful in work and training. Some suggested activities to help build self-determination skills include: Teaching your child how to make phone calls to make appointments, write emails with a professional tone and speak directly to people in stores or restaurants. Parents may need to start with a script to help a child practice, then fade support so the child is speaking as independently as possible in various settings. Other activities include having your child plan and prepare a weekly family meal (including making the grocery list, shopping for items, etc.), playing financial literacy games and activities (, or talking with your child about how to begin to interact more independently with healthcare providers.

As parents, it is important to know that as your children become more independent, such as going to college, while they are now holding onto the reins, they are likely to need your help with the steering.

While these differences may seem daunting, self-advocacy, executive functioning and independent living skills taught throughout an individual’s transition to adulthood (starting as early as possible) can help to ease the jump to post-secondary education and its accompanying expectations. If you would like to discuss this topic in greater detail as it relates to you/your student, please complete our online intake form and note that your inquiry is for Transition Services.



Center on Community Living and Careers, Indiana Institute on Disability and Community, Indiana University

National Council on Disability 

Santa Clara University

Think College

Life After IEPs

Financial Education for Everyone: Practical Money Skills



About the Author: 

Dina DiGregorio Karlon, M.A., is a seasoned counselor who has worked as both a school counselor and vocational rehabilitation counselor, guiding and coaching students and adults through transitions toward independence in both college and the working world. With NESCA, she offers transition assessment services in Londonderry, New Hampshire as well as transition planning consultation and coaching to students and families throughout New England.


To book Transition Services at NESCA or an evaluation with one of our expert neuropsychologists, complete NESCA’s online intake form. To book Transition Services in N.H., ask for Dina Karlon. 


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 or call 617-658-9800.

Introduction to Acupuncture with Licensed Acupuncturist Meghan Meade

By | NESCA Notes 2019


By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

Acupuncture is one of eight branches of Chinese Medicine that dates back over 3,000 years and involves the insertion of hair-thin needles into the body to provoke a healing response.

The body registers needling as a microinjury to which it responds by summoning the immune, nervous and endocrine systems to increase circulation, produce endorphins and other pain-relieving substances and flips the switch on the stress response.1,2,3 The treatment itself effectively assesses the internal imbalance and sends a signal to the body to address it; for this reason, acupuncture’s effects are often described as regulating – reducing elevations in inflammatory markers, enhancing the production and function of essential neurotransmitters, and so on. 1,2,3

Because acupuncture is so regulating to the body’s internal environment, the effects experienced by the patient can be both targeted and systemic2 – while pain relief could be achieved for a specific injury such as a sprained ankle, a patient might also noticed improved sleep or reduced anxiety, for example.

As a practitioner of Japanese style acupuncture, a style that is particularly reliant on using the body’s feedback to guide treatment decisions (though not to the exclusion of a patient’s verbal feedback about their health concerns and experiences), I incorporate pulse diagnosis and palpation into my overall diagnosis and treatments. Because an individual is considered to be the ever-changing reflection of their environment and experiences – physical, mental and emotional – my treatments for a given patient and a given condition will never look the same; each day the body is slightly different than the day prior, and treatments are designed with this principle in mind.

Another important theme within Chinese Medicine is that of duality; acupuncturists consider mutually opposing and complementary elements, such as heat and cold, internal and external, male and female, and yin and yang to be crucial in both assessment and treatment. Whereas yang represents heat, energy, masculinity, day time and light, yin, by contrast, represents coolness, substance, femininity, night time and darkness. When we are born, we are at our peak state of yang, which progressively gives way to yin throughout the lifetime. Because children are by nature more yang, their energy is ample and at the surface; accordingly, treating children and adolescents with acupuncture requires less stimulation to yield a desired response. Often needling is not involved, and non-insertive tools and techniques are preferred for their gentle, effective and often expedient results. Pediatric treatments may involve the use of magnets placed on acupuncture points, as well as brushing and tapping techniques using stainless steel, copper and/or silver tools. Because acupuncture points exist along 14 channels that run up and down the body, an acupuncturist can effect change both in a given channel/organ system and systemically by stimulating a channel through brushing and tapping techniques. While the above statement is true that inserting needles into the skin triggers an extensive sequence of immune, nervous and endocrine system events, so, too, does the more superficial work that acupuncturists perform for their pediatric patients.

The goal of acupuncture is always to harmonize, reducing what is in excess and restoring what is deficient. On a biomedical level, this typically entails a shift in the autonomic nervous system from a sympathetic dominant state – fight or flight mode – to a parasympathetic state – the calmer and more productive – though elusive – ‘rest and digest’ mode.2,3 Similarly, acupuncture regulates the function of hormones, neurotransmitters and immune mediators to achieve this balance. While many feel a positive response from a single treatment, acupuncture is generally not a ‘one and done’ therapy; instead, the response to acupuncture becomes stronger and more lasting over the course of several treatments, as a cumulative signal is often required for the body to carry out the work of regulating imbalances. Often after an initial series of treatments, a patient can enter a maintenance mode of treatment, spacing treatments out in increasingly longer windows and eventually receiving treatment on a maintenance or as-needed basis.

I hope this introductory conversation provides some insight as to how acupuncture works. I will be back with a follow-up post to shed some light on the effect of acupuncture on specific conditions commonly seen among NESCA’s client base.

  1. Cheng, Kwokming James. “Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician’s Perspective.” Journal of Acupuncture and Meridian Studies 7.3 (2014): 105-14. Web.
  2. Carlsson, C. “Acupuncture Mechanisms for Clinically Relevant Long-term Effects – Reconsideration and a Hypothesis.” Acupuncture in Medicine 20.2-3 (2002): 82-99. Web.
  3. Cheng, K. J. “Neuroanatomical Characteristics of Acupuncture Points: Relationship between Their Anatomical Locations and Traditional Clinical Indications.” Acupuncture in Medicine 29.4 (2011): 289-94. Web.


About the Author: 

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.


To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at

Monday: 10am – 6pm

Thursday: 9am – 7pm


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 or call 617-658-9800.