NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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high school student working as a grocery store clerk over the summer

What Should My High Schooler Do This Summer?

By | NESCA Notes 2025

high school student working as a grocery store clerk over the summerBy: Lyndsay Wood, OTD, OTR/L
NESCA Executive Function and Real-life Skills Program Manager

As summer approaches, many parents find themselves asking the same question: “What should my high schooler do this summer?” While it’s tempting to let the months slip by in a haze of late mornings and screen time, summer can be an incredible opportunity for teens to grow in ways that go far beyond academics. Whether your child needs to build their resume, explore career interests, or just enjoy some well-earned downtime, there are plenty of ways to use the summer months meaningfully. Here are six ideas to help your teen make the most of their summer break:

  1. Get a Job

It doesn’t have to be glamorous or connected to their dream career; just having a job can make a big difference in a teen’s development. Research shows that teens who work, even part-time in unrelated fields, often have better long-term outcomes, including higher earnings and stronger work habits. A summer job teaches responsibility, time management, and communication skills, while also boosting confidence and independence. Whether it’s scooping ice cream, lifeguarding, or stocking shelves, your teen will be gaining skills that matter.

  1. Volunteer

If a paid job isn’t in the cards this summer, volunteering can be just as valuable. Volunteer work offers teens a chance to develop important job-readiness skills, like collaboration, commitment, and leadership. It can also provide a strong sense of purpose and build self-esteem, especially when the cause is one they care about. From local food banks to animal shelters to community theater, volunteering helps teens learn what it means to contribute and be part of something bigger than themselves.

  1. Attend a Camp Related to a Career Interest

Is your child into coding, engineering, creative writing, or environmental science? Summer camps focused on specific interests or career paths can be an exciting way for teens to dig deeper into a passion. These experiences are not only educational but also energizing, they can spark new goals, introduce teens to mentors and peers who share their interests, and even inspire future college and career plans. Many camps now offer virtual or hybrid options, making it easier to find a good fit.

  1. Build Skills through Coaching

Summer can be the perfect time to focus on the skills that teens don’t always have time to develop during the school year. Executive function skills, self-determination, and future planning are all crucial for a smooth transition to adulthood. One-on-one coaching can help teens explore careers, practice goal-setting, and learn strategies for time management and self-advocacy. At NESCA, we offer a variety of summer intensives focused on transition planning, career exploration, executive functioning, self-awareness, and sexual health and relationship education. Many students benefit from individualized instruction in these areas to stay safe, informed, and confident. These short-term programs are designed to empower students and help them build a meaningful roadmap for the future. If you have any interest in these programs, NESCA’s intake form can be found here: https://nesca-newton.com/intake/

  1. Try an Overnight Experience to Practice Being Away from Home

Whether it’s a traditional sleepaway camp, a weekend college program, a college prep experience, staying with extended family, or planning a trip with friends, having an overnight experience can be a powerful step in your teen’s growth. Being away from home helps young people practice independence, responsibility, and problem-solving in a new environment. It can also reveal areas where they may need more support, like managing personal hygiene, communicating needs, or sticking to routines, giving families a clearer picture of what to work on before college or adulthood. Even short trips away from home can boost confidence and build valuable life skills.

  1. Allow Time for Fun and Independence

While structure and growth are important, don’t underestimate the value of downtime. Summer is also a time for teens to relax, socialize, and explore who they are without the pressures of school. Giving your teen some autonomy (whether it’s planning a trip with friends, trying a new hobby, or managing their own schedule) helps them build self-confidence and a strong sense of identity. Fun and independence aren’t just luxuries; they’re essential parts of growing up.

There’s no one “right” way to spend the summer, but with a little thought and planning, your teen can come away from the break with new skills, deeper self-knowledge, and renewed confidence. Whether they’re working, volunteering, exploring a passion, or simply learning how to manage their time, every experience counts. The goal isn’t to fill every hour; it’s to offer opportunities that support growth, discovery, and a smoother transition into young adulthood.

For more information about NESCA’s summer programming opportunities for students, check out our recent newsletter: https://mailchi.mp/nesca-newton/summer2025.

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, Vermont-based Executive Function and Real-life Skills Program Manager, 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.

Dr. Wood accepts Vermont- and Massachusetts-based transition and occupational therapy assessments. Her in-home and community-based coaching services are available in the greater Burlington, Vermont area. Dr. Wood can accept virtual coaching clients from both Massachusetts and Vermont.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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young child undergoing a neuropsychological evaluation

Early Childhood Evaluations, Lifelong Impact: Why Acting Early Can Make All the Difference

By | NESCA Notes 2025

young child undergoing a neuropsychological evaluationBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

Early childhood is a time of rapid development, marked by significant growth in physical, cognitive, social, and emotional domains. While every child develops at their own pace, sometimes parents, caregivers, or healthcare providers may notice certain behaviors and developmental patterns that raise questions or cause concern. In such scenarios, a neuropsychological evaluation can serve as a powerful tool to better understand a child’s specific needs and guide interventions to promote their overall growth and well-being.

Common Signs That a Neuropsychological Evaluation May Be Warranted

Identifying the need for a neuropsychological evaluation can be challenging, particularly for young children between the ages of 2 and 6, as this is a time when developmental milestones vary widely. The following signs may indicate that consulting with a qualified professional would be beneficial:

1. Developmental Delays

Children typically reach certain developmental milestones within specific age ranges. Delays in areas such as speech and language, fine and gross motor functioning, adaptive/self-care skills, or social interactions may signal the need for further evaluation. For example:

  • Absence of babbling or only making a few sounds by age 1
  • Not using word combinations by age 2 or speaking in simple sentences by age 3
  • Difficulties with walking, running, or grasping objects
  • Limited eye contact or lack of interest/engagement with peers
  • Unresponsive to their name being called
  • Limited use of gestures (pointing, waving) or facial expressions
  • Difficulties interpreting social cues in others (personal space, tone of voice, body language)

2. Behavioral Challenges

While tantrums and emotional outbursts are common in young children, persistent or extreme behavioral issues may require closer attention. These might include:

  • Frequent, intense, prolonged meltdowns that are difficult to soothe
  • Aggressive behaviors toward others or self-harm
  • Frequent property destruction
  • Unusual rigidity or resistance to transitions and changes in routine

3. Attention and Focus Issues

Young children have naturally short attention spans and are often very active; however, indicators such as an inability to engage with toys or activities for any length of time, or frequently seeming to be in their “own world,” might suggest underlying difficulties.

Attention deficits do not always stem from an attention-deficit/hyperactivity disorder, and may have a myriad of different etiologies, including anxiety, sleep problems, trauma, learning problems, impairment in vision or hearing, or other underlying medical conditions. Neuropsychological evaluations can help to better understand the cause of inattention, which can provide a crucial roadmap to helping address the behaviors.

4. Sensory Sensitivities

A child who is unusually sensitive to sounds, textures, lights, or smells (or in contrast, seems under-responsive to sensory input) may benefit from an evaluation. Sensory sensitivities can impact daily routines and interactions.

5. Regression in Skills

If a child starts to lose previously acquired skills, such as language, motor, or adaptive abilities, this could be a red flag that warrants close attention and prompt assessment.

6. Medical Complexities

A child who has a known history of medical complications (e.g., premature birth, low birth weight, chronic illness, neurological insult, such as stroke or seizures, in utero substance exposure, head injury) may require a neuropsychological evaluation early in life to identify potential developmental challenges and to guide timely interventions that support their growth and learning.

7. Family History

Parents and caregivers of children with a family history of neurodevelopmental disorders, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and/or learning disabilities, should closely monitor their child’s developmental progress, as these children are at increased risk for developmental challenges.

It’s important to remember that every child learns at their own pace, and variations in reaching milestones are often a normal part of development. Noticing delays or differences does not always mean there’s a major cause for concern. However, if you do have questions or observations you’d like to explore further, speaking with your child’s primary care provider or consulting with a pediatric neuropsychologist can be a helpful step in understanding whether a neuropsychological evaluation may be beneficial.

Families may find the following resource helpful as a detailed guide to understanding the key milestones to watch for at various stages of development:  https://www.cdc.gov/ncbddd/actearly/milestones/index.html

The Benefits of Neuropsychological Evaluations for Young Children

Neuropsychological evaluations are comprehensive assessments that examine how a child’s brain development impacts their behavior, learning, communication, and overall functioning. For children aged 2 to 6, these evaluations are particularly beneficial for several reasons:

1. Early Detection and Intervention

When detection of developmental delays and appropriate intervention begins during these formative, early years, children are set up with the best opportunity to develop essential skills during their most receptive learning period. The earlier challenges are identified, the sooner targeted interventions can begin, which is critical as early intervention has been shown to lead to better long-term outcomes, aiding in the child’s future cognitive, social-emotional, and academic success.

2. Comprehensive Understanding, Guidance, and Coordinated Support

Neuropsychological evaluations offer a thorough understanding of a child’s cognitive strengths and challenges, emotional well-being, and social skills. This holistic approach enables caregivers and professionals to gain insight into the child’s unique learning style, allowing for tailored interventions that address their specific needs.

For parents and educators who may feel overwhelmed or uncertain about how to best support children with developmental delays or dysregulation, these evaluations can provide clear guidance and practical recommendations. These may include strategies to implement at home and in the classroom, therapeutic options, or referrals to specialized services. Additionally, neuropsychological evaluations serve as a roadmap for coordinating essential therapies, such as speech, occupational, physical, behavioral, or parent-child interaction therapies, while facilitating communication among the various professionals involved. This collaborative approach ensures that adults across different settings can work together effectively to support the child’s overall development and well-being.

3. Tracking Progress

Early childhood neuropsychological evaluations establish a baseline to understanding a child’s early cognitive, emotional, and social functioning. These assessments provide a starting point from which progress can be accurately tracked over time. Once children begin receiving developmental support, regular neuropsychological re-evaluations, typically every 2 to 3 years, may be essential in monitoring progress, assessing the effectiveness of interventions, and making timely adjustments to treatment plans as needed.

Embracing the Journey Towards Greater Understanding

The idea of a neuropsychological evaluation may initially feel daunting to some parents, yet it’s important to view an evaluation as a proactive step toward better understanding and nurturing a child’s potential. Every child deserves the opportunity to thrive, and sometimes that journey begins by asking questions, seeking answers to potential barriers in their development, and embracing the valuable insights a neuropsychological evaluation can offer.

By recognizing the signs early and accessing the appropriate resources, caregivers can help to empower their children with the tools and support they need to flourish. Ultimately, the goal is not merely to address identified challenges, but to celebrate, embrace, and amplify the countless ways in which a child can grow and excel.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Image of child with profound autism and quote from Erin Gibbons

Understanding and Supporting Profound Autism

By | NESCA Notes 2025

Image of child with profound autism and quote from Erin GibbonsBy: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

In April, I had the good fortune to attend the Profound Autism Summit, a multidisciplinary conference hosted by the Profound Autism Alliance and Nashoba Learning Group. Presentations were given by a variety of specialists from behavior analysts to pediatricians to speech pathologists… I am eager to apply my newfound knowledge and help educate those around me about this important and often overlooked population within the autism community.

In my role as a neuropsychologist, I often see clients with autism spectrum disorder (ASD). As its name implies, ASD represents a broad spectrum of individuals whose strengths, weaknesses, and behaviors vary widely. During the 1980s and 1990s, much of the research devoted to ASD included individuals with significant challenges, such as lack of speech, self-injurious behaviors, and limited independent living skills. Over the last 20 years or so; however, there has been a shift in the research such that most of the recent studies exclude autistic individuals who are nonverbal and/or exhibit unsafe behaviors. As a result, this portion of the autism community has become increasingly marginalized, under-researched, under-funded, and under-served. This was part of the impetus for the Profound Autism Alliance, an organization created by parents and other activists who saw a need for more awareness of and education about the needs of their dependents.

The term profound autism is used to describe autistic individuals who require 24/7 care throughout their lives. Individuals who fit criteria for profound autism experience a unique set of challenges that make them one of the most vulnerable communities in our society. The statistics show that profoundly autistic individuals are significantly underserved in preventative medical and dental care because they have such difficulty tolerating the appointments. Through the Summit I attended, I learned about local organizations that are working to improve access to healthcare for this population. The Lurie Center at MGH offers behaviorally-based exposure treatments so that profoundly autistic patients learn the skills to endure what many people would consider simple procedures, such as blood draws. The Arc is pairing with local medical schools to improve the training of medical students in how to work effectively with autistic patients. I was inspired by so many individuals and felt moved to do my part as well.

I have been working with profoundly autistic individuals for over 20 years. As a college student, I worked as a behavior therapist at a residential school for students with ASD and other developmental disabilities. Throughout graduate school and into my early career years, I turned my focus to neuropsychological testing and have been fortunate to continue supporting the autistic community in this capacity. Having worked at NESCA for almost 15 years, I provide evaluations to children, adolescents, and young adults with profound autism, many of whom have been unfairly deemed “untestable.” It is true that many of our standardized assessment tools were not developed for individuals who are nonverbal or have limited fine motor precision, for example. However, test scores are not the only way to capture a student’s strengths and potential. Providing quality evaluations for profoundly autistic students is incredibly important. Not only can the findings help caregivers and educators better understand the student’s learning style, but the information helps create road maps for the future, a key component of NESCA reports.

Through my work as a neuropsychologist, I am dedicated to supporting families of profoundly autistic individuals, helping them to find the supports and services they need. Further, I strive to educate schools, medical professionals, and other providers about the unique needs of this population. I learned an immense amount at the Summit I attended and felt honored to be further educated by some of the top researchers in the world of ASD. Please read more about the Profound Autism Alliance here: www.profoundautism.org.

 

About the Author

Since 2011, Dr. Gibbons has been a trusted expert at NESCA where she evaluates children presenting with a range of attentional, learning,Erin Gibbons headshot and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories. In addition, she evaluates adults who have concerns about whether they meet criteria for an ASD or ADHD diagnosis.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, 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, Hingham, and Plainville, Massachusetts; Londonderry, New Hampshire; and staff in Burlington, Vermont and Brooklyn, NY, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Inattentive student image and quote from Dr. Alison Burns

To Test or Not to Test (for ADHD)?

By | NESCA Notes 2025

Inattentive student image and quote from Dr. Alison BurnsBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that is characterized by difficulty with sustained attention, hyperactivity, and/or impulsivity. Some kids mostly have difficulty with attention (referred to as ADHD, Predominantly Inattentive Presentation, formerly called ADD), some kids mostly have symptoms of hyperactivity and impulsivity (referred to as ADHD, Predominantly Hyperactive-Impulsive Presentation), and some kids have difficulty with both attention and hyperactivity/impulsivity (referred to as ADHD, Combined Presentation).

The diagnosis of ADHD can be very straightforward for a subset of children. These kids may demonstrate highly impairing, overt symptoms of ADHD, often from a young age. These children tend to have symptoms of hyperactivity and impulsivity that are quickly noted by parents and preschool or kindergarten teachers. This group of children may appear as if they are driven by a motor or always on the go, and they have trouble paying attention within a very short period of time. The diagnosis of ADHD for this subset of children is frequently made by a pediatrician after parents and teachers complete a questionnaire (often the Vanderbilt Assessment Scale) and the child scores above a certain threshold.

However, the larger majority of children exhibit symptoms of inattention, hyperactivity, and impulsivity that are not as overt or clear cut. This may present as a lack of focus for certain tasks or in certain situations, daydreaming or distractibility, poor attention to detail or rushing through work, talking constantly, or fidgeting. Parent and teacher questionnaires may show levels of inattention and hyperactivity/impulsivity that are above the threshold, but this subset of children would greatly benefit from testing to confirm the diagnosis. That is because there are many other reasons why a child may be distracted, inattentive, rush through their work, not start a task independently, fidget, or chat excessively. Here are a few examples:

  • A child with anxiety may be distracted because they are focused on their worries (e.g., “I forgot to study for my next period’s test!” “What if people laugh at me when it’s my turn to read aloud?”). They may rush through their work because they are worried about completing the test in the allotted time period or have trouble starting a task as they “freeze.” They may fidget or talk excessively when feeling nervous.
  • A child with a learning disability may zone out or appear distracted when they are having trouble understanding a concept or completing an assignment. They may get bored or frustrated and begin to move around in their seat, and they may rush through their work to get it done as quickly as possible out of embarrassment. They may also have trouble starting a task independently as they do not know how to complete the work.
  • A child with a language disorder may become inattentive and distracted when they cannot understand what the teacher is saying. They may become fidgety and “check out,” and they may not start tasks independently as they did not understand the task instructions.

These example children (a child with ADHD, anxiety, a learning disability, and a language disorder) may all present in a similar fashion, with the same behaviors endorsed on a questionnaire (e.g., does he have trouble paying attention? Is he fidgety or restless?). But the reasons why these behaviors are occurring are fundamentally different. Making an accurate diagnosis is critical to getting the right treatment plan in place. We would not want to treat a child with a stimulant medication if the underlying cause of inattention is a language disorder, just as we would not recommend speech and language therapy for a child with ADHD (without language issues).

This is where testing comes into play. A neuropsychological assessment is an excellent tool for teasing out the underlying root cause behind the surface symptoms. A comprehensive neuropsychological assessment, such as the ones done at NESCA, assesses a child’s intellectual ability, academic skills (e.g., reading, writing, math), expressive and receptive language skills, visual-spatial skills, learning and memory style, fine motor skills, attention and executive functioning, social-emotional well-being, and adaptive living skills. This breadth and depth of testing can help to rule out alternative explanations and ensure that attention difficulties are truly caused by ADHD.

Testing also allows us to compare a child’s performance on testing to a sample of children the same age. This objective information is considered along with a host of other information (e.g., history given by the parents/caregivers, record review, questionnaires completed by parents and teachers, behavioral observations during testing). This comprehensive evaluation provides a great deal of information and increases the likelihood of an accurate diagnosis and effective treatment plan.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

To book a consultation with Dr. Burns or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Teen reaching his or her goal at the top of a mountain with a quote from Kristen Simon

Building Self-determination Skills: Goal Setting without SMART Goals

By | NESCA Notes 2025

Teen reaching his or her goal at the top of a mountain with a quote from Kristen SimonBy: Kristen Simon, M.Ed, Ed.S
Transition Specialist; Psychoeducational Counselor

Summer break offers more than just a pause from school—it can be an opportunity for personal growth. With fewer academic pressures and a more flexible schedule, teens can use this time to build self-determination skills. Self-determination is a foundational skill that includes the ability to make choices, set goals, and advocate for oneself. Improving on these skills can mean the difference between total overwhelm and having the confidence to steer your own path.

Many teens come to coaching with vague goals in mind but have little practice in breaking their goals down and following through with planned steps. For some adolescents, using the SMART framework (Specific, Measurable, Achievable, Relevant, Time-Bound) helps them to set clear and realistic goals. For others, this framework can feel like too much pressure (e.g., leaves lots of room for “failure”). If the SMART goal framework is too constricting, the following supports may be helpful:

  • Build flexible systems: create routines and timelines that can flex with your energy and focus levels
  • Develop multiple lines of success (e.g., if your goal is to scroll on your phone less, you can track 1 hour less, 3 hours less, or 10 minutes less as tiers of success)
  • Use external scaffolding: body doubling, accountability partners, coaches, or scheduled time in a separate environment
  • Allow for play and novelty: Make sure your goals excite you; be sure to add fun reinforcers
  • Make them short term (e.g., seasonal or monthly)

Learning the best strategies to help adolescents plan for and stick to a goal is a great use of time over the summer.

NESCA offers coaching services for students who are looking to bolster their organization, scheduling, time management, goal setting, and routine building skills. Students work 1-on-1 with occupational therapists and education specialists to identify specific skills that will help them be more organized and in control of their academic and general life tasks. If you would like to explore ways to support your student in building executive function or real-life skills, please complete our online Intake Form.

 

About the Author

Kristen Simon, M.Ed, Ed.S, has worked with transition-aged youth as a licensed School Psychologist for more than a decade. She has extensive experience working with children and adolescents with a range of learning and social/emotional abilities. Kristen’s strengths lie in her communication and advocacy skills as well as her strengths-based approach. She is passionate about developing students’ self-awareness, goal-setting abilities, and vision through student-centered counseling, psychoeducation, social skills instruction, and executive functioning coaching. Mrs. Simon has particular interests working with children and adolescents on the Autism spectrum as well as individuals working to manage stress or anxiety-related challenges.

Mrs. Simon is an expert evaluator and observer who has extensive working knowledge of the special education process and school-based special education services, particularly in Massachusetts. She has been an integral part of hundreds of IEP teams and has helped to coordinate care, develop goals, and guide students and their families through the transition planning process. Mrs. Simon further has special expertise helping students to learn about their diagnoses and testing and the IEP process in general. She enjoys assisting students, families, and educators in understanding a student’s disability-related needs as well as the strategies that can help the student to be successful in both academic and nonacademic settings. Mrs. Simon has often been a part of teams in the years when students are initially participating in transition services, and she has helped countless students to build the skills necessary to be part of their first team meetings. She is committed to teaching students—as well as parents and educators—how to participate in student-centered team meetings and the IEP processes.

At NESCA, Mrs. Simon works as a transition specialist and psychoeducational counselor. She works with adolescents, their families, and their school communities to identify and build the skills necessary to achieve their postsecondary goals. Mrs. Simon provides transition assessment (including testing, functional evaluations, and observations), program observations and evaluations, case management and consultation, and individualized counseling and skills coaching.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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Image of a distraught teen on his phone and a quote by Dot Lucci

Do You Know Who Your Teen’s Friends Are?

By | NESCA Notes 2025

Image of a distraught teen on his phone and a quote by Dot LucciBy Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Artificial Intelligence (AI) is a part of our lives, and we may even be using it ourselves at work, in our cars, and at home. There has been much press about the pros and cons of AI, and it continues to evolve at a rate that our laws can’t keep up with. AI is here to stay and is present in almost all aspects of our lives whether we want it to be or not, or whether we use it deliberately or not. Sometimes, we aren’t even aware of its infiltration into our lives.

So, you’ve heard of AI, but have you heard of character.ai? Do you have an AI companion that keeps you company by chatting with you, helping you with your mental health issues, or brainstorming ideas with you? At this point you may be thinking what is an AI companion? Well, if you are a parent of a teen or young adult or work with teens or young adults, you might want to read on. Many of our teens and young adults have heard of it, and according to Common Sense, it is trending in teens and young adults with 51% having used it at least once; some using it daily as their sole companion (Common Sense, 2024).

Character.ai is an AI tool where you can digitally create a character/persona (avatar) of famous people, historical figures, athletes, politicians, movie characters, anime, gaming worlds, or anyone who’s in your imagination. This is where your ideal friend and companion comes in! Usually, AI characters are positive, supportive, and caring. There are many different AI apps and tools to pick from, such as character.ai, Talkie, CHAI, Replika AI, to name a few. Character.ai differs from regular AI, which is frequently used in professional settings to help create efficiencies in our daily tasks. These character-based tools, however, are built for entertainment, companionship, role playing, storytelling, to play a game with, practice a foreign language, or get feedback and brainstorm different ideas or topics with, etc. These avatars can even be your mental health counselor. You can have a companion/friend at your fingertips who is there to support you at any given moment 24/7 for entertainment or emotional support. In essence, these apps let you talk in real time with whomever you’ve created, and it can carry on realistic conversations based on how you’ve programmed it to “be.”

Character.ai and other similar apps have been trained on large language learning models (LLM) and natural language processing (NLP) as well as deep machine learning (DML), which allows them to create natural, flowing, and engaging conversations. Like all AI, it has been trained on massive amounts of data, and these applications consider context and can predict responses. These apps are programmed to show and sound emotionally concerned. The characters can respond with different tones, word choice, personality traits, and more – all based on what you’ve built into it. Within the privacy settings, you can also have your character be available to others on the platform, so you can essentially create a “community of companions and friends” to engage with. These Ai companions can even talk amongst themselves with you in a group chat and share differing opinions and ideas for you to think about.

Like all digital platforms and apps, there are disclaimers, safety rules, and community guidelines, etc. These AI apps also include disclaimers addressing risks like exposure to hate speech, sexual harassment, self-harm, etc., in their safety rules. However, like all AI and social media, it is not foolproof and can be overlooked or bypassed. Because it is trained with LLM, NLP, and DML, the person who it interacts with it runs the risk of the potential for harmful and inappropriate content being included in its interactions.

Since our legal system has not yet caught up with the rapid-fire developments of the AI space, legal issues have been emerging about the duty of the technology companies to protect the mental health, and the emotional and psychological wellbeing of its users, especially those who are more vulnerable. For younger-aged users, or youth who are naïve, have mental health challenges, have less access to professional counselors, or may be in countries where mental health is not endorsed, this type of AI can have dire consequences if left unchecked. For instance, a mother in Florida filed a lawsuit against character.ai after her teenage son, who was diagnosed with an autism spectrum disorder, took his own life after getting emotionally attached to his character (World Law Group, 2024).

Many users of character.ai and tools with AI chatbots/avatars, allow the characters or avatars to become and serve as their sole friend. Users can develop a strong emotional attachment to their character, which can lead to a dependence and over-reliance on the character. The danger is that some characters may provide inaccurate, harmful, dangerous, or misleading advice, depending on their database, if they are not monitored properly (which many are not), as in the case of the Florida teen. These avatars are only as good as their training, and they are not humans. Needless to say, they are not fully able to understand the complexities of human interactions (and the nuances that come with them) and relationships, particularly in the contexts in which they occur. Becoming more reliant on an AI character can lead to isolation and a decrease in real life social interaction with family and friends. (Science Digest, 2024)

As with all technology, there are advantages and disadvantages to character AI avatars. For many, AI avatars/chatbots can also have positive benefits. For instance, they offer immediate accessibility to a listening ear, a non-judgmental friend, mental health support, and more – all which can quickly turn into cons. They can also be an outlet for creativity, imagination, working out the anxieties of connecting with a person in real life, and helping them practice and try on different ways of interacting.

In the broader context, character AI tools can be used for educational purposes, such as personalizing learning, simulating real-world scenarios, training individuals in various skills, using scientific figures to teach concepts, and more. If used properly, the story-telling and role-playing aspects can be harnessed to create interactive formats.

As with all technology usage, adults should be aware of what teens and young adults are engaged in online. As a parent or caregiver, it is important to stay ahead of this trend and its usage, especially if it is being used as a substitute for human companionship and mental health support. For many young people, the benefits of “having a friend, being seen, heard, and valued” by a chatbot/avatar is better than not having a friend, being seen, heard, and valued in real life. Although there are warnings on all of these platforms that the avatar is not real and that the conversation is computer-generated, it may not matter to the user if it feels real, sounds real, and provides real comfort. For them, it is worth it. This real-time friend, who is non-judgmental, supportive and readily available, is powerful for many teens and young adults.

If you notice a person changing their habits regarding engagement in real life activities, connection with family and friends, retreating/isolating to their room, becoming secretive, or only talking about their AI character, these could all be “red flags.”

Guidelines for Usage of Character-based AI

If you know of a teen who is using character AI, begin by checking in about their app use with a conversation. Approach it with curiosity and openness; not blame and punishment. Ask to see their avatars/characters to see if there is anything potentially harmful about their personalities. Assess whether there is anything beyond their maturity level. Teens and many young adults do not have fully-developed frontal lobes, or critical thinking and decision making skills to use character AI and manage potential harmful content and situations.

Schools are teaching teens about social media, internet safety, privacy, etc.; parents and caregivers must build on what is being taught at school in the home by reviewing the privacy and safety features with their teen/young adult and the reasons they are necessary. Review how they can spot harmful content when they see it, report it, and fully understand the app’s community guidelines.

If you feel the user may not be ready to access character-based AI, use parental controls on their devices, in the app store, and on the internet network to restrict character-based AI access. Just like other social media platforms, there are published guidelines for using character-based AI: don’t upload images of themselves, friends, or family members or recordings of their voices.

As teens become more active with AI and character-based AI, set time limits for its use and where they can use character-based AI (i.e., at the kitchen table), and how they will use it by identifying what function will it serve for them (i.e., practice conversational foreign language). Explain why the boundaries are there and how you want to help them make good decisions about AI usage in general, as it is and will continue to be all around them now and as they move on in life, where they will be making these decisions themselves. Set a good foundation early on.

References

 

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 clinicians, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant/service in the referral line.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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Image of a tortoise studying on a notebook with a quote from Miranda Milana, Psy.D., NESCA Neuropsychologist

Smart Doesn’t Always Mean Fast: Understanding Intelligence and Processing Speed

By | NESCA Notes 2024

Image of a tortoise studying on a notebook with a quote from Miranda Milana, Psy.D., NESCA NeuropsychologistBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

Picture what it means to be intelligent.

Do you imagine someone who knows many facts about a variety of topics? Someone who has quick wit? The first person to offer up answers? Chances are that you picture someone who not only knows a lot of information—but thinks fast on their feet. Maybe you envision someone who finishes tests before everyone else, completes homework effortlessly, or could dominate any round of Jeopardy.

Those are all common examples of what comes to mind when someone is described as “smart.” Society often rewards efficiency and how fast someone is to provide answers and results, which is why we equate efficiency and speed with high intellect. The fact of the matter is that intelligence does not always mean fast, and there are many extremely bright individuals who perform slower when it comes to tasks like timed tests, fast-paced conversations, or quick decision-making.

This might seem confusing—how can someone so clearly intelligent struggle to perform tasks efficiently? If they have so many answers, why can’t they provide them quickly?

The answer to this question lies in how our brains are wired. Your cognitive profile is complex and includes many factors. Someone can be intellectually gifted, or considered a “genius,” but still be slow to process information.

If you imagine the brain as a car:

  • Core cognitive abilities—things like reasoning, memory, and language—are the engine. They represent how powerful, thoughtfully designed, and capable the car is.
  • Processing speed is the acceleration. It’s how fast that car can go.

Some people might have a powerful engine that takes longer to accelerate. Once it gets going, however, and gains momentum, it can go far and handle any road it encounters. Others might have very fast acceleration but a reduced capability of maneuvering on complex routes.

How Does This Happen?

Many individuals with this “smart but slow” learning profile have exceptional cognitive skills but need more time to show what they know as it takes them longer to take in, make sense of, and respond to information (functions of processing speed).

This discrepancy between intellect and processing speed can cause significant frustration, both for the individual and for those around them. It can be especially difficult in environments that place an emphasis on speed, such as classrooms, standardized testing, or high-pressure workplaces with fast work deadlines/turnaround times.

Factors that Affect Processing Speed

Some brains are simply wired for a slower pace. But other factors can influence processing speed as well, including:

  • Anxiety
  • ADHD and attentional differences
  • Autism spectrum traits
  • Depression and mood disorders
  • Fatigue or chronic stress
  • Substance use or medications

These factors can cause weaknesses and/or variability in processing speed—even in individuals with otherwise high cognitive reasoning abilities. Unfortunately, this “smart but slow” presentation often leads to incorrect labels, such as laziness or reduced capabilities, when in fact, they just need more time to showcase what they know.

No matter the reason for slower processing speed, these individuals benefit from accommodations and strategies such as:

  • Extended time on tasks, tests, or writing assignments
  • Flexible expectations in fast-paced discussions or decision-making settings
  • Alternative ways to demonstrate knowledge, like untimed projects or creating visuals

Now that we have taken some time to understand how intelligence is defined, I encourage you to consider expanding your idea of what comprises intelligence as a whole the next time someone asks you what it means to be intelligent. Some of the most insightful, creative, and capable thinkers are the ones who take their time to pause, reflect, and dive deep before they respond. These individuals might be the smartest people in the room who just move at their own pace and deserve just as much recognition.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, includingMiranda Milana PsyD headshot attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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Picture depicting the root cause of a person's functioning or challenges

When Neuropsychological Evaluations Fall Short: Finding the Root Cause through Thorough Analysis vs. Giving a Label

By | NESCA Notes 2025

Picture depicting the root cause of a person's functioning or challengesBy Ann Helmus, Ph.D.
Founder & Director, NESCA

In a recent blog, I discussed how not all neuropsychological evaluations yield equally useful outcomes for helping a struggling child and touched on the consequences of misdiagnosis. This week, I’d like to explore another common challenge: evaluations that merely label a symptom without uncovering the underlying cause.

Consider a patient who visits a doctor with concerns of persistent fatigue and weight gain. After routine labwork returns normal results, the doctor offers the diagnoses  “mild obesity” and “idiopathic fatigue”—labels that describe the symptoms but do not provide a meaningful explanation. The patient is advised to get more sleep or possibly prescribed a new medication. After waiting months for the appointment and paying out of pocket, the individual is left feeling frustrated and still without clarity or direction about how to address the root cause of the problem.

Parents sometimes experience this result from their child’s neuropsychological evaluations, particularly when conclusions focus primarily on standardized test results without integrating the broader picture of a child’s daily functioning, course of development, and learning profile.

For example, I recently reviewed a report for a fifth grader whose parent was deeply concerned about the emotional distress their child experienced with writing. Despite the teacher reporting that the child’s writing was “fine,” and the child handling other homework with ease, the parent observed significant distress during writing tasks. The evaluation found a discrepancy between IQ and written expression scores, diagnosing a Disorder of Written Expression (ICD-10 F81.81), and recommending a writing tutor as intervention.

While this diagnosis is valid based on test scores, it simply labels the problem rather than explaining why the writing challenge existed or what type of support might be most effective for this individual. Difficulties with written expression can stem from a variety of root causes—fine motor challenges, language deficits, executive functioning difficulties, or learning differences like dyslexia, among others. Effective interventions vary widely depending on the underlying issue. For example:

  • Children with communication disorders may benefit most from working with a speech-language pathologist on written expression embedded in the context of language development
  • Children with dyslexia often require structured literacy approaches
  • Children with executive functioning challenges may need explicit, scaffolded instruction in planning and organizing written output

In the case I reviewed, the child’s intellectual abilities were in the Very Superior range, with especially strong abstract reasoning and pattern recognition. Standard tests showed that his organizational skills were age-appropriate, yet he struggled to express his ideas in writing. Why? Because the complexity and richness of his ideas exceeded his ability to structure them effectively. In this case, his frustration stemmed from a bottleneck in translating thoughts into written form—a challenge not uncommon in gifted learners.

The solution wasn’t simply more writing practice; it was a targeted program matched to his unique cognitive profile, along with strategies for reducing emotional stress around writing.

After additional observation and analysis, we were able to offer the family not only a clear explanation but also a tailored plan, including specific interventions and home supports. Most importantly, we helped the child understand why writing felt so difficult and reassured him that effective help was available.

When done thoughtfully, a neuropsychological evaluation can be truly transformative. At NESCA, we are deeply committed to providing comprehensive evaluations that go beyond scores to understand the whole child. We aim to provide the kind of service we would want for our own children—thorough, compassionate, and actionable.

NESCA clinicians receive ongoing training and mentorship to ensure a consistently high standard of care. Each clinician participates in multiple weekly case conferences to discuss complex profiles and refine their clinical thinking. We also offer weekly seminars to stay informed about evolving interventions and treatments. New team members—regardless of prior experience—receive six months of mentorship to support their transition into our collaborative model. This structure fosters a culture of continual learning and clinical rigor. We take pride in our work because we know that careful, individualized evaluations can change the trajectory of a child’s life.

 

About the Author

NESCA Founder and Director Ann Helmus, Ph.D., is a licensed clinical neuropsychologist who has beenAnn Helmus headshot practicing neuropsychology for 35 years and has been director of NESCA’s Neuropsychology practice for nearly three decades, continuously training and mentoring neuropsychologists to meet the highest professional standards.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Madeline Manning Headshot and quote

NESCA Welcomes Neuropsychologist Madeline Manning, Ph.D., to its Hingham Location

By | NESCA Notes 2025

Madeline Manning Headshot and quoteBy Jane Hauser
Director of Marketing & Outreach, NESCA

I recently had the opportunity to get to know the most recent clinician to join NESCA’s neuropsychology practice, Madeline Manning, Ph.D. Dr. Manning is a wonderful addition to NESCA’s Hingham location, where she joins Dr. Moira Creedon in serving families on the South Shore. I hope you can take the time to get to know more about her as well.

Tell us about your background.

My background in pediatric neuropsychology has been shaped within academic medical centers, where I’ve had the privilege of working with children and families navigating complex medical and developmental challenges. During my doctoral training at Northeastern University, my clinical experiences focused primarily on understanding neurocognitive, behavioral, and social-emotional functioning in children with medical complexities—such as epilepsy, brain tumors, cardiac conditions, and genetic disorders—and how these health conditions impact a child’s overall well-being and day-to-day life.

This foundation led me to an APA-accredited internship at Nicklaus Children’s Hospital in Miami, Florida, where I received rich and diverse training in both neuropsychological assessment and therapeutic modalities. It was there that I deepened my understanding of neurodevelopmental disorders and how they often co-occur with complex medical and psychiatric presentations.

From there, I completed a two-year clinical post-doctoral fellowship at Massachusetts General Hospital/Harvard Medical School. At MGH, I gained extensive experience assessing youth with a wide range of neurodevelopmental presentations—including autism spectrum disorder, ADHD, learning disabilities, and complex profiles where psychiatric, neurological, and socioecological factors all play a role.

Throughout this journey, I’ve been incredibly fortunate to learn from and be supported by dedicated mentors, supervisors, and colleagues. Their guidance has been instrumental in shaping the clinician I am today, and I’m excited to bring that training and experience into my work with children and families at NESCA.

You mentioned your experience working with patients with medical complexities. Can you tell us more about who you worked with?

During my internship at Nicklaus Children’s Hospital, I had the opportunity to work closely with medically complex pediatric populations. I provided neuropsychological assessments for children with epilepsy undergoing Phase 1 pre-surgical evaluations, helping to inform surgical planning and overall treatment decisions. I also assessed patients referred through the oncology, hematology, and neurogenetics clinics, which gave me valuable insight into how medical conditions and treatments, such as chemotherapy, can affect cognitive, emotional, and behavioral functioning.

During my postdoctoral fellowship at MGH, I continued to build on this foundation. While many of the presenting concerns for patients were centered around neurodevelopmental and psychiatric symptoms, I also had the opportunity to work with young patients navigating complex medical conditions—including pediatric stroke, epilepsy, and a range of genetic disorders.

These experiences further strengthened my understanding of how neurodevelopmental, medical, and psychiatric factors interact in shaping a child’s development. They also enhanced my ability to conduct comprehensive, individualized evaluations that consider the whole child—not just the diagnosis—and offer tailored recommendations to support them across settings.

What made you explore a new opportunity?

I’m someone who truly values lifelong learning, which in large part is why I’ve appreciated working in hospital settings—they’re often centered around collaboration, teaching, and tackling complex clinical questions as a team. That environment has been incredibly formative for me. At this point in my career, I feel ready—and genuinely excited—to transition into a group practice setting, and NESCA felt like the perfect fit. Their strong commitment to teamwork, continued education, and high-quality, individualized care really stood out to me.

On a more personal note, I recently became a mom, and embracing this new season of life has been so meaningful. Finding a role that allows me to continue growing as a neuropsychologist in a supportive, mission-driven environment, while also being closer to home and more present for my family, is something I feel incredibly grateful for.

Why were you interested in joining NESCA?

NESCA’s mission is closely aligned with my values—both as a clinician and as a person. I’ve long admired NESCA’s reputation for providing the highest level of care to families, and that made me eager to learn more about the organization. When I met Dr. Ann Helmus, NESCA’s founder and director, I was deeply impressed by her dedication to fostering a positive team culture, while also holding an unwavering commitment to clinical excellence. I’ve felt that same sense of respect and appreciation in the way everyone I’ve spoken to during my transition has been incredibly welcoming and clearly proud to be part of this team.

What also excites me about joining NESCA is how it offers the best of both worlds—an organization with the flexibility of a group practice that also emphasizes collaboration and continued learning, similar to a hospital setting. The weekly case conferences and team meetings create a space for discussing clinical questions, sharing resources, and learning from one another, which fosters professional growth and ultimately allows us to provide exceptional care to the families we support. I feel so fortunate to be joining the team at NESCA, and I can’t wait to get started!

What do you think you will be able to bring to NESCA?

What I look forward to bringing to NESCA is my strong foundation in both clinical assessment and developmental psychology, as well as my passion for supporting children and their families with empathy and care. My training has equipped me to evaluate youth across developmental stages—from as young as 2 years old through young adulthood— experiencing a wide range of challenges. I approach each case with a commitment to understanding the whole child and place a strong emphasis on collaboration—with families, schools, and medical providers—to ensure that my evaluations translate into meaningful, practical recommendations. My goal is also to empower families with the knowledge and tools they need to support their child’s growth, and I strive to bring a warm, patient, and culturally sensitive approach to every case.

You will be joining NESCA’s Hingham office? Who will you be seeing there?

At NESCA’s Hingham office, I’ll be seeing a diverse range of children, adolescents, and young adults who are navigating complex neurodevelopmental, social-emotional, and/or medical challenges. This includes children with autism spectrum disorder, ADHD, learning disabilities, developmental delays, executive functioning difficulties, and those managing health-related conditions that impact cognitive and emotional development.

I’m especially looking forward to supporting families who may be seeking clarity around a diagnosis, looking for school-based recommendations, or working through transitions—whether that’s entering preschool, kindergarten, middle school, or preparing for high school and post-secondary life. I’m excited to collaborate with NESCA’s talented team of clinicians and to contribute to the high-quality, comprehensive evaluations that NESCA is known for.

You live on the South Shore. Why is it important to serve families in the South Shore communities?

As a South Shore native, I know there is a high level of need in this area for quality neuropsychological services. Families here are often traveling long distances in order to obtain the level of care their children need, which adds stress and limits access to services, especially for younger children or those with complex needs. That’s why it’s so exciting that NESCA has expanded its practice to Hingham!

There’s a real gap in local resources on the South Shore, and NESCA’s decision to meet families where they are at reflects a deep understanding of both the clinical and practical needs of this community. I’m thrilled to be part of that effort and to contribute to making high-quality neuropsychological care more accessible to families in this region.

Is there anything else you would like the NESCA community to know about you?

I’d love for the NESCA community to know that I’m deeply passionate about helping youth and families feel seen, understood, and supported every step of the way. I take a collaborative approach and aim to make the evaluation process not only informative, but also empowering, compassionate, and grounded in each child’s strengths.

Outside of clinical work, I am someone who values community, connection, and balance. I love being outdoors, spending time with family, and staying active—which helps keep me grounded and present in the work I do.

I’m truly honored to be joining the NESCA team, and I’m excited to grow alongside such an experienced and thoughtful group of professionals while contributing to the care of families in my own community.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Graphic with the words, "THE HIGH COST OF MISDIAGNOSIS" and a quote from Dr. Ann Helmus

When Neuropsychological Evaluations Fall Short: The High Cost of Misdiagnosis

By | NESCA Notes 2025

Graphic with the words, "THE HIGH COST OF MISDIAGNOSIS" and a quote from Dr. Ann HelmusBy Ann Helmus, Ph.D.
Founder & Director, NESCA

At NESCA, we often see students who have been through neuropsychological evaluations before—but whose needs remain unmet. Unfortunately, not all evaluations are created equal, and a poorly done assessment can have serious, lasting consequences for a child.

It’s important for parents to understand that test scores do not provide the answers; tests are tools that skilled evaluators use to evaluate hypotheses that arise from analyzing information provided by parents and teachers (e.g., the presenting concerns could be caused by ADHD, anxiety, or a poor teacher match). When an evaluator fails to carefully integrate the testing data with history and observations, the child’s underlying issues may not be accurately explained, and they are unlikely to receive the treatment or educational supports they truly need. Worse, they may be misdirected into interventions that are ineffective or even inappropriate. Time is lost. Money is wasted. And critically, the window for meaningful intervention begins to close.

Consider a recent case we saw at NESCA. A middle schooler had been diagnosed by an outside evaluator with Autism Spectrum Disorder (ASD) at a young age. More recently, she had another neuropsychological evaluation, again not at NESCA. The clinician didn’t question or reevaluate the ASD diagnosis and recommended placement in a specialized program for students with autism.

The problem? This student was not autistic.

She was more cognitively and socially advanced than her peers in the program and made little effective progress on her IEP goals.

Her parents knew that something was wrong and sought a reevaluation at NESCA. Our clinician doubted the diagnosis of ASD based on information provided by her parents and teachers. The results of NESCA’s comprehensive neuropsychological assessment clearly indicated that this student did not meet criteria for ASD. Rather, she was found to have a significant communication disorder, along with social anxiety, which is commonly seen in individuals with weak language skills.

Because these underlying challenges had not been identified, they had not been properly treated. By the time the student was reevaluated, she was already finishing middle school, and valuable years for remediation had been lost.

The differential diagnosis between autism, communication disorders, and anxiety can be complex. These conditions share many overlapping symptoms—difficulty with social interaction, trouble expressing oneself, rigid thinking patterns, emotional dysregulation—and it takes careful, thoughtful assessment to tease apart the diagnostic picture.

Too often, I read reports from outside of NESCA that show little analysis of the data: tests are administered, deficits are listed, and a diagnosis is selected without adequate integration of the child’s history, day-to-day functioning, and observed behavior. Neuropsychological testing is not a mechanical process or a checklist; it is a process of clinical reasoning based on experience, judgement, knowledge, and acumen.

When done properly, a neuropsychological evaluation can be life-changing. At NESCA, we take the power of this tool seriously and honor our commitment to parents to provide the high level of service that we would want for our own children. We train our clinicians to analyze test results in the full context of a child’s developmental history, real-world behavior, and educational trajectory. We make diagnoses carefully and intentionally, because we know that accurate identification is the first step toward effective support.

The NESCA Difference is in the level of training, support, and accountability that we provide for our clinicians. I am actively involved in training our neuropsychologists—reading and editing reports and providing guidance. We have two clinical directors who have been at NESCA for more than 15 years and are responsible for supporting clinicians in thinking through complex cases, reviewing reports, and honing recommendations. All NESCA clinicians participate in one to two case conferences each week for group discussion of complicated cases. All clinicians attend a weekly seminar or discussion group to learn about various evidence-based interventions and treatments, often from trusted professionals that we invite in to share their knowledge. Neuropsychologists who join the NESCA team are provided with at least six months of mentoring by a senior clinician on staff, regardless of how experienced they are when they are hired. As a result of these requirements, NESCA attracts intellectually curious professionals who want to continue to learn and develop skills as they progress in their careers. They are passionate about their work and take pride in the high quality of their evaluations, knowing that they are impacting the course of a child’s life.

 

About the Author

NESCA Founder and Director Ann Helmus, Ph.D., is a licensed clinical neuropsychologist who has beenAnn Helmus headshot practicing neuropsychology for 35 years and has been director of NESCA’s Neuropsychology practice for nearly three decades, continuously training and mentoring  neuropsychologists to meet the highest professional standards.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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