NESCA Notes 2022

Summer Reading Ideas

By | NESCA Notes 2022 | No Comments

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Research demonstrates that children lose reading skills over the summer break. A 2020 study found that students in 3rd to 5th grades lost, on average, about 20 percent of their school-year gains in reading during the summer. So, how do we encourage a reluctant reader to read during the summer? There are several fun opportunities that allow your child to read a book of their choice and earn prizes at the same time!

For example: Scholastic Books offers a program that encourages children to “read books and stories; attend author events; interact with their favorite characters; play book-based games and activities; join dance parties; and more!” Children can read any book of their choice. They can also download and print a report of their reading progress. Additionally, by keeping Reading Streaks™, your child will help unlock a donation of 100,000 books from Scholastic to Save the Children, providing books to children in rural America with limited or no access to books.

Bookworm Wednesdays | Showcase Cinemas According to their website, Bookworm Wednesdays is “A fun and rewarding summer reading program developed to encourage young children to read during the summer months.” Bookworm Wednesdays allows children to earn free movie admission to a select children’s film when they present a book report at a participating Cinema de Lux, Showcase, or Multiplex Cinemas box office. There are several local participating sites, including Patriot Place and Legacy Place. (Parents, as well as children under the age of 6, receive free admission and do not need to submit a book report). This is an opportunity for your child to earn free books! Your child can read any 8 books and complete the reading journal available at the Barnes & Noble website. Then your child brings the completed reading journal to any participating Barnes & Noble bookstore and chooses their free book from the books listed on the Reading Journal list (see the website for the list of titles available to choose from this summer). Free reward books must be collected from a local Barnes & Noble store during July and August.

Finally, check out your local library for programs! Most local libraries have reading incentive programs that children can participate in all summer long.

Other ideas include…

  • Have your child read a book that has been made into a movie (If the book is above their reading level, read the book to them or allow them to listen to the book as an audio recording). Once the child has completed their reading, enjoy a family movie night with popcorn and more.
  • Have your child read about a specific topic or place and then plan a field trip. For example, an older student could read “Little Women” and then visit Louisa May Alcott’s house in Concord, MA, or watch the 2019 version of the movie and then visit Lyman Estate in Waltham where some of the filming took place!
  • Allow your child to pick their own books. Allow them to choose from subjects of interest to them (parent-approved, of course), as they are more likely to read something they picked! Also, allow them to choose books from different book types (e.g., paperback, graphic novel, audiobooks).
  • If you are going on a family vacation, encourage your child to read books about the area (fact or fiction) and plan to visit some of the places mentioned in the book. Day trips are also encouraged. Your child could read a book about animals and then visit a local zoo or aquarium.

If you are unsure of which books are at your child’s reading level, many libraries break down books by grade level. Ultimately, summer reading should not be so easy that it is boring, but it also should not be too difficult, as that can cause frustration. Allowing children to pick out books at their independent reading level is best. Research has found that children read more and learn best when they are allowed to select the books they read.

Happy Summer Reading!


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.

What Is Projective Testing and Why Might My Child Need It?

By | NESCA Notes 2022

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

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

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

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

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

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

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


About the Author

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


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


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

How Do I Know If My Child Needs Early Intervention?

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

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

The Centers for Disease Control and Prevention is a great resource to utilize as reference for what is expected of children by age. You can access more information here: or through their developmental milestone checklist.

What are age-appropriate milestones?

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

6 months:

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

9 months:

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

1 year:

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

18 months:

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

2 years:

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

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

What is EI?

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

Who qualifies for EI?

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

At the end of the day, you know your child best. If you have concerns, reach out to their pediatrician. You can also reach out to a local EI provider on your own. In MA: In NH:


About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including 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.​


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. Miranda Milana, please complete our Intake Form today. For more information about NESCA, please email or call 617-658-9800.


So, You Are Taking a Leave of Absence from College—Now What?

By | NESCA Notes 2022

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

Almost 75% of college students reported moderate to severe psychological distress during the 2020-2021 school year (National College Health Assessment, American College Health Association, 2021). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. In the weeks leading up to Thanksgiving, my appointment calendar consisted primarily of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.


About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.


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, call 617-658-9800 or complete our online Intake Form.

Technology to Relieve Holiday Stress – Really?

By | NESCA Notes 2022

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


About the Author

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

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


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.


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.


Low Motivation-based Procrastination: Tips for getting over the hurdle

By | NESCA Notes 2022

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


About Lyndsay Wood, OTD, OTR/L

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


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

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

Paying Proper Attention to Inattention

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

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

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

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


About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.


To book a consultation with Dr. Rodriguez 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.

Receiving, Understanding, and Sharing Diagnostic Labels and Profiles

By | NESCA Notes 2022

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

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

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

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

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

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


About the Author

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.


The SLP’s Role in Written Language Disorders

By | NESCA Notes 2022

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

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

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

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

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

Reading: Pre-reading Skills

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

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

Reading: Language Comprehension

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

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

Writing: Organization/Planning

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

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


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

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

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



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

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

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


About the Author

Olivia Rogers received her Master of Arts in Speech-Language Pathology from the University of Maine, after graduating with a Bachelor of Arts in Communication Sciences and Disorders and concentrations in Childhood Development and Disability Studies.

Ms. Rogers has experience working both in the pediatric clinic setting as well as in public schools, evaluating and treating children 2-18 years of age presenting with a wide range of diagnoses (e.g., language delays and disorders, speech sound disorders, childhood apraxia of speech, autism spectrum disorder, social communication disorder, and Down syndrome). Ms. Rogers enjoys making sure therapy is fun and tailored to each client’s interests.

In her free time, she enjoys listening to podcasts and spending times with friends and families.


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 Olivia Rogers, please complete our Intake Form today. For more information about NESCA, please email or call 617-658-9800.


A Halloween for Everyone

By | NESCA Notes 2022

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

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

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

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

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

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

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


About the Author

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