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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NESCA Notes 2025

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Image of student walking into middle school with a quote from Dr. Madeline Manning

Navigating the Transition from Elementary to Middle School with ADHD

By | NESCA Notes 2025

Image of student walking into middle school with a quote from Dr. Madeline ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

The transition from elementary to middle school is a significant developmental milestone, bringing new academic demands, shifting social dynamics, and greater expectations for independence. For students with attention-deficit/hyperactivity disorder (ADHD), who often experience executive function (EF) vulnerabilities, this period can be particularly challenging. Understanding and proactively addressing the academic, social-emotional, and behavioral needs of these students is essential to support their adaptation and long-term success.

Academic Demands and Executive Function

Middle school introduces a significantly more dynamic, fast-paced academic environment, characterized by multiple teachers, changing classrooms, and a heavier workload. Students must manage assignments from various instructors, each with different expectations and communication methods. This environment requires cognitive flexibility and other advanced EF skills, including organization, time management, task initiation, and prioritization. For students with ADHD, these demands can quickly overwhelm existing coping strategies, leading to forgotten assignments, missed deadlines, and difficulty transitioning between classes. This, in turn, can contribute to a reduced sense of self-efficacy as a learner.

Notably, many students have not yet been explicitly taught the EF skills needed for this new level of independence. Evidence shows that many students with ADHD require direct instruction, repetition, clear structure, frequent feedback, and opportunities to practice these skills in real contexts. Early identification of EF difficulties and targeted supports, such as executive function coaching, visual organizers, structured routines, and regular teacher check-ins, can ease the transition and build confidence (Giannakopoulos, 2025).

Social Dynamics and Emotional Development

Middle school is also marked by greater complexity in peer interactions. Friendships shift from more convenience-based connections, often formed through proximity and shared activities in elementary school, to deeper emotional bonds, and students face heightened peer pressure and the formation of social cliques. The onset of puberty, elevated emotional sensitivity, emerging interest in romantic relationships, and the influence of social media can further complicate peer dynamics during this developmental stage.

Students with ADHD are already at increased risk of experiencing challenges with impulse control, emotional regulation, and social problem-solving. The reduced adult scaffolding in middle school means students are expected to navigate social situations with more independence, which can be both empowering and challenging. Difficulties in these areas can negatively affect self-esteem and lead to anxiety or withdrawal.

Fostering resilience involves teaching prosocial coping strategies and promoting self-advocacy. This includes encouraging students to seek support from trusted adults when needed and to practice assertive communication skills. Guidance on managing peer pressure, conflict resolution strategies, and building and maintaining healthy friendships is critical for positive social development and emotional well-being in middle school and beyond.

The Adolescent Brain: Developmental Realities

During early adolescence, the brain undergoes significant changes. The prefrontal cortex (responsible for planning, decision-making, and self-control) is still maturing, while the limbic system (a complex set of brain structures governing emotions and reward systems) develops far earlier. This developmental mismatch means that adolescents are more likely to exhibit heightened emotional responses, increased impulsivity, and a greater sensitivity to rewards and peer influence, often before they have fully developed the cognitive skills necessary for effective self-regulation and long-term planning.

These neurodevelopmental factors mean that even typically developing students may struggle with EF tasks and social functioning during middle school. For those with ADHD, whose brains are already wired for greater difficulty with attention and self-regulation, the challenges can be far more pronounced.

Supporting Skill Development

To help students with ADHD navigate this transition, families and educators can collaborate to provide:

  • Explicit instruction in organizational and planning skills
  • Consistent routines and predictable expectations
  • Visual supports (e.g., checklists, planners)
  • Regular feedback and positive reinforcement
  • Opportunities for guided practice and reflection

These supports help students gradually build independence, resilience, and the executive function skills necessary to meet new demands.

A Critical Window for Evaluation and Intervention

The transition from elementary to middle school is a pivotal time to address concerns around academic, social-emotional, and/or behavioral functioning. A comprehensive neuropsychological evaluation can clarify your child’s unique strengths and challenges, guide targeted interventions, and support the development of formal education plans (e.g., IEPs or 504 Plans) to ensure they are receiving the services they require. Early identification and collaboration between home and school are essential for maintaining self-esteem, fostering self-efficacy, and ensuring access to appropriate supports.

If you have questions or concerns regarding your child’s transition to a new school, executive functioning, or any other aspect of their development, please contact NESCA for guidance. Comprehensive evaluation and targeted strategies can make a meaningful difference in your child’s educational journey and overall well-being.

 

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 and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 someone who could head in multiple directions; quote from Dr. Jessica Greene about where to start with recommendations from neuropsychological evaluations

What to Do with All the Recommendations?

By | NESCA Notes 2025

Image of someone who could head in multiple directions; quote from Dr. Jessica Greene about where to start with recommendations from neuropsychological evaluationsBy: Jessica Greene, Psy.D.
Postdoctoral Fellow, NESCA

Your child’s neuropsychological evaluation is complete, and your family now has a greater understanding of your child – and a long list of recommendations. After you review the list, it can feel as though every recommendation is the most important one. How do you know where to start? The steps outlined below are general guidance; your team may recommend a different timeline based on your child’s needs.

Prioritize

Recommendations are meant to provide a roadmap for the next two to three years. Step back and ask yourself, “What is most important for my child and for my family right now?” Choose one to two recommendations that make the most sense and gradually find ways to work them into your routine. Making intentional changes, at a reasonable pace, gives everyone time to adjust. Also, it is much easier to tell whether a strategy, intervention, or service is helping when you try one thing at a time.

Reflect

After you have tried the chosen recommendations for a reasonable amount of time, take a moment to consider your child’s progress. Day-to-day life can make growth easy to overlook, particularly when there are still other pressing needs. But, before returning to your list of recommendations, consider the changes that have occurred. Growth is not always linear, so perhaps your child has made growth in one area, but something new has presented itself. On the other hand, perhaps things have moved forward for the better and there is time to focus on recommendations that were less pressing.

Review

When ready, return to recommendations and consider what to implement next. Again, choose one or two items, so as not to overwhelm yourself or the family system.

Set Boundaries with Others (if needed)

Caregivers often tell me they feel flooded with opinions from everyone they know. While outside input can be helpful at times, it’s also okay to set boundaries. You might simply thank people for their advice and say you have a plan you intend to follow. That response acknowledges their concern without letting you get derailed.

Need Help Choosing a Next Step?

If you are unsure where to start or what to focus on next, reach out to a trusted provider that understands your child’s needs. That may be the NESCA neuropsychologist who completed the evaluation, an outside provider (occupational therapist, counselor, speech-language pathologist), your pediatrician, or a school contact (special education teacher or school counselor). They can help you plan next steps.

If you’d like more details about next steps and who to share the report with, see Dr. Maggie Rodriguez’s post, which outlines practical actions to take after a neuropsychological evaluation. Read her full article here: https://nesca-newton.com/navigating-life-after-a-neuropsychological-evaluation-what-comes-next/.

 

About the Author

Dr. Jessica Greene is a licensed clinical psychologist who has worked After working with Dr. Angela Currie in NESCA’s Londonderry, N.H. office from 2023-2024 as a practicum student, Dr. Jessica Greene re-joins NESCA to complete her postdoctoral fellowship in pediatric neuropsychological assessment. Dr. Greene has a particular interest in understanding clients’ strengths as well as differences, integrating a therapeutic assessment approach, when appropriate.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 road sign with College ahead on it portraying the topic of the blog about college planning with ADHD

College Planning for Families of Students with ADHD

By | NESCA Notes 2025

Image of a road sign with College ahead on it portraying the topic of the blog about college planning with ADHDBy: Julie Weieneth, Ph.D.
Pediatric Neuropsychologist, NESCA

The transition from high school to college brings stress for most families. As a parent of a high school junior, I am currently helping my teen juggle schoolwork, extracurriculars, and all the “must-do’s” for college planning. At times, it feels very overwhelming for me, so I can only imagine how it feels for my daughter. As a neuropsychologist, I often reflect on how neurodiversity, especially ADHD, shapes this journey.

Over the years, I have worked with many bright students with ADHD who have successfully navigated the college planning process. These teens bring unique strengths to the table. When families are able to recognize these strengths, support ongoing areas of need, and seek professional guidance as needed, college planning can become a process of growth for both teens and their parents.

ADHD Strengths in College Planning

  • Creativity and Problem-Solving: Many students with ADHD naturally think outside the box. They approach challenges from fresh angles, which can help them identify colleges, majors, or support services that might otherwise be overlooked. Their creative solutions can make the search process more dynamic and tailored to their needs.
  • Energy and Enthusiasm: Students with ADHD often bring a high level of energy and excitement to new experiences. This enthusiasm motivates them to explore a wide range of colleges, participate in campus tours, and engage with student groups. Their passion can help them stand out in interviews and application essays.
  • Hyperfocus on Interests: While ADHD is often associated with distractibility, many students experience periods of intense focus, especially on topics that truly interest them. This hyperfocus can be a tremendous advantage when researching colleges, preparing application materials, or delving into extracurricular opportunities that align with their passions.
  • Resilience and Adaptability: Navigating the ups and downs of ADHD often builds resilience. Many students learn to adapt quickly, bounce back from setbacks, and persist in the face of challenges. These qualities are invaluable during the college search and application process, which can involve rejection, waitlists, or unexpected changes.

How Parents Can Help

Parents play a key role in supporting their teens’ transition to college. Here are some practical steps:

  • Foster Self-Advocacy: Encourage your teen to understand their needs and practice asking for help. Role-play conversations about accommodations and celebrate their efforts.
  • Find the Right Fit: Focus on colleges that match your teen’s needs, not just prestige. Visit campuses, meet with disability services, and consider factors like class size and available supports.
  • Secure Accommodations: Keep neuropsychological testing up to date, as colleges require documentation. Encourage early use of academic supports and check in regularly.
  • Build Executive Function Skills: Practice time management and organization before college. Gradually let your teen take the lead and consider executive function coaching if needed.
  • Plan for Medication and Health: Help your teen set up prescription management and health routines. Practice independence with gentle reminders.
  • Support Social and Emotional Well-being: Encourage involvement in clubs and normalize seeking help from campus resources. Keep long-term supports in place, and encourage booster sessions with therapists, executive function and real-life skills coaches, tutors, during breaks or through virtual sessions as needed.

Also, it is important to remember to care for yourself! This transition is significant for parents, too. Seek support for yourself as needed.

At NESCA, in addition to neuropsychological evaluations, we offer consultations and executive function and real-life skills coaching. Please feel free to reach out to us if we can help you and your child navigate this process.

 

About the AuthorJulie Weineth headshot

Dr. Weieneth is a licensed clinical psychologist who has worked with children and families with complex diagnostic and treatment needs for the last twenty years. Her areas of specialty include ADHD, autism spectrum disorders, anxiety, mood disorders, learning disabilities, executive functioning, and school-related challenges. That being said, Dr. Weieneth also understands that not all individuals fit cleanly into diagnostic groups or labels. Her goals for each evaluation are to help families feel comfortable with the process, use all the tools available to best understand each individual’s unique strengths and needs, and to write a clear and comprehensive report that will guide educational and treatment planning.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 person's brain with gears working in sync, representing Executive functioning

Executive Functioning: What is it and how do we address weaknesses?

By | NESCA Notes 2025

Image of a person's brain with gears working in sync, representing Executive functioningBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Although the concept of executive functioning has existed since the 19th century, it began to gain significant attention in the fields of psychology, education, and neuroscience in the late 1990s and early 2000s. Executive functioning can be thought of as the brain’s “management system.” It enables us to plan ahead, stay organized, remember important information, initiate tasks, control impulses, adapt to changes, and manage our emotions. These skills help us get started on homework or chores, remember what we need to buy at the store, keep track of our schedules, stay calm when upset, switch gears when plans change, and finish tasks without getting distracted. When executive functioning skills are strong, individuals are able to juggle responsibilities, solve problems, and cope effectively with everyday challenges.

Executive functioning difficulties can arise from a variety of causes. Neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, and learning disabilities frequently involve challenges with executive skills. Neurological conditions – including brain injury or stroke, particularly those affecting the frontal lobes – can impair executive functioning. Mental health disorders such as depression, anxiety, bipolar disorder, and schizophrenia may also impact these skills, making it harder to plan, organize, or regulate emotions. Environmental factors, including chronic stress, lack of sleep, poor nutrition, or substance use (alcohol or drugs), can temporarily or permanently weaken executive functioning. Additionally, some individuals may have a genetic predisposition to weaker executive functioning, and developmental delays due to prematurity, or early childhood adversity can further contribute to difficulties in these areas.

Fortunately, executive functioning weaknesses can be improved through targeted interventions. Direct interventions may include cognitive-behavioral therapy to enhance skills such as self-regulation, cognitive flexibility, and self-monitoring. Executive function coaching can also be beneficial, focusing on skills like planning, organization, and time management by identifying barriers and providing practical strategies for implementation.

In addition to direct intervention, accommodations can be provided to help individuals compensate for areas of challenge. Accommodations should be matched to an individual’s specific executive functioning weaknesses. Below are examples of accommodations for specific areas of challenge. This is not meant to be an exhaustive list, but rather to provide examples of the types of accommodations that may be recommended depending on an individual’s specific profile.

Planning & Organization

  • Use a paper planner, wall calendar, or smartphone app to record assignments, appointments, and deadlines. Review these tools daily to clearly see what needs to be done and when.
  • Divide complex assignments or larger projects into smaller, more manageable tasks, and set individual deadlines for each one. This approach will make the overall project less overwhelming and easier to tackle.
  • Use visual tools such as graphic organizers, outlines, or flow charts to organize ideas and information before beginning an assignment or task.
  • Use folders, color-coding, and binders to organize physical belongings. Use trial and error to identify what works best and take time every day to maintain organizational systems (i.e., put it away before it piles up and feels overwhelming).

Working Memory (the brain’s “scratch pad” where we hold and manipulate information)

  • Use detailed checklists for tasks that require memory of several steps to reduce the burden on working memory. Check off each step when completed. Apply this strategy to recurring tasks, such as morning or bedtime routines, but also schoolwork or chores that have multiple steps or components.
  • Give the individual verbal instructions more than once and ask them to repeat the instructions back to ensure they understand what needs to be done. Instructions should be provided in in small chunks, rather than all at once, so the individual can focus on one step before moving to the next.
  • Permit individuals to use audio recorders or AI technology to capture information during lectures or meetings, so they can replay and review content as needed.

Task Initiation

  • Define the first action required for a task, such as “open your book to page 10,” so it is clear exactly how to begin.
  • Sentence starters or example problems can be helpful in clarifying task expectations, and, in turn, improving task initiation.
  • Establish regular routines and schedules, such as starting homework at the same time each day, to make it easier to get started on tasks.

Inhibition (Impulse Control)

  • Have a teacher, supervisor, or caregiver nearby to provide quick feedback or reminders when impulsive behaviors occur.
  • Provide items like fidget spinners, putty, or doodling pads to give individuals a safe way to channel their energy and reduce impulsive actions. Allow individuals to take short movement breaks to help manage restlessness or impulsivity.
  • Provide praise or rewards when individuals demonstrate restraint or appropriate behavior, encouraging them to continue using impulse control strategies.

Cognitive Flexibility

  • Inform individuals ahead of time about changes in plans or schedules so they can mentally prepare and reduce stress. Give warnings ahead of transitions (e.g., “You have five minutes to finish up that essay) to assist in the transition from one activity to the next, particularly when shifting from a preferred to non-preferred task.
  • Using written or visual stories that describe upcoming events and expected behaviors will help individuals anticipate and cope with new experiences.
  • Teachers or supervisors should preview any partner and group work ahead of time, including carefully outlining roles and expectations.

Emotional Regulation

  • Offer designated quiet areas or allow breaks for individuals to calm down when feeling overwhelmed or upset.
  • Use charts, cards, or other visual tools to help individuals recognize and communicate their emotions.
  • Allow individuals a few minutes to reflect or calm down after an emotional incident before discussing their behavior or asking them to resume work or activities.

Self-Monitoring

  • Provide tools that allow individuals to evaluate their own work against specific criteria and track their progress over time. For example, an editing checklist for a writing assignment should include specifics such as a review of content, spelling, punctuation/capitalization, and grammar/run-ons. This would help shift the vague task of “check your work” into a more actionable task with greater success of being beneficial.
  • Schedule frequent reviews and provide constructive feedback to help individuals stay on track and make adjustments as needed.
  • Allow individuals extra time to double-check their work for errors or improvements before turning it in or finishing a task.

This vast network of skills, collectively referred to as executive functioning, plays a critical role in an individual’s ability to function in daily life. Comprehensive neuropsychological evaluations can provide valuable insight into specific areas of weakness and how they impact an individual’s functioning. This understanding allows for tailored, targeted recommendations that are more likely to be effective than implementing broad, non-specific executive functioning supports.

If your child or student can benefit from executive function coaching, complete NESCA’s online inquiry/intake form to receive additional information or book sessions.

 

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 related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 depicting a student growing, developing, and changing over time

Why Follow-up Matters

By | NESCA Notes 2025

Graphic depicting a student growing, developing, and changing over timeBy: Erin Gibbons, Ph.D. 
NESCA MA Clinical Director; Pediatric Neuropsychologist

When a child undergoes a neuropsychological evaluation, families often breathe a sigh of relief – finally, there are answers to questions about learning, behavior, or development. But neuropsychological assessment isn’t a “one-and-done” process. Children’s brains are constantly growing, and their needs change as they move through school and life. That’s why follow-up evaluations are a crucial part of a family’s journey.

Why Is Follow-up Important?

  1. Children Change! Unlike adults, children’s brains are still developing. Skills like attention, memory, and executive function can improve or shift dramatically as kids mature. A child who struggles with reading in first grade may have different needs by fourth grade. Follow-up helps ensure recommendations stay relevant.
  2. Medical and Neurodevelopmental Conditions Evolve Developmental disabilities such as ADHD or autism may impact a child differently as they age. Some challenges become less pronounced, while others may surface later. Regular assessment helps families and providers spot these changes early and tailor services accordingly.
  3. School Demands Increase As children progress through school, academic and social expectations rise. What worked in elementary school may not be enough in middle or high school. Follow-up assessments help tailor services to new environments and demands.
  4. Interventions Need Adjustment Therapies, accommodations, and strategies should be reviewed periodically. Follow-up evaluations provide data to refine interventions, ensuring they are effective and appropriate.

What Does a Follow-up Look Like?

  • Consult Sometimes a short check-in is enough. A clinician can review recent progress reports, meet with families, and ensure that things are on the right track.
  • Academic Re-evaluation For some students, academic progress is the primary concern, whereas other areas (e.g., social skills, motor skills, emotional self-regulation) are less concerning. To ensure that your child is making appropriate academic gains, an academic re-evaluation can be critical. These are typically scheduled 6-12 months after interventions have been initiated.
  • Full Re-evaluation A complete re-evaluation might be necessary in order to monitor progress across domains and evaluate the effectiveness of current treatment. Schools must evaluate students with IEPs every 3 years. Many families use a similar timeline for independent evaluations.

The Takeaway

A quality neuropsychological evaluation is about more than a single snapshot in time. There needs to be a process of understanding, supporting, and celebrating each child’s unique journey. Follow-up evaluations empower families and professionals to provide the right help, at the right time, so children can thrive.

 

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. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Hingham, and Plainville, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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Student struggling over homework

When Capable Children Struggle

By | NESCA Notes 2025

Student struggling over homeworkBy Leah Weinberg, Ph.D. 
Pediatric Neuropsychologist, NESCA

Understanding the Gap Between Intelligence and Performance

“I know my child is smart.” This is something parents sometimes say to me with both confidence and confusion.

During intake meetings, parents describe their children to me as being able to grasp complex ideas, ask thoughtful questions, and often seem to understand more than their schoolwork shows. Yet school feels harder than it should. Assignments take too long, work is inconsistent, focus slips under pressure, and emotions rise quickly when tasks become demanding.

Over time, a gap becomes visible where intelligence is clear, but performance does not consistently reflect it. Understanding that gap requires looking beyond intelligence alone.

Intelligence Is Only Part of the Picture

Intelligence reflects the ability to reason, understand concepts, and make connections. It is an important foundation.

Performance reflects how intelligence interacts with other essential skills, such as attention, language, memory, organization, emotional control, and follow-through. When one or more of these areas is strained, a child may know the material yet struggle to show it consistently.

Sometimes attention drifts. Sometimes reading or writing requires more effort than it appears. Sometimes instructions are harder to hold in mind. Sometimes frustration rises quickly when work feels open-ended. Often, it is not one issue. It is the interaction among several of these areas.

Intelligence and performance are not the same thing.

Why It Often Becomes More Noticeable Over Time

In the early years, structure is built in, tasks are shorter, and teachers provide frequent guidance. As children grow older, expectations shift, and assignments become longer and less structured. Organization is assumed, and independence is expected. As demands increase, underlying vulnerabilities become harder to compensate for. The child’s intelligence has not changed, but the demands have.

What Happens When Demands Rise

Academic tasks require coordination. A child must sustain attention, organize ideas, remember instructions, manage frustration, and monitor accuracy – often at the same time. When any part of that system is stretched, patterns shift, work slows down, mistakes increase, focus drops, frustration intensifies, and often voidance or shutdown follows.

These reactions are not signs of limited ability; they are often signs that demands are exceeding capacity in one or more areas. That distinction matters. It shifts the question from “Why aren’t they trying?” to “What is making this harder right now?”

When Structure Helps…and When It Doesn’t

Some children appear steady in structured settings but struggle during independent work. External support can temporarily reduce strain. But when that support is reduced, inconsistencies become more visible. Without context, this can feel confusing; however, with a broader understanding, it often makes sense.

A Broader View

Looking only at intelligence can leave the picture incomplete. Considering how intelligence interacts with attention, learning processes, language, emotional patterns, and self-management brings greater clarity. Children and students are not simply performing or underperforming. Instead, they are navigating a complex interaction of strengths and vulnerabilities within changing demands. Understanding that interaction allows parents and educators to respond with greater clarity and thoughtfulness.

My Approach

In my work with children, teens, and families, I focus on integration. I consider how different aspects of a child’s profile – from cognitive strengths to patterns of attention and emotional response – all come together within the real demands of school and daily life.

My goal is not to simplify difficulty to a single cause, but to clarify patterns. When these interactions are understood, conversations shift. Blame decreases, and direction becomes clearer.

Clarity does not eliminate challenges. It does, however, replace confusion with understanding, which helps adults respond in ways that are steadier, more precise, and better aligned with their child or student.

 

About the Author

Dr. Weinberg specializes in the assessment of school-aged children and adolescents with a wide range of concerns including development disorders, such as autism spectrum disorder, learning disabilities (e.g. dyslexia, dysgraphia), language-based learning difficulties, AttentionHeadshot of Leah Weinberg, Ph.D. Deficit Hyperactivity Disorder (ADHD), Nonverbal Learning Disability (NVLD), and executive functioning disorders (e.g. slow processing speed). She also has experience in working with individuals with psychiatric difficulties, such as anxiety, mood disorders (e.g. depression), and behavioral disorders. Dr. Weinberg has expertise in working with children with complex profiles or multiple areas of strength and weakness that cannot be encapsulated by a single diagnosis. Dr. Weinberg is passionate about helping families better understand their child’s neuropsychological profile and the impact it may be having on their behavior or functioning in order to best support them in all areas of their life.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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Child saying no

Understanding the Pathological Demand Avoidance (PDA) Conversation

By | NESCA Notes 2025

Child saying noBy: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

Pathological Demand Avoidance (PDA) is a term that has sparked both interest and debate within the autism community and among professionals. While some families and clinicians find the concept meaningful, it remains a debated and not formally recognized profile within current diagnostic frameworks.

First described by British psychologist Elisabeth Newson in the 1980s and formally introduced in a 2003 research paper, PDA was proposed as a way to identify a group of children who did not fit the prevailing definitions of autism at that time. Instead, these children shared a key characteristic: a persistent and marked resistance to everyday demands. Since then, researchers and clinicians have suggested variations to this list, but the core descriptions have remained largely consistent.

The most commonly cited core features of PDA include:

  • Resisting and avoiding the ordinary demands of life: This resistance is continual and can be seen in daily routines, requests, or expectations.
  • Using social strategies (e.g., excuses or negotiation) as forms of resistance to avoid demands.

Other proposed characteristics include:

  • Appearing sociable, but experiencing differences in social understanding (such as recognizing social and family hierarchies);
  • Experiencing intense mood swings and impulsivity;
  • Appearing comfortable in role play; and
  • Displaying dedicated and focused interests, often centered on other people.

It’s important to note that historically, descriptions of PDA have used language associated with the “deficit model” of autism vs. a strengths-based perspective. Many now consider such language outdated and prefer terminology that recognizes the diversity of neurodevelopmental profiles without pathologizing difference.

While demand avoidance, especially when accompanied by social strategies, is widely recognized as a characteristic observed in some individuals, research has not yet provided strong evidence for the full group of traits proposed for PDA. Because of the current lack of research, PDA is not recognized as a clinical diagnosis in major U.S. or international medical manuals, such as the ICD or DSM. Although PDA is not a formal diagnosis recognized by the DSM, some individuals receive a diagnosis of autism with a “demand avoidant profile” or even a “PDA profile” noted. Others may self-identify with the PDA label and as a “PDAer.” There is also discussion about the terminology itself, with some objecting to the word “pathological,” preferring alternatives like “Persistent Drive for Autonomy.”

At NESCA, we focus less on labels and more on understanding the underlying drivers of a child’s behavior, such as anxiety, cognitive flexibility, sensory sensitivities, and social-emotional development,so that supports and recommendations can be individualized and clinically grounded, regardless of the terminology used.

As understanding of neurodevelopmental differences grows, so, too, does the conversation around PDA. For now, it remains a descriptive profile rather than a formal diagnosis, but one that resonates with many individuals and families. Continued research and open dialogue are essential to better understand the experiences of this population and to ensure that support and language reflect their needs and perspectives.

 

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents,Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

 

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

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the Coral Gables, Florida, 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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High school student image who is struggling with the overwhelm of school pressures

When High School Feels Overwhelming: How Neuropsychology Can Help Students Thrive

By | NESCA Notes 2025

High school student image who is struggling with the overwhelm of school pressuresBy: Moira Creedon, Ph.D. 
NESCA Hingham Director & Pediatric Neuropsychologist

I frequently meet high school students and families who are feeling the weight of academic expectations, especially at this point in the school year. Maybe your child recently finished midterms and the results weren’t what you hoped for. Maybe the daily stress of managing coursework of AP classes, standardized test preparation, extracurriculars, and college research feels like too much. The pressure to keep up can buckle even a strong student, and small vulnerabilities can suddenly be amplified in this context. If this sounds familiar, there are steps to take to support the daily midwinter stress.

Why Are So Many Students Struggling?

The challenges of high school are not limited to academics alone. It is a time of rapid growth in physical size, independence, academic demands, social environment, and emotional development. For some students, it is a time to shine with increased independence and responsibility. For others, the demands quickly exceed their skill set. The minor organizational and study challenges of middle school are amplified with more content and the burden to juggle simultaneous demands. Put simply, the executive functioning system gets put to the test in high school. These struggles do not mean you have a student who is not capable or intelligent. It may mean they need support for their unique learning profile.

What are Some Warning Signs of the Mid-year Slump?

Warning signs can include trouble keeping track of deadlines or assignments. It can be studying for hours for a test with a lackluster performance that doesn’t match the effort. It can come in the form of increased procrastination, trouble finishing tasks, and poor follow-through. It can also come in the form of increased fatigue, a sense of “burn out,” anxiety, or overall perception of stress. For some students, it can feel like their plate is too full but without a great plan for how to prioritize to make life manageable.

What Can Help?

  1. Consider a Neuropsychological Evaluation

A neuropsychological evaluation is a comprehensive assessment that looks at how a student learns with an eye toward their unique pattern of strengths and weaknesses. A neuropsychological examination can help clarify a diagnosis or diagnoses (ADHD, anxiety, or a learning disability, to name a few), but it can also provide a detailed understanding of the overall process of learning. Bright students who feel overloaded can learn valuable information about their approach to learning so they can figure out how to study smarter, not longer. These evaluations can also include tailored recommendations for how to approach the stress, with suggestions for where and how to seek the appropriate help.

  1. Explore Executive Functioning Coaching

Executive functioning coaches work with students to develop practical strategies for organization, time management, and study skills. Unlike a tutor in a specific subject domain, executive functioning coaches work across subject areas. Coaching sessions are individualized and can help students learn how to break down large assignments, create effective study schedules, prioritize tasks, and manage distractions. In addition to improvement in your academic performance, coaching can help students build independence and confidence.

  1. Seek Support at School

Start with your academic advisor, adjustment counselor, or favorite teacher. Let them know your student is struggling to manage all the demands of their academic life. Many students pursue learning supports or accommodations at school via special education. Your school will need to review evaluations to determine if your child qualifies for a 504 Plan or Individualized Education Program (IEP) as these formalized supports require a diagnosis of a disability. Outside of these more formal support avenues, many schools offer peer tutoring or after-school homework support. Your student does not have to hide their struggles from their teachers!

  1. Take Care of Yourself

With all of the growth in high school, it is important to remember to prioritize emotional health. Your academic success cannot last if it comes at the expense of your mental health. I encourage students to prioritize the basics – to get enough sleep, eat nutritious foods, exercise or move daily, and leave time for fun. If you sit down to create a calendar or task list with your child, keep these items on the list. A rested and restored brain is far more effective at learning.

We Can All Be in This Together

It is normal for your teen to feel a little overwhelmed at times in high school. Instead of viewing this as an opportunity for panic, let’s see it as an opportunity for growth. It does not have to be a journey you and your child take alone. With the right supports, your high schooler can manage their workload, develop more effective study habits, and build resilience to handle future stress. Neuropsychologists at NESCA are happy to support you in this journey through evaluations, consultation, and to connect you to executive functioning and school resources.

 

About the Author

Dr. Creedon offers her expertise in evaluating children and teens with a variety of presenting issues. SheMoira Creedon headshot is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. She tailors each assessment to address a range of referral questions, such as developmental disabilities, including Autism Spectrum Disorder, learning disabilities, attention challenges, executive functioning deficits, and social-emotional struggles. She also evaluates college-/grad school-age/adult individuals with developmental issues, such as ASD and ADHD, particularly when there is a diagnostic clarity or accommodation question.

 

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

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 student being testing in school

When School-based Testing Is Not Enough

By | NESCA Notes 2024, NESCA Notes 2025

Image of a student being testing in schoolBy: Sean Hyde O’Brien, Psy.D., ABPdN 
Pediatric Neuropsychologist, NESCA

Often when a child is struggling at school — whether related to academic, behavioral, or social-emotional functioning — they may be referred for testing by a member of their educational team (often at the parents’ request). Such testing can include psychological, educational, speech-language, occupational, and physical therapy assessments conducted by qualified school personnel, as well as more specialized transition, functional/adaptive behavioral, and autism-related assessments. These evaluations are generally conducted to determine a student’s eligibility for special education services, identify appropriate supports, and establish goals to monitor progress.

In many cases, school-based testing is sufficient to meet the needs of the student and family by facilitating access to services and supports. However, there are situations in which school-based testing may not be sufficient on its own:

Need for a Clinical Diagnosis
School evaluations are designed to determine eligibility for special education services under educational categories (e.g., “Health Impairment,” “Specific Learning Disability,” or “Sensory Impairment”), rather than to establish diagnoses for medical or treatment purposes. When a formal diagnosis is needed to guide treatment, medication decisions, or access to private insurance-based services, a neuropsychological evaluation may be necessary.

Complex or Co-occurring Issues
Neuropsychological evaluations are designed to integrate information across multiple domains, offering a more comprehensive understanding of the student as a whole.

Disagreement with School Findings
If parents have concerns about the conclusions or recommendations from a school evaluation, they may pursue an Independent Educational Evaluation (IEE) or seek private testing with a neuropsychologist to obtain an additional perspective.

Evaluation of Non-academic Concerns
Concerns such as anxiety, depression, trauma, or family stressors — which can significantly affect learning — may fall outside the primary scope of school-based testing and may be more fully explored through a comprehensive neuropsychological evaluation.

Legal or Eligibility Requirements
Certain services, accommodations, or agencies (such as Social Security Disability benefits, specific therapies, or independent schools) may require documentation or diagnoses from a licensed clinical provider. Neuropsychologists are licensed psychologists with specialized doctoral and post-doctoral training in brain-behavior relationships who can provide this type of documentation when needed.

In summary, school-based testing is often a valuable and important first step in understanding a child’s needs within the educational setting. In some cases, however, a comprehensive neuropsychological evaluation can provide additional insight into a student’s profile as well as medical documentation needed to access a variety of services.

 

About the Author

Dr. Sean O’Brien has been providing comprehensive neuropsychological evaluations in the GreaterSean Hyde O'Brien Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as  Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To schedule an appointment with one of NESCA’s neuropsychologists, 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 Coral Gables, Florida, 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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Unbiased Does Not Mean Uninformed

By | NESCA Notes 2025

By Angela Currie, Ph.D.

NH Clinical and Operational Director; Pediatric Neuropsychologist; PSYPACT-authorized

Families often come to NESCA after a long journey through previous evaluations, diagnoses, and educational plans, sometimes feeling frustrated or misunderstood. When seeking a new neuropsychological evaluation, it is common for parents to hope for a “clean slate.” Understandably, some request that we not review prior reports, IEPs, or teacher input, worrying that this information will bias our perspective or simply repeat what’s been said before.

This desire for objectivity is completely valid. If you disagreed with a previous diagnosis or felt that earlier testing missed the mark, it’s natural to want the new evaluator to approach your child or teen without any preconceived notions. However, it is important to understand that unbiased does not mean uninformed¸ and, in fact, review of previous documents and school input is a critical component of a fresh perspective and comprehensive evaluation.

Why Background Information Matters

A comprehensive neuropsychological evaluation is much more than a set of test scores – it is a synthesis of data, history, observation, and context. Reviewing previous reports, IEPs, and teacher feedback is not about accepting others’ conclusions at face value. Rather, it allows the evaluator to:

  • Understand the full picture: Seeing how strengths and challenges evolve over time helps identify patterns, progress, and trajectories, rather than isolated moments in time.
  • Spot gaps and inconsistencies: Previous testing may have missed key areas of possible concern or used measures that just scratch the surface. Knowing what was done helps the evaluator focus on what still needs to be explored.
  • Avoid unnecessary repetition: There are many measures that should not be repeated within a given timeframe, so it is important to know what to avoid. Knowing recent scores also allows the evaluator to avoid unnecessary redundancy and dig deeper into other skills.
  • Clarify and explain differences: If a previous diagnosis or past recommendations are not supported, the evaluator can integrate previous information into a bigger picture explanation for why a shift in perspective is supported.
  • Address discrepancies in presentation across settings: Often times disagreements between families and schools can result from the fact that children and teens may present differently across settings. Integrating teacher input is critical for determining if concerns are consistent across settings or if the client is working hard to compensate and “look good.”
  • Support IEP development and special education due process: Evaluations that lack integration of school records and input are much more likely to be rejected by the IEP team, as they do not provide a complete picture of the child’s functioning. They are also more likely to be viewed as lacking in credibility should the family proceed with special education due process.

Building Trust Through Transparency

Our role as neuropsychologists is to provide an assessment that is both thorough and fair. We approach each client with fresh eyes, critically evaluating all available information. Reviewing past reports allows us to be confident in our conclusions and build on what is already known. This allows for greater clarity and better advocacy for the client’s unique needs. By blending past information with new observations and data, we can provide the most accurate, insightful, and actionable recommendations possible.

If you have questions about how background information is used in our evaluations, please reach out. At NESCA, we believe that true objectivity comes from being informed and that every client deserves an evaluation that tells their whole story.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed. She also evaluates adults for concerns regarding ASD and ADHD.

 

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

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; greater Burlington, Vermont, and Coral Gables, Florida, 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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