NESCA Notes 2025

By Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

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

Common Signs That a Neuropsychological Evaluation May Be Warranted

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

1. Developmental Delays

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

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

2. Behavioral Challenges

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

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

3. Attention and Focus Issues

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

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

4. Sensory Sensitivities

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

5. Regression in Skills

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

6. Medical Complexities

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

7. Family History

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

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

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

The Benefits of Neuropsychological Evaluations for Young Children

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

1. Early Detection and Intervention

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

2. Comprehensive Understanding, Guidance, and Coordinated Support

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

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

3. Tracking Progress

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

Embracing the Journey Towards Greater Understanding

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

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

About Dr. Madeline Manning

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

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

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