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NESCA Notes 2026

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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 2026 | No Comments

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 a reward chart and quote from NESCA

“I’ve tried a sticker/reward chart, and it does not work!” – Strategies to Make Incentive Plans Actually Work

By | NESCA Notes 2026

Image of a reward chart and quote from NESCABy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Behind the simple sticker chart or reward chart is decades of solid science. Psychologists and brain researchers have found that these charts work because they tap into how the human brain naturally learns and stays motivated. When a child gets a sticker or a point towards a reward immediately after doing a good job, their brain releases a tiny splash of dopamine, the “feel-good” chemical that helps us focus and feel successful. Decades of research, especially with kids who have ADHD, shows that rewards make boring or difficult tasks feel achievable. By focusing on positive rewards rather than nagging or punishment, these charts help shape behavior through slowly motivating changes which become habits or routines.

Incentive charts are highly versatile tools. While most commonly associated with young children, they are effective for anyone, including elementary-aged students and teenagers, who need help changing behaviors, building new habits, or staying motivated.

Despite these benefits, many parents I work with share the same frustration: “I’ve tried a sticker/reward chart, and it just didn’t work.”

When I dig a little deeper, I usually find that the incentive system wasn’t set up in a way that allowed the child, and the family, to succeed. I provide the following guidance to make their incentive plans more effective:

  1. Pick Your Battles: Focus on just 2 to 3 goals at a time (or even just one for very young kids). Ask yourself: What is the most pressing behavior change we need right now? Is it brushing teeth without an argument? Getting out the door on time for school? Stopping hitting or food-throwing? Trying to change too many things at once is a major reason why these charts fail. Think of it like New Year’s resolutions: when we try to overhaul our diet, go to sleep early, start a daily workout routine, complete a gratitude journal, and read a book a week all at the same time, we quickly burn out. It is simply too hard to maintain that much change long enough for new habits to stick. The same is true for your child. Keep it simple. Once your child masters one specific goal, you can “graduate” them from that goal and introduce a new one.
  2. State Goals Clearly and Positively: Tell your child exactly what you want them to do, rather than what you want them to stop doing. Instead of “Don’t be late for school,” phrase the goal as “Be ready with your shoes on and backpack packed by 7:20 AM.”
  3. Start with “Easy Wins”: Incentive plans often fail when parents set the bar too high right away; if a child goes several days without earning a reward, they will lose motivation and give up. Instead, start with an easy, highly achievable version of your goal and slowly raise the bar. For example, if your ultimate goal is for your child to have their shoes on and backpack packed by 7:20 AM, start by rewarding them just for having their shoes on by 7:20. Once that becomes a habit, you can raise the bar to include the backpack. Slowly shaping the behavior in these small, manageable steps keeps your child winning, building the momentum they need to succeed rather than setting the bar out of reach and causing them to throw in the towel.
  4. Reward the Behavior Immediately: Timing is everything. To help your child’s brain connect the good behavior with the reward, hand over the incentive right away. For timed tasks (like being ready by 7:20 AM), give the sticker, token, or point the second they finish. For all-day goals (like keeping hands to themselves), have a set time every day (like right after dinner) to hand out the reward. Connect the dots for them by saying: “Because you kept your hands to yourself today, you earned your sticker!” The more immediate or consistent the reward process is, the more likely the incentive system will be a success.
  5. Let Your Child Choose the Rewards: Children are far more motivated by rewards they actually care about. Sit down together and make a list of prizes. Remember, rewards do not have to be toys or cost money. Kids are highly motivated by quality time and special privileges, such as an extra bedtime story, 10 minutes of one-on-one time with a parent, choosing what’s for dinner, or picking the movie for family night.
  6. Make the “Exchange Rate” Clear: Make sure your child knows exactly what their stickers/points can buy. For young kids: Keep it simple. Placing the sticker on the chart might be enough, or they can “cash in” 3 stickers for a reward (like 10 minutes of screen time). For older kids, let them save up. They can earn points daily, but saving up 5 points might earn them a larger weekend reward (like a trip to get ice cream).
  7. Never Take Stickers Away: This is the golden rule of incentive charts. Once a sticker or point is earned, it is locked in. If your child has a great morning and earns a sticker/point, but has a meltdown in the afternoon, do not peel the morning sticker off or take away a point. Taking away earned rewards feels unfair to kids and ruins their motivation to keep trying. If they have a tough afternoon, simply say: “You didn’t earn your sticker/point for this afternoon, but you can try again tomorrow.”

Why Summer is the Perfect Time to Start

Summer is a fantastic time to introduce an incentive plan because it provides a light, predictable structure to those otherwise unstructured summer days. Furthermore, behavior change can be easier to accomplish when kids are relaxed and free from the daily stress of the school year. Making small, positive changes over the summer months can pay large dividends and set your family up for a smooth transition back to school in the fall. Not only will your child be accustomed to using a reward system by then, but they will also have already established several positive habits that will make the start of the school year much easier for everyone!

 

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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Image showing a father with two daughters, one of whom has special needs, A quote also follows.

Supporting Sibling Relationships in Families with Special Needs

By | NESCA Notes 2026

Image showing a father with two daughters, one of whom has special needs, A quote also follows.By: Erin Gibbons, Ph.D. 
NESCA MA Clinical Director; Pediatric Neuropsychologist

I am a parent of two amazing children, one of whom is neurotypical and one of whom is neurodiverse. Finding the balance between supporting my neurodiverse child while also giving my other child enough attention can feel like walking a tightrope. Siblings of children with developmental or learning challenges often experience a unique family dynamic.

  • To foster healthy sibling relationships, it’s crucial to promote open communication. Creating a safe and open environment for discussions helps them understand the situation and feel heard.
  • Providing age-appropriate information about the sibling’s disability can help demystify behaviors and challenges, fostering empathy and reducing misconceptions or frustrations.
  • Recognizing and validating the emotions of siblings, whether positive or negative, is also important. It’s natural for them to have mixed feelings, and acknowledging these emotions helps them process and cope effectively.
  • Encourage siblings to pursue their own interests, reinforcing their identity outside of the family role.
  • Try to dedicate individual time with each child to strengthen personal bonds and make them feel special and attended to.
  • Encourage siblings to support each other and work as a team.

If you find that sibling dynamics are causing family discord, it might be helpful to connect with sibling support groups where children can meet others in similar situations. Consulting a family therapist or counselor can also be helpful and provide tailored strategies to facilitate improved family interactions.

 

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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Image of teo children reading outside on the grass with a quote from NESCA Pediatric Neuropsychologist Alissa Talamo, Ph.D.

How to Encourage Summer Reading with Your Child

By | NESCA Notes 2026

Image of teo children reading outside on the grass with a quote from NESCA Pediatric Neuropsychologist Alissa Talamo, Ph.D.By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Summer is an important time for children to relax and recharge, but it also provides a valuable opportunity to make reading enjoyable. Research consistently shows that students who do not read over the summer are at risk for the “summer slide,” which is a decline in reading skills acquired during the school year. In contrast, children who continue to read during the summer not only maintain but can even improve their literacy abilities.

The benefits of summer reading extend well beyond academics. Regular reading helps expand general knowledge, improve vocabulary and spelling, and strengthen focus and attention. According to Dr. Sally Shaywitz, author of Overcoming Dyslexia, children who read for just 20 minutes a day are exposed to approximately 1.8 million words each year, compared to only 8,000 words for those who read just a few minutes daily. This increased exposure to language supports both language development and writing skills.

Reading for just 20 minutes each day offers numerous advantages. Children experience significant vocabulary growth, encounter diverse perspectives that foster empathy, and develop stronger critical thinking skills as they engage with stories and information. Additionally, reading can be a relaxing activity, particularly before bedtime, helping children unwind after a busy day.

Despite these benefits, some children may be reluctant to read due to reading difficulties, uncertainty about their interests, or a preference for other activities. To encourage reading, it is important to let children choose books that interest them, set aside time to read together, and create a cozy reading environment at home. Pairing reading with interactive activities, such as visiting a museum, landmark, or travel destination related to a book’s topic, characters, or setting, can also make reading more appealing. Regular library visits, audiobooks, and a variety of reading materials—including magazines, comics, and graphic novels—can also help sustain interest. Introducing children to book series and modeling your own enjoyment of reading are additional strategies to foster a positive reading culture.

Helpful Resources and Tools

There are many excellent websites and apps that can support your child’s reading journey. Here are some sites to consider:

  • Unite for Literacy: A collection of audio/picture books read aloud to your child.
  • Reading Rockets—Reading Adventure Packs: Downloadable guides with book suggestions and activities.
  • Starfall.com: Early literacy games and books, ideal for young children.
  • Talking is Teaching: Encourages parents to talk, read, and sing with children to boost early brain and vocabulary development.

Other Resources:

Conclusion

Encouraging your child to read over the summer—and throughout the year—can have lasting benefits for their academic, social, and emotional development. By making reading enjoyable and accessible, and by supporting their individual interests and needs, you can help your child build a lifelong love of reading.

 

References:

  • Sally Shaywitz, MD, Overcoming Dyslexia (2020 Edition): Second Edition, January 4, 2005
  • https://specialedresource.com/benefits-of-reading-20-minutes-a-day
  • https://www.k12reader.com/why-read-20-minutes-a-day/
  • https://www.understood.org/articles/en/14-ways-to-encourage-your-grade-schooler-to-read

 

About the Author

Alissa Talamo headshotWith 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 college-aged daughter.

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, 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 child receiving summer services

Why Summer Is the Perfect Time to Start Services for Your Child

By | NESCA Notes 2026

image of a child receiving summer servicesBy: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

For many families, summer is a welcome break from the busy routines of the school year. Without homework, early morning schedules, and packed extracurricular calendars, children often have more flexibility and downtime. While summer is commonly viewed as a season for relaxation and fun, it can also be an ideal time to begin therapeutic, educational, or developmental services.

As a psychologist, I often hear parents wonder whether they should wait until the fall to start services. In most cases, my recommendation is simple: if a child would benefit from support, summer is one of the best times to begin. Schedules are more open, and you may even be able to meet more often and make as much progress in the summer as you would over the course of an entire semester. I personally have two children getting services this summer, and here is why:

Reduced Academic Demands Create More Capacity for Growth
During the school year, children are balancing academics, social expectations, extracurricular activities, and family responsibilities. Adding a new service can sometimes feel overwhelming for both children and parents. Summer offers a different environment. With fewer academic pressures and more flexible schedules, children often have greater emotional and cognitive bandwidth to engage in learning new skills, and parents may have more bandwidth to take on the scheduling of yet another thing. Whether they are working on emotional regulation, social communication, executive functioning, speech and language development, or motor skills, children may be more receptive to intervention when they are not simultaneously managing the demands of a full school day.

Time to Build Relationships Before School Starts
One of the most important factors in successful intervention is the relationship between the child and the provider. Trust and comfort take time to develop. Starting services during the summer allows children to establish rapport with therapists, specialists, or support providers before the school year begins. By the time fall arrives, many children feel more comfortable, confident, and familiar with the therapeutic process, allowing them to make more meaningful progress when academic demands increase.

Opportunities to Practice Skills in Real-Life Settings
Summer often provides more opportunities for children to practice new skills in everyday situations. Family outings, camps, playdates, vacations, and community activities create natural opportunities to apply what they are learning.

For example:

  • Children working on social skills can practice initiating conversations and maintaining friendships.
  • Children receiving counseling can use coping strategies during new experiences and transitions.
  • Children developing executive functioning skills can practice planning, organization, and independence.
  • Children receiving speech or occupational therapy can apply newly learned skills across a variety of environments.

This real-world practice helps strengthen learning and promotes generalization of skills beyond the therapy setting.

Preventing the “Wait and See” Delay
Parents sometimes hope that a challenge will improve on its own over time. While development naturally occurs as children grow, delaying support can sometimes mean missing valuable opportunities for intervention. Summer provides a proactive window to address concerns before they potentially become more significant during the school year. Beginning services early allows professionals to assess needs, develop goals, and implement strategies that can help children start the school year with greater confidence and support.

Easing School-Year Transitions
Transitions can be challenging for many children. Starting a new school year often brings changes in routines, teachers, expectations, and social dynamics. When children begin services during the summer, they can enter the school year with established supports already in place. They may have stronger coping skills, increased confidence, and a clearer understanding of their strengths and challenges. This foundation can make the transition back to school smoother and less stressful for both children and parents.

More Opportunities to Participate
Parent involvement is one of the strongest predictors of successful outcomes in many therapeutic and educational interventions. The school year in our house often feels hectic. With two working parents and three kids in school, our day-to-day is fast-paced and complicated, to say the least. During the summer, families like ours often have more flexibility to attend appointments, participate in consultations, and implement recommended strategies at home. This increased bandwidth and collaboration allows providers and families to work together more effectively, creating consistency between sessions and daily life.

Progress Before the Next School Year Begins
Perhaps one of the greatest advantages of starting services during the summer is the opportunity to make meaningful progress before school resumes. A few months of targeted support can help children develop new skills, increase confidence, and establish positive routines. Rather than beginning services while already managing the demands of a new school year, children can start the fall with momentum and a stronger foundation for success.

 

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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images showing what In-person or Teletherapy Speech Services look like and a quote from Olivia Rogers, CCC-SLP

Teletherapy vs. In-Person Therapy: What Families Should Know

By | NESCA Notes 2026

images showing what In-person or Teletherapy Speech Services look like and a quote from Olivia Rogers, CCC-SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Speech-language therapy has evolved significantly over the past several years, giving families more options than ever before. While in-person therapy has long been the traditional model, teletherapy has emerged as an effective, flexible, and research-supported way to deliver high-quality services.

Both approaches can support meaningful progress, but they offer different advantages depending on a student’s needs, learning style, and family schedule.

What is In-Person Therapy?
In-person therapy takes place face-to-face in a clinic, school, or home setting. Sessions often include hands-on materials, physical movement, and direct interaction with the clinician in the same space.

Benefits of In-Person Therapy

  • Natural opportunities for play-based learning
  • Physical prompts and hands-on support
  • Easier for very young children who need frequent redirection
  • Helpful when targeting feeding, articulation placement, or sensory-motor skills

For some students – particularly younger children or those needing physical cueing – in-person therapy can be an important option.

What is Teletherapy?
Teletherapy delivers speech, language, and coaching services through a secure video platform. Sessions remain interactive, individualized, and structured and use digital materials, shared screens, real-time coaching, and collaborative activities. Teletherapy is not “less than” in-person therapy. In many cases, it offers unique advantages that directly support academic and functional skill development.

The Benefits of Teletherapy

  1. Therapy Happens in the Student’s Real Learning Environment

Students often join sessions from home or school, allowing strategies to be applied immediately to real assignments, writing tasks, and classroom demands. This is especially powerful for:

  • Academic language
  • Writing
  • Executive functioning
  • Organization and study skills

Skills transfer more naturally because therapy is embedded in everyday routines.

  1. Increased Engagement for Older Students

Many school-age students and adolescents are highly responsive to digital learning. Interactive slides, collaborative documents, and visual supports can increase participation and independence. Teletherapy often feels:

  • Less intimidating
  • More conversational
  • Provides more room for independence
  • More aligned with how students already learn

This can lead to stronger buy-in and carryover.

  1. Greater Family Involvement

Caregivers can easily observe sessions, ask questions, and learn strategies without travel. Due to the ease of meeting, consultation time can easily be built into teletherapy sessions or added on as a monthly service. This improves consistency between therapy and daily life – one of the biggest predictors of progress.

  1. Flexible Scheduling and Reduced Barriers

Teletherapy eliminates commuting, waiting rooms, and geographic limitations. Families can access specialized services that may not exist locally. This flexibility is particularly helpful for:

  • Busy families
  • Students with extracurricular schedules
  • Students who fatigue easily
  • Families planning transitions or moves
  1. Strong Fit for Language, Literacy, and Executive Functioning

Many higher-level communication skills naturally occur on screens, such as reading passages, writing responses, organizing ideas, and managing tasks. Middle and High School students now type essays, rather than handwriting. Teletherapy allows clinicians to:

  • Model writing in real time
  • Scaffold comprehension strategies
  • Practice planning and organization
  • Teach digital learning skills students already need

For these goals, the teletherapy environment can actually mirror classroom expectations more closely than a clinic setting.

When One Approach May Be Better Than the Other
In-person therapy may be preferred when:

  • Physical cueing is essential
  • Attention regulation is extremely challenging
  • Sensory-motor or feeding work is a primary goal

Teletherapy may be ideal when:

  • Goals are academic or language-based
  • Students benefit from visual/digital supports
  • Families need scheduling flexibility
  • Collaboration with caregivers or teachers is important

Often, the best approach is individualized, and some students benefit from a combination over time.

Final Thoughts
Teletherapy has expanded what is possible in speech-language support. For many students, particularly those working on language, literacy, and executive functioning, it provides a flexible, effective, and highly relevant model of care.

Rather than replacing in-person therapy, teletherapy offers another pathway for families to access specialized support and help students build skills that extend beyond the therapy session.

At NESCA, we know that the research shows that outcomes depend less on location and more on the clinician’s expertise, individualized goals, consistency of sessions, and strategy carryover into daily life. Whether sessions occur in-person or online, meaningful progress happens when therapy is functional, engaging, and connected to a student’s real-world demands. For more information on Speech and Language Therapy and services at NESCA, please complete our online Inquiry/Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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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a roadmap wirh a treatment plan sign showing the way; quote from Dr. Ann Helmus

Beyond Recommendations: Creating a Roadmap for Change

By | NESCA Notes 2026

a roadmap wirh a treatment plan sign showing the way; quote from Dr. Ann HelmusBy Ann Helmus, Ph.D.
Founder & Director, NESCA

I recently attended a continuing education course on the treatment of sleep problems. The instructor shared something not altogether surprising, but genuinely thought-provoking: simply giving people a list of “sleep hygiene” recommendations has not been shown to be particularly effective.

Most of us have heard these recommendations before:

  • Turn off screens before bed
  • Keep the room cool and dark
  • Avoid caffeine late in the day
  • Maintain a consistent sleep schedule

The problem isn’t that these recommendations are wrong. The problem is that they are often delivered as a generic list. So, what does work? A personalized approach to a plan.

For example, instead of handing someone a list of 10 recommendations, an effective approach by a clinician might be to say: “Let’s focus on one thing this week – moving your afternoon coffee a little earlier in the day. We’ll see how that goes, what obstacles come up, and whether it makes a difference before we add anything else.”

Here, the recommendations are tailored to the individual, prioritized based on what is most likely to help, and then followed up on to determine what is working and what needs adjustment.

The same can be said about the recommendations that are provided after a neuropsychological evaluation. After an assessment, families receive evaluation reports that often contain pages of recommendations. While many of those suggestions may be reasonable, a long list can leave parents wondering where to start, which recommendation matters the most, or which recommendation will make the biggest difference for my child right now. It can be overwhelming.

At NESCA, our goal is not simply to generate recommendations. Our goal is to develop a treatment plan.

A treatment plan factors in the full understanding of the child’s unique strengths and challenges, identifies the issues that are having the greatest impact on daily functioning, and prioritizes the interventions that are most likely to improve quality of life and long-term improvement.

For one child, improving sleep may be the most important first step. For another, it may be anxiety management, executive functioning support, social skills coaching, speech-language intervention, or school accommodations. The recommendations may look similar on paper, but the strategy is very different.

A thoughtful evaluation should answer not only what to do, but why, when, and in what order.

Most importantly, meaningful change rarely comes from a report sitting on a shelf. It comes from partnership, implementation, progress monitoring, and adjustments as needed.

Just as effective treatment for sleep difficulties involves more than a list of sleep hygiene tips, effective support for a child involves more than an exhaustive list of recommendations.

It requires a roadmap. At NESCA, our goal is to help families build one.

 

About the Author

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

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

NESCA is a pediatric neuropsychology and related services group 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 showing the transition from elementary to middle to high schools and a quote from Olivia Rogers, CCC-SLP

What Is a School Transition Intensive – And Who Is It For?

By | NESCA Notes 2026

Graphic showing the transition from elementary to middle to high schools and a quote from Olivia Rogers, CCC-SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Transitions between school levels are exciting – but they are also academically demanding. Whether a student is moving from elementary to middle school, middle to high school, or into a new independent school environment, expectations around writing, organization, and independence increase dramatically. A School Transition Intensive is a short-term, highly focused summer program designed to strengthen the language and executive functioning systems students need before those expectations rise. It’s not tutoring. It’s proactive skill-building.

Why School Transitions Are So Challenging
Each new school level brings longer writing assignments, multi-paragraph essays, increased note-taking demands, greater independence, fewer teacher prompts, and more complex academic language. Many capable students struggle not because they lack intelligence, but because organizational and language demands exceed their internal systems.

What Skills Are Targeted?
Depending on grade level, a transition intensive may include:

  • Paragraph structure foundations
  • Expanding sentences with detail
  • Multi-paragraph writing
  • Analytical paragraph writing
  • Text-based evidence integration
  • Academic vocabulary development
  • Written summaries of complex texts
  • Comprehension of texts of varying length and complexity
  • Note-taking systems
  • Planning and project organization routines
  • Independent study and homework systems

The focus is always on integrating language and executive functioning together.

Who Would Benefit Most?
A School Transition Intensive is particularly helpful for students who are:

  • Bright but disorganized
  • Struggle to get ideas onto paper
  • Avoid writing or academic tasks
  • Require extra support to get homework or assignments done
  • Have ADHD or executive functioning weaknesses
  • Receive feedback such as “needs more organization” or “struggles with written expression.”
  • It is also ideal for students entering competitive independent schools where writing expectations are high from day one.

Why Summer Is the Ideal Time
During the school year, students juggle multiple subjects, deadlines, and social demands. Summer allows for focused, structured practice without grade pressure, helping students build independence and confidence before the school year begins.

The Real Goal
The goal is not simply better essays. It is stronger internal organization, reduced academic anxiety, clearer thinking on paper, increased independence, and confidence walking into a new academic environment.

At NESCA, we offer intensive summer therapy that targets communication (such as listening comprehension, and expressive language), written language, and academic executive functioning.  For more information on summer intensives at NESCA, please complete our online Inquiry/Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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 showing a student concentrating in class; quote from Dr. Sean Hyde O'Brien

Hearing Loss and Neuropsychological Development

By | NESCA Notes 2026

Image showing a student concentrating in class; quote from Dr. Sean Hyde O'BrienBy: Sean Hyde O’Brien, Psy.D., ABPdN 
Pediatric Neuropsychologist, NESCA

As the husband of a pediatric audiologist, I often hear stories of children referred for audiological evaluations that end up having normal hearing but are thought to have other conditions that fall within the purview of neuropsychology, including Language Disorder, Autism Spectrum Disorder, Intellectual Disability, and Attention-Deficit/Hyperactivity Disorder. It made me think about the way that children typically referred for neuropsychological evaluations can be potentially impacted by hearing loss, particularly in terms of their cognitive, academic, and social-emotional functioning. Review of the literature indicates the following:

  1. Language Acquisition and Communication:

Children with hearing loss may experience delays in development of communication skills including speech articulation and receptive-expressive language. This can make it difficult to for children to understand instructions, participate in discussions, and express ideas.

  1. Literacy Skills:

Development of reading and writing skills are closely tied to language abilities. Hearing loss can lead to difficulties in phonological awareness, decoding, and comprehension, resulting in lower literacy achievement in children with otherwise intact cognitive profiles.

  1. Executive Functioning:

Hearing loss may affect executive functioning skills such as attention, organization, and task completion due to difficulties in following multi-step instructions or classroom routines.

  1. Cognitive Load:

Increased effort required to listen and comprehend spoken information can lead to cognitive fatigue, reducing the capacity for learning and retention.

  1. Classroom Engagement:

Students with hearing loss may struggle to follow lessons, especially in environments with significant background noise or when teachers are not facing the class. They may miss important information, instructions, or peer interactions, leading to reduced participation and engagement.

  1. Academic Achievement:

Studies have shown that children with hearing loss are at greater risk for lower academic achievement, particularly in subjects that rely heavily on verbal instruction and interaction (language arts, social studies, etc.).

  1. Access to Curriculum:

Without appropriate accommodations (e.g., hearing assistive technology, preferential seating, captioning, sign language support), students may not have equitable access to curriculum content.

  1. Social-Emotional Functioning:

Finally, hearing loss can contribute to feelings of social isolation, frustration, and decreased self-esteem if communication barriers lead to difficulties in making friends or participating in group activities.

Based on the various ways that hearing loss can impact the cognitive, academic, and social-emotional development of your child, it is important that their hearing be evaluated at the first signs of concern. Paired with a comprehensive neuropsychological evaluation, this can result in early identification and treatment (e.g., speech-language therapy, hearing assistive technology, and classroom accommodations) that leads to the optimal outcome for your child.

For more information, please visit the American Speech-Language-Hearing Association (ASHA) website at https://www.asha.org/public/hearing/effects-of-hearing-loss-on-development/

 

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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image of multiple students in a school based speech session vs a private one on one session

School Speech-Language Services vs. Private Speech-Language Services

By | NESCA Notes 2026

image of multiple students in a school based speech session vs a private one on one sessionBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Understanding the Difference
Speech-language support can be life-changing for students, helping them by improving communication, academic access, confidence, and independence. Families often wonder whether school-based speech therapy is enough, or if private services might better meet their child’s needs. Both models provide valuable support, but they serve different purposes. Understanding these differences helps families make informed decisions.

The Role of School Speech-Language Services
School speech-language pathologists (SLPs) help students access their education. Services are designed to support academic participation rather than address every area of communication difficulty.

School SLPs often manage large caseloads, group therapy, strict eligibility criteria, and limited session frequency. Therapy typically focuses on what is necessary for a student to function at school – not always what would be most beneficial for overall communication growth.

What Private Speech-Language Services Offer
Private speech-language services allow therapy to be individualized based on the student’s whole profile. Sessions can be one-to-one, more frequent, and flexible. Goals often extend beyond minimum academic access and may integrate language, literacy, and executive functioning.

Importantly, students do not need to “qualify” for private services. Support can begin based on functional concerns, prevention, or a family or client’s desire for more targeted growth.

Why Families Use Both
Many students benefit from a combined approach. School services ensure educational access, while private services deepen skill development and allow more intensive work on underlying skills.

Quality vs. Capacity
The difference between school and private therapy is often capacity. Private therapy provides more time for practice, feedback, collaboration, and personalization, which can support faster progress and stronger carryover.

Take It From Me – I’ve Been on Both Sides
Having worked inside public schools and now providing private services, I’ve seen how system limitations impact therapy. School therapy is essential in some cases, but private services create space to address skills more deeply.

When Private Services May Be Helpful
Families often explore private therapy when progress feels slow, their child does not qualify for school services, needs extend beyond speech sounds, literacy overlaps with language, or they want more individualized or preventative support.

Final Thoughts
School speech-language services are designed to ensure access to the curriculum. Private speech-language services are designed to optimize growth. Both are valuable and work best when coordinated.

At NESCA, our speech language pathologists have been in both settings. They provide individualized, contextualized, functional, and curriculum-based support to facilitate generalization to the real world.  For more information on Speech and Language Therapy at NESCA, please complete our online Inquiry/Intake Form or email me directly at orogers@nesca-newton.com.

 

 About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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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