NESCA Notes 2019

Teenage Stress and Executive Functioning

By | NESCA Notes 2019

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

It is increasingly clear to educators, parents, clinicians and the like that teens are experiencing high levels of stress. Why? There are, of course, many reasons stemming from family, social, historical, and systemic “forces” that impact a teen’s personal day-to-day experience.

As an evaluator, I am very aware of one “force” affecting our teens: the “mis-match” between what teens are expected to do and what their executive function skills can handle. I recently participated in a panel discussion along with professionals from Summit Education Group, Engaging Minds and Beyond BookSmart to discuss this “mis-match,” a large contributing factor to student stress. Here are a few important “take-aways” from the discussion:

First, what is executive functioning?  Executive functioning skills are a “family” of skills that operate in a “top-down” process, controlling and regulating brain regions associated with attention, impulse control, emotion regulation and meta-cognition or “thinking about thinking.” A helpful analogy is that executive function skills are the CEO or the “boss” in the brain that monitors, plans, organizes and makes decisions. Here is a useful diagram from ADD Vantages describing executive function skills.

This depicted “family” of executive function skills develops throughout our development. A six year-old is not expected to plan multi-step assignments and check for errors when they write. A six year-old is expected to begin controlling impulses (e.g. waiting their turn in a game) and respond to adult prompts to organize belongings. As a child grows, their brain develops, and executive function skills expand.

However, higher-level metacognition and executive function skills do not simply “magically appear in the brain” or develop “in a vacuum.” Akin to learning a subject, such as math or science, children and teens need to learn executive function skills through teaching, modeling, observing and doing.

We know that teens face a number of responsibilities, particularly in high school – whether that be studying for exams, working on projects, participating in extra-curricular activities, participating in community-run volunteer opportunities, considering academic options post-high school, following their family’s weekly schedule, manage their social media page – and all while getting enough sleep, eating three meals a day and having self-care or “me time.” That adds up to a lot of expectations and demands. Some may posit that these are higher expectations for teens than in decades prior. Yet, what we know is that all teens are unique and develop executive function skills at different speeds. It is therefore logical to expect that many teens will become stressed…stressed because there is a “mis-match” between their daily expectations and the executive function skills that are required to carry out and manage those activities.

As an evaluator, I have worked with a number of teens who experience this “mis-match.” They haven’t yet learned the tools and strategies needed to manage their academic, social and personal responsibilities, and this contributes to low self-confidence, academic underperformance, limited independence, depression and worries about the future. They not only need support and teaching to grow executive function skills to study, work and live more efficiently now and in the future, they also need this “mis-match” and the stress it produces identified and acknowledged by the adults around them.

This “mis-match” can be identified by parents, teachers and/or through a comprehensive neuropsychological evaluation, which is oftentimes critical for determining a teen’s unique learning strengths and challenges. This “mis-match” is also sometimes identified by teens themselves – who are often highly aware of their own needs and simultaneously aware of difficulties that are impacting their vision and goals. As educators, clinicians and professionals who work with stressed teens, we have a responsibility to recognize when executive function “mis-matches” may be a source of stress and support our teens in developing an individualized, collaborative action plan.


About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.


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


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


Why Sexuality Education For People With Developmental Disabilities Is So Important

By | NESCA Notes 2019

By: Dina DiGregorio Karlon, M.A.
Transition Specialist, NESCA

Sexuality is something that connects all humans throughout the lifespan. We, as parents, want to see our children as forever young and protect them. For many parents it is extremely difficult to consider our children as sexual beings. Add the complexity of having a child with a developmental disability, and it appears even more challenging; yet ironically, it is even more important. Here are some reasons why:

People with developmental disabilities are not children. While many people believe that children with disabilities are childlike and dependent on others, their humanity and independence should be respected. They have desires and needs similar to others. They deserve to have access to information which will help the make good choices and have healthy relationships.

Sexual education should be taught according to one’s biological age, not cognitive age. Most children with disabilities experience physical changes (i.e., puberty) at the same time as their neurotypical peers. Therefore, sexuality education should be given to them at similar times as peers, but the delivery needs to be the different – one which allows them to access the information.

Sexual education is a protective factor. Educating people with disabilities about sexuality is a protective factor for them, because it provides the knowledge they need to protect themselves against sexual crimes, unprotected sex, unwanted pregnancies and unhealthy relationships. Information is power.

Understanding sexuality will not encourage your children to have sex. Giving individuals with developmental disabilities sexuality education will not put the idea to embark on sexual explorations in their heads. Giving them access to sexuality education gives them information and ultimately the power to make educated choices about their bodies.

People with disabilities are significantly more likely to be a victim of a sexual or violent crime than their non-disabled peers. Understanding consent and sexual advocacy empowers people to protect themselves from being the predator or the prey by learning about concepts, such as, “my body, my choice” and “no means no.”

Much of the general population learns about sexuality and relationships from friends. This means that some of the information they receive about sexuality is not always accurate. People with disabilities may not have as many friendships as their peers without disabilities. Those with developmental disabilities tend to be more isolated, so they do not have the opportunity to learn from friends. Often, they learn about sexuality information from parents and television. Another concern is the ease with which the internet provides sexual information. Access to pornography and posting pictures can be confusing to a person with a disability who doesn’t understand the legal, privacy and employment implications, putting them at even greater risk. So, as parents, it’s very important to give accurate information or seek out professionals who can work with your child.

Sexuality education does not teach sexual values. Parents are the ones who should be teaching their children with and without disabilities about their values around sex. Sexuality education focuses on teaching accurate information in a format that students can access and understand. It is then incumbent upon those students to develop their own values.

Because of the nature of some disabilities, picking up on social cues is challenging. So much of relationships is understanding verbal and non-verbal social cues, so many people with disabilities can struggle with identifying healthy relationships. It makes it easier for others to take advantage of them, instead of enjoying a relationship with both partners on equal footing. Therefore, it is important to teach social skills as part of sexuality education.

There are common universal values:

  1. It is important to respect others by treating them well and listening to them.
  2. It is important to get consent from a partner before being sexual with them.
  3. Relationships should be equal and positive without violence or abuse.

When discussing sex with your children, it’s okay not to have all the answers and to ask for a pause, take a break or a deep breath, and return later with more information. There are always plenty of opportunities for teachable moments. We know that people with disabilities can take in a great deal of information, and sexuality education is critical information to have healthy, sexual relationships. So, while we hate to see our children grow up, we all want the same things – to see them be happy and belong in an appropriate and respectful, safe way.

NESCA has personnel trained to provide sexuality education training to parents and to teens and young adults with disabilities. Training can be done one-on-one or in a group. If you are interested in learning more, contact Dina DiGregorio Karlon at (603)818-8526 to set up a consultation.



Elevatus Training: GULP! Talking with Your Kids About Sexuality Newsletter, Volume 4, Number 1, May 2003


About the Author: 

Dina DiGregorio Karlon, M.A., is a seasoned counselor who has worked as both a school counselor and vocational rehabilitation counselor, guiding and coaching students and adults through transitions toward independence in both college and the working world. With NESCA, she offers transition assessment services in Londonderry, New Hampshire as well as transition planning consultation and coaching to students and families throughout New England.


To book Transition Services at NESCA or an evaluation with one of our expert neuropsychologists, complete NESCA’s online intake form. To book Transition Services in N.H., ask for Dina Karlon. 


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

Mindfulness: It’s Not Just for Grown-ups

By | NESCA Notes 2019

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow

There has been increasing interest in intervention strategies that target self-regulation in childhood. Self-regulation is the process through which the systems of emotion, attention and behavior are controlled in response to a situation, stimulus or demand. It develops rapidly in the early years of life. Self-regulation is necessary for social development because it supports and enhances peer acceptance and social success. Furthermore, it increases academic performance, particularly in elementary school. Problems with self-regulation and the accompanying executive functioning have been shown to correlate with a number of behavioral and emotional problems, particularly depression and anxiety. Mindfulness is emerging as an effective intervention for children struggling with self-regulation, especially when implemented at a time when children are acquiring these foundational skills.

Mindfulness is a way of paying attention, on purpose and non-judgmentally, to the experience of the present moment. Being mindful involves reflecting on the current internal experiences such as thoughts or emotions and the current external environment, such as sights and sounds, both clearly and objectively. This act of purposeful reflection enhances and facilitates self-regulation by promoting control, such as sustained attention and cognitive flexibility. Furthermore, it helps to reduce the incidences of such things as snap judgments, emotional reactivity or distressing thoughts.

Mindfulness-based social-emotional training has been shown to be effective in reducing stress, improving coping skills and building resilience when used with children. Mindfulness teaches children the skills needed to improve focus, calm themselves, plan and organize, and behave in a thoughtful manner. Research on adult populations shows that practicing mindfulness may reduce symptoms of anxiety and depression, and limited number of studies show some of the same benefits in children. Mindfulness is well tolerated by children and has been proven to improve psychological well-being. Introducing mindfulness practices to children has the potential to make a positive impact on a child’s ability to self-regulate, and thus facilitate their social, emotional and educational growth.

There are a number of ways to introduce children to mindfulness. One activity that children have responded positively to is being challenged to sit still and silent for as long as they possibly can. I have used this strategy in classrooms of children from pre-k to high school, as well as individually with children of all ages. Sometimes they are able to sit for 15 seconds, but they embraced the challenge of trying to beat their record by trying it again. Another mindful technique that works well with children is called “grounding.” Grounding techniques use the five senses to bring ourselves into the present moment. One grounding technique is finding five things in the room – they can be 5 things of the same color or any five things; four things the child can feel; three things the child can hear; two things the child can smell; and one thing the child can taste. Mindfulness can be playful and fun for children and families while effectively reducing stress, improving coping skills, improving ability to self-regulate and building resilience in children.


Helpful resources for families:

Mindful Games Activity Cards: 55 Fun Ways to Share Mindfulness with Kids and Teens. Susan Kaiser Greenland and Annaka Harris

A Still Quiet Place: A Mindfulness Program for Teaching Children and Adolescents to Ease Stress and Difficult Emotions By Amy Salzman, MD

I am Peace: A Book of Mindfulness By Susan Verde and Peter H. Reynolds

Breathe Like a Bear: 30 Mindful Moments for Kids to Feel Calm and Focused Anytime, Anywhere By Kira Willey



Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.

Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and psychopathology, 2(4), 425-444.

Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social–emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental psychology, 51(1), 52.

Schonert-Reichl, K. A., & Lawlor, M. S. (2010). The effects of a mindfulness-based education program on pre-and early adolescents’ well-being and social and emotional competence. Mindfulness, 1(3), 137-151.

Sibinga, E. M., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: an RCT. Pediatrics, 137(1), e20152532.


About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie and Dr. Jessica Geragosian.


To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form


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


10 Everyday Financial Literacy Activities to Build Skills

By | NESCA Notes 2019

By Kathleen Pignone, M.Ed., CRC
Transition Specialist

Financial Literacy is a much-discussed topic in the field of transition planning and life skills acquisition. Basically, we want our teenagers and young adults to have competence or knowledge in this broad area. Who is responsible for teaching this? Schools, parents, other community providers? The simple answer is all of the above.

Here are 10 quick, easy and hopefully engaging ways to support financial literacy and lots of other life skills in teenagers and young adults while juggling all of our other many parental responsibilities.

  • Plan a preferred meal or dessert and make a budget for ingredients – learn cost comparison and cooking
  • Calculate a tip in a restaurant – teach about tipping habits and budgeting; similarly schedule a haircut and pay adding tip calculation – learn multiplication and practice phone skills
  • Provide a menu of chores and determine prices for duration and frequency – help teens be seen as resources to parents by providing a menu of desired activities and a money value associated with each task
  • Help plan for a vacation – pick an activity in the destination and price it out or cost-compare flight options
  • Cost out weekly snacks – make decisions about healthy spending and healthy eating habits
  • Volunteer at school bake sale with your teen – practice making change for cash purchases while helping fundraise and give back to your school community
  • Purchase birthday card and/or birthday present – model how to budget and cost out how much for a DIY card and birthday present versus buying both from a store
  • Figure out how much it will cost to fill a gas tank – determine how far can you get on one tank of gas versus an hourly salary for entry level competitive job
  • Bus fare or uber fare comparison – great conversation about wants versus needs!
  • Play an online financial game with your teenager, such as Financial Soccer by Visa or Plan It Prom App – learn together how much it costs to attend a prom (and subsequently plan for the expenses) or play a fun game where both parents and teen can learn together

All of these activities teach saving, budgeting, financial goals, wise use of credit, cost comparison and other key executive functioning skills. Hopefully this will make spending time with your teen enjoyable and educational.

About the Author:

Kathleen Pignone, M.Ed. CRC is a deeply knowledgeable and experienced transition specialist. Prior to her tenure at NESCA, Ms. Pignone was the Career Development Director at Bay Cove Academy for 15 years, providing students with classroom and real-world employment skills training, community job placement and on the job employment-training. She has also worked at Massachusetts Department of Secondary and Elementary Education and privately as a vocational rehabilitation consultant. As a certified rehabilitation counselor, Ms. Pignone brings unique expertise carrying out vocational assessment and employment planning for adolescents and young adults as well as supporting local school programs. In addition to fortifying NESCA’s premier transition assessment services, Ms. Pignone engages in person-centered planning with teens and young adults, consultation and training for parents, providers and schools, and community-based coaching services.


To book a transition assessment or consultation with Kathleen or one of NESCA’s expert neuropsychologists and consultants, please complete NESCA’s online intake form


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

A Halloween for Everyone

By | NESCA Notes 2019

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-based Skills Coach

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

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

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

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

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

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


About the Author

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.
To book an appointment or to learn more about NESCA’s Occupational Therapy Services, please fill out our online Intake Form, email or call 617-658-9800.


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


We’re All “Perfection Pending”

By | NESCA Notes 2019

By: Ann Helmus, Ph.D.
NESCA Founder/Director

I recently came across a raw and powerful blog post on Perfection Pending by Meredith Ethington. It’s a worry-filled, heartfelt and all-too-familiar account of a mother dropping her child off at school in tears, questioning her parenting skills after a tough, embattled morning with her struggling child. We can all relate to her fears, questioning and self-doubt.

At NESCA, I often meet with parents, just like the mom in the blog post, who question the decisions they’ve made as well as the indecision they’ve allowed on behalf of their children. They blame themselves for the challenges their child has at home and/or in school and frequently ask themselves and me what they could have done better. Many times, the answer is nothing. These are normal emotions for any parent, but when there are special needs present, these emotions are intensified.

Recently, our staff across NESCA’s three offices met as a team to get to know new staff  better, discuss what’s going on in the field of pediatric neuropsychology and hone in on what makes NESCA different. After lots of insightful discussions throughout the day, we were struck by the consistent theme that emerged—when families come to NESCA, they don’t just get a cookie cutter neuropsychological report about their child’s learning style, diagnosis and rote recommendations. At NESCA, not only do families get a thorough, individualized report with an accurate diagnosis and highly customized, realistic recommendations, but they get—sometimes even more importantly—an entire team of experts in their field all contributing ideas and resources to support families in the quest help their child.

Our expert neuropsychologists and providers don’t arrive at the label of “expert” solely by their degrees, years of experience and broad networks of resources who may help the children and young adults we see. Many of our clinicians and providers also have children or relatives they care for—a large number with their own identified challenges and special needs. We see things from both sides, can relate to the ongoing struggles and are there alongside the parents and caregivers during the testing process and over the long haul. We work side by side with parents, families, schools and children throughout a person’s development, not just the hours or days of testing and observation. Our jobs are not done when we deliver that final report to families. We serve as teammates throughout your journeys.

So, to the parents and caregivers crying tears of worry, doubt and blame, we hear you and we support you.

Additional reading:

Perfection Pending by Meredith Ethington

Mom Life: Perfection Pending


About the Author: 

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.


To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists, complete NESCA’s online intake form


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



The Path to Eligibility

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist

A child’s pediatrician is often the first professional who hears a parent’s concern that their child is struggling in school. It is comforting to know that The American Academic of Pediatrics has recently provided guidelines to pediatricians that outline the important role they can play when a child is struggling in school. The guidelines refer to pediatricians’ involvement in prevention (e.g. avoiding brain injuries, good nutrition, etc.), early recognition, diagnosis, treatment, advocacy/monitoring and referral. Regarding referral, pediatricians are asked to consider involvement of a number of subspecialties, including neuropsychologists, child psychologists, speech and language pathologists and others.

In my prior work as a Special Needs Advocate and now as a pediatric neuropsychologist, I understand how the referral to a neuropsychologist for a comprehensive evaluation can assist a parent in the Special Education eligibility process, but it is still too often an unknown for many others. To be eligible for Special Education services, a child must meet three basic criteria (1) present with a qualifying disability; (2) demonstrate a lack of effective progress in the general education setting; and (3) require specialized instruction or related services (e.g. Speech Therapy, Occupational Therapy, Psychological Services, etc.). The determination of eligibility is made by the school team that includes the parents. The school will conduct its own assessments which may provide the information needed to make a determination of eligibility. A private neuropsychological evaluation provided by the parents can also help to inform the process, by providing a diagnosis(es) as well as a deeper and more integrated look at the child’s cognitive, academic and social/emotional profile.

School evaluators do not typically provide what are considered medical diagnoses, such as ADHD, Autism Spectrum Disorders or Dyslexia. A neuropsychologist can make such a diagnosis, and a comprehensive neuropsychological evaluation should also provide an understanding of how the disability is impacting the child’s academic, social and/or emotional development. The neuropsychologist can then relate the diagnosis to the appropriate educational disability category for the school’s consideration. A neuropsychological evaluation can also assist in determining if a child is making effective progress within the general education setting. Data obtained through standardized testing, teacher reports and observation of the student in the school setting can provide information needed to determine if the child is making progress commensurate with their potential. Finally, delineation of specific skill deficits identified in an evaluation can provide information necessary for selecting appropriate specialized methodologies or the related services the child requires to make progress.

We often hear the phrase, “It takes a village.” It certainly “takes a village” of professionals to provide the coordinated and comprehensive care that a child who is struggling in school requires. With pediatricians providing the first line of support and referrals for parents, the outside professionals, including neuropsychologists, can work with the pediatrician and in conjunction with the school staff to provide the struggling student the range of services needed to foster their academic, social and emotional development.


About the Author

Combining her experience and training in both pediatric neuropsychology and educational advocacy, Dr. Reva Tankle has particular expertise in working with families who are navigating the IEP process. Having participated in numerous team meetings over the years, Dr. Tankle is especially knowledgeable about the many ways that schools can support and accommodate students with special learning needs, information that she clearly communicates in her evaluation reports and in team meetings, if needed. She also has a great deal of experience in articulating the reasons that a student may need a program outside of the public school.

Dr. Tankle evaluates students with ADHD, learning disabilities, high functioning autism spectrum disorders, and neurological conditions, as well as children with complex profiles that are not easily captured by a single diagnostic category.


To schedule an appointment with Dr. Reva Tankle in Plainville, MA, or any of our expert neuropsychologists, please complete our online intake form


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


Having a Seat at the Table

By | NESCA Notes 2019

By Dot Lucci, M.Ed., CAGS

Many people come to NESCA because their child/children or they are struggling in some aspect of their life, school or work. They come to be evaluated, counseled or to access our integrative services. Often, they are hoping to gain insight into what is amiss and ultimately receive recommendations to help develop a “roadmap” toward improving their lives. The roadmap provides them with a greater understanding of themselves or their child/children, including strengths, challenges and possibilities. Through the neuropsychological evaluation, a diagnostic label is often provided, if warranted, that conceptualizes their learning and psychological profile. This label typically implies a difference from the “norm” – a disability. So, is getting a label of a disability a relief, a shock, a curse, a dream shattered or an “ah ha” moment? It may be all of these, and these feelings may change over time. Is a disability a “bad thing” or a “good thing” or both? I like to say, “It just is.” It is a piece of who we are, but it isn’t everything – nor does it define us in our totality.

Did you know that 60 million Americans have a disability? That’s 20% of our population. Many of us will enter this category of disability as we age; therefore, all of us will know someone with a disability or will develop one ourselves. As Jay Ruderman, disability advocate, says, “It’s the only minority group almost all of us are guaranteed to join at some point in our lives.” If we look at it this way, wouldn’t we all be better off if we embraced people with disabilities across all aspects and stages of life? Wouldn’t it be nice to know that there’s a place for us at the table and one that we didn’t have to fight for?

It’s been 30 years since the Americans with Disabilities Act (ADA), the civil rights law that prohibits the discrimination against individuals with disabilities in all areas of life (work, schools, housing, etc.), was passed. It states that people with disabilities should have the same rights and opportunities as everyone else, meaning they belong at the table and should be included. But do individuals with disabilities truly have the same rights as non-disabled people? On paper, yes, but in practice, not necessarily. While people with disabilities do have many more rights today than they did before the ADA was passed, barriers still exist – people are still marginalized and fighting for equality. The law says everyone is equal, yet people are still discriminated against in profound and subtle ways every day.

Compared to 30 years ago, public education, communities and businesses are doing a much better job at recognizing individuals with disabilities and providing opportunities for them. We now have universal design principles utilized in architecture, community planning, schools and businesses. However, there is still much to be done! Data from the National Center for Education Statistics shows that in 2017, 63% of students across all disability categories spend 80% or more of their school day in classrooms with typically developing peers. That’s a dramatic increase from pre-ADA years. Yet in contrast, only 17% of students with intellectual impairment and 14% with autism spend their time in general education classrooms.

When disabled students age out of the educational system, they are not faring as well as their nondisabled peers in opportunities for housing, community and employment inclusion. Data from the Department of Labor Statistic states that the employment to population ratios in 2018 are still lagging for persons with a disability. In fact, 20.8 % are employed, whereas 69.2% of “non-disabled” persons are employed. Why is that? This is an untapped workforce. What holds back employers, communities and housing authorities from hiring and including people with disabilities? Is it fear? Is it a belief that they can’t do the job, or that it will cost more to hire/include a person with a disability? The reasons/excuses cited are endless, and unfortunately inhibit us from including people with disabilities from being truly valued and contributing members of society.

So, even 30 years later, there is much work to be done to improve outcomes for individuals with disabilities. We have to look inside ourselves and ask, “What are we doing to create an inclusive society?”. How have we fostered an inclusive community at school, work, as we walk down the street or at a café? How have we overcome our own biases and fears, or helped to alleviate the fear of other people? How have we helped to change the hearts, minds and beliefs of others so we have true inclusion and true equality? Much like the civil rights movement did – it’s taking a stance and doing what’s right for everyone. Inclusion is about creating a better world, where everyone belongs, is valued and honored for who they are and what they contribute to our society.

Remember, in the word “disability” is “ability.” This should be the guiding principle. See the ability before you see the disability in people. Everyone has abilities, interests and strengths that can be used to better our world. Recognize the abilities and strengths of individuals who learn and work differently, for it is what makes the world a better place. We hope that after coming to NESCA for an evaluation, counseling or integrative services, our clients leave with a better understanding of themselves or their child/children, recommendations for next steps, an acceptance of who they are and hope for the future.

For additional resources, please visit:

Commit to Inclusion

National Center for Educational Statistics

Disabled World


About the Author:

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

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


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


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


In Defense of the Lowly Questionnaire

By | NESCA Notes 2019

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

When gleaning information about a child’s areas of strength and challenge, neuropsychologists gather information from multiple sources, including parent and child interviews, conversations with teachers and mental health professionals working with the child, clinical observations, structured testing and questionnaires.

In my work with families, I sometimes hear complaints from parents about the myriad questionnaires that I saddle with them as part of the evaluation process – that some questionnaires might appear to be geared toward more challenged children than their own or that they are unsure how to respond to some of the questions (e.g., Is this behavior exhibited “sometimes” or “often?”).  While those are valid complaints, I find data from questionnaires to be particularly valuable in my work.

For instance, simply relying on clinical observations to glean information about a child’s attention span and degree of distractibility would be often misleading.  While the distraction-reduced, one-to-one, highly-structured testing setting is an ideal context in which to administer standardized assessments, within such a setting, even students with moderate attention disorders can often remain on task to an extent they are not able to demonstrate in less-structured, real-world contexts.

Similarly, children with mild social communication or autism spectrum disorders might be able to demonstrate reasonably-intact social skills within the context of a structured, one-to-one setting with an adult, while they struggle in their interactions with peers in less structured settings.

Conversely, children who might present with moderately high levels of test anxiety might appear so wound-up in a testing setting that, without additional information about their emotional state outside of the testing context, they could mistakenly be diagnosed with a generalized anxiety disorder.

In addition, relying exclusively on results of standardized testing to glean information about a child’s learning profile can be equally misleading.  For instance, children who might well present with executive function challenges can often fare well on specific tests of executive function, as those tests provide a level of structure not present in daily contexts.  Further, the nature of those standardized tests is such that specific executive function skills are measured in isolation (e.g., how well is a child able to brainstorm or switch gears or see the big picture), as opposed to in real life, when a child needs to make use of multiple different executive function skills in concert to complete given tasks.

Of further importance, I often find that a comparison between a child’s responses on a self-report questionnaire and those of parents or teachers yields critical information.  More specifically, it is often the case that from the parent perspective a child is running into pronounced executive function challenges, while from the child’s perspective they have minimal challenges in that domain of functioning.  That discrepancy can provide useful information about a child’s level of self-awareness or self-acceptance, information that can, in turn, illuminate an important area to address moving forward.

Again, a thorough, comprehensive, integrated neuropsychological evaluation draws on multiple sources of information.  As part of a thorough assessment, questionnaire data is a critical data source, not only in confirming observations made during the testing and results of structured assessments, but also in providing an additional perspective as to how a child might present outside of the structured testing setting.


About the Author:


Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.


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


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


When is it Actually Bullying?

By | NESCA Notes 2019

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

Autumn holds excitement for many students – heading back to school to see old friends, meet new teachers and learn new skills. However, for some, a new school year holds more apprehension than enthusiasm. Students worry that their teacher will be mean, their math homework will be hard or that their recess time cut short by bad weather. One fear that is described more and more often by parents and children is the fear of bullying.

What is bullying?

There is no single definition of bullying, but most researchers describe the following necessary and sufficient characteristics:

  • unwanted, intentionally aggressive behavior that is aimed at harming another person
  • carried out repeatedly
  • in a relationship where there is a power differential

The quintessential example of this is the hulking, five-foot-five elementary schooler who pushes, shoves and steals the lunch money of a short, scrawny younger child every day. Luckily, this kind of aggression is rare; however, the rarity of “classic” bullying requires us to be somewhat more mindful of what childhood behaviors are (and, are not) considered bullying.

First and foremost, behavior must be unwanted and intended to harm. This means that the rambunctious children rough-housing on the playground is generally not a bullying situation. Playful acts, or acts with the intent of friendly, physical play, are not bullying. Certainly, there are times when children may misunderstand the intent of their peers or friends and perceive an action as hurtful. In that case, a frank discussion of intended message versus experienced consequence is required, but there is no immediate concern for bullying. If a child did not intend to hurt their peer, bullying is not the issue.

When researchers use the term “aggressive behavior,” it should be clarified that aggression is not always physical. Aggression comes in three forms: physical, verbal and relational. Physical aggression is exactly what you are imagining – punching, kicking, hitting and similar behaviors. This kind of aggression occurs in very young children (think: toddlers), most often as a means of communication due to their limited verbal skills. By early childhood, kids rarely use physical aggression to communicate, as most children are able to talk and verbalize their wants, needs and feelings.

The second type of aggression is verbal aggression. This can involve things like yelling, screaming, swearing, threatening and name-calling. This kind of aggression occurs throughout childhood and adolescence, with the frequency decreasing as children mature.

The last form of aggression is the most complex. It is called relational aggression. Researcher Nicki Crick defined relational aggression as any act that uses the social relationships, social standing or social experiences of an individual to harm them. The stereotypical examples of relational aggression come from films like Mean Girls. Gossip, social exclusion, humiliation, embarrassment, rumor spreading and intentional ignoring are all examples of behaviors that fall into the category of relational aggression. This frequency of relational aggression generally increases as children develop, as relational aggression requires more sophisticated verbal and social skills to carry out. In addition, relational aggression is rarely noticed by adults and often does not carry the same disciplinary consequences as physical or verbal aggression. Children learn quickly that refusing to play with a peer or spreading a nasty rumor is unlikely to get them “in trouble,” making this type of aggression far more effective for older children and adolescents.

It is important to note that both boys and girls engage in aggressive behavior. Girls tend to start using relational aggression younger, and use it consistently throughout their lives. Boys tend to start out using physical aggression, and shift to relational aggression as they mature. However, both boys and girls engage in aggressive behavior at all developmental stages.

Back to our definition of bullying – the next element is “happens repeatedly.” Bullying is not a one-time occurrence. The behavior, or harm caused by the behavior, must happen over and over. Two children who are angry and get into a fight in the cafeteria may well be intending to harm one another. However, if the fight is a one-time occurrence, there is no immediate concern for bullying. One challenging aspect of this part of the definition is how we handle online or cyberbullying (i.e., bullying that happens through electronic media such as text or social media). Because posts to social media, texts and images online can be viewed multiple times by multiple people, a single act carried out online may meet the definition of bullying. For example, posting a message that conveys a nasty rumor about a peer to one classmate’s profile can have untold impact on the victim’s social relationships depending on how many times that post is forwarded, tagged, “liked,” discussed or otherwise shared across the social network.

The last part of the definition of bullying is that it occurs “in a relationship where there is a power differential.” Power differentials exist in many relationships – parent/child, teacher/student, employer/employee, landlord/renter, therapist/patient and so on. In children, power differentials may exist when a child is:

  • older
  • physically larger
  • more popular
  • more socially skilled

While this is not an exhaustive list, these are the most common situations where we find power differentials in children. Without a power differential present in the relationship, bullying is not an immediate concern. It is not uncommon for children to have challenges in their friendships, such as teasing, unwanted horseplay, sitting with other friends at lunch and choosing to work with a different partner on a project. However, these challenges typically do not meet the “power differential” criterion of bullying. They are better defined as normal, healthy obstacles in relationships that, when worked through productively, can help children develop more sophisticated social problem-solving skills.

What to do when it is bullying

We’ve discussed many examples of what is not bullying, so what should happen when behaviors are best characterized as bullying? First and foremost, assess your child’s safety. If physical aggression is part of the bullying, consider immediate action, such as talking to your child’s teacher or school administrator. Note that bullying is now a legal matter in many states, including Massachusetts. When talking to your child, remember that bullying comes with plenty of shame and anxiety, so make every effort to ask simple, clear, direct questions with as calm a tone as possible.

If your child’s safety is not a primary concern, ask your child if they want your help to solve the problem. If so, consider helping your child map out the social dynamics of what is happening. Who is saying what? To whom? Is it just you who is the victim, or are the bullies doing the same thing to other children? Does the teacher notice? If so, do the bullies get in trouble? Depending on the answers, help your child work toward a strategy to solve the problem. Younger children may require more adult intervention, such as a parent reaching out to the teacher. Older children and adolescents may be able to try out problem-solving strategies independently, with your support at home.

If your child does not want your help, consider letting them try to solve the problem on their own. Remind them that you love and trust them, and have confidence in their ability to figure out tough situations. Encourage your child to participate in other social activities where they experience more positive interactions, such as martial arts, Girl or Boy Scouts, team sports or clubs outside of school. Having strong, positive friendships is one of the most important resiliency factors when a child is the victim of bullying.

It may help to know that upwards of 90% of adults report having been the victim of bullying at least once in their lifetime. Interestingly, over 70% also report having bullied someone else.


About Pediatric Neuropsychologist Dr. Yvonne Asher:

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.


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


To book an appointment with Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email or call 617-658-9800.