NESCA Notes 2019

What is a Nonverbal Learning Disability?

By | NESCA Notes 2019

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

There is often lack of awareness or confusion about what a Nonverbal Learning Disability (NLD or NVLD) is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management.  As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning. On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception. In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration. Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills. Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive Functioning. Executive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning. With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges. Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD? The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. Some available options include Pamela Tanguay’s Nonverbal Learning Disabilities at Home: A Parent’s Guide and Nonverbal Learning Disabilities at School: Educating Students with NLD, Asperger Syndrome and Related Conditions, and Kathryn Stewart’s Helping a Child with Nonverbal Learning Disorder or Asperger’s Disorder: A Parent’s Guide.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at


About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.


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


Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email or call (603) 818-8526.

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2019


By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

I recently attended the International Dyslexia Association Conference in Atlanta, GA ( Among the conference attendees were researchers, teachers, speech-language pathologists, psychologists, and parents of children with dyslexia. One recurring key point was the importance of early identification of reading difficulties, as early provision of appropriate interventions and services leads to better outcomes.

It is important to remember that unlike seeing, hearing, and eating, reading is not something humans do naturally. Reading must be learned and it is not easy (Maryanne Wolf, Proust and the Squid).

As a parent, your early observations are important as there are many developmental indicators that may signal a risk for reading difficulties such as:

  • Experiencing repeated early ear infections
  • History of speech delay and/or pronunciation problems
  • Slow vocabulary growth, frequent difficulty finding the right word, use of less specific words such as “the thing,” “the stuff,” or “that place.”
  • Your child struggles to recognize words that start with the same sound (e.g., cat and car) or end with the same sound (rhyming).
  • Difficulty learning letter and number symbols when in preschool
  • Family history of reading problems

During first grade, you can watch for these warning signs as you listen to your child read aloud:

  • Does not know the sounds associated with all of the letters
  • Skips words in a sentence and does not stop to self-correct
  • Cannot remember words; sounds out the same word every time it occurs on the page
  • Frequently guesses at unknown words rather than sounding them out
  • If you ask your first grader to read aloud to you and he/she is reluctant and avoidant


Early identification of reading issues is extremely important for outcome. If children who have dyslexia receive effective phonological awareness and phonics training in Kindergarten and 1st grade, they will have significantly fewer problems learning to read at grade level than children who are not identified or helped until 3rd grade.

What should I do if I suspect my child has challenges with reading?
If you suspect your child is struggling to learn to read, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

To learn more about evaluations and testing services with Dr. Talamo and other clinicians at NESCA, you may find the following links helpful:

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

Sources used for this blog:


About the Author:

With NESCA since its inception in 2007, Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School Students.”

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders, and emotional issues. She is also interested in working with highly gifted children.

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.


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


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


This blog was originally published in 2017.

Parenting Orchids and Dandelions

By | NESCA Notes 2019

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

I recently evaluated a 15-year-old boy, who we’ll call Sam, whose parents brought him in due to some concerning new behaviors, including failing classes, disobeying his parents’ rules – particularly around curfew and technology use – and smoking marijuana on a daily basis. When meeting Sam, I was amazed at how engaging, polite and good-natured he was. It was hard to imagine this young man disobeying his parents and staying out all night, which he was also doing frequently.

Sam had grown up in an affluent and supportive family, the third of four children. The other three were, like their parents, easy-going, adaptable and successful – academically, socially and athletically. They were on the path to becoming independent and successful adults. Sam had always been a bit different. He was the child who had colic as an infant, sleep disturbances throughout childhood, separation anxiety at preschool, and extreme sensitivity to sensory stimuli. His parents cut tags out of his clothes, bought him loose-fitting pants, and avoided birthday parties at Chuck E. Cheese’s – or almost anywhere there would be crowds of loud children, as these situations could reduce Sam to tears.

When evaluating Sam, I was impressed by his intelligence, quick reasoning and solid academic skills.  There was nothing obvious that standard neuropsychology tests uncovered. But Sam was also open and articulate about his difficulties. He explained that he was easily overwhelmed – “jangled,” he called it – in social situations, in a fast-paced classroom or on an athletic field. When he started ninth grade in a challenging parochial school, he was faced with more stressful situations, academically and socially. He became extremely anxious about tests and lengthy homework assignments, so he fell behind academically and developed pretty serious school anxiety. Given his sensitive nature, he was particularly likely to struggle in a class where the teacher was, in his words, “too strict,” or even “mean.” He wasn’t successful enough socially or athletically to sustain his self-esteem in these areas, particularly compared to his talented siblings. He found himself becoming angry and anxious, and he started using marijuana to calm himself. As he described it, getting high was the only time he felt happy and relaxed.

Sam was clearly struggling, easily meeting criteria for an anxiety disorder and a substance use disorder.  But I wanted to explain some of the “why” behind his struggles, so, in talking to his parents, I relied on the explanation put forth by Dr. W. Thomas Boyce, in his book, Orchids and Dandelions: Why Some Children Struggle and How All Can Thrive. He explains that most children are like dandelions, born with sturdy, resilient temperaments so that they, like dandelions, grow and thrive wherever they land –  assuming there’s some minimal level of appropriate conditions. But about 20% of children are more like orchids. They are born with a very sensitive nervous system, which is highly attuned to all the stimulation in the world around them. Dr. Boyce found that for these children, lower levels of stress precipitated a full-fledged anxiety response, involving the release of stress hormones that create a Fight, Flight or Freeze response – an appropriate response for a life-threatening situation, but not much help when facing, say, a strict teacher or a hard test. These children are therefore much more likely to develop full-blown anxiety disorders. On the positive side, their high level of sensitivity to the world around them means they are typically very empathic and emotionally attuned. Like an orchid with careful nurturing, they will develop into exceptional adults.

Fortunately, many orchids do naturally gain resilience as they grow, according to Elaine Arons, Ph.D. In her book The Sensitive Child, she cites studies that find most children who are shy as preschoolers – suffering social and separation anxiety – will develop coping strategies and not appear shy by the time they reach school age. These orchids gain resilience without losing their sensitivity.

But this positive evolution requires good parenting. While dandelions do fine with the average “good-enough” mother, as famously defined by psychologist Donald Winnicott, orchids need parents to be just a bit better.

How does one do this? How can a well-meaning, good-enough parent help these orchids become better able to manage the squalls, large and small, that occur in any one’s life?

Fortunately, there is a wealth of research – contained in books and articles – on building resilience in children. Most emphasize that we need to allow children to struggle with challenges, even to the point of sometimes failing, so they learn that they can cope and succeed in the face of adversity. This message is clear from the title of several such books: e.g. The Blessing of the Skinned Knee: Using Timeless Teachings to Raise Self-Reliant Children, by Wendy Mogel and The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed by Jessica Lahey.

We also have a neurobiological explanation for this process. We know that continued exposure to a stressful situation allows the body to habituate and the terrible feelings – such as fear and panic – that accompany a stress response gradually recede. As this happens, the previously scary situation becomes routine, and the child’s self-confidence and willingness to tackle new risks grows. Every preschool teacher knows this. The crying child who is being left by his parents in an unfamiliar preschool will eventually calm down and start to enjoy himself. The process goes more quickly if parents calmly and confidently reassure the child, then leave. The parent who is also anxious, who hovers over the child, attempting to sooth his fears, only increases the child’s anxiety by sending the message that this IS a scary situation. This phenomenon was dramatically illustrated in a study by Susan Crockenberg and Esther Leerkes (Development and Psychopathology, 2006). They found that 6-month-old children had different levels of reactivity – or startle – in response to unfamiliar stimuli. These infants also showed differences in how much they tried to avoid the situation, versus distracting themselves while staying in the presence of the stimuli. Children with high reactivity and a tendency to withdraw from novel stimuli, along with parents who were less sensitive, were more likely to show high anxiety at 2.5 years of age. Exposure to challenge causes the body to habituate and builds resilience. Trying to avoid stressful situations only exacerbates fears.

However, this can be counterintuitive for parents of very sensitive children. In fact, the more attuned a parent is to his/her child’s sensitivity, the harder it becomes. Sam’s parents had always coddled him a bit more than their other children. Knowing that he didn’t like loud birthday parties, his mother tended to decline these invitations. When he became upset and started to cry at a soccer game, his father felt so sorry for him that he didn’t insist that Sam return the next week. This avoidance did not allow Sam to grow and master new situations, but instead narrowed his world.

This is not to say that Sam’s parents should have been less emotionally attuned. Rather, it’s important for parents of children like Sam to walk a fine line between exposing the child to moderate challenges that he can manage but do not overwhelm him. It’s also important that they stay calm themselves, empathizing with the child’s fears but reassuring him at the same time. Not an easy task.

Fortunately, Sam has many strengths, not the least of which are his sensitivity and his intelligence, as well as great artistic gifts. He also has a solid relationship with his parents, even though it has been quite strained of late. After our evaluation, Sam and his parents decided to place him in a therapeutic wilderness program so he could withdraw from daily pot use in a safe place and learn skills from therapists there, as well as learn from peers who were going through similar struggles. This coming year, he will not return to the challenging parochial school he attended for ninth grade and will instead start at an independent school that offers some academic supports and a flourishing arts program. Sam’s roots are well-established, and with a bit more awareness of the gifts and challenges inherent in his sensitive nature, he is expected to grow into a self-confident and resilient young man.


About the Author: 

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

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

How High School and College Differ for Students with Disabilities

By | NESCA Notes 2019

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

Today, more students with disabilities are opting to attend college. As students plan to pursue college, it’s important for them to understand the increased expectations in college in the areas of academics, independence and social environments. For example, while in high school, the responsibility to get the students the services needed to be successful fell on parents and teachers; however, college students must advocate for themselves in post-secondary education. Below are some important ways in which the college and high school settings differ for students with disabilities, as well as some suggested strategies to prepare them.

Applicable Laws – In high school, students with disabilities are covered under the Individuals with Disabilities Act (IDEA), which mandates a free, appropriate public education for students with a disability (3-22 years of age). Some students in high school are covered under Section 504. In college, schools must comply with the Americans with Disabilities Act (ADA) and Section 504 – both laws are based on civil rights and prevent discrimination for people with disabilities. In short, IDEA is about success; ADA is about access.

Required Documentation – In high school, the school district is responsible for providing an evaluation at no cost to the student; this documentation focuses on whether a student is eligible for services under specific disability categories. Colleges are not responsible for the documentation. Students must get an evaluation at their own expense (if documentation is not current). Most colleges will accept current testing (within three years). This documentation must provide information about how the disability impacts the student and demonstrate the need for accommodations. Colleges will list on their website the type of documentation needed.

Modifications vs. Accommodations – In high school, if necessary, classes and materials may be modified, and the school is responsible for those accommodations and modifications. Some modifications may include reduced assignments or readings, adjusted grading to weigh a student’s daily work equal to semester tests. However, in college, there are no modifications to assignments or the curriculum; there are only accommodations. School is no longer responsible for arranging accommodations; rather students must advocate and arrange accommodations  for themselves.

Self-disclosure and Self-advocacy – In high school, teachers and parents support the student’s needs, with teachers approaching students if they believe assistance is needed. In college, the student is primarily responsible for arranging accommodations and advocating for their own needs. This is a significant shift—not just for the student, but for the parents, too. Parents no longer have access to the student’s records. The high school cannot disclose to a college a student’s disability—only the student can choose to disclose.

Disclose or Not to Disclose…That is the Question – Choosing to disclose that a student has a disability to a college is a deeply personal decision. As discussed, it is up to the student to disclose. If the student decides to disclose a disability, they need to understand not only the name of the disability, but also be able to communicate and describe how the disability impacts them and their learning. This is critical in determining what types of accommodations will be written into their 504 plan. While in high school, the student should be honest and realistic about the types of accommodations actually used and which of those were helpful. Helping your child practice discussing their disability and how it impacts them is very useful in preparing them to meet with the Office of Disability to share their needs. If a student decides not to disclose, they will not receive accommodations. However, all colleges have some type of tutoring and/or writing center to help students improve their academic skills. If a student chooses not to disclose and does not do well, they can still meet with the Office of Disability at any time to look into a 504 plan. However, their 504 plan will not be retroactive for the semester. Instead, accommodations will start from the date of the plan.

What Can Parents Do?

Preparing your child with a disability is critical to helping them be successful. Specifically, they will need self-determination skills. Self-determination is the understanding of one’s strengths and limitations together with a belief in oneself as capable and effective. These skills enable a person to participate in goal-directed, self-regulated, independent behavior. A person with self-determination skills is more likely to be independent and successful in work and training. Some suggested activities to help build self-determination skills include: Teaching your child how to make phone calls to make appointments, write emails with a professional tone and speak directly to people in stores or restaurants. Parents may need to start with a script to help a child practice, then fade support so the child is speaking as independently as possible in various settings. Other activities include having your child plan and prepare a weekly family meal (including making the grocery list, shopping for items, etc.), playing financial literacy games and activities (, or talking with your child about how to begin to interact more independently with healthcare providers.

As parents, it is important to know that as your children become more independent, such as going to college, while they are now holding onto the reins, they are likely to need your help with the steering.

While these differences may seem daunting, self-advocacy, executive functioning and independent living skills taught throughout an individual’s transition to adulthood (starting as early as possible) can help to ease the jump to post-secondary education and its accompanying expectations. If you would like to discuss this topic in greater detail as it relates to you/your student, please complete our online intake form and note that your inquiry is for Transition Services.



Center on Community Living and Careers, Indiana Institute on Disability and Community, Indiana University

National Council on Disability 

Santa Clara University

Think College

Life After IEPs

Financial Education for Everyone: Practical Money Skills



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.

Introduction to Acupuncture with Licensed Acupuncturist Meghan Meade

By | NESCA Notes 2019


By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

Acupuncture is one of eight branches of Chinese Medicine that dates back over 3,000 years and involves the insertion of hair-thin needles into the body to provoke a healing response.

The body registers needling as a microinjury to which it responds by summoning the immune, nervous and endocrine systems to increase circulation, produce endorphins and other pain-relieving substances and flips the switch on the stress response.1,2,3 The treatment itself effectively assesses the internal imbalance and sends a signal to the body to address it; for this reason, acupuncture’s effects are often described as regulating – reducing elevations in inflammatory markers, enhancing the production and function of essential neurotransmitters, and so on. 1,2,3

Because acupuncture is so regulating to the body’s internal environment, the effects experienced by the patient can be both targeted and systemic2 – while pain relief could be achieved for a specific injury such as a sprained ankle, a patient might also noticed improved sleep or reduced anxiety, for example.

As a practitioner of Japanese style acupuncture, a style that is particularly reliant on using the body’s feedback to guide treatment decisions (though not to the exclusion of a patient’s verbal feedback about their health concerns and experiences), I incorporate pulse diagnosis and palpation into my overall diagnosis and treatments. Because an individual is considered to be the ever-changing reflection of their environment and experiences – physical, mental and emotional – my treatments for a given patient and a given condition will never look the same; each day the body is slightly different than the day prior, and treatments are designed with this principle in mind.

Another important theme within Chinese Medicine is that of duality; acupuncturists consider mutually opposing and complementary elements, such as heat and cold, internal and external, male and female, and yin and yang to be crucial in both assessment and treatment. Whereas yang represents heat, energy, masculinity, day time and light, yin, by contrast, represents coolness, substance, femininity, night time and darkness. When we are born, we are at our peak state of yang, which progressively gives way to yin throughout the lifetime. Because children are by nature more yang, their energy is ample and at the surface; accordingly, treating children and adolescents with acupuncture requires less stimulation to yield a desired response. Often needling is not involved, and non-insertive tools and techniques are preferred for their gentle, effective and often expedient results. Pediatric treatments may involve the use of magnets placed on acupuncture points, as well as brushing and tapping techniques using stainless steel, copper and/or silver tools. Because acupuncture points exist along 14 channels that run up and down the body, an acupuncturist can effect change both in a given channel/organ system and systemically by stimulating a channel through brushing and tapping techniques. While the above statement is true that inserting needles into the skin triggers an extensive sequence of immune, nervous and endocrine system events, so, too, does the more superficial work that acupuncturists perform for their pediatric patients.

The goal of acupuncture is always to harmonize, reducing what is in excess and restoring what is deficient. On a biomedical level, this typically entails a shift in the autonomic nervous system from a sympathetic dominant state – fight or flight mode – to a parasympathetic state – the calmer and more productive – though elusive – ‘rest and digest’ mode.2,3 Similarly, acupuncture regulates the function of hormones, neurotransmitters and immune mediators to achieve this balance. While many feel a positive response from a single treatment, acupuncture is generally not a ‘one and done’ therapy; instead, the response to acupuncture becomes stronger and more lasting over the course of several treatments, as a cumulative signal is often required for the body to carry out the work of regulating imbalances. Often after an initial series of treatments, a patient can enter a maintenance mode of treatment, spacing treatments out in increasingly longer windows and eventually receiving treatment on a maintenance or as-needed basis.

I hope this introductory conversation provides some insight as to how acupuncture works. I will be back with a follow-up post to shed some light on the effect of acupuncture on specific conditions commonly seen among NESCA’s client base.

  1. Cheng, Kwokming James. “Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician’s Perspective.” Journal of Acupuncture and Meridian Studies 7.3 (2014): 105-14. Web.
  2. Carlsson, C. “Acupuncture Mechanisms for Clinically Relevant Long-term Effects – Reconsideration and a Hypothesis.” Acupuncture in Medicine 20.2-3 (2002): 82-99. Web.
  3. Cheng, K. J. “Neuroanatomical Characteristics of Acupuncture Points: Relationship between Their Anatomical Locations and Traditional Clinical Indications.” Acupuncture in Medicine 29.4 (2011): 289-94. Web.


About the Author: 

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.


To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at

Monday: 10am – 6pm

Thursday: 9am – 7pm


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.

What Does Autism Look Like? Exploring the Differences among Girls and Boys

By | NESCA Notes 2019


By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

In 2018, the Centers for Disease Control and Prevention (CDC) determined that approximately 1 in 59 children is diagnosed with Autism Spectrum Disorder (ASD). Boys are still four times more likely be diagnosed with ASD; however, research indicates that the diagnosis is often missed in girls, especially those who have average intelligence and “milder” forms of ASD. To understand why ASD is more often missed in girls, let’s explore the differences between boys and girls with ASD. This discussion will focus on children with average to above average intelligence (about 50% of all children diagnosed with ASD).


Boys Girls
Poor impulse control, more acting out Likely to be quiet and withdrawn
Disruptive behaviors in the classroom setting Tend to be reserved and cooperative at school
Frequent repetitive motor behaviors that are directly observable Lower frequency of these motor behaviors
Lack of interest in imaginary play Very much engaged in imaginary play
Restricted interests may seem unusual – e.g., train schedules, maps, windmills Restricted interests may seem “age appropriate” – e.g., horses, unicorns, ballet
Trouble making friends Might have a few friends
Likely to exhibit angry outbursts when frustrated/anxious Likely to engage in self-harm or other behaviors that are not observed by others when frustrated/anxious
Lack of awareness of being different or not fitting in More motivated to fit in and “hide” social difficulties – might try to imitate the behavior of a peer that is perceived as popular


Due to these differences, the diagnosis of ASD is often missed in young girls. Adults might agree that a girl is “odd” or “quirky,” but dismiss these concerns because she has good eye contact, has some friends, and does not engage in hand flapping or other unusual behaviors. Unfortunately, other girls might be misdiagnosed, which could lead to ineffective or inappropriate treatment interventions. Most commonly, they might be misdiagnosed with ADHD or Anxiety Disorder.

In many cases, girls with ASD have increasing difficulties with social interactions as they get older and demands get higher. A young girl with ASD might be able to “get by” in social interactions but by the time she reaches adolescence, she is not able to navigate the intricacies of the social milieu. This can lead to social isolation and high risk of being bullied or rejected by peers.

Unfortunately, a missed diagnosis of ASD for a young girl can have long-reaching ramifications. She might experience depression, anxiety and/or low self-esteem, wondering why she doesn’t “fit in” and “feels different” from other girls. She might start to struggle in school or disconnect from activities that she used to enjoy. Moreover, missing the diagnosis in childhood means that she did not receive services to support her social and peer interaction skills during her formative years.

As always, when parents or other caregivers have concerns about a child’s development, it is important to seek an evaluation from a professional. And if the findings do not feel quite right, parents should never feel uncomfortable about seeking a second opinion.


About the Author: 

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.


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


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

Transition Planning for Adulthood—It Starts at Birth

By | NESCA Notes 2019


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

There are many transitions throughout a person’s life, but as a transition specialist working at a pediatric neuropsychology practice, my focus is most often on helping students who have struggled with learning, social and/or emotional difficulties to plan for and successfully navigate the transition from secondary school to whatever comes next in life (e.g., employment, transition program, community college, apprenticeship, etc.). I focus on helping young people envision their future selves and set short- and long-term goals for themselves—putting them into the driver’s seat for their own lives and helping them manage the risks and responsibilities that come with making choices for themselves.

When a family walks into my office for the first time, it is common for one parent or caretaker to worry aloud that they are starting transition planning for their child “too late.” I consistently respond that it is never too late to start planning and to begin transferring responsibility from one generation to the next. But today, I also want to emphasize that “it’s never too early” to start to plan for your child to be a more independent and competent adult—the best transition planning starts at birth.

Some common examples of transitions that start at a very early age that many parents and caregivers can relate to are: a child sleeping through the night for the first time unsupported, holding a cup and drinking without spilling, feeding oneself with a spoon, and/or riding a bicycle. Each of these activities is an example of a child building competence and independence while their parents simultaneously relinquish some amount of control. Often times, mistakes, messes and even pain are a natural part of the process.

From a young age, there are many skills that children can learn that will make a big difference for them later in life. Some examples include:

  • Picking out clothes for the next morning
  • Putting dirty clothes in a hamper
  • Loading the washing machine
  • Putting clean clothes away in drawers
  • Washing hands before eating, after using the bathroom and after playing outside
  • Setting the table (maybe not plates or glasses, but perhaps napkins, forks and spoons)
  • Carrying dishes to the counter and placing them next to the sink after dinner—or even in the dishwasher
  • Putting their own garbage in the trash
  • Collecting small trash bins to dump into a larger bin/bag on trash day
  • Helping to pack their own lunch
  • Helping to prep a meal (e.g., washing veggies, pouring ingredients, etc.)
  • Getting condiments from the refrigerator and putting them away after dinner
  • Getting a snack for self or a sibling from the refrigerator or pantry
  • Wiping down the table after a meal
  • Feeding/providing water for pets
  • Weeding
  • Raking leaves
  • Shoveling snow
  • Helping to get the mail
  • Brainstorming for/making a shopping list
  • Finding assigned items at the grocery store
  • Carrying light grocery bags
  • Helping to pack belongings for a family trip
  • Making gifts/cards for a celebration
  • Budgeting a few dollars to buy inexpensive but thoughtful gifts for family members

Some of these will apply to your child and some of them will not. And some of these may require adding time to your schedule, allowing a child to complete tasks at their own pace, or doing some household reorganization, allowing a child to access items necessary to complete tasks. Finally, a lot of deep breathing and patience—for both you and your child—will be required!

At any point in time, you can identify a task  you regularly do for your child and consider where there are pieces they can do for themselves. If your only role in the task is to prompt your child, consider whether there might be a low-technology tool (post-it, photograph) or high-technology tool (alarm, phone reminder) that could take the place of your prompt. If you are not sure how to make a change, it may be a good time to get help from a teacher, pediatrician, behavioral therapist, special educator, etc.

The important thing is that you are starting to think about where there is a potential for increasing competence, independence, confidence and self-esteem for your child. You are starting to plan for your own obsolescence in your child’s life, or at least in their carrying out every day self-care activities and chores. While that is a scary thing, it is also a beautiful and empowering thing!


If you are interested in working with a transition specialist at NESCA for consultation, planning or evaluation, please complete our online intake form:


About the Author:

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

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


Back to School 101: How to Support your Child

By | NESCA Notes 2019

By: Reva Tankle, Ph.D.
Pediatric Neuropsychologist


When should I start transitioning back to the “school routine?”

The summer break should be a time for kids to have fun playing with their friends and family and enjoying new adventures and experiences. As the new school year looms, however, parents start to think about how to transition from the flexible downtime of summer to the more structured and rigid schedule of the school year. As such, they often wonder when to start the process of getting back to the school routine. Of course, it will be different for each child but, for most children, a slow transition is the best plan. Things to consider are:

  • Probably the most important routine to get back into is the bedtime and morning schedule. Parents should consider a slow transition starting 1–2 weeks before the first day of school. Move the bedtime by 10–15 minutes earlier every few days; inching closer to the school night bedtime. By the time it is the night before the 1st day of school, your child should be back to their regular bedtime. After allowing for an adequate number of hours of sleep, parents might consider waking their child up earlier in the morning, again, inching closer to the wake-up time on school days.
  • During the summer months, some children’s access to screen time might increase. Parents should consider reducing screen time during the day and especially in the evening; closer to their family’s rules for access to screens during the school year. Since many children have summertime reading to do, this might be a good time to get your kids off the screens and focused on completing their summer reading.
  • Regardless of your best intentions to transition smoothly to the school year routine, the beginning of school can be challenging for many children. Giving children, especially younger children, adequate time after school for play and ensuring the right amount of sleep will help children make the transition from summer to school.

What can I do to help this year’s teachers, specialists and therapists get to know my child as well as what’s in their IEP or 504 Plan?

If you child is in elementary school, your child will likely have one or at most two new teachers. It is a good idea to make sure the teachers are prepared to meet your child’s educational needs from the first day of school. But it is also important to recognize that it will take time for the teacher to get to know your child, and you want to make sure that you don’t overload the teachers with more information than they can handle. They will read the IEP, but that can be very overwhelming. To help them get started, you can send an email on the teachers’ first day back at school. Keep it short. Write a few sentences describing your child’s strengths and weaknesses. And then write the 2 or 3 things in the classroom that you think will be most important for your child to be successful in the upcoming year. I can’t stress enough how important it is to be short and to the point in this note. If you keep it focused on the most important information, it is more likely that the teachers will remember what you have shared.

If your child is in middle or high school, you could use a similar approach and write a short note about your child. You may choose to send it to all their content teachers or specifically to their Special Education teacher/liaison.

Finally, if your child is on a 504 Plan, it is definitely worthwhile to send a note to all your child’s teachers that informs them of the 504 Plan, listing the accommodations that are in your child’s 504 Plan. If, however, it is a very long list, you might consider writing the most important accommodations and request that they refer to the official 504 Plan for the comprehensive list. If you have a scanned copy, you could attach it to the email and make it easier for them to have access to it.

My child is anxious – how can I help my child feel more at ease?

Many children feel anxious at the start of a school year. They worry about having a new teacher and being with new classmates. To ease your child’s worries about the first day of school, here are some suggestions:

  • Often teachers start working in the school a few days before the students arrive. Call the teacher and arrange for your child to visit the classroom and have a brief 1:1 meet and greet with the child. If the classroom is set up, the teacher might be able to show your child where their desk will be. Consider taking pictures of the room, desk, locker/cubby and other locations in the school where your child may frequent throughout the school day. As the first day approaches, you can remind your child about how nice the teacher was and possibly, where their desk is, reviewing the photos, if taken. Taking away some of the “unknowns” should reduce your child’s anxiety.
  • Find out from other parents which children from last years’ class are in your child’s new class. Arrange playdates toward the end of summer so you child has some familiar faces to look for.
  • Make sure your child has a “go-to” person in the school with whom they feel comfortable. If they had a counselor the prior year, make sure that person is available to them and remind your child they can go see them if needed.
  • Most importantly, be positive and optimistic about the upcoming year. If you are calm and expect the best, your child will pick up on that and approach the new year with a positive attitude.

New School?

If your child is moving to a new school, many of the suggestions listed above will be helpful in your child’s transition to that school. Most importantly, the opportunity to tour the school and meet teachers should ease their concerns. If they are a middle or high school student, it might be helpful for them to know where their locker is and to “practice” going to their different classrooms. Again, revisit pictures, if  taken during the school visit/meet and greet. The more familiar they are with the environment, the better!

My child doesn’t have an IEP or 504, but I have concerns. What do I do?

If, as the school year begins, you have concerns from the previous year, you should be prepared to act quickly to ensure that your child doesn’t fall further behind. Within the first few days of school, you should send your child’s primary teacher a brief note that outlines your concerns. For example, you might write: “My son didn’t meet the end of the year benchmark in reading last year. I am concerned about his reading development. I would like more information from you about his reading level after you do your beginning of the year benchmark assessment.” It will be important for you to follow up with the teacher within 3–4 weeks and get the information you requested. If you remain concerned because of academic, behavioral or emotional issues you are seeing at home, you should not hesitate to request a Special Education evaluation for your child. Make your request in writing to either the Special Education coordinator at your school or the main Special Education office (find out from your school where to send it or, to be sure, send it to both).

It is critical that you don’t let too much time go by at the beginning of the year to make your request for an evaluation. The school is obligated to evaluate at your request so, don’t be dissuaded from the evaluation if you have concerns about your child’s development and their ability to make progress in school.

I wish you and your family a positive and happy return to school this year!



Reva Tankle, Ph.D.
Pediatric Neuropsychologist

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.


Identifying and Supporting Twice-exceptional (2e) Children

By | NESCA Notes 2019

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

  • Rodney gets decent grades and achieves close to or at grade level in all of his district assessments. When concerns about his reading achievement were raised and an evaluation was conducted, it was found that his IQ is well above average, superior in some areas, but his reading decoding scores are below the average range for students his age. He has a combination of some gifted abilities and other areas that require intensive intervention. Rodney is twice-exceptional. (National Education Association, The Twice Exceptional Dilemma).
  •  Because of his behavioral difficulties, James attends a special program within his school for students with emotional and behavioral disorders. His teachers have difficulty seeing him as “gifted” as he is often uncooperative and reluctant to perform academic tasks in class. However, indicators are there. He participates in a weekly community program with students who are not disabled, to design a functioning robot and does so with a tremendous amount of ingenuity. He is also an avid reader outside of school and can offer a very keen oral analysis of the works he has read.  James is twice-exceptional.  (National Education Association, The Twice Exceptional Dilemma).

Twice exceptional—or “2e”—students are those who possess outstanding gifts or talents and are capable of high performance, but who also have a disability that affects some aspect of learning (Brody & Mills, 1997).  The largest group of twice exceptional children are those students who are academically gifted but who also have a disability (e.g., learning, physical, social/emotional or behavioral).

Some common characteristics of gifted students who also have a disability include:

  • Demonstrates a high verbal ability, but displays extreme difficulties in written language (reading, written expression)
  • Has strong observation skills but difficulty with memory skills
  • Shows attention deficit problems, even though they demonstrate special talents that consume their attention
  • Understands concepts at a high level, but struggles with basic skills (e.g., reading decoding, math fact fluency).

As a result, these students are at risk of facing challenges, such as:

  • Asynchronous development (the child is far ahead intellectually, but far behind socially and emotionally)
  • Underperforming academically
  • Frustration
  • Argumentative personality
  • Sensitivity to criticism
  • Poor study habits and organizational skills
  • Difficulty in social situations
  • Because they are clearly bright but performing poorly, they may be perceived as “lazy,” which, in turn, puts them at risk for criticism that can negatively impact self-esteem, which can also put them  at risk for depression.

Unfortunately, in the states of Massachusetts and New Hampshire, there is currently no gifted education legislation. As a result, schools are not required to identify gifted students.  Even if a specific school system does choose to identify these students, there is no mandate to create a program for those identified, and there is no gifted funding.  Massachusetts and New Hampshire are two of only eight U.S. states that do not have a gifted and talented mandate. And while Rhode Island has mandated identification of gifted students and requires programs to serve those students, it does not provide the schools with any government funding.

Since Massachusetts and New Hampshire are not yet mandating screenings for giftedness, nor mandating programs for these students (although some schools do so independent of the lack of mandate), it is important for parents to be informed of their child’s learning profile to advocate for needed services as well as to encourage their child’s areas of strengths and interests. The best way to determine if a child meets criteria for twice exceptionality is through a neuropsychological evaluation. A thorough neuropsychological evaluation will help a parent and school understand a child’s cognitive, academic and social/emotional strengths and weaknesses, helping to identify what supports or programming that specific child truly needs.

In addition, there are supports out there, as many giftedness programs and extra-curricular opportunities exist. Some helpful websites include:

  • – along with a strong (and easily searchable) database, the Davidson Institute and Davidson Academy are dedicated to supporting profoundly gifted students in the United States, including summer programs, scholarships and an accredited online school.
  • – The Massachusetts Association for Gifted Education’s (MAGE) mission is to support and advance the understanding of high potential/gifted children and their special needs, to promote the establishment of programs, services and opportunities for high ability/gifted students, and to encourage the exchange of information pertaining to gifted individuals among educators, parents, policy-makers and students on the national, state and local levels.

Additional sources used for this article: kids both gifted and challenged about twice exceptional 2e students



About the Author:

With NESCA since its inception in 2007,  Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center. After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University. She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School StudentsDr. 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.


To book a neuropsychological evaluation or consultation  with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate that you would like to see “Dr. Talamo” in the referral line.


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.

We’re All “Perfection Pending”

By | NESCA Notes 2019

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

The final months of the school year always feel intense at NESCA as the clinical staff works diligently to get reports out on shorter timelines, squeeze in extra meetings and school observations, and ride the waves of joy and disappointment with parents who are seeking different educational placements for their child in the fall.  And somehow, every year, it all gets done, and then I can feel everyone let their breath out.  The halls of NESCA are a bit quieter now with staff taking well-deserved time off to be with their families and friends, relaxing and renewing in their favorite places.  I’ve just come back from a week of hiking in Norway, feeling rejuvenated by the time in nature and physical challenge—something we all need.

Even with the quieter summer months upon us, we continue to improve and expand NESCA’s services to meet the needs of the children and families we serve.

  • NESCA is very fortunate to have Dot Lucci, M.Ed., CAGS, join us as the Director of Consultation and Psychoeducational Services. I have worked with Dot many times over the last 30 years and am thrilled to have her as part of our team. She now brings her vast experience with the meaningful inclusion of children with special needs and her exceptional ability to work with school systems effectively to our NESCA families.
  • We also recently welcomed a new pediatric neuropsychologist, Dr. Yvonne Asher, who is splitting her time between the Newton and Londonderry offices. While she sees a wide range of children, Dr. Asher specializes in the evaluation of preschoolers and children with Autism Spectrum Disorder.
  • We are sad to be saying farewell to Holly Pelletier, our acupuncturist, who will be practicing full time in Maine, but welcome Meghan Meade, who will be taking her place starting today, today, July 15.
  • In September, Dr. Sophie Bellenis, OTD, OTR/L, will be joining us full time as a member of the Transition Planning Team under the leadership of Kelley Challen, Ed.M., CAS.

I hope you and your children enjoy the different pace and energy of the summer months and that this is a time of growth as well as reflection for all of you.


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.