Real-life Skills Coaching Alert!

NESCA now has two Occupational Therapists offering in-person, community-based Real-life Skills Coaching in the Newton area. To learn more or book sessions, complete our Inquiry/Intake Form.

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Picture of a teen with a disability at work getting assistance

How Occupational Therapists Can Support Neurodivergent Teens and Young Adults with Self-Regulation in the Workplace

By | NESCA Notes 2025

Picture of a teen with a disability at work getting assistanceBy: Lyndsay Wood, OTD, OTR/L
NESCA Executive Function and Real-life Skills Program Manager

Self-regulation is a critical skill for anyone entering the workplace, but for neurodivergent teens and young adults, it can be particularly challenging. These individuals may face overstimulation, burnout, emotional dysregulation, and many other unexpected challenges in the work setting. Occupational therapy (OT) can play a pivotal role in helping these young adults develop the tools they need to thrive in a work environment.

What is Self-Regulation, and Why is it Important?

Self-regulation refers to the ability to manage your emotions and state of arousal in order to meet the demands of your environment. In the workplace, self-regulation is essential for staying calm under pressure, responding appropriately to feedback, and managing the various sensory and social demands of the job.

For neurodivergent teens and young adults, challenges may arise when dealing with unexpected changes, new work tasks, over or under stimulation of the sensory system, or complex interpersonal workplace dynamics. Learning to regulate within the context of these challenges can make the difference between a successful work experience and one that leads to frustration, anxiety, burnout, or job termination. Below is a list of three different ways occupational therapists can support teens and young adults with self-regulation in the workplace.

Developing a Personalized Self-Regulation Plan

One of the most effective ways to support workplace success is through the development of a self-regulation plan. This plan is individualized to each person and can serve as a guide for both the individual and their supervisors or co-workers. Here is a breakdown of essential items to include within the plan.

  1. Strengths

Before diving into potential challenges, it’s important to highlight strengths. What skills does the individual already possess that can help them succeed in the workplace? For example, a teen with an autism spectrum disorder (ASD) might have exceptional attention to detail, while a young adult with Attention-Deficit/Hyperactivity Disorder (ADHD) may excel in creative problem-solving. Identifying these strengths helps boost confidence and serves as a foundation for skill building.

  1. Triggers

Triggers are external or internal factors that can lead to dysregulation. These can include:

  • Sensory triggers: Bright lights, loud noises, hot rooms, specific textures, etc.
  • Emotional triggers: Criticism, frustration, misunderstandings
  • Cognitive triggers: Task-switching, or multi-tasking demands, large quantities of information being given verbally

A key part of OT intervention is helping the individual recognize their personal triggers, because understanding triggers can help prevent or minimize dysregulation.

  1. Develop Preventive Strategies

Once triggers are identified, the next step is to create strategies to prevent dysregulation before it happens. These strategies might include:

  • Environmental modifications: Wearing noise-canceling headphones, keeping fidgets at your desk, requesting a desk near a window for natural light, adjusting the workload to prevent overwhelm, or bringing a therapy animal to work
  • Routine adjustments: Incorporating short, frequent breaks during the workday, using visual schedules and reminders to manage tasks more efficiently, or requesting that work tasks be provided in writing
  • Emotional prep: Practicing self-talk or role-playing scenarios that may be challenging, engaging in daily mindfulness activities, spending time doing an activity that improves your mood prior to a work shift
  • Medication: Ensuring essential medications are taken daily at a consistent time

By establishing preventive strategies, individuals can feel more in control and reduce the likelihood of becoming overwhelmed.

  1. Create In-the-Moment Strategies

Even with preventive measures in place, there will be moments when the individual feels dysregulated. Developing in-the-moment strategies is critical to managing these situations effectively. Some in-the-moment strategies include:

  • Breathing techniques: Deep breathing exercises to help calm the nervous system and lower anxiety in stressful situations
  • Distraction: Watch a funny or calming video on your phone for a couple of minutes to help your brain reset
  • Physical movement: Taking a short walk or doing some discreet stretching at the desk can help release built-up tension
  • Taking a break: Request or take a 5-minute break from your work tasks to reset

These strategies should be easy to access and implement in the workplace, allowing the individual to regain control without disrupting their workflow.

Building a Toolbox of Sensory Strategies

Sensory regulation is a key part of self-regulation, particularly for neurodivergent individuals. Occupational therapists can help teens and young adults build a sensory toolbox that includes items or activities to help them self-soothe and regulate their sensory systems. Examples of sensory tools might include:

  • Fidget tools for tactile input
  • Aromatherapy oils or scented items to calm or refocus
  • Weighted blankets, heavy work, or pets on the lap (if the work environment allows) for proprioceptive input
  • Noise-canceling headphones or earplugs to manage auditory input

The goal is for the individual to have access to sensory supports that can be used in non-disruptive way while at work. These tools can be critical in maintaining focus and emotional regulation during the workday.

Building Self-Advocacy Skills

An essential part of successful self-regulation in the workplace is the ability to advocate for one’s own needs. Many teens and young adults have a difficult time with this skill, but occupational therapists can help individuals build the skills and confidence they need to successfully advocate for themselves in the workplace. Self-advocacy involves:

  • Knowing one’s needs: The individual should have a clear understanding of their strengths, challenges, and what accommodations are most beneficial. It is extremely beneficial to create a document that the individual can access and update throughout their lifetime that details all of this information.
  • Communicating needs: Learning how to express these needs clearly and assertively to supervisors or co-workers is crucial. This may involve requesting a quieter workspace or asking for a sensory break during particularly stressful tasks. Role-play is often a helpful tool to practice these communication skills.
  • Setting boundaries: Advocating for one’s needs also includes setting personal boundaries to avoid burnout. This could mean learning to say “no” to additional tasks when overwhelmed or asking for extra time to complete certain projects.

Occupational therapy can support the development of these communication skills through role-playing, practicing real-life scenarios, and building confidence in expressing needs.

Conclusion

Occupational therapy can play a crucial role in supporting neurodivergent individuals with self-regulation in the workplace through the development of an emotional regulation plan, the building of a sensory toolbox, and the development of self-advocacy skills. With these tools in place, individuals are empowered to manage their emotions, arousal, and sensory needs, leading to greater success and fulfillment in their professional lives.

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, Vermont-based Executive Function and Real-life Skills Program Manager, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

Dr. Wood accepts Vermont- and Massachusetts-based transition and occupational therapy assessments. Her in-home and community-based coaching services are available in the greater Burlington, Vermont area. Dr. Wood can accept virtual coaching clients from both Massachusetts and Vermont.

 

To book coaching and transition services at NESCA, complete NESCA’s online intake form

 

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

Image of a stressed out teenager along with a quote from Julie Weieneth, Ph.D..

Is This Stress or Something More?

By | NESCA Notes 2025

Image of a stressed out teenager along with a quote from Julie Weieneth, Ph.D..By: Julie Weieneth, Ph.D.
Pediatric Neuropsychologist, NESCA

Understanding ADHD, Anxiety, Depression, and Typical Adolescent Development

As both a neuropsychologist and a parent, I see firsthand how challenging academic and social pressures can be for teenagers. Like many parents, I sometimes wonder whether my own teen’s struggles are just part of growing up or if they might signal something more serious, such as ADHD, anxiety, or depression. From my clinical perspective, recognizing the difference is crucial. Early intervention not only supports long-term success but can also help prevent more persistent issues in the future.

Why It Can Be Hard to Tell

Many symptoms, such as difficulty concentrating, mood swings, irritability, and sleep problems, are common and often temporary during adolescence. However, these same concerns can sometimes point to underlying conditions. Careful observation, professional support, and sometimes a thorough evaluation are needed to truly understand what’s happening.

Signs of ADHD

  • Ongoing struggles with attention, organization, and time management in different settings
  • Frequently losing items or forgetting important things
  • Trouble staying focused on tasks that require sustained effort
  • Restlessness or fidgeting
  • Symptoms usually begin in childhood (often by age 12) and are consistent, not just a reaction to stress or specific situations

Signs of Anxiety

  • Excessive worry about school, friendships, or the future
  • Physical complaints, such as headaches or stomachaches
  • Avoidance of stressful situations, including tests or social events
  • Perfectionism and fear of making mistakes
  • Symptoms often become more noticeable during times of increased stress

Signs of Depression

  • Persistent sadness or irritability
  • Loss of interest in activities that used to be enjoyable
  • Fatigue and low energy
  • Changes in sleep or eating habits
  • Withdrawal from friends and family
  • Symptoms last for two weeks or longer and can significantly affect motivation and daily functioning

Typical Adolescent Challenges

  • Occasional procrastination or forgetfulness
  • Temporary mood swings or frustration
  • Feeling stressed before exams or social events
  • Desire for more independence and privacy
  • These concerns are usually mild, short-lived, and tend to improve with support, structure, and time

How a Neuropsychological Evaluation Can Help

A neuropsychological assessment can help clarify whether a teen’s symptoms are part of normal development or indicate a clinical concern. This process includes reviewing developmental and academic history, conducting standardized testing, and gathering input from parents, teachers, and the teen.

Ways to Support Teens Based on Their Needs

  • For ADHD, strategies such as organizational (Executive Function – EF) coaching, academic accommodations, behavioral therapy, and sometimes medication may be needed
  • For anxiety, counseling, stress management techniques, a supportive environment, and sometimes medication may be needed
  • For depression, therapy, healthy routines, and sometimes medication can make a significant difference
  • For teens experiencing more than one of these concerns, a combination of strategies and coordinated care is often most effective
  • For typical adolescent challenges, open communication, structure, and encouragement usually work well

If your teen’s difficulties persist or begin to interfere with everyday life, reaching out to a neuropsychologist can provide clarity and guidance. Early understanding and tailored support can help your teen feel better and succeed both now and in the future. If you are unsure whether your teen needs a full neuropsychological evaluation, you can schedule a consultation with a NESCA clinician who will review your concerns and help you decide how best to proceed.

 

About the AuthorJulie Weineth headshot

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

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of pencils lined up perfectly, as a sign of OCD, along with a quote from Dr. Alison Burns

When Worry Becomes a Cycle: Understanding and Treating OCD in Children

By | NESCA Notes 2025

Image of pencils lined up perfectly, as a sign of OCD, along with a quote from Dr. Alison BurnsBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Obsessive-Compulsive Disorder (OCD) causes strong, unwanted thoughts or worries called obsessions or intrusive thoughts. These intrusive thoughts can be about a wide range of things—such as fears of germs/getting sick, something bad happening to loved ones, or making a mistake. These thoughts can be very upsetting and hard to ignore, even when the child knows they don’t really make sense. The anxiety caused by these intrusive thoughts can feel overwhelming and can take up a lot of mental energy.

To cope with these thoughts, children with OCD often develop compulsions—repetitive actions or mental rituals that they feel they must do to feel safe or to stop something bad from happening. These might include excessive cleaning, checking, counting, arranging items in a certain way, or asking for reassurance repeatedly. While these behaviors may temporarily relieve anxiety, they tend to reinforce the cycle of OCD and make it harder to break over time. Parents might notice their child spending a lot of time on these routines, getting very upset if interrupted, or struggling to keep up with school or social activities.

The good news is that OCD is treatable. The most effective therapy for children is a form of cognitive-behavioral therapy (CBT) called Exposure and Response Prevention (ERP), which helps them face their fears gradually while learning not to rely on compulsions. The Supportive Parenting for Anxious Childhood Emotions (SPACE) curriculum is a parent-focused program designed to help caregivers reduce accommodations of a child’s anxiety or OCD behaviors and promote healthy coping skills. Lastly, medication can also help reduce symptoms.

OCD must first be properly differentiated from other disorders that have overlapping symptoms, such as anxiety, autism spectrum disorder, or tic disorders. Anxiety disorders involve persistent worry, fear, or nervousness about real-life situations, whereas OCD is characterized by a cycle of obsessions and compulsions that the person feels compelled to perform. OCD and autism spectrum disorder can both involve repetitive behaviors or strict routines, but they differ in motivation, awareness, and broader patterns. In OCD, behaviors are driven by anxiety or fear. In autism, repetitive behaviors or routines are often comforting, sensory-driven, or based on special interests. Tics are sudden, brief, involuntary movements or vocalizations—such as blinking, throat clearing, or jerking—that are often preceded by a physical urge and relieved temporarily by performing the tic. While both tics and OCD can appear repetitive, tics are automatic and not driven by specific fears or beliefs, whereas OCD behaviors are purposeful responses to obsessive thoughts and aim to relieve anxiety. A comprehensive neuropsychological assessment will utilize a combination of interviews, observations, and standardized tools to understand the nature and impact of symptoms to ensure an accurate diagnosis and treatment plan.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

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

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

school student frustrated over the work

Navigating the Post-Honeymoon Phase: Signs Your Child May Need Support This School Year

By | NESCA Notes 2025

school student frustrated over the workBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

With the start of the school year well underway, we are beginning to see students and teachers settling into their classroom routines. Along with this increase in familiarity and comfortability, parents often start to see bits and pieces of challenges arise around this time of year that may have gone unnoticed during the initial “honeymoon period.” You may be wondering what challenges you should be looking out for and when those challenges warrant an evaluation to determine further supports and services. Let’s take some time to explore what to keep an eye on, and when it might be time to reach out to schedule an evaluation to dive a bit deeper into what is going on.

Academics

No matter their age, if you ever feel your child is inundated and overwhelmed with schoolwork, it is a great idea to reach out to their teachers; ask how long homework should be taking and whether it should feel like review vs. new material. If homework starts to consistently become a battle, it might be worth taking a closer look into why. It could be because it’s a new and appropriately challenging course. It could also be because there are underlying language-based learning disabilities, a nonverbal learning disability, executive function challenges, or increasing symptoms of anxiety or depression. Some specific things to watch for:

  • Frequent tears during homework that appear to be getting worse instead of better
  • Not appearing to “get it” even after review and repetition
  • Difficulty studying/holding information in memory
  • Dysfluent reading or not understanding what they’ve read
  • Challenges understanding math concepts or memorizing math facts
  • Difficulty applying and generalizing concepts
  • Opposition to handwriting tasks or when asked to compose a writing assignment
  • Poor penmanship that is illegible and/or immature for age
  • Not meeting benchmarks on assessments

Social Skills

At this point in the school year, children are typically starting to be interested in other peers within their classrooms. For younger kids, they are likely to feel more comfortable interacting with other children in their play. Common social concerns can include:

  • Not remembering any names or faces of kids in their class
  • Preferring to play alone; hesitant to join in with a group
  • Appearing unaware of social cues or how to initiate conversation with others
  • Rigidity in play – always wanting to play their own game by their own specific rules
  • Frequent peer conflicts and feeling rejected or left out

Emotional Functioning

A new school year often elicits feelings of anxiety in kids no matter how outgoing and social they may be! When might it be a sign that there is something more?

  • Continued and persistent resistance to going to school
  • Frequent somatic complaints with no apparent cause (e.g., headaches, stomachaches)
  • Change in sleeping patterns – not being able to fall asleep at night or waking up frequently
  • Difficulty with regulating their emotions/frequent tantrums
  • Changes in appetite
  • Negative statements about themselves
  • Increase in irritability
  • Withdrawal from others or previously preferred activities
  • Always wanting to know what is happening next and struggling with changes in routine (i.e., Does a substitute teacher derail their whole day? If a friend is out sick, is there a perseveration on where they are? Do you wait to tell them about changes in plans so they don’t worry in advance?)

Attention/Focus

Have you ever found yourself feeling restless and distracted when sitting through a work meeting? Kids are no different! Sitting still and paying attention for extended periods of time can be really tough – especially after being on summer break! Here are a few things to keep an eye on:

  • Frequently fidgeting in their seat or needing a fidget item to increase concentration
  • Difficulty with multi-step directions
  • Not remembering information presented during lectures
  • Acting impulsively
  • Easily distracted/daydreaming
  • Acting as if running by a motor
  • Blurting out thoughts, interrupting conversations
  • Teacher feedback that they are interrupting other students or not able to sit quietly and attend to class discussions

As always, you know your child best! If you feel like this year is off to a rocky start, or you’re starting to have questions regarding their functioning, do not hesitate to reach out and schedule an evaluation. A comprehensive neuropsychological evaluation is designed to look at ALL aspects of a child to determine what is getting in their way of reaching their potential. We are always here to help!

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children, adolescents, and young adults with a wide range of concerns, includingMiranda Milana Headshot attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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

 

Dr. Luisa Hernandez Medellin evaluating a child

NESCA’s Heading South to Care for Children and Empower Families

By | NESCA Notes 2025

Dr. Luisa Hernandez Medellin evaluating a childBy Jane Hauser
Director of Marketing & Outreach, NESCA

Dr. Luisa Hernandez Medellin Discusses NESCA’s Miami Launch

NESCA recently opened its latest pediatric neuropsychology office in Coral Gables/Miami, Florida, headed up by Dr. Luisa Hernandez Medellin. I had the opportunity to speak with Dr. Luisa Hernandez Medellin to get to know more about her background, the current evaluation landscape in South Florida, Latin America, and the Caribbean, and to hear from her what unmet needs NESCA addresses in bringing its expertise to that region.

Tell us about your background and how you chose to become a pediatric neuropsychologist.
I was born and raised in Mexico City in a family that valued service and helping others. As a teen, I considered becoming a missionary nun because I wanted to travel to deliver services and support to children in need. During those years, I spent time in Cuba, Nicaragua, Guatemala, and Costa Rica, where I witnessed numerous disparities in the way people lived. That experience shaped my commitment to serving children and families.

When I returned to Mexico, I explored different careers, including teaching and medicine, as my father was a doctor, and eventually landed in psychology almost by chance—but it felt like home as soon as I discovered it. Later, when I moved to Miami, I completed my bachelor’s degree and entered a doctoral program in child psychology. During my training, I discovered neuropsychology, and it was a perfect fit: a way to combine psychology with the medical world, caring for both the mind and the body of an individual.

I trained at Jackson Memorial Hospital, where I fell in love with pediatric neuropsychology, working with children with neurodevelopmental disorders in both inpatient and outpatient settings. That experience set the foundation for my career. Since then, I’ve worked in hospitals, private practice, and now with NESCA, where I get to provide high-quality evaluations in a compassionate way that will help children and their families have a path to move forward on.

What is your philosophy when working with children and families?
I treat every child as I would my own. I’m a mother of three, all neurodivergent in different ways, so I understand how hard it can be to navigate the challenges of having children with disabilities while also loving them so deeply. My role is to get to know each child who comes in for an evaluation—what makes them unique, what’s important to them—and to help uncover what’s happening so they can flourish.

How do you feel neuropsychological evaluations benefit individuals and families?
Evaluations give us a deeper, objective understanding of a child’s strengths and challenges. Parents often come to me worried that they’ve done something wrong that caused their child’s struggles. I reassure them that no one is at fault. The goal is not to find problems or identify something or someone to blame; rather, it’s to identify the root cause of a child’s challenges while also highlighting each child’s strengths. It’s about finding the “lights AND the shadows.” For example, if a child struggles in math but loves music, we lean into music as a source of joy and growth for the child while knowing how to  properly provide support in areas like math, that may be more stressful.

How do you approach parents or caregivers who are resistant to the evaluation process or the possibility of their child receiving a diagnosis from it?
In Miami, many families are hesitant about their child receiving a diagnosis(es). I take the time during the intake process to listen to their concerns and gently plant seeds about the types of issues we may be seeing. That way, parents aren’t shocked during the feedback session where they learn the findings from the evaluation, which may include one or more diagnosis(es). It helps them process the information and reduces their fears. I emphasize that neurodivergence isn’t caused by parenting choices or styles, screen time, or the Covid experience. It’s just how a child is wired. My focus is on supporting families and children and building hope with new information from the evaluation.

How did you connect with NESCA, and what excites you about bringing NESCA to Miami?
While considering a move to Boston, I met NESCA’s founder and director, Dr. Ann Helmus, and our conversation felt like meeting a kindred spirit. She reminded me of my attending supervisor from Jackson Memorial Hospital in that they both expect very high quality evaluations, really care about their patients, and truly value the quality of the training provided to their trainees. That’s not always the way with providers, so that was very important to me.

She shared that NESCA was planning to open a Miami office, which felt like the perfect match. Now, I get to help NESCA bring its 30 years of expertise to our region, while I’m also contributing my own 20 years of experience right here in Miami. Together, we’re offering high-quality, culturally-sensitive evaluations in both Spanish and English.

Why does Miami need a practice like NESCA?
The system here in South Florida often creates delays in the identification of developmental, emotional, or learning disabilities. Pediatricians sometimes use a “wait and see” approach; bilingualism is sometimes mistaken for a speech delay when it’s really a sign of autism; and schools often face huge, lengthy backlogs for testing students.

It can be tricky to find the right resource or professional to help identify challenges early on. Neurologists tend to be trained in the brain as “hardware,” whereas we examine the brain’s operating system and how it functions when there is a brain injury, a developmental disorder, or other issue. More often, they look to scans and imaging for answers, where we look at the child’s wellbeing and growth, especially when there is a more complex presentation that may lead to several diagnoses, like ADHD, autism, and anxiety, all co-occurring. And due to productivity pressures in large Miami hospitals, they are only able to see patients for 15 minutes or so and often via telehealth.

And again, with our medical system not being optimized, there is a lot of overwhelm among pediatricians who are forced to operate in a factory-like system. Many people here in South Florida don’t actually have a dedicated pediatrician who knows them and their families. It’s more of a walk-in urgent care system, and that means there is no follow-up in six months or even a year to see how a child is progressing or not. No one is tracking them and is dedicated to their developmental well-being. This is another reason for the frequent delays in diagnosis here.

Because of all of these issues, too often, families don’t receive timely or comprehensive evaluations, and diagnoses and services are delayed. NESCA offers an alternative: in-depth, individualized assessments that consider the whole child—what their lives look like and how they do in school, at home, and in the community. NESCA coming to Miami is filling a very large gap in getting families the answers they are looking for and getting children the support they need to thrive.

What do you evaluate at NESCA in Coral Gables?
I focus primarily in pediatric neurodevelopmental disorders, ADHD, Autism Spectrum Disorders, and learning disabilities, providing evaluations and highly tailored recommendations for interventions. I have also been training practicum students in the Miami area, which we will continue to do as part of the NESCA practice in Coral Gables. There are currently only two sites in Miami where doctoral-level students can train at a practicum level in pediatric neuropsychology, and one of them is now NESCA.

What are your plans for working with schools and international families?
International families and private schools are actively seeking support for their students. Many families from Latin America and the Caribbean face limited resources in their home countries. They come to NESCA for specialized, highly personalized evaluations and recommendations on how to support their child or student at home or in school, in their country. NESCA in Miami will provide these families with the guidance and expertise they need—tailored to their cultural context and delivered with compassion.

Any final thoughts?
NESCA offers families in South Florida, Latin America, and the Caribbean the best of both worlds. We’re bringing NESCA’s legacy of excellence from 30 years of practice in New England, along with my decades of experience living and practicing in Miami, to serve families in this diverse, multicultural community. My goal is simple: to help every child be understood, supported, and given the guidance and tools necessary to thrive.

Headshot of NESCA Pediatric Neuropsychologist Dr. Luisa Hernandez MedellinAbout the Author

As a bilingual pediatric neuropsychologist, Dr. Hernandez Medellin conducts comprehensive and culturally sensitive neurodevelopmental and neuropsychological assessments, comprehensive diagnostic evaluations, and effective care plans, providing appropriate recommendations for the client’s school, home, and the community. She specializes in the identification and assessment of neurodevelopmental disorders such as Autism Spectrum Disorders, ADHD, developmental and learning disorders, and their co-occurrence with anxiety and mood disorders. She also works with children and young adults with acquired brain injuries, epilepsy, brain tumors, strokes, general medical conditions, and genetic disorders affecting the nervous system. She is a native Spanish-speaker, passionate about serving the eclectic and vibrant South Florida community, as well as international patients looking for high-quality and compassionate care.

To book evaluation services at NESCA in Coral Gables, Florida, complete NESCA’s online intake form. 

To book a neuropsychological evaluation or other services at NESCA’s New England offices, complete NESCA’s online intake form

NESCA is a pediatric neuropsychology practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Miami/Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Engineered for Excellence

By | NESCA Notes 2025

Image of NESCA clinicians conferring with each other and a quote from Dr. Ann HelmusBy Ann Helmus, Ph.D.
Founder & Director, NESCA

NESCA supports your clinician—so your clinician can support you and your child

When you choose NESCA, you’re not just hiring an individual clinician—you’re accessing an entire organization built to deliver excellence to each family who works with us. From the first intake call to the final report, every step of our process is designed to ensure quality, accuracy, and the best outcomes for your family. Parents invest in this process to resolve complex questions about their child’s learning, development, or emotional well-being—questions that can only be addressed by a thoughtful, thorough evaluation leading to recommendations that will truly make a difference.

At NESCA, we believe that the best way to provide this level of care is to take extraordinary care of our clinicians. Our equation is simple:

Lower Case Volume + High Clinician Support =

Exceptional Evaluations + Better Outcomes

Supporting Clinicians in Doing Their Best Work
In some practices and settings, clinicians face heavy caseloads, which can make it difficult to dedicate as much time to each child as they’d like. With larger caseloads, clinicians are often left with little time for reflection, professional growth, or collaboration. At NESCA, we intentionally structure things differently. We greatly value our clinicians as highly educated professionals with many years of training and provide them with the support, environment, and opportunity to produce their most thorough and careful work.

From the beginning, NESCA was intentionally designed for clinicians to typically work with six or fewer clients each month—a low volume compared to many other practices or settings. This structure ensures that every child’s evaluation receives the time, attention, and individualized analysis it deserves.

We Care for Our Clinicians—So They Are Able to Care for Your Child
Behind the scenes, our clinicians are supported in ways that are uncommon in many private practices:

  • Professional Development: Weekly seminars, ongoing mentorship, and access to senior clinical directors to ensure that every clinician is continually learning and growing.
  • Collaboration: Regular case conferences provide a forum for discussing complex cases and drawing on the expertise of their NESCA colleagues who specialize in multiple disciplines, providing well-rounded and forward-looking perspectives. Your child’s clinician is never working in isolation.
  • Dedicated Support Staff: Psychometricians handle test scoring, and administrative staff manage scheduling and logistics. This frees clinicians to focus entirely on the heart of their work—understanding your child.
  • Quality over Quantity: Because we are not driven by volume, clinicians can invest the time needed to observe your child carefully, analyze test results holistically, speak with educators and providers on your team, and craft thoughtful recommendations.

What This Means for Families
We know that clinicians do their best work when they feel secure, valued, and engaged. That’s why NESCA provides stability, top notch administrative support, and a professional community. When challenges arise, we work with our clinicians to resolve them, offering mentorship and guidance rather than leaving them to struggle and produce work that doesn’t meet NESCA’s high standards.

This culture of care is not just good for our staff—it’s essential to the families we serve. It means that when you come to NESCA, you are working with professionals who are deeply committed, well supported, and fully equipped to provide the highest quality evaluations and recommendations.

We take care of our clinicians so that they can take the best possible care of your child.

 

About the Author

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

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

NESCA is a pediatric neuropsychology practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Miami/Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of an SAT and an ACT exam with a quote from Dr. Erin Gibbons

Don’t Miss Out: Planning Ahead for College Entrance Testing Accommodations

By | NESCA Notes 2025

Image of an SAT and an ACT exam with a quote from Dr. Erin GibbonsBy: Erin Gibbons, Ph.D. 
NESCA MA Clinical Director; Pediatric Neuropsychologist

If you’re the parent of a high schooler with a disability, you might be thinking ahead to college entrance exams like the ACT or SAT. These tests can be stressful for any student, but for those who need accommodations—such as extended time, additional breaks, or accessible testing formats—planning ahead is especially important. One of the most common pitfalls families encounter is missing the deadline to apply for accommodations. Here’s why you should check those deadlines now, and how to get started.

Why Accommodations Matter

Accommodations help level the playing field for students with disabilities, ensuring they have the support they need to demonstrate their potential. Whether your student has ADHD, a learning disability, anxiety, or another disability, the right accommodations can make a significant difference in their performance and confidence.

Deadlines Sneak Up Fast

Exams, such as the ACT, SAT, and Advanced Placement, require students to apply for accommodations well in advance of the test date—sometimes several months ahead. The process involves gathering documentation, working with your child’s school, and waiting for approval. If you miss the deadline, your student may have to take the test without the support they need or wait for the next test date.

Don’t Forget About Updated Evaluations

One important detail to keep in mind: the College Board and similar organizations require current documentation to support accommodation requests. If your student’s last neuropsychological evaluation is more than 2 years old, you will likely need to schedule an updated evaluation this fall.

What You Should Do Now

  • Check the official website for deadlines: https://accommodations.collegeboard.org/
  • Contact your school’s guidance counselor or learning support specialist
  • Gather documentation – most recent neuropsychological evaluation, current IEP or 504 Plan
  • Schedule updated neuropsychological testing if needed
  • Apply early! If the requested accommodations are not approved, you may need to start an appeal process, which can take a good amount of time to gather the required documentation or other materials.

 

About the Author

Since 2011, Dr. Gibbons has been a trusted expert at NESCA where she evaluates children presenting with a range of attentional, learning,Erin Gibbons headshot and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories. In addition, she evaluates adults who have concerns about whether they meet criteria for an ASD or ADHD diagnosis.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form

NESCA is a multidisciplinary practice with offices or staff in Newton, Hingham, and Plainville, Massachusetts; Londonderry, New Hampshire; the Burlington, Vermont region: and Coral Gables/Miami, Florida, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

image of adults observing a school classroom

Why School Observations Matter in a Neuropsychological Assessment

By | NESCA Notes 2025

image of adults observing a school classroomBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

When families seek a neuropsychological evaluation for their child, it’s usually because they’re looking for a deeper, more comprehensive understanding of their child’s profile—including both strengths and challenges. This kind of evaluation helps answer important questions about how a child learns, thinks, manages emotions, and interacts with others.

By gaining this insight, we can better support a child in all areas of life—at school, at home, with friends, and in community settings. Sometimes, however, the most valuable piece of the puzzle doesn’t come from test scores at all.

In some cases, your neuropsychologist may determine that observing your child in their natural learning environment—a school observation—can provide crucial information that simply can’t be gathered in an office setting.

What Is a School Observation?

A school observation involves a trained professional—usually the neuropsychologist conducting your child’s evaluation—visiting your child’s school to observe them in real time.

This observation might include time spent watching your child:

  • During classroom instruction
  • In social settings like lunch or recess
  • While transitioning between classes
  • In additional services, such as speech/language therapy or occupational therapy

The purpose is to see how your child functions across different settings and situations throughout their school day.

Why Is a School Observation So Valuable?

You might wonder: if the evaluator already has detailed testing results, rating forms from parents and teachers, and information from the intake appointment and outside providers, why observe at school?

Even the best testing environment can’t fully replicate real-world situations. In a quiet, 1:1 testing setting, a child might appear regulated, focused, and engaged—but in a classroom filled with distractions and increased demands, their behavior and overall presentation might look very different. A school observation helps us understand how a child manages in the real-world environments where challenges often arise.

Observations allow us to:

  • Identify situations that may be triggering challenging behaviors (like transitions, group work, or unstructured time)
  • Determine whether a child is well-matched with their peers or may be in the wrong instructional group
  • Notice social dynamics—Are they connecting with peers? Are they withdrawn or overly controlling during play?

Another critical area we assess during school observations is whether the learning environment is a good fit for your child:

  • Is the classroom appropriately structured?
  • Are staff using the tools and supports outlined in the IEP?
  • Does your child respond well to the strategies, like visual schedules or token boards, being used?

Observing how a child responds to the classroom setup and supports can help determine whether their current environment is truly meeting their needs—or if changes are required to allow them to access the curriculum.

When Is a School Observation Recommended?

Not every evaluation requires a school observation, but there are several situations where it can provide especially meaningful insight. Examples include:

  • A child who struggles with behaviors at school that aren’t seen at home or during testing
  • A child who performs well on standardized tests but is reported to be having a hard time keeping up in class
  • Uncertainty about whether the child’s current classroom or program is the right fit for their learning profile
  • Questions about whether the child would benefit from a different instructional approach, such as a language-based classroom or one using ABA methods

At NESCA, our clinicians are trained to determine when a school observation would add helpful information to the evaluation process. We view it as one of many tools to build the most accurate picture of your child’s needs.

What to Expect During the Observation

If you and your evaluator decide that a school observation would be helpful, we’ll coordinate the visit with your child’s school—with full permission from you and the school team.

On the day of the observation:

  • The evaluator typically sits in the back of the classroom, making every effort not to disrupt the flow of the day.
  • The goal is to blend in and observe naturally occurring interactions and behaviors.
  • Observations are done in a respectful, non-intrusive manner with the sole purpose of helping your child.

Afterward, the evaluator will include a summary of the observation in the written report, and the insights gained will be integrated into the diagnostic impressions and recommendations.

A school observation is about understanding your child in the context of their daily environment. When paired with testing, rating scales, and interviews, this real-world view helps ensure that recommendations are not only accurate, but truly actionable.

If you have any questions about the school observation process—or want to know whether it might be helpful for your child—don’t hesitate to reach out to your evaluator. We’re always here to help guide you through the process and help your child get the support they need to succeed.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, includingMiranda Milana PsyD headshot attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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

 

Child with behavioral challenges is evaluated

Often Overlooked: Recognizing and Supporting Children with Fetal Alcohol Spectrum Disorder

By | NESCA Notes 2025

Child with behavioral challenges is evaluatedBy Leah Weinberg, Ph.D. 
Pediatric Neuropsychologist, NESCA

One of the reasons I joined the NESCA team was for the opportunity to continually learn and grow professionally. NESCA has a well-earned reputation for fostering an environment where clinicians can expand their knowledge and refine their skills in meaningful ways, and a session I was able to attend for our staff earlier this year was a perfect example of that.

I attended an insightful seminar on Fetal Alcohol Spectrum Disorder (FASD), a topic that is often overlooked yet critically important in neuropsychological practice. The presentation provided clinically relevant information and tools to better recognize and address this condition.

One key takeaway was a reminder of how challenging FASD can be to diagnose. While many people associate the condition with characteristic facial abnormalities, these features are present in only a minority of affected children. Additionally, the social stigma around alcohol use during pregnancy means parents may be reluctant to disclose this history. This can make it easy to miss the diagnosis, particularly in children who present with behavioral or learning challenges that could be attributed to other conditions.

Hallmark symptoms of FASD include executive functioning deficits (e.g., working memory), poor impulse control, difficulties with generalization (people, situations, consequences), difficulties with abstraction, perseverations, and diminished adaptive skills within the context of healthy levels of intellect.

The seminar emphasized why making an accurate diagnosis is so critical: It directly informs how we approach treatment, including how we assist families in accessing services, setting realistic expectations for the child, diminishing the risk of the child receiving inappropriate diagnoses (e.g., Oppositional Defiant Disorder), and assisting the child in developing stronger self-awareness and self-advocacy skills. Moreover, it is important for the adults in the child’s life, including parents and educators, to understand that behaviors that are part of the disability are not willful. Behavioral challenges in children with FASD, for example, often do not respond well to traditional behavioral programs. Instead, a trauma-informed approach is typically more effective, as it accounts for the neurodevelopmental impact of prenatal alcohol exposure and addresses the underlying emotional and regulatory difficulties these children face.

Being part of a team that prioritizes professional development, like the one at NESCA, means continually sharpening my skills and expanding my understanding to better serve the children and families we work with. The FASD seminar was not only a great learning experience but also a reminder of the importance of staying open to complex diagnoses and tailoring treatment plans to meet the unique needs of each child.

About the Author

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

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

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

Image of a cell phone with a banned symbol over it; quote from Angela Currie, Ph.D.

Teaching Executive Function Strategies in the Landscape of Cell Phone Ban Policies

By | NESCA Notes 2025

Image of a cell phone with a banned symbol over it; quote from Angela Currie, Ph.D.By Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

As students head back to school this fall, many are facing new policies and restrictions around cell phone use in school. For many states and districts, this is defined by a “bell to bell” cell phone ban, which prohibits students from using their phones from the first bell to final dismissal. For many, these policies are long awaited, as there has been growing concern about student distraction, social disengagement, and the negative impact of social media access in schools. By removing access to cell phones, tablets, and smart watches, “bell to bell” policies aim to reduce distractions and foster a more focused, interactive learning environment.

The benefits of cell phone policies are clear; however, they also may present unique challenges for some students who have learned to rely on technology as an appropriate tool for executive function. Executive function refers to a set of cognitive and self-management skills that help individuals manage time, stay organized, remember information, and meet goals efficiently. Because cell phones and tablets are readily accessible and have many embedded tools, many students have integrated technology into their daily routines, using features like calendars, alarms, and note-taking apps to stay on top of assignments and deadlines. These digital tools have become a practical way for some students to stay organized and ensure they are meeting expectations.

With “bell to bell” cell phone bans in place, students will no longer have “on demand” access to the apps or other executive function tools that previously kept them organized, possibly raising concern about increased forgetfulness, missed assignments, and heightened stress. Positively, the laws provide exemptions for students whose IEP, 504 plan, or Title IX needs identify specific technology accommodations (e.g., insulin monitoring, assignment log, communication tools, etc.). However, these students may feel hesitant to use their devices during the school day out of concern for standing out or feeling stigmatized. As a result, even students who are permitted to use their devices may choose to find alternative ways to manage their academic demands in order to avoid feeling singled out.

Cell phone policies are being developed for good reasons, but within this landscape, schools and families must start thinking about how to teach executive function strategies that are not technology-based. Children and teens are developing in a technological world, and they may not have the skills for managing demands without these supports. This provides an opportunity for them to learn more independent skills for daily management, but they may not figure this out on their own. To support students, educators and parents can introduce practical strategies, such as using physical planners to track assignments and deadlines, breaking down larger projects into smaller, actionable steps, and organizing materials with color-coded folders or checklists. Teaching time management techniques, encouraging regular routines, and modeling how to prioritize tasks can also help students build the foundational skills they need to succeed both in and out of the classroom, even without the constant aid of technology.

Ultimately, cell phone bans have the potential to create a more focused and engaged learning environment, fostering improved learning and social interactions. However, as access to technology is reduced, it becomes increasingly important for schools to provide explicit instruction in executive function strategies. By offering concrete tools and strategies, educators can help all students develop enduring, life-long skills that will benefit them not only in managing their responsibilities at school, but also in their future personal an

 

About the Author

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

 

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

 

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

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