To accommodate requests for neuropsychological evaluations after the start of the new school year, NESCA has added evaluation dates in its Newton, MA office. Immediate openings are now available for scheduling. Please complete our Inquiry/Intake Form for more information or to start the scheduling process.

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An image of a high school graduate and a quote from a NESCA professional about how getting a diploma and being ready to graduate are not the same thing.

Diploma and Readiness Are Not the Same Thing

By | NESCA Notes 2026 | No Comments

An image of a high school graduate and a quote from a NESCA professional about how getting a diploma and being ready to graduate are not the same thing.By: Sarah LaFerriere, M.Ed.
Transition Specialist, NESCA

For many families, high school graduation is viewed as the finish line.

After years of IEP meetings, evaluations, academic goals, and services, earning a diploma can feel like the moment when a student is finally ready to move on. But for students with disabilities, graduation is not necessarily the end of the transition process. In fact, it can be the point when transition planning becomes even more important.

Massachusetts is experiencing significant changes in how we think about high school graduation and what students need to be prepared for in their life after high school. For families of students with disabilities, understanding these changes and separating the diploma from true postsecondary readiness is especially important.

A Diploma and Readiness Are Not the Same Thing

In November 2024, Massachusetts voters approved Ballot Question 2, removing the requirement that students pass MCAS in order to earn a high school diploma. Massachusetts still has a statewide Competency Determination, which requires students to demonstrate mastery of core skills and satisfactorily completed coursework established by their district. MCAS continues to be administered for state and federal purposes, but it is no longer the mechanism students must pass to earn a diploma.

This is an important change, but it does not change one of the central questions transition specialists ask:

“What does this particular student need to be successful after high school?”

A student may meet the requirements for a diploma while still needing significant support with executive functioning, communication, self-advocacy, employment, transportation, independent living, social skills, or navigating adult systems. This is not an argument against graduation. Rather, it is a reminder that graduation status and readiness for adulthood are two different conversations.

What Is Changing in Massachusetts?

Massachusetts is also considering a broader statewide approach to graduation requirements. The state’s 2026 recommendations include components such as postsecondary planning, a culminating experience, financial literacy, digital literacy, work-based learning, and other preparation for life after high school. These recommendations are not yet fully in effect and would still require legislative action.

The direction of this work is notable: preparation for life after high school is increasingly being recognized as an important part of what it means to graduate. For students with disabilities, this reinforces something transition professionals have long emphasized: postsecondary preparation should not be limited to academic achievement.

So…What Should Families Be Thinking About?

When a student is approaching graduation, families often ask: “Is my child ready to graduate?”

To help parents and caregivers with some of the critical questions they should be thinking and asking about, we created this graphic that can serve as a reminder of what type of preparation, planning, and skills may still be needed. If you have questions about your child’s transition, let us know if you are interested in a consult to help you get started.

 

Checklist of Questions to Ask your IEP Team Before Graduation

About the Author

Headshot of Sarah LaFerriere, M.Ed.

Sarah LaFerriere, M.Ed., is a transition specialist and special educator who has nearly a decade of experience working with transition aged students in public schools, college, and home-based settings. She provides transition assessment, consultation, and coaching services to a wide range of clients, and specializes in supporting students with autism, intellectual disabilities, developmental disabilities, mental health conditions, and medical conditions.

To book a transition assessment or consultation, complete NESCA’s online intake form.

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.
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Headshot of Dr. James Lynch and a quote from him about joining NESCA

NESCA Welcomes James Lynch, Ph.D., to its Pediatric Neuropsychology Team

By | NESCA Notes 2026

Headshot of Dr. James Lynch and a quote from him about joining NESCABy: Jane Hauser
Director of Marketing & Outreach, NESCA

I recently had the opportunity to learn more about NESCA’s latest addition to its Pediatric Neuropsychology staff, Dr. James Lynch. We are thrilled to have Dr. Lynch on our team at NESCA! I hope you enjoy getting to learn more about him here as well.

What are your areas of expertise in pediatric neuropsychology?
I have worked with many individuals with a wide range of ages and ability areas from my previous educational and professional experiences. Most of my experience is with children and adolescents who show signs of Attention-Deficit/Hyperactivity Disorder (ADHD), autism spectrum disorders (ASD), learning disorders, developmental delays, and intellectual disabilities, as well as the interventions that are used to support those students.

How did you get your start in pediatric neuropsychology?
I started in clinical psychology by training in evaluating children and adolescents with concerns for ADHD and/or autism. While that is my area of specialty, I was also doing a lot of evaluations during my fellowship at Boston Children’s Hospital with complex presentations in children who were often considered “difficult to test” for many reasons, whether due to behavioral challenges, language abilities, or other factors.

What is your approach in evaluating children and young people?
I try to optimize the performance of the evaluations for the students with whom I work. I like to focus specifically on what I am trying to measure and whether I am getting the information that will help me identify the root cause of the challenges the individual is experiencing. I try to look for the patterns of skills – whether they are strong or need support to find out what we are looking for.

What kind of guidance do you offer to parents and caregivers about going through the evaluation process for their child?
It can be scary for families. I try to help parents and caregivers understand that we know how to work with kids and that we understand that the challenges they and their child are experiencing can be very difficult. I explain that our aim is to help them better understand what is causing those struggles and recommend a treatment plan that is targeted specifically to their child. I assure them that while their child’s challenges may be new to them, we are very used to working with kids with similar presentations and that they are not alone.

You have a lot of research experience. Can you tell us more about that?
I’ve done a lot of research into neuropsychological functioning – and how that may help explain differences in real-world outcomes. For example, kids with ADHD tend to have executive functioning (EF) challenges, but there is so much variability in this… so how can we use this variability to make predictions about real-world outcomes. For example, I’ve conducted research examining whether children with ADHD are more susceptible to EF challenges or post-concussive symptoms after a season of high school football or soccer. I’ve also done a study on whether EF can predict which teenagers with ADHD are more or less likely to have automobile crashes or near-crashes when they begin to drive. I’ve also conducted research examining whether differences in reinforcement processing and temperament predict which kids are more likely to respond to an external reward system or develop future anxiety or mood symptoms.

I have also been involved in a lot of caregiver-focused research, such as whether the outcomes for autistic children were better when families participated in an adapted Applied Behavior Analysis (ABA)-based program and if participating had downstream impacts on other services for the child or the wellness of parents of kids with autism.

You join NESCA from Boston Children’s Hospital. What did that experience give you and how will that support you in your work at NESCA?
Working at Children’s for two years allowed me to see a wide range of kids with highly complex challenges, including those with ADHD and ASD, as well as those who were also experiencing GI, genetic, and neurological complexities. We also frequently worked with children whose symptoms made it difficult to tease apart exactly what the underlying issues were.

Children’s also gave me the training on and regular opportunity to make decisions on the fly. This has been extremely beneficial in being able to select the individualized battery of tests we use in our evaluations. Based on behavioral observations mid-testing, I have learned to easily pivot, incorporating additional tests that will allow me to better identify cognitive challenges, which helps to home in on an accurate diagnosis. It’s those in-the-moment choices that I’ve become very accustomed to that are so helpful in getting to the bottom of what’s actually going on with a child.

Finally, the interdisciplinary experience Children’s provided has also been extremely helpful in understanding a child as a whole during evaluations so I can create a targeted treatment plan that will support them once the evaluation is concluded.

What drew you to NESCA?
I was drawn to the focus on helping families in areas that other neuropsychology practices may not focus on, mainly how we can support children with their education based on our evaluation findings. I really wanted to move my career forward in a place where I could make an impact on a child’s everyday life, whether behaviorally, developmentally, or helping them thrive academically.

I also really appreciate the efforts that NESCA makes in keeping its clinical staff trained and current on evidence-based treatments, school-based interventions, among other areas from internal and external experts. The case conference and seminar trainings were very familiar to me from the hospital setting, and I greatly appreciate that I can continue to further my education in this manner.

Finally, I saw first-hand in the interview process and throughout my onboarding at NESCA how closely connected NESCA clinicians are with the kids and families they work with. That is something deeply important to me.

 

About Dr. James Lynch

Headshot of James Lynch, Ph.D.Pediatric Neuropsychologist Dr. James Lynch, Ph.D., conducts comprehensive evaluations of toddlers, preschoolers, school-aged children, and adolescents with developmental concerns. These include challenges with cognitive functioning, behavior and emotion regulation, communication skills, and academics. He has expertise in the evaluation of neurodevelopmental disorders such as ADHD, autism, developmental delays, intellectual disabilities, and learning disorders.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.
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Image of a student having a hard time initiating homework. Quote from a NESCA clinician.

Understanding LBLD and Executive Functioning: Securing the Right IEP or 504 Support

By | NESCA Notes 2026

Image of a student having a hard time initiating homework. Quote from a NESCA clinician.By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

When a student struggles to start writing, loses track of directions, or takes hours to complete homework, the immediate assumption is often: “This is an attention or ADHD issue.” While ADHD and executive functioning (EF) challenges frequently co-occur with learning differences, there is often a deeper, misunderstood culprit: Language-Based Learning Disability (LBLD).

For parents, advocates, and educators, understanding the relationship between language processing and EF is critical. Without this insight, schools risk implementing accommodations that merely bypass the problem, rather than providing the specialized instruction a student needs to build independence.

What are LBLD and Executive Functioning?

An LBLD is a neurodevelopmental spectrum of difficulties affecting how individuals process, understand, and use spoken and written language. It is a processing difference entirely unrelated to intelligence, motivation, or instructional quality. LBLD typically impacts:

  • Reading (Dyslexia): Decoding, phonics, and comprehension.
  • Written Expression (Dysgraphia): Mechanics, spelling, and organizing thoughts.
  • Spoken Language: Receptive (understanding instructions) and expressive (word retrieval) language.
  • Organization & Memory: Working memory deficits and difficulty planning multi-step tasks.

Executive Functioning is the brain’s “management system” – housed in the prefrontal cortex – enabling individuals to plan, focus, remember instructions, regulate emotions, and prioritize tasks.

The Intersection: How Language Weaknesses Disrupt EF

To support these students, we must distinguish between primary ADHD and LBLD-driven executive dysfunction:

  • Primary ADHD: Driven by global deficits in behavioral inhibition and executive control.
  • LBLD: Executive dysfunction is a secondary consequence of the high cognitive load of language processing.

When a student expends immense energy decoding words, retrieving vocabulary, or analyzing syntax, it rapidly drains their cognitive battery. This cognitive fatigue manifests as apparent executive dysfunction (task avoidance, distractibility, or poor initiation). Treating this solely as an attention issue misses the opportunity to provide necessary language-based instruction.

This breakdown occurs in three key areas:

  1. Working Memory Overload: Weaknesses in word meaning require so much conscious effort to decode that the student’s working memory overflows, causing them to lose track of multi-step directions.
  2. The Processing “Bottleneck”: Translating auditory language into an internal concept, and then into a written response, takes longer. This delay acts as a bottleneck when trying to get ideas onto paper.
  3. The Absence of “Internal Language”: Cognitive flexibility and task initiation rely on “internal language” (self-talk used to plan and organize). Students with LBLD lack strong internal language, resulting in task initiation paralysis.

Moving Beyond Accommodations to Specialized Instruction

Schools often default to accommodations, such as providing extra time, pre-filled graphic organizers, or reduced assignments. While these accommodations act as a passive bypass – altering the environment or format to circumvent a deficit – they do not teach skills. By bypassing the weakness without remediating it, accommodations can create prompt-dependency, where the student relies on an adult or a tool to do the cognitive heavy lifting.

In contrast, specialized instruction serves as active remediation by explicitly and systematically teaching cognitive and linguistic strategies. For example, instead of simply handing a student a graphic organizer, specialized instruction teaches the metacognitive process of how and when to use it. This approach targets the deficit directly, transforming the student from a passive recipient of support into an active, self-regulating learner.

To foster independence, students must learn to internalize strategies through:

  • Explicit Strategy Instruction: Teaching how to identify and map the relationship between main ideas and details.
  • Self-Monitoring Training: Teaching students to use self-talk checklists (e.g., “Stop, Review Prompt, Check”) to monitor their own progress.
  • Working Memory Strategies: Instructing students in verbal rehearsal, visualization, and chunking.

Drafting Measurable EF/LBLD Goals for IEPs and 504s

IEP goals must shift from passive task completion to active skill acquisition by targeting the underlying cognitive-linguistic process, not just the final academic product.

Goal Comparison

  • Weak Goal (Product-Oriented): “Student will use an organizer to complete writing assignments with 80% accuracy.”
    • Why it fails: Focuses on worksheet completion (the product), not the planning skill. It does not define independence level or the specific strategy used.
  • Strong Goal (Skill- & Strategy-Oriented): “Given a multi-step writing prompt, the student will independently apply a 3-step planning strategy (brainstorm, categorize, sequence) to initiate writing within 5 minutes, in 4 out of 5 opportunities.”
    • Why it works: Targets the executive functions of planning and initiation, defines the exact strategy, and measures independence to build internal language.

Three Essential Elements of an EF/LBLD Goal

When advocating for IEP goals, ensure these three elements are explicitly defined:

  1. The Specific Strategy (The “How”): Name the exact cognitive tool (e.g., verbal rehearsal, a 3-step planning strategy, a self-monitoring checklist).
  2. The Level of Independence (Prompt Fading): Quantify the support required using precise, observable terms (e.g., independently, given no more than one verbal prompt), avoiding vague terms like “with minimal assistance.”
  3. Measurement of the EF Skill: Directly measure the executive function deficit (e.g., task initiation latency, planning time) rather than curriculum accuracy.

By shifting the focus of IEPs and 504 plans from passive accommodations to explicit, strategy-based specialized instruction, we can help students with LBLD build the internal language and executive functioning skills they need to navigate school – and life – independently.

 

About the Author

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

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

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

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

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

She is the mother of one daughter.

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

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

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Image of a parent trying to wake his child and get them to school accompanied by a quote from a NESCA clinician

When the Honeymoon Period Is Over: Signs of School Refusal

By | NESCA Notes 2021

Image of a parent trying to wake his child and get them to school accompanied by a quote from a NESCA clinicianBy: Moira Creedon, Ph.D. 

NESCA MA Clinical Director; Pediatric Neuropsychologist, NESCA

As we reach the end of our first month back to school, many of us may be reaching the end of that glorious honeymoon period – the phase when kids are excited to see friends, optimistic for the school year, and reviewing material they likely already know. For some, the return did not start this rosy; the bloom is falling off the rose and kids are getting tired. You and your child are not alone in this. My goal for today’s blog is to share with you some warning signs that your child may be struggling and ways to get support before they grow to become bigger problems. The biggest problem I want to avoid: school refusal.

Have you heard this yet? – “My tummy hurts. I have to stay home.” Or, “I hate school. Please don’t make me go.” Or, “I’m not going!” Or perhaps these messages are communicated more subtly with covers over their heads in the morning, difficulty getting out the door on time, tantrums or disruptive behaviors in the mornings, missed buses, or the overwhelming frustration of homework that erupts into nightly battles. According to researcher Christopher Kearney, these are signs to pay attention to as they can evolve into what he terms “school refusal behavior.” School refusal is an umbrella term used to describe behaviors that interfere with a child being in school for their expected and scheduled time. This is a problem that can impact anywhere between 28-35% of students! While there are the more extreme cases for children or teens who are out of school for months at a time, my purpose here is to address the smaller, but more likely, problems. When we address smaller problems, we can keep them small.

Risky signs that your child is struggling with school:

  • Consistent statements of hating school, their teacher, or specific peers. A casual mention of a bad day is not cause for alarm. We all have bad days. If the statements keep coming and they get louder and stronger, then parents should pay attention.
  • The outward behaviors are getting bigger in the mornings before school or over homework. Behavior is a way for children to communicate with us how they are feeling. So, explosions over homework or tantrums in the morning that lead to tardiness are warning signs. The occasional homework meltdown or rushed morning is normal; we are all human! But, the problem is in the pattern.
  • Avoidance rears its ugly head. While some kids show on the outside that they are uncomfortable through their explosions, others communicate very clearly through their withdrawal. Some kids and teens struggle to get out of bed, are constantly tired, not completing work, falling asleep in class, or sharing every somatic complaint or symptom available on Google. If medical causes are ruled out, anxiety can be a culprit.
  • Consider the role of a major transition. According to Kearney, the riskiest time for a child to develop a pattern of school refusal is during times of significant transition – like starting kindergarten or changing schools from middle to high school. In addition to the social and emotional jump that these transitions bring, there is also a massive leap in demands for academic independence. It is very common for kids to struggle with the leap initially.

Oh no. So now what?

  • First and foremost, keep calm. It is far easier to keep small problems small when we have a clear-headed approach. Pull in anxiety management techniques like deep breathing, sleep, and exercise to support your own anxiety as a parent.
  • Reach out to your child’s teacher or school psychologist. Let them know your child is struggling with homework or coming to school. This is a great chance to gather information on what is going on in your child’s day and put your child on their teacher’s radar. This is critical as the only effective approach to remedy a problem with school refusal is a team approach.
  • Talk to your child honestly about what is going on. This has to include a chance for kids to talk about what might be happening to make them feel stressed or why they dislike school. Don’t shortcut this step. If your child has trouble explaining what is going on (which can be especially true for younger kids), try this approach: you and your child are both going to be detectives to learn together what is making school feel hard. We can’t solve a problem until we understand it. By joining with your child in gathering information, you are demonstrating great empathy and validating that their feelings are real.
  • Be careful of your language and conversation about school. It can be tempting to go too far in validating a child to give the message that the assignment really is stupid or their teacher really is unreasonable and mean. It’s best to stick to the feeling (“that must feel so frustrating”) without reinforcing negative messages about school.
  • Hold the line. As you gather more information, it is really important to maintain the message that it is your child’s job to go to school. It might feel conflicting to both validate the feelings of hating school and give the message to attend school. It might feel something like this: It’s either “I love and support my child OR I’m going to force them to go to school even when it’s hard.” Let’s change that OR to AND. Reframe the thought to: “I love and support my child AND they have to go to school AND they can do hard things.”

If you are trying to determine the root cause of your child’s struggles or avoidance, consider a neuropsychological evaluation. NESCA has immediate openings in its Newton, MA office to accommodate the needs of students at the outset of the new school year. For more information or to begin the scheduling process, complete our Inquiry/Intake Form. An intake coordinator will reach out to answer your questions or assist in scheduling an evaluation.

For more information, please check out:

Kearney, C.A. (2007). Getting your child to say “yes” to school: A guide for parents of youth with school refusal behavior. New York: Oxford University Press.

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She isMoira Creedon headshot interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

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

 

NESCA is a pediatric neuropsychology and related services practice in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; 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.

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Image showing college students studying together and a quote by a NESCA OT and Executive Function Coach

College Freshman and Executive Function: The Often Unexpected Demands

By | NESCA Notes 2026

Image showing college students studying together and a quote by a NESCA OT and Executive Function CoachBy Sophie Zeif, OTD, OTR/L
Occupational Therapist; Executive Function & Real-life Skills Coach

It is no surprise that the experience of a high school student is vastly different than that of a college student. This transition is seen as a pivotal step towards independence as we send students off to learn, grow, and explore in an often substantially less supported and less controlled environment. The hope is that after 13 years of K-12 education, our students have developed the academic, communication, and organization skills needed for success in school. They know the tricks of the trade. They have systems to employ and even more systems to fall back on if needed. They have become experts at learning, and they know the drill. But what happens when students get to college and everything, from the style of instruction to the flow of coursework, all the way to the demands outside of learning, are just…a little bit different? For some students, this is a welcome opportunity to rise to the challenge, but for others, this is a daunting, overwhelming, and seemingly impossible ask.

As an occupational therapist specializing in executive function, I have spent the last few years directly supporting those college freshman – the ones who look at the new demands and think, “I was never prepared for this, I don’t know if I can do this.” And I don’t blame them for feeling that way! The demands and expectations truly change. Here are a few that stand out:

  • Time management – High school schedules are rigid. Students are expected to arrive at a specific time, follow a block schedule, and make it to each of their classes (generally all in one building). If they forget what period it is, they can ask a friend, teacher, or almost anyone in the hallway. Conversely, every student in college has their own schedule that they are expected to track and manage. On Monday, they may be in class from 10am-2pm, while on Tuesday they are in class from 3pm-5pm on the other side of campus. There is no one to quickly ask or check in with regarding when and where they are supposed to be, and consistency is rare. This trouble is further compounded by the fact that college coursework requires a substantial amount of work to be done outside of the classroom that must be planned for and built into the weekly schedule.
  • Reading a syllabus – While “reading a syllabus” may sound simple, these documents are often over 20 pages long, providing information about course content, course expectations, each professor’s preferred method of communication, grading systems, and a full schedule of what is due and when. Additionally, each of these documents uses a different format and is frequently amended during the semester. High school students are used to an online portal that is consistently used by their teachers and provides built-in reminders and updates. Syllabi are tricky, and many students skim them without absorbing.
  • Assignment tracking – As mentioned above, college portals are nowhere near as comprehensive, up-to-date, or accurate as most ex-high school students expect. Professors may change a due date in class without updating a syllabus or expect students to keep track of a paper that is due more than a month away. Many college students need support putting a system in place to quickly consolidate due dates, set internal deadlines, and track what they need to hand in. This is especially important when breaking down large assignments into manageable chunks or learning to prepare in advance for busy times in the semester, such as midterms or finals week.
  • Communicating with instructors – Many college students need support in pushing themselves to attend office hours, reach out early and often via email if they have questions about classwork or assignments, and even introduce themselves to their professors.
  • Developing healthy habits and routines – On top of academic executive function demands, college students are dealing with an increase in life-based executive function demands. They are managing their own eating habits, morning routines, evening routines, and organizing all of their personal belongings in their own space. Completing all of this while maintaining life balance can be tricky and may require some support.
  • Accessing accommodations – The accommodation process at a college level is vastly different from the IEP or 504 process in high school. While this topic could be a blog on its own, the biggest takeaway for me is the level of responsibility that falls on the students. They are in charge of letting each professor, at the beginning of every semester, know about their accommodations for sitting in classes, taking exams, or turning in assignments. This requires a level of self-advocacy and functional communication that they may not have had to demonstrate in high school. This demand does not disappear throughout the semester, as they often need to remind professors a week before an exam about their needs or independently book a room to take their test.

While this may seem like a lot, the good news is that our students have learned how to learn. Their systems may need updating, and their strategies may need fine tuning, but with guidance, I have found college success to be a truly achievable goal. I often find that once provided with a foundation and tips for how to be successful, my college freshmen do rise to the challenge and eventually build the ability to do all of this independently. If you feel that your student could benefit from some executive function support as they embark on their college journey, please reach out about NESCA’s EF Coaching Program!

 

About the Author

Dr. Sophie Zeif is a licensed and registered Occupational Therapist in Massachusetts, specializing inSophie Zeif headshot educational occupational therapy and functional life skills development. For the past eight years, her work has primarily been split between children and adolescents on the Autism Spectrum in the United States and marginalized children in Tanzania, East Africa.

Dr. Zeif graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists.

Dr. Zeif has worked for the Northshore Education Consortium and the Salem Public Schools providing occupational therapy services across vastly different educational settings. She also has experience working at the Northeast ARC Spotlight Program using a drama-based method to teach social skills to children, adolescents and young adults with autism, Asperger’s Syndrome and related social cognitive challenges.

Internationally, Dr. Zeif has done extensive work in Tanzania collaborating with fabulous Tanzanian professionals from a few different non-profit organizations. She has spent significant time working with the Tanzanian Children’s Fund, Asali Project and How to Draw a Lion providing educational enrichment and support. She has also spent time working with The Plaster House, a post-surgical, pediatric rehabilitation center, in Ngaramtoni, Tanzania.

Dr. Zeif currently works as part of NESCA’s transition team and offers transition assessment, educational occupational therapy assessment, consultation and virtual executive function coaching. Additionally, she is the program manager for NESCA’s Real-life Skills Program, providing community- and home-based coaching for functional skill development. She believes that individual sensory needs and visual skills must be taken into account to create comprehensive educational programming.

To book coaching services, please complete our Intake Form today. 

NESCA is a pediatric neuropsychology and related services practice in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; 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.

 

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A collage of various extracurricular activities and quote from a NESCA clinician

How to Choose Kids’ Activities Without Overloading Your Family

By | NESCA Notes 2026

A collage of various extracurricular activities and quote from a NESCA clinicianBy Luisa Hernandez Medellin, Psy.D., PMH-C
Pediatric Neuropsychologist, NESCA

A practical guide for finding the right balance between enrichment, rest, and family life

Back-to-school season often comes with a long list of sign-ups: soccer, dance, music, tutoring, art, clubs, and more. As parents, it is easy to feel like we should say yes to everything so our kids do not miss out.

Extracurricular activities can be wonderful. They help children make friends, build confidence, learn new skills, and discover what they enjoy. But when the calendar gets too full, those same activities can start to feel stressful for kids and exhausting for the whole family.

Start With One Simple Question: Why Are We Doing This?

Before signing up, pause and ask yourself: Is my child truly interested? Are we choosing this because everyone else seems to be doing it? Will this activity fit our family’s schedule, budget, and energy level?

There is no perfect answer. Some children need to try a few things before they find what they love. Others may be happier with one activity and plenty of time to play, rest, and just be kids.

Why Activities Can Be Good for Kids

When the fit is right, activities can support a child in many ways. Sports can teach teamwork and patience. Music, art, and dance can give children a way to express themselves. Clubs and volunteer opportunities can help older kids feel connected and responsible.

Activities can also help children build confidence. A child who struggles in one area of life may feel proud and capable when they learn a song, finish a swim lesson, score a goal, or make something with their hands.

But Downtime Matters, Too

Kids need space in their day that is not scheduled, coached, graded, or rushed. Free play helps younger children solve problems, use their imagination, and learn how to manage boredom. Older kids also need quiet time to think, relax, and recover from school demands.

If your child goes from school to homework to practice to bed most days, it may be too much. A busy schedule is not automatically a better schedule.

Signs Your Child May Need a Break

It is normal for kids to have hard days or feel nervous when trying something new. But if the stress keeps showing up, it may be time to pause and reassess, especially if the following behaviors or signs become frequent:

  • Crying, meltdowns, or big resistance before every practice or class
  • Stomachaches, headaches, or complaints about going
  • Trouble sleeping because of pressure or a packed schedule
  • Falling behind on schoolwork
  • Loss of joy in an activity they used to like
  • Constant exhaustion for your child – or for you

Stopping does not always mean quitting forever. Sometimes a child just needs a season off, a shorter class, a different coach, or an activity that better matches their personality.

Choose Activities That Fit Your Child’s Age

Young children usually do best with playful activities that focus on movement, fun, and simple skills, like tumbling, swimming, music, or art. They may not be ready for competition, strict rules, or teamwork in the way adults sometimes expect.

School-age children may enjoy trying team sports, clubs, or lessons, but they still need support with time management and those emotional ups and downs. Older children and tweens may be ready for more focused activities, but fun and balance should still come first over competition.

Think Beyond the Usual Options

Extracurriculars do not have to mean competitive sports or five-days-a-week commitments. A nature club, library program, art workshop, scouting, coding class, animal shelter volunteer opportunity, or adaptive recreation/therapeutic movement program may be a better fit.

For children with developmental, behavioral, or health needs, the right activity can be especially meaningful. Look for programs that are welcoming, flexible, and willing to make supports available when needed. Your child’s pediatrician or therapist may also be able to suggest options that match their developmental level.

A Family-friendly Rule of Thumb

Try starting with one activity at a time, especially during busy school seasons. After a few weeks, ask: Is my child enjoying this? Are we still eating dinner together sometimes? Is there time for homework, sleep, and unstructured play? Are we calmer…or more stressed?

If the activity is helping your child grow and still leaves room for family life, great. If not, it is okay to make a change. Parenting is not about creating THE perfect schedule. It is about noticing what your child and your family need right now.

The Bottom Line

Activities can enrich childhood, but they should not take over childhood. The goal is not to do everything. The goal is to help your child feel supported, confident, curious, and connected – while still protecting time for rest, play, and family.

 

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 and related services 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.

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Image of an anxious child and a quote from a NESCA clinician

Anxiety: It’s Not Always Obvious

By | NESCA Notes 2025

Image of an anxious child and a quote from a NESCA clinicianBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

When we hear the word anxiety, we often picture someone who is visibly worried – someone who says, “I’m scared,” asks a lot of “what if?” questions, or seems nervous about what might happen next. But anxiety doesn’t always present that way – especially in children. Anxiety can manifest as physical symptoms, behavioral challenges, emotional outbursts, sleep disruptions, school avoidance, or changes in relationships. A child may not have the words to say, “I’m anxious.” Instead, they may complain of a stomachache, become unusually irritable, refuse to go to school, have frequent meltdowns, or suddenly need much more reassurance.

It is also important to remember that a behavior or symptom that looks like anxiety isn’t automatically anxiety. Symptoms that may appear anxiety-related can have many possible explanations – and sometimes more than one diagnosis is present at the same time.

Anxiety in Young Children

Young children often don’t have the ability to identify and explain anxiety. Instead, adults may see it through behavioral challenges or physical complaints such as:

  • Complaining frequently about a stomachache, headache, nausea, or feeling sick
  • Becoming clingy or having difficulty separating from caregivers
  • Resisting school, daycare, activities, or unfamiliar places
  • Having trouble sleeping or experiencing nightmares
  • Becoming irritable or emotional
  • Having more frequent tantrums or meltdowns
  • Asking for repeated reassurance
  • Becoming upset when plans change
  • Avoiding things that make them uncomfortable
  • Seeming quiet, cautious, or tense

For example, a child who says, “My tummy hurts,” every Sunday night may not simply have a sensitive stomach. Their body may be responding to the anticipation of school the next morning.

It is important to note that physical symptoms are very real. Emotional distress can produce genuine physical sensations, and children may experience symptoms such as stomachaches, nausea, headaches, dizziness, or changes in appetite.

Anxiety in School-Age Children

As children enter elementary school, there are greater academic expectations, more complexities in friendships, increasing extracurricular activities, new environments, and often an increasing awareness of how other people perceive them.

Anxiety may begin to look more like avoidance or shut down/withdrawal.

You might notice:

  • Frequent complaints of feeling sick before school
  • Asking to stay home or repeatedly visiting the school nurse
  • Difficulty separating from caregivers
  • Worrying about making mistakes
  • Perfectionism
  • Reassurance-seeking, asking lots of questions about what is to come
  • Difficulty falling asleep because of worries about the next day
  • Irritability or large reactions
  • Trouble concentrating
  • Avoiding activities
  • Becoming upset when plans change

Sometimes children who seem “defiant” are actually overwhelmed.

A child who refuses to participate in an activity may be avoiding something that feels scary. A child who melts down over homework may be overwhelmed by the possibility of getting something wrong. A child who says they hate school may be experiencing significant anxiety about academics, social situations, separation, bullying, or another aspect of the school environment.

Importantly, while avoidance can provide short-term relief, it can also allow anxiety to become more entrenched over time.

Anxiety in Teens

Adolescence brings a different set of challenges. Friendships become more complicated. Academic expectations increase. Social comparison becomes significant. Teens may be thinking more about who they are, their relationships, wanting more independence, and transitioning into adulthood. In teens, sometimes anxiety looks like:

“Leave me alone.”

“I don’t care.”

“I’m not going.”

“I hate everyone.”

“My stomach hurts.”

A teen experiencing anxiety may become more irritable, withdraw from others, have difficulty sleeping, struggle to concentrate, or avoid situations they once enjoyed. For teens, it may appear as though they have an “attitude problem” when what they actually are experiencing is internal distress.

With that said, that doesn’t mean every argument, eye roll, withdrawal, or change in mood is anxiety. Adolescence is marked by ever-changing hormones and a complicated period of development. To this end, irritability can have many causes. If you are noticing a significant change in behavior; however, it is worth paying attention to – especially when it persists or begins interfering with everyday life.

Anxiety in Adults

Adults may be better able to identify worry, but anxiety can still present in less obvious ways.

An adult may experience:

  • Constant “what if?” thinking
  • Irritability or feeling constantly on edge
  • Difficulty relaxing
  • Racing thoughts
  • Trouble concentrating
  • Insomnia or disrupted sleep
  • Muscle tension
  • Headaches
  • Stomachaches or digestive symptoms
  • Fatigue
  • Avoidance
  • Excessive reassurance-seeking
  • Difficulty making decisions
  • Feeling overwhelmed by ordinary responsibilities

In adults, anxiety can also feel so familiar that you may have thoughts such as:

“I’ve always been a worrier.”

“I’m just a perfectionist.”

“I just like to know what to expect so I can plan accordingly.”

“I’ve always been bad at relaxing as I prefer to stay busy.”

Not Everything That Looks Like Anxiety Is Anxiety

Something important to note about anxiety symptoms is that they often overlap with other possible conditions as well. This is where things can get complicated. For example, an upset stomach could be anxiety, but it could also be a gastrointestinal condition. Irritability could be anxiety, but it could also be related to sleep deprivation, depression, ADHD, hormonal changes, or learning difficulties. Difficulty concentrating could be anxiety, but it could also be ADHD, learning challenges, inadequate sleep, depression, or stress. School avoidance could be anxiety, but it could also be bullying, academic difficulties, social challenges, depression, or an environment that isn’t meeting the child’s needs.

Another important piece of the puzzle is that conditions don’t always exist in isolation. For example, ADHD and anxiety can occur together. Anxiety can also co-occur with learning disorders, sleep problems, depression, and other conditions, which can make it more difficult to determine what is driving a particular set of challenges.

For example, imagine a child who can’t complete homework. Is the child anxious about getting the answers wrong? Are they struggling to sustain their attention because of ADHD? Is the assignment particularly difficult because of an underlying learning disorder? Are they exhausted? Or maybe a few of these things are happening all at once. The answer matters because the most helpful support may look very different depending on what’s underneath the behavior. A good assessment looks beyond the most obvious symptom.

When Is It Time to Get Help?

Everyone experiences anxiety. Fear and worry are normal parts of development and everyday life. The concern is when anxiety (or the behaviors associated with it) becomes persistent or disruptive. Should symptoms persist, cause significant distress, or interfere with school, work, relationships, sleep, activities, or daily functioning, it is time to seek out an evaluation to better understand the root cause. An evaluation can also be particularly helpful when you’re unsure what you’re seeing. You don’t have to start the evaluation process knowing whether it’s anxiety, ADHD, autism, depression, a learning disorder, a medical issue, or something else. That’s precisely what an evaluation is for.

The bottom line is that anxiety doesn’t have one look. And sometimes what appears to be anxiety isn’t anxiety at all – or isn’t only anxiety. Understanding the whole picture matters. Through better understanding and an appropriate evaluation, we can begin on the road to providing supports that addresses the underlying need – not just what we see on the surface.

 

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 and related services practice in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; 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.

 

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Image of a student putting forth effort on an exam and a quote from a NESCA clinician

The Right Praise Leads to Grit – Part 2

By | NESCA Notes 2026

Image of a student putting forth effort on an exam and a quote from a NESCA clinicianBy Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

In my last blog, I discussed why the right kind of praise matters for students. In Part 2 of my blog series about Praise, I’m going to discuss how the right kind of praise leads to students having grit or perseverance. Grit or perseverance is often understood as sustained effort toward a achieving a goal. Research links grit, self-regulated learning, and resilience with students’ engagement and persistence in challenging academic tasks as the ability persist through challenges, setbacks, and failures.

In Part 1, I discussed Carol Dweck’s research that distinguished praising intelligence versus praising effort. When students are told they are “smart,” their identity gets “locked in” on being/appearing smart, so they avoid difficult tasks that could expose them to failure or being perceived as “dumb or not smart.” Therefore, praising effort encourages a “growth mindset,” which is the belief that abilities can develop through learning, practice, and persistence.

This idea connects directly to grit. Praising effort naturally encourages grit. It teaches that productive failure is part of the learning process and prepares students for setting long-term goals or assignments that are challenging. It prepares them for life! Failure should be viewed as a part of life and learning, and not associated with shame or a permanent label. Failure can be used as a jumping off point to explore where the breakdown happened. This is why we praise “productive failure.” It encourages students to ask questions about what happened and move forward with curiosity. Grades should not be ignored, but they should not be the sole object of praise. Instead, use good grades as a recognition of mastery of content, study habits, effort, perseverance, practicing the hardest problems, asking for help when needed, and revising mistakes, etc.

Teachers and parents should praise actions instead of results or identity labels. Instead of saying, “You’re such a math whiz,” try saying, “You stuck with those confusing word problems and kept trying a different approach, that’s great.” Or instead of, “You failed the test,” one can offer, “This test score shows me that you didn’t really understand this concept or study in a way that allowed you to master the content.” These types of phrases show students that failure and setbacks are temporary and actionable – not permanent.

A growth mindset allows students to approach life with an openness that allows them to fail, make mistakes, and be/feel okay about themselves. It does not define who they are as a person! Praise about the process they took or the effort they put forth helps students develop intrinsic motivation, resilience, and greater challenge-seeking behaviors. They don’t see themselves as a failure and won’t give up as easily. Remind them that failure is part of learning, and building grit will carry them forward in future endeavors. Praising effective strategies, improvement, and sustained effort can help students develop resilience. Ultimately, praise that emphasizes the process of learning can strengthen the mindset that supports grit, helping individuals persist because they understand that effort can lead to growth.

As we send students back to school for the new academic year, remember the impact that giving the right kind of praise can make in the short- and long-term in helping them to build both a growth mindset and grit in their school life and life in general.

 

Resources:

“How to Encourage Academic Grit and a Growth Mindset in Your Students”
By Princy Quadros-Mennella, PhD, Associate Professor of Psychology, Director of the Neuroscience Program, Bay Path University and Thomas Mennella, PhD, Associate Professor of Biology Director of the M.S. in Applied Laboratory Science and Operations Program, Bay Path University
https://www.academicimpressions.com/how-to-encourage-academic-grit-and-a-growth-mindset-in-your-students/

Psychologist Angela Duckworth’s research about grit:
https://www.angeladuckworth.com

https://americanradioworks.publicradio.org/features/tomorrows-college/grit/angela-duckworth-grit.html

 

About the Author

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

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

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

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

 

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Image of a parent praising a student with a high five and a quote from a NESCA provider.

The Right Type of Praise Matters – Part 1

By | NESCA Notes 2026

Image of a parent praising a student with a high five and a quote from a NESCA provider.By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

I just returned from consulting to a couple of schools in Honduras. While there, I met with teachers, parents, and students, and provided workshops to the teachers there. I have been honored and excited to consult to these schools and to witness the teachers implementing the lessons gained from our workshops, showing how they have positively shifted their habits and practices as they have welcomed students back for their new school year.

On the first day of school at one of the schools, the graduating seniors lead a pep rally for the whole school, and it was exhilarating. Watching this assembly then witnessing all of the students – not just the seniors – go to their classes with enthusiasm, excitement, and optimism was palatable.  The whole experience energized the entire student body and faculty alike. My goal in all my school consults is to help teachers keep this spirit and enthusiasm alive within their students throughout the whole school year.

One of the workshops I gave was on how to keep students’ motivation, optimism, and positive self-worth alive. Most students start off the year with a positive attitude and hope for the future, but as the school year progresses these feelings tend to shift and wane. Sometimes this shift is influenced by how the adults in the student’s life provide feedback. Teachers, parents, and caregivers can sometimes provide feedback that turns the student off to working harder and trying difficult tasks. When we say things like, “You’re so smart,” “You got an A,” or “You’re a great creative writer,” we are praising a person’s worth on achievement, talent, results, and intelligence. Grade-, intelligence-, and achievement-based praise, or results-driven praise places a student’s worth on the final result. Praise that encourages effort, grit, and perseverance activates the brain to keep going with an attitude of, “I can do it,” “I’ll try even if it is hard,” or “I’m good enough even if I make a mistake.” It fosters the mindset that their self-worth isn’t tied up in getting the good grade or isn’t attached to being intelligent.

Psychologist Carol Dweck’s research on the growth mindset highlights how powerful this difference is when students are confronted with difficult work or failure. Dweck’s growth mindset research contrasts the belief that intelligence is fixed with the belief that ability can develop through practice, effective strategies, feedback, and help from others. When teachers, parents, and caregivers repeatedly praise grades, intelligence, or talent alone, students then infer that they have to be smart, successful, and can’t make mistakes to be loved (by parents) and valued and respected (by teachers). Thus, when a student gets a disappointing grade, it feels like evidence that they are not good enough or smart enough, which often leads to feelings of unworthiness and a lack of risk-taking behavior related to academic challenge. Studies conducted by Carol Dweck and fellow Stanford psychologist and research director Claudia Mueller showed that students who were praised for their intelligence after achieving a good grade were more likely to choose easier tasks afterward and showed weaker performance following failure than students who were praised for their effort. In contrast, the effort-praised students demonstrated greater persistence, enjoyment, and post-failure performance, choosing a more difficult test to complete than their counterparts. For more on this, watch this YouTube video: Carol Dweck – A Study on Praise and Mindsets – https://www.youtube.com/watch?v=NWv1VdDeoRY.

Adults should use praise to their advantage to help students keep their beginning-of-the-school-year optimism, excitement, and positive attitude alive all year long. Praise should communicate that students are more than their grades and that they are enough! By honoring solid effort, thoughtful strategies and attempts, perseverance, and learning from mistakes, teachers and parents help students develop the confidence to attempt difficult things and the resilience to continue even when success does not come naturally.

 

Resources:

Carol Dweck – Praising Intelligence: Costs to Children’s Self-Esteem and Motivation
https://bingschool.stanford.edu/news/carol-dweck-praising-intelligence-costs-childrens-self-esteem-and-motivation

Claudia Mueller and Carol Dweck – Praise for intelligence can undermine children’s motivation and performance.
https://psycnet.apa.org/record/1998-04530-003

 

About the Author

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

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

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

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

 

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Image of parents meeting with educators

From Report to Classroom: Translating Your Child’s Evaluation into Real-World School Supports

By | NESCA Notes 2026

Image of parents meeting with educatorsBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

A comprehensive neuropsychological evaluation offers a clear, objective look at how your child learns, processes information, and navigates their environment. However, receiving the evaluation report is only the first step in the journey to ensuring those findings translate into meaningful, everyday classroom support. The next crucial phase is working alongside educators to transform these clinical insights into real-world, school-based strategies. By understanding how to utilize the recommendations provided within the report, parents are equipped to foster a collaborative relationship with the school team and establish the precise structural and academic supports their child needs to succeed.

Navigating the educational landscape and special education terminology can sometimes feel like learning a foreign language. Bridging the gap between a clinical diagnosis and school-based eligibility requires a structured, team-based approach. By gaining insight into school procedures, clarifying the difference between support frameworks, and using targeted clinical recommendations, parents can confidently advocate for the resources and learning environment their child requires.

Understanding the Frameworks: 504 Plan vs. IEP

The first step in advocacy is understanding the two primary pathways for school-based support. While both provide essential assistance, these public school documents are governed by different federal laws and serve distinct purposes:

  • The 504 Plan (Section 504 of the Rehabilitation Act): This civil rights statute is designed to prevent discrimination by ensuring “equal access” to learning. A 504 Plan provides accommodations, which are changes to how a student learns, without altering the curriculum. Examples include extra time on tests, preferential seating, or sensory breaks. It is appropriate for students who can access the general education curriculum but need environmental adjustments to do so.
  • The Individualized Education Program (IEP; Individuals with Disabilities Education Act): An IEP is a specialized blueprint for students who require specialized instruction. This involves changes to what they are being taught, where they are being taught, or the delivery of direct services (such as speech-language therapy, occupational therapy, or specialized reading instruction). To qualify for an IEP, a student must have a documented disability that directly impacts their ability to make effective progress in school, requiring targeted, specialized instruction.

A comprehensive neuropsychological evaluation is invaluable for both pathways, as it provides the objective, standardized data necessary to document a child’s functional limitations and academic needs. A primary goal of our evaluation report is to clearly connect your child’s profile directly to appropriate recommendations, including practical classroom strategies.

Translating Clinical Findings into Classroom Supports and Placement

A high-quality neuropsychological report does not simply list test scores and diagnoses; it outlines the underlying cognitive, learning, and social-emotional factors driving a student’s classroom challenges. At NESCA, what sets our reports apart is our commitment to understanding the whole child, including the complex, interacting variables that shape their daily experience. This holistic view allows us to provide highly individualized, detailed recommendations rather than generic lists of accommodations. We specify the exact nature of the support your child needs, including the recommended frequency of services, the provider best suited to deliver the intervention, tailored environmental accommodations, and the specific setting where the support should occur.

A comprehensive evaluation can also inform appropriate classroom placement. For some students, making effective progress requires a specialized language-based, co-taught, or therapeutic classroom setting rather than a standard general education environment.

You do not need to be a clinical expert to advocate effectively during this process. A high-quality report does the heavy lifting by reframing classroom struggles into clear, actionable solutions. For instance, a student who appears “disorganized” or “unmotivated” is often actually experiencing executive dysfunction. Thus, the report may reframe this difficulty to advocate for structured scaffolding, like breaking long-term projects into mini-deadlines with daily staff check-ins.

Similarly, a child labeled “inattentive or slow to finish work” may be managing the impact of slow processing speed, meaning they comprehend the material well but require significantly more time and cognitive energy to show what they know. The report can use this insight to justify pacing accommodations, such as reduced homework volume to prioritize concept mastery over repetitive task completion.

Even emotional vulnerabilities, such as presenting as “withdrawn or resistant to participate,” may be reframed within a report through the lens of underlying sensory overload or social fatigue, pointing the school team toward proactive supports like a designated safe space or scheduled sensory breaks throughout the day. Ultimately, by translating complex behaviors into these precise, real-world connections, the evaluation report provides you and the school with a shared, compassionate roadmap towards supporting the student’s success.

Collaborative Advocacy: Partnering with the School Team

Preparing for a multidisciplinary team meeting can be a deeply personal process, and it is completely natural to want to ensure your child’s needs are fully understood. The most productive school meetings are often built on a foundation of partnership, where everyone brings valuable expertise to the table. Successful advocacy relies on uniting two distinct areas of expertise: the school team’s deep knowledge of curriculum and classroom dynamics, and your unmatched understanding of your child’s unique personality, strengths, and history. By uniting these unique perspectives, you and the school team can work together to build the best possible path forward. To foster a collaborative partnership during your next team meeting, consider these strategies:

  1. Share the Report Early to Build a Collaborative Bridge (Preparation): When possible, provide the school’s multidisciplinary team with the neuropsychological report at least two weeks prior to the scheduled meeting. This gives the educators and specialists adequate time to digest the findings and formulate thoughtful, proactive service proposals. To foster a true partnership, consider sending a brief, friendly email along with the report highlighting your top two or three priorities or questions, ensuring your voice is integrated into the meeting agenda from the very start.
  2. Reframe Behavior Through a Clinical Lens (During the Meeting): Use the evaluation findings to identify the root cause of certain behaviors, allowing the team to reframe classroom challenges and guide targeted, proactive interventions. If it is noted that your child is “disengaged” or “refuses to write,” pointing to the objective data showing fine-motor fatigue, language-retrieval deficits, or underlying performance anxiety helps the team view the behavior as a skill deficit rather than a compliance issue. Reframing these challenges empowers the team to focus on teaching coping strategies and providing proactive supports that set your child up for success.
  3. Focus on “Effective Progress” and Accountability (The Goal): Under special education guidelines, eligibility and services hinge on whether a child is making meaningful, “effective progress” in school. Use the standardized, objective data in your report to highlight where your child is struggling, both compared to their peers and relative to their own capabilities. Rather than asking for generalized help, frame your requests around helping them close these specific developmental and academic gaps, and ask the team how the success of any new accommodations or interventions will be actively measured and tracked.

Translating a neuropsychological evaluation into a school-based plan is a journey that requires patience, clarity, and persistence. Ultimately, your child’s report is far more than a diagnostic document; it is a powerful roadmap designed to align parents and educators around a shared vision. By using objective clinical data to guide the conversation, you can ensure your child receives the precise, individualized support required to build academic self-efficacy, emotional resilience, and the foundation they need to thrive.

School Meeting Support

Are you preparing to navigate an upcoming multidisciplinary school meeting to discuss an IEP or 504 plan for your child? To bridge the gap between our clinical findings and your child’s classroom, neuropsychologists at NESCA are available to attend school team meetings. In these meetings, our role is to succinctly present the objective evaluation findings directly to the school team, illustrate how your child’s unique profile impacts their classroom learning, and walk educators through our tailored recommendations.

Please note that school meeting attendance is a distinct clinical service and is not included in the core evaluation and report process. Clinicians participate strictly in an advisory, clinical capacity rather than as educational advocates. To inquire about your clinician’s availability and the rates for this service, please reach out to our intake team at NESCA.

 

About Dr. Madeline Manning

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

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

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

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