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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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Image of teen participating in art therapy and a quote explaining why some individuals may need different forms of therapies.

What If My Child Is Not Ready For Traditional Therapy?

By | NESCA Notes 2026

Image of teen participating in art therapy and a quote explaining why some individuals may need different forms of therapies.By: Jessica Greene, Psy.D.
Postdoctoral Fellow, NESCA

When parents receive a recommendation that their child begin therapy, it can feel overwhelming. Many people are familiar with traditional “talk therapy,” but some may not realize there are many different therapeutic approaches designed to meet children where they are at developmentally or emotionally. After receiving a recommendation for therapy, many parents immediately ask, “Do you recommend anyone?” While that is an important question, it can be just as helpful to first ask, “What type of therapy is the best fit for my child?” Not all children and adolescents are ready to sit down with a therapist and talk about their thoughts and feelings in a traditional therapy setting. Younger children, children with developmental differences, those who have experienced trauma, or children who become overwhelmed by emotions may benefit from therapies that allow them to communicate in other ways.

Fortunately, there are several therapeutic approaches that may be a better fit.

Play-based Therapy

In play-based therapy, children use play to work through challenging feelings, day-to-day stressors, and/or difficult experiences. Rather than relying on conversation, the play allows the child to express themselves in the way that comes most naturally to them. Through the child’s play, the therapist may gain insight into how the child understands experiences, relationships, or emotions. For example, a child may use toy cars to make sense of a car accident, replaying the accident as they work toward understanding and processing the experience.

It is important to know that registered play therapy is different from simply playing games with a child during a therapy session. In play therapy, play itself is the therapeutic language, and the therapist has specialized training in using play to support assessment and treatment. It is okay to ask a potential therapist about their approach.

Find a Registered Play-based Therapist: https://www.a4pt.org/search/custom.asp?id=3571

Music Therapy, Dance/Movement Therapy, and Art Therapy

Music, dance/movement, and art therapy use creative expression as the primary way children explore emotions, build coping skills, strengthen self-awareness, and process difficult experiences. For some children, creating art, moving their bodies, or making music feels safer and more natural than talking. What they may not be able to say in words, they may be able to demonstrate through one of these other forms. These therapies naturally offer rhythmic, patterned, repetitive movements that can support internal regulation while giving children an alternative avenue to express themselves.

Find a Music Therapist: https://my.cbmt.org/cbmtssa/f?p=CRTSSA:17800:1865299384:::17800::

Find an Art Therapist: https://arttherapy.org/art-therapist-locator/

Find a Dance/Movement Therapist: https://www.adta.org/find-a-dmt#/

Occupational Therapy

Occupational Therapy is another alternative that may be a better entry point for some children who are not quite ready for the above-listed therapies. Although occupational therapy is often associated with fine motor skills or handwriting, many occupational therapists also specialize in sensory processing and emotional regulation. Through movement, sensory experiences, and structured activities, children learn what helps their bodies feel calm, organized, and ready to participate in everyday activities. As children engage with swings, climbing equipment, crash pads, sensory tools, and other therapeutic activities, they begin to recognize what helps them feel better regulated. As occupational therapists can provide support for many different needs, seek an occupational therapist that focuses on sensory processing and/or emotion regulation.

To learn more about NESCA’s Occupational Therapy services, visit: https://nesca-newton.com/educational-occupational-therapy-services/

Sensory Motor Arousal Regulation Treatment (SMART)

SMART is a trauma-informed therapy that combines sensory experiences with movement, while also focusing on the importance of the caregiver/child relationship to help children feel safer and more regulated. If your child has experienced trauma, SMART therapy may be an appropriate place to begin. Similar to occupational therapy, the SMART room provides various types of therapeutic equipment to help a child regulate their body throughout the session. Sessions may include crashing into crash pads, throwing a ball back and forth, or jumping on a trampoline to help the client increase or decrease their level of arousal, depending on their needs. Caregivers are an important part of the therapeutic process, helping strengthen attachment, during sessions, while learning to recognize what supports their child’s regulation. The process also encourages caregivers to better understand their own emotional responses and how these can influence their child’s ability to feel safe and regulated.

Find a SMART-trained Therapist: https://smartmovespartners.com/find-a-smart-therapy-therapist/

Regardless of the type of therapy, one factor consistently predicts better outcomes: the relationship between the child and therapist. Children are most likely to make progress when they feel safe, understood, and connected to the person supporting them. If your child does not seem comfortable with a therapist after an appropriate adjustment period, it is okay to ask questions or explore whether another provider may be a better fit.

 

About the Author

Dr. Jessica Greene is a licensed clinical psychologist who has worked After working with Dr. Angela Currie in NESCA’s Londonderry, N.H. office from 2023-2024 as a practicum student, Dr. Jessica Greene re-joins NESCA to complete her postdoctoral fellowship in pediatric neuropsychological assessment. Dr. Greene has a particular interest in understanding clients’ strengths as well as differences, integrating a therapeutic assessment approach, when appropriate.

To book an evaluation with one of our many 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; 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 going back to school along with a quote from a NESCA clinician

Helping Children with Social and Emotional Needs Navigate the Back-to-School Transition

By | NESCA Notes 2026

Image of a student going back to school along with a quote from a NESCA clinicianBy: Julie Weieneth, Ph.D.
Pediatric Neuropsychologist, NESCA

As summer winds down, many families begin shifting their focus to the upcoming school year. We start to notice store shelves filled with backpacks and notebooks. We update our calendars with orientation events and fall sports schedules. Parents also start thinking about new teachers, changing routines, and everything their children will need for a successful start.

For many children and families, the return to school brings a mix of excitement and nervousness. However, for children with diverse social, emotional, or neurodevelopmental needs – such as anxiety, ADHD, or Autism Spectrum Disorder (ASD) – this transition can be especially challenging. Sudden shifts in routines, expectations, sensory environments, and social dynamics can trigger significant stress, even when the changes are positive.

Fortunately, with proactive planning and preparation, families can make the transition smoother and reduce anticipatory anxiety before the first day of school arrives.

Why the Back-to-School Transition Can Be Difficult

Children with anxiety, ADHD, or ASD often rely on predictability, structure, and familiar environments to feel secure and regulated:

  • For children with anxiety, the unknown can trigger a cycle of worry. This may include apprehension about academic performance, social acceptance, or simply not knowing the daily schedule.
  • For children with ADHD, the transition from the relatively relaxed pace of summer to the high executive functioning demands of the classroom – which requires sustained attention, organization, and self-regulation – can feel overwhelming.
  • For children with ASD, differences in social communication and a strong preference for sameness mean that new teachers, different peer groups, and novel sensory environments require significantly more cognitive effort to manage.

Helping children understand exactly what to expect before these changes occur builds confidence and makes unfamiliar situations feel manageable. Below are some practical steps that families can take to help reduce this stress:

  1. Visit the School Before Classes Begin

One of the most effective ways to reduce first-day anxiety is to make the new environment feel physically familiar. This sensory and spatial familiarity benefits anxious, hyperactive, and sensory-sensitive children alike. Replacing uncertainty with physical familiarity significantly lowers anxiety on the first day of school.

If possible, arrange a visit to the school before classes officially start. Many schools host orientation days or can accommodate a brief walk-through during teacher preparation week. During the visit, your child can:

  • Meet their new teacher to establish an early, positive connection.
  • Locate their classroom, desk, and cubby or locker.
  • Walk the routes to key locations like the cafeteria, gym, library, and bathrooms.
  • Identify a “safe space” or a designated staff member they can access if they feel overwhelmed during the day.
  1. Use Social Narratives and Visual Schedules

Social narratives are personalized, step-by-step stories that help children understand what to expect in specific situations and outline helpful coping strategies. While originally developed for children with autism, these narratives are highly effective for children with ADHD and anxiety, as they clarify expectations and reduce executive functioning demands.

Using photos taken during your school visit can make the story even more meaningful. For example:

Tomorrow is my first day of fifth grade. I will walk into my classroom and see my teacher, Mrs. Smith. I will put my backpack in my cubby and find my desk. The classroom might be loud, or I might feel nervous, and that is okay. I can take deep breaths or ask to use my sensory tool. At the end of the day, I will take the bus home, and my family will be waiting for me.

Reading this narrative together several times before school starts allows children to mentally rehearse the day, reducing anxiety and boosting their sense of control.

  1. Utilize Video Modeling and Visual Walkthroughs

Many neurodivergent children are strong visual learners who process information more effectively through images and video than through verbal explanations alone.

Before school begins, consider recording a brief video on your phone during your school visit. Narrate the steps as you walk through the building: entering the front doors, finding the classroom, opening a locker, or navigating the cafeteria. Watching this video repeatedly at home allows your child to familiarize themselves with the sights and sounds of the school layout from the safety of a comfortable environment.

If you cannot visit the school in person to record, check the school’s website or reach out to the principal – many schools now host virtual tours or welcome videos recorded by staff that you can watch together at home. Video modeling is a highly versatile tool; it can also be used to prepare children for other transitions, such as medical appointments, family gatherings, or community outings.

  1. Gradually Shift Routines Before Day One

The transition from the relaxed schedule of summer to the highly structured routine of the school year can be a shock to a child’s internal clock. For children with ADHD and ASD, sleep disruption directly impacts daytime attention and emotional regulation.

About two weeks before school starts, begin incrementally shifting bedtimes and wake-up times by 15 minutes each day. Additionally, start practicing the morning routine – waking up, getting dressed, and having breakfast in the same sequence they will on school mornings. This gradual shift prevents first-week sleep deprivation and makes the first real school morning feel like a routine they have already mastered.

  1. Share a “One-Page Profile” with the New Teacher

Teachers receive a significant amount of paperwork at the start of the year, but a brief, personalized “One-Page Profile” (or “About Me” sheet) can be incredibly helpful. Before the first day, email a simple, bulleted summary to your child’s teacher. Consider including:

  • My Strengths: What your child loves and what motivates them (e.g., “loves space science,” “highly creative”).
  • What Helps Me: Strategies that work well (e.g., “needs a visual timer,” “benefits from sitting near the front”).
  • What I Struggle With: Early warning signs of distress (e.g., “fidgets when overwhelmed,” “may shut down if confused”).

This quick-reference guide helps the teacher understand your child’s unique profile from day one, fostering a collaborative home-school partnership.

  1. Plan for the “After-School Letdown”

For children with diverse needs, holding it together during a highly structured school day requires immense cognitive and emotional effort. When they finally return to their safe haven at home, it is incredibly common for them to release that built-up tension. This often looks like sudden irritability, meltdowns, or extreme fatigue right after school – a very normal reaction often referred to as the “after-school letdown” or decompression.

To help your child gently decompress at the end of the day:

  • Keep the transition quiet: Avoid immediately asking, “How was your day?” as they get in the car or walk through the door. Give them time to transition in comfortable silence.
  • Provide a comforting snack: Have a favorite snack ready immediately to address any hunger-related irritability.
  • Schedule quiet downtime: Allow for 30 to 60 minutes of unstructured, low-demand time (like quiet play, outdoor movement, or relaxing screen time) before starting homework or chores.

Small Steps Make a Big Difference

Transitions naturally involve uncertainty, which can fuel anxiety and behavioral challenges. Providing opportunities to preview and practice what lies ahead helps children feel more secure and confident.

Whether it is visiting the school, reading a personalized narrative, watching a video walkthrough, or gradually adjusting routines, these proactive strategies can help children with diverse needs approach the new school year with greater ease. While every child’s profile is unique, thoughtful preparation can make the transition back to school a more positive experience for the entire family.

Wishing you and your family a smooth transition back to school. Please feel free to reach out with any questions, or to share your own transition strategies with the NESCA community!

 

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 practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) 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 student walking into middle school with a quote from Dr. Madeline Manning

Navigating the Transition from Elementary to Middle School with ADHD

By | NESCA Notes 2026

Image of student walking into middle school with a quote from Dr. Madeline ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

The transition from elementary to middle school is a significant developmental milestone, bringing new academic demands, shifting social dynamics, and greater expectations for independence. For students with attention-deficit/hyperactivity disorder (ADHD), who often experience executive function (EF) vulnerabilities, this period can be particularly challenging. Understanding and proactively addressing the academic, social-emotional, and behavioral needs of these students is essential to support their adaptation and long-term success.

Academic Demands and Executive Function

Middle school introduces a significantly more dynamic, fast-paced academic environment, characterized by multiple teachers, changing classrooms, and a heavier workload. Students must manage assignments from various instructors, each with different expectations and communication methods. This environment requires cognitive flexibility and other advanced EF skills, including organization, time management, task initiation, and prioritization. For students with ADHD, these demands can quickly overwhelm existing coping strategies, leading to forgotten assignments, missed deadlines, and difficulty transitioning between classes. This, in turn, can contribute to a reduced sense of self-efficacy as a learner.

Notably, many students have not yet been explicitly taught the EF skills needed for this new level of independence. Evidence shows that many students with ADHD require direct instruction, repetition, clear structure, frequent feedback, and opportunities to practice these skills in real contexts. Early identification of EF difficulties and targeted supports, such as executive function coaching, visual organizers, structured routines, and regular teacher check-ins, can ease the transition and build confidence (Giannakopoulos, 2025).

Social Dynamics and Emotional Development

Middle school is also marked by greater complexity in peer interactions. Friendships shift from more convenience-based connections, often formed through proximity and shared activities in elementary school, to deeper emotional bonds, and students face heightened peer pressure and the formation of social cliques. The onset of puberty, elevated emotional sensitivity, emerging interest in romantic relationships, and the influence of social media can further complicate peer dynamics during this developmental stage.

Students with ADHD are already at increased risk of experiencing challenges with impulse control, emotional regulation, and social problem-solving. The reduced adult scaffolding in middle school means students are expected to navigate social situations with more independence, which can be both empowering and challenging. Difficulties in these areas can negatively affect self-esteem and lead to anxiety or withdrawal.

Fostering resilience involves teaching prosocial coping strategies and promoting self-advocacy. This includes encouraging students to seek support from trusted adults when needed and to practice assertive communication skills. Guidance on managing peer pressure, conflict resolution strategies, and building and maintaining healthy friendships is critical for positive social development and emotional well-being in middle school and beyond.

The Adolescent Brain: Developmental Realities

During early adolescence, the brain undergoes significant changes. The prefrontal cortex (responsible for planning, decision-making, and self-control) is still maturing, while the limbic system (a complex set of brain structures governing emotions and reward systems) develops far earlier. This developmental mismatch means that adolescents are more likely to exhibit heightened emotional responses, increased impulsivity, and a greater sensitivity to rewards and peer influence, often before they have fully developed the cognitive skills necessary for effective self-regulation and long-term planning.

These neurodevelopmental factors mean that even typically developing students may struggle with EF tasks and social functioning during middle school. For those with ADHD, whose brains are already wired for greater difficulty with attention and self-regulation, the challenges can be far more pronounced.

Supporting Skill Development

To help students with ADHD navigate this transition, families and educators can collaborate to provide:

  • Explicit instruction in organizational and planning skills
  • Consistent routines and predictable expectations
  • Visual supports (e.g., checklists, planners)
  • Regular feedback and positive reinforcement
  • Opportunities for guided practice and reflection

These supports help students gradually build independence, resilience, and the executive function skills necessary to meet new demands.

A Critical Window for Evaluation and Intervention

The transition from elementary to middle school is a pivotal time to address concerns around academic, social-emotional, and/or behavioral functioning. A comprehensive neuropsychological evaluation can clarify your child’s unique strengths and challenges, guide targeted interventions, and support the development of formal education plans (e.g., IEPs or 504 Plans) to ensure they are receiving the services they require. Early identification and collaboration between home and school are essential for maintaining self-esteem, fostering self-efficacy, and ensuring access to appropriate supports.

If you have questions or concerns regarding your child’s transition to a new school, executive functioning, or any other aspect of their development, please contact NESCA for guidance. Comprehensive evaluation and targeted strategies can make a meaningful difference in your child’s educational journey and overall well-being.

 

About Dr. Madeline Manning

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

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

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

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Image of a reward chart and quote from NESCA

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

By | NESCA Notes 2026

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

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

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

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

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

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

Why Summer is the Perfect Time to Start

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

 

About the Author

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

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

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

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

Supporting Sibling Relationships in Families with Special Needs

By | NESCA Notes 2026

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

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

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

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

 

About the Author

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

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

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

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Image of a child doing an obstacle course and a quote by Julie Weieneth, Ph.D.

Summer Treatment Ideas for Children with ADHD

By | NESCA Notes 2025

Image of a child doing an obstacle course and a quote by Julie Weieneth, Ph.D.By: Julie Weieneth, Ph.D.
Pediatric Neuropsychologist, NESCA

For many families with children who have ADHD, the end of the school year brings both relief and anxiety. While the break is welcome, the sudden loss of routine can be daunting, leading to unstructured days and endless requests for screen time. But what if this summer could be different? The season’s freedom presents a powerful opportunity to build new skills, strengthen family bonds, and explore creative ways to manage ADHD symptoms. To help you begin, we have gathered summer treatment and planning ideas for every age, including preschoolers, elementary schoolers, middle schoolers, and young adults preparing for college. If any of these ideas resonate with you, try one out this summer and let us know how it goes. We would love to share your experiences with other families!

Preschool (Ages 3-5)

For the little ones, learning through play and interaction is key.

  1. Parent-Child Interaction Therapy (PCIT): PCIT is a hands-on approach that helps parents build better relationships with their kids using play and clear discipline strategies, with real-time coaching from a therapist. It focuses on boosting positive behaviors and reducing the tough ones to create a happier home life. For more information, check out PCIT.org or reach out to NESCA for provider recommendations.
  2. Occupational Therapy (OT): OT can support young children with ADHD by targeting sensory processing, self-regulation, and fine motor skills.
  3. Academic Readiness through Play: Head to a local craft, school supply, or thrift store, or a learning store, like Lakeshore Learning, to find games and activities that build fine motor skills, counting, sorting, and creativity. Here are some additional fun ideas to try out:
    • Treasure Hunts: Create simple treasure hunts with clues to improve attention, focus, and listening skills.
    • Storytime with Puppets: Use puppets to act out stories, encouraging participation and retelling to boost language skills.
    • Craft Projects: Try out different crafts involving cutting, gluing, and coloring to strengthen fine motor skills and creativity.
    • Obstacle Courses: Set up indoor or outdoor courses to enhance physical coordination and follow instructions. If you have an older sibling, get them involved in setting up and running the obstacle course.
    • Cooking Together: Involve your child in cooking simple recipes to improve focus, following directions, and fine motor skills.
    • Memory Games: Play memory games with cards or objects to boost attention and recall.
    • Building Challenges: Use blocks or LEGO sets to encourage planning and problem-solving.
    • Dance and Movement Games: Play games, like freeze dance or follow-the-leader, to help with self-regulation and listening skills.

Elementary School (Ages 6-10)

Kids in this age group thrive with structured activities that enhance social skills and organization.

  1. Behavioral Therapy: Enroll your child in therapy sessions targeting goals including impulse control and organization.
  2. ADHD Summer Camps and Social Skills Groups: These camps/group programs offer structured environments tailored for kids with ADHD, focusing on social skills, self-esteem, and executive functioning.
  3. Bibliotherapy or Self-Help: Summer is a great time to read books on parenting children with ADHD, like “Taking Charge of ADHD” by Russell A. Barkley. There are also many children’s books, such as “The Secret Superpowers of ADHD” by Jennifer Everly. Explore resources on CHADD and ADDitude for more ideas.

Middle School (Ages 11-13)

As your child enters adolescence, focus on fostering independence and self-awareness.

  1. Cognitive Behavioral Therapy (CBT): CBT helps middle schoolers learn strategies to manage impulsivity and improve attention, with summer sessions focusing on real-life situations, such as managing social conflict and academic stress.
  2. Mindfulness and Relaxation Techniques: Introduce mindfulness practices –  meditation or yoga – to improve focus and reduce stress. Many apps can help integrate these into daily routines.
  3. Volunteer Opportunities: Encourage community service projects to boost self-esteem, teach life skills, and reinforce social skills and early vocational skills.

Young Adults Transitioning to College/Vocational Endeavors (Ages 14-18)

For these young adults, it is all about preparing for college or vocational work, and managing academic, social, and daily living demands more independently.

  1. Executive Function Coaching: Consider hiring a coach to work on time management, organization, and goal setting, which are key skills for college and career success. NESCA offers transition-related assessments and coaching services tailored to transition-age youth. Explore NESCA Transition Services to help determine if college or a different path is right for you, and NESCA Coaching Services to build and practice skills that will be needed for all future paths.
  2. Medication Management: Check in with your healthcare provider to review medications and make any necessary changes before college starts. Learn more about what they are, what they are for, how to refill them, and when a new prescription is needed.
  3. Transition Workshops and College Immersion Programs: Look for workshops or programs that focus on transitioning to college or postsecondary life, covering self-advocacy, stress management, academic strategies, and social problem-solving.
  4. Updated Neuropsychological Evaluation: Ensure updated testing within three years of starting college or work to receive accommodations. If you have relied on accommodations in high school, have a support plan in place before your first college semester in order to ensure your success. Get to know more about on-campus resources to support you. If you are interested in learning about neuropsychological evaluations, please check out our website or contact us by filling out an Intake Form for more information.

We hope that you have a relaxing, fun, and rewarding summer! Feel free to reach out with any questions or concerns, or if you have any additional ideas to share with the NESCA community!

 

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; 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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