NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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Teen frustrated with homework

When Effort Masks Inefficiency – The Student That Flies Under the Radar

By | NESCA Notes 2022, NESCA Notes 2025 | No Comments

Teen frustrated with homeworkBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

There is a particular kind of student who rarely raises concern. They follow directions. They turn in assignments. They earn decent grades. They don’t disrupt class. They are described as sweet, hardworking, responsible – and they are exhausted.

These are the students who fly under the radar. You may notice it at home before anyone else does. Homework takes hours. Writing assignments feel disproportionately heavy. Reading requires constant rereading. They erase and rewrite sentences repeatedly. They melt down at home – not at school. From the outside, everything appears fine. From the inside, everything feels effortful.

Tiered support systems are designed to identify clear gaps: measurable academic decline, benchmark concerns, noticeable skill deficits, etc. But under-the-radar students often compensate beautifully. They memorize sentence frames. They overprepare and tend to avoid risks. They rely on intelligence to mask inefficiencies and oftentimes, they meet expectations…but at a cost.

Compensation works…until it doesn’t. As academic demands increase, including longer texts, multi-paragraph essays, and independent projects, the effort curve steepens. Middle school is often when the cracks begin to show – not because the child suddenly can’t, but because the system was never optimized.

These students frequently have subtle weaknesses in:

  • Academic language processing
  • Sentence formulation flexibility
  • Discourse-level organization
  • Working memory under load
  • Cognitive flexibility
  • Idea generation efficiency

They can explain ideas verbally but struggle to organize them in writing. They understand what they read, but only after rereading. Frequently they know the answer, but tend to hesitate to share it. The issue is rarely intelligence; instead, it’s about efficiency.

Over time, this exhaustive effort can unfortunately become a student’s identity. Students begin to believe school is supposed to feel this hard. They start to internalize messages like, “I just need to try harder. I’m just slow. I’m not good at writing.” But often, they are working around systems that were never explicitly strengthened. This is not about remediation; these students are not failing. They are often highly capable.

What they need is system strengthening. When we strengthen language networks, syntactic flexibility, executive functioning integration, organizational frameworks, and generalization across contexts, tasks that once felt overwhelming become manageable.

Support does not have to begin with failure. Some of the most powerful growth happens when we intervene before burnout. An integrative model that targets language, literacy, and executive functioning together addresses the systems underneath performance, not just the performance itself.

When these systems are strengthened, families often tell us that it no longer takes three hours to do homework, that they are raising their hands to answer questions in class again, that students don’t dread writing anymore, and that everything seems to feel lighter. Strong academic performance isn’t just about effort. It’s really about the systems.

Working Smarter, Not Harder

High-functioning students don’t always need remediation. Sometimes they may need optimization. When we strengthen the underlying systems, like language organization, executive functioning integration, and discourse-level structure, effort decreases and independence increases. The goal is not to push harder; it’s about building smarter.

If your child is capable but working harder than they should be, an integrative approach focused on building foundational skills with a speech-language pathologist may provide the missing layer of support.

If you’re curious whether this integrative approach would benefit your child, I welcome the opportunity to connect to identify what kind of targeted support would make the greatest difference. For more information on Speech and Language Therapy, Literacy, and Executive Functioning Support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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 kids exploring in nature, with a quote from Dr. Yvonne Asher

In Praise of Under-Scheduling

By | NESCA Notes 2025

image of kids exploring in nature, with a quote from Dr. Yvonne AsherBy: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

This is the time of year where things can go off the rails. Standardized testing, planning for summer, planning for next year, winter sports wrapping up, spring sports starting, recitals, end of year performances, science fairs, prom, graduation. And somewhere on social media are the perfect families with the impeccable photo collages of their children’s activities, everyone posed in matching outfits, effortlessly adorable.

Somewhere far more real are the rest of us, begging one child to put on anything other than sweatpants for their piano recital while comforting another because they KNOW they will “never have friends again” once they start middle school, all while someone eats too many cookies at the lacrosse banquet and pukes all over the car.

Extracurricular activities can be wonderful – they can teach valuable motor and self-regulation skills, build creativity and independence, help children gain self-confidence, build friendships and social competence, and support emotional development. As neuropsychologists, we recommend a multitude of non-school-based activities – sports, martial arts, tutoring, outpatient therapies, therapeutic horseback riding, social skills groups, and more.

And.

They can be a lot. Draining, expensive, exhausting, and unpleasant. For some kids, some families, and some situations, extracurricular activities are the lynchpin. Maybe your kid lives to play soccer. Or participate in competitive gymnastics. Or play violin. If it works for your kid and your family, that is amazing. However, for many families, there is downward pressure into toddlerhood to “expose” children to dozens of structured activities. This can cause stress and anxiety for kids, parents, and siblings, and can eat away at the small amounts of calm family time remaining in between work and school.

What is true is that children need exposure to new things in order to learn and build skills. But, as adults, we forget that so much of simply living is novel to children. Going to a new grocery store? Let’s figure out how to get there using a map and our visual-spatial skills. Beautiful spring day? Take a walk in a new neighborhood. Better yet? Take a hike! What plants do you see? Bugs? Animals? Habitats? Science abounds outside. Have a weekend day with nothing to do? Make a new recipe! Read the recipe, write a shopping list, use math to double it or halve it.

Extracurricular activities themselves are, of course, not the true problem. As often happens in this digital age of parenting, the problem is pressure from others. Feeling like our kids are falling behind the curve, late to the game. And this is dramatically exacerbated for kids with disabilities or challenges, when parents know that they are, in some areas, behind their peers already. It can feel embarrassing to have the one kid who won’t stand up for the choir concert or cries when it is their turn at bat in t-ball. So why must we push them into it?

Of course, sometimes there is a very good “why.” Maybe they love it most of the time and are anxious at recitals. Maybe it’s deeply important to your family and a long tradition for kids to learn this particular skill. Maybe they really need outpatient speech therapy. Many “whys” make it worthwhile to push through an activity. But, sometimes, the “why” is simply “everyone else seems to be doing it” or “they have to do something.”

In these cases, a step back may be worthwhile. At least for now. Enjoy some Saturday mornings spent in pajamas making six different kinds of pancakes because you have nowhere else to be. Play a board game after a lengthy family dinner because everyone got home early. Let your kid pick up every rock they see on the way home from school – maybe today is a good day to paint some for your garden.

 

About the Author

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

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

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

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

 

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

 

To book an appointment with a NESCA clinician, please complete our Inquiry/Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

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SLP working with a student on a summer intensive program focused on speech

Seven Signs Your Child Would Benefit from a Summer Writing Intensive

By | NESCA Notes 2022, NESCA Notes 2025

SLP working with a student on a summer intensive program focused on speechBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Summer is often seen as a break from academics, but for many students, it’s also the most powerful window for growth. If writing has been a source of stress, avoidance, or frustration during the school year, a structured summer writing intensive program can make a meaningful difference before fall. Here are the most common signs that a student may benefit from targeted, language-based writing support.

  1. They Have Strong Ideas. . . But Difficulty Getting Them Onto Paper
    Your child may speak clearly and express complex ideas verbally, yet struggle to translate those thoughts into written form. Pages remain blank, sentences feel short or incomplete, and written work does not reflect their true ability.
  2. Writing Takes a Long Time
    Assignments that should take 20 minutes stretch into an hour or more. Slow writing can signal challenges with planning, organization, working memory, or executive functioning fatigue.
  3. Paragraphs Lack Structure
    You may notice missing topic sentences, disconnected details, weak transitions, or repetitive ideas. These patterns often reflect underlying language organization challenges rather than simple grammar issues.
  4. Writing Causes Emotional Stress
    Avoidance, frustration, or shutdown at the mention of writing or during the writing process are common signs. When writing feels overwhelming, students often lack internal planning systems to guide them.
  5. Teacher Feedback Highlights Organization or Elaboration Concerns
    Comments such as, “needs more detail,” “ideas are unclear,” or “work lacks organization” often indicate that both language development and executive functioning need targeted support.
  6. ADHD or Executive Functioning Challenges
    Writing requires planning, working memory, inhibition, flexibility, and self-monitoring. Students with executive functioning weaknesses often benefit from explicit writing routines that reduce cognitive load.
  7. Transitioning to a New School Level
    Rising 3rd, 6th, or 9th graders face increased writing demands. Strengthening foundational systems before expectations rise can dramatically improve confidence and performance.

Why Summer Is So Effective
Without academic pressure and competing demands, students can build writing fluency, strengthen organization systems, and increase independence in a focused and supportive environment. Application can be embedded in students’ areas of interest, for added motivation. The goal of a writing intensive is not simply to be able to create “better essays.” It is reduced anxiety, stronger thinking on paper, increased independence, and systems students can carry into the fall.

 

At NESCA, we offer intensive summer therapy that targets both verbal communication (such as listening comprehension, expressive language, and social communication) and written expression, an area where many students struggle. For more information on summer intensives and written language support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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 child working in an OT session on balance and movement; quote from Dot Lucci of NESCA

Coming to our Senses

By | NESCA Notes 2025

Image of child working in an OT session on balance and movement; quote from Dot Lucci of NESCABy Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

If you ask young children and adults to name their senses, they will typically name the five senses that are taught to all children in school – taste, smell, sight, hearing, and touch. Some of these senses “come on board” at birth while others continue to develop, refine, and mature into early adulthood. Then as we age, some of our senses may diminish – think eyesight and hearing, as well as fluidity of movement and balance. Most people wouldn’t think of fluidity of movement and balance as senses, but they are. These are considered part of our “hidden or internal senses,” and are connected to the three others. Who knew we had eight senses? Many adults don’t even know about these three other senses, yet they are very important to our functioning and are in use all the time. These three other hidden or internal senses are proprioception, vestibular, and interoception, each having a crucial role in our daily functioning in the world and with materials or objects.

Proprioception is often described as a sense of our body awareness in relation to the world around us. This system helps us integrate systems such as our musculoskeletal and central nervous systems. We get feedback from our muscles, ligaments, and joints so we know how to coordinate movements, sense where our body parts are in relation to our surroundings, and how to determine and apply the right amount of pressure or tension needed for certain tasks or movements. Proprioception is the secret ingredient that makes our motor skills intentional.

People with excellent proprioception are coordinated and may even be graceful. They rarely bump into things/people, don’t spill food on themselves, or misjudge how much pressure to use when touching someone else. They navigate their environment and materials well.

On the other hand, a person with poor proprioception may often bump into people, especially if the room/hallway is crowded. Or they may step on others’ toes while waiting in a line, stub their own toe, spill things on themselves, touch other people too hard or too lightly when playing tag, tear the paper when erasing, and so on. They may also experience difficulty with handwriting, using scissors, and doing other weight-bearing activities.

The vestibular system is located in the middle ear and is concerned with balance and gravitational awareness. I often use the term “sea legs” to describe this sense. If you are not familiar with “sea legs,” it is often used to describe a person’s ability to adjust their balance to a ship’s motion and not get seasick as well as the lingering sensation of movement or rocking when on land after disembarking a ship. It also is responsible for an awareness of gravity. Think of the astronauts who recently left the Artemis shuttle. They needed to be helped onto the “porch platform” and were then sat down as their bodies, having just been in space, had to adjust to the gravitational pull of the earth. This sense helps us to know if we are moving or stationary, how fast/slow we are moving, if we are standing still/speeding up, lying down, and more. Our vestibular system can be impacted by inner ear infections, head injuries, and other medical conditions. People with heightened vestibular systems may get dizzy often, suffer from car sickness, and dislike swinging, spinning, having their feet off the ground, or being upside down. On the flip side, some individuals have a hypo-responsive vestibular system. This can look like a constant hunger for movement. In this situation you may see someone excessively rocking back and forth, spinning for a long period of time without getting dizzy, happily swinging for hours, trying to reach the highest height, and have the constant need for high speed. People with “intact” vestibular system are seen as perfectly calibrated and can smoothly multitask balance, movement, and purposeful actions to move through the world with more ease.

Interoception is the third “hidden sense” and is related to what is happening inside our bodies – bringing our internal needs and awareness to our minds. This sense makes us aware of our internal organs, helping us to know when we are in pain, hungry, thirsty, or full, have to use the bathroom, are cold or hot, tired, ill, or have a fast heart rate. They can easily identify these sensations, whereas people with diminished awareness of their internal states have difficulty identifying feelings or sensations in their bodies. They may not notice when they are hungry, in pain, have to use the restroom, have a stomach or headache, are feeling their heart race, among other internal sensations. They may forget to drink or eat and get dehydrated or shake from low blood sugar, whereas people with heightened interoception may get “hangry” (hungry and angry) because they can’t tolerate hunger…and they recognize it. They may be overly sensitive to pain or temperature changes. Likewise, some foods are intolerable due to texture (smooth, chewy, etc.), and certain flavors (sweet, bitter, sour, etc.) may also not be tolerated. Therefore, they only eat bland foods.

People with impacted interoception “know they have a need or sensation,” but can’t identify it. This disrupts their quality of life as they may overeat or drink. People who are overly aware may become so anxious about these sensations that their anxiety may intensify until their need to handle the sensation is met.

Our senses and sensory profiles change with development, age, lifestyle, and health. Many of our senses work independently or behind the scenes, without our even thinking about them. However, if you try to walk on a balance beam versus just walking down the sidewalk, your balance may be challenged, requiring more conscious awareness. All of the senses work together to help us utilize, understand, and integrate sensory information to be in the world in a “functional way.” Many individuals with impacted sensory processing or integration systems may experience physical, mental, emotional, and social consequences as a result of an atypical sensory profile. Understanding one’s own sensory profile is important to living a full life. If warranted, an occupational and sensory evaluation may be necessary to help identify sensory-motor processing needs. This self-awareness and knowledge may help guide individuals to understand what they need, what they can and can’t do, what makes them comfortable, and what will help them better function and interact in the world. We are all sensory beings, and the better we are at knowing ourselves, the better we will be at advocating for ourselves.

If your child or teen can benefit from learning about their sensory system, complete NESCA’s online Inquiry/Intake Form for additional information or to book sessions with NESCA’s occupational therapists.

 

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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student writing in a notebook and quote by Olivia Rogers, SLP

Why Speech-Language Pathologists Are Uniquely Equipped to Support Written Language

By | NESCA Notes 2022, NESCA Notes 2025

student writing in a notebook and quote by Olivia Rogers, SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Written language refers to the system of communication that involves the use of written symbols to represent language, and it encompasses skills such as fluent word recognition, reading comprehension, written spelling, and written expression. It is one of the most complex academic skills students are asked to master. It requires vocabulary, grammar, organization, working memory, attention, reading skills, and the ability to translate ideas into structured sentences and paragraphs.

Because written expression sits at the intersection of language, literacy, and executive functioning, Speech-Language Pathologists (SLPs) are uniquely positioned to support it. At NESCA, speech language pathologists bring specialized training – including EmPOWER, Brain Frames, and The Orton-Gillingham Approach – that allows them to address writing and reading comprehension in a comprehensive, structured, and functional way.

Written Language Is… Language
Writing is not just handwriting or spelling. At its core, writing is language expressed on paper. Students must generate ideas and vocabulary, use grammar and sentence structure, organize thoughts into narratives or explanations, maintain cohesion across sentences, and consider audience and purpose.

Reading is not just decoding words on a page. True, reading happens when a child understands, connects, and makes meaning from what they read. Comprehension – linking new information to background knowledge, vocabulary, and language skills – is what transforms word calling into real literacy.

These are core areas of SLP expertise. SLPs are trained to analyze how language breaks down,  whether at the word, sentence, or discourse level, and to teach skills explicitly and systematically.

The Executive Function Connection
As discussed in last week’s blog, writing and reading are executive functioning tasks. When writing, students must plan what to say, hold ideas in working memory, organize information, initiate writing, and revise and edit. When reading, students exercise their working memory, inhibition, and metacognitive skills.

NESCA SLPs use the EmPOWER and Brain Frames approaches to make these invisible thinking processes visible. EmPOWER supports students in navigating “how” to bring the writing process from start to finish. Brain Frames provide visual scaffolds that help students map ideas before writing, organize paragraphs, and understand the structure of different text types.

Structured Literacy Strengthens Writing
Strong writing depends on strong reading and spelling skills. NESCA SLPs, trained in Orton-Gillingham, also bring a structured literacy lens to written language intervention through explicit teaching of phonology, morphology, and spelling patterns – all while integrating reading and writing instruction systematically.

SLPs Bridge Ideas and Expression
Many students know what they want to say but cannot translate it into written form. SLPs help students expand sentences, develop narrative and expository structure, use academic vocabulary, improve cohesion and clarity, verbalize ideas before writing, and revise language for precision.  Because SLPs focus on communication, written language therapy is functional and meaningful. Intervention often targets classroom assignments, essays and projects, note-taking, digital communication, and self-advocacy writing so that strategies learned transfer directly to school demands. SLPs brings a functional, real-world approach to written language.

Speech-Language Pathologists are not an alternative option for written language support; they are a natural fit. With explicit strategy instruction, visual scaffolding, and structured literacy methods, SLPs help students move from uncertainty to confident, organized expression. When writing is approached through language, thinking, and literacy together, students gain tools that extend far beyond the page.

The NESCA Difference
NESCA SLPs combine deep knowledge of language development with specialized training in executive functioning and structured literacy. Our intervention addresses how students think, understand language, read and spell, and express ideas in writing.

 

At NESCA, we use evidence-based strategy to target written language. Our clinicians use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom!  For more information on written language support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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 feedback session with a parent and neuropsychologist along with a quote from Dr. Rodriguez

Beyond a Label: The Value of Neuropsychological Evaluation Even When There’s No Clear Diagnosis

By | NESCA Notes 2024

Image of a feedback session with a parent and neuropsychologist along with a quote from Dr. RodriguezBy: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Why Diagnosis Matters

Most parents seek out a neuropsychological evaluation because they’re looking for answers. Often, someone in the child’s life—whether a parent, teacher, or caregiver—has noticed something that doesn’t quite add up. Pursuing testing is a wise and proactive step toward understanding the root of a child’s challenges. In many cases, families hope to find a diagnosis that explains what’s going on. To borrow a phrase from psychiatrist and author Dan Siegel, “You have to name it to tame it.” Having a name for a child’s difficulties is often the first step toward effective support and intervention. Many parents describe feeling validated and relieved when a professional can identify and explain what their child is experiencing. Knowing there is an understandable reason behind their child’s struggles can be both reassuring and empowering.

Why A Clear Diagnosis Isn’t Always Possible

Despite everyone’s best efforts, sometimes a child’s challenges don’t fit neatly into a single diagnostic label. There are several reasons for this:

  • Human complexity: Diagnoses can be helpful frameworks, but they don’t always capture the full picture. Children are wonderfully complex, and their unique mix of strengths and challenges often doesn’t align perfectly with one specific category.
  • Overlap between conditions: Diagnoses are often presented as distinct “boxes,” but in real life, there is a lot of overlap between conditions. It’s often more accurate to picture diagnoses as overlapping circles in a Venn diagram, with many children’s experiences falling in the spaces where these circles intersect. It’s not always possible—or even helpful—to fully separate features into distinct diagnoses.
  • Gradual emergence of symptoms: Some conditions develop slowly and may not be fully recognizable until later in life. For example, mild Autism Spectrum Disorder can be subtle and hard to identify, especially in gender-conforming girls and women. Social challenges may not be obvious in early childhood but can become clearer as social demands increase in adolescence, delaying a clear diagnosis.
  • Lack of formal diagnostic labels: There are profiles commonly seen in clinical settings that don’t yet have formal diagnostic labels. For instance, significant executive functioning weaknesses can greatly impact daily life and academics, but there is no official diagnosis for this. Similarly, while we may use the term “Non-Verbal Learning Disorder” to describe certain patterns of difficulty with visual-spatial skills, organization, social cues, or motor abilities, this label isn’t formally recognized in current diagnostic systems.

What To Do Next

Receiving an evaluation without a clear diagnosis can be disappointing and even anxiety-provoking for parents; however, a neuropsychological assessment still offers significant value. The true strength of a thorough evaluation lies in its ability to provide a detailed understanding of your child’s unique strengths and challenges, and to clearly outline the supports and interventions that will be most helpful. Even among children who share a diagnosis, there can be important differences in how their difficulties present. A high-quality assessment goes beyond simply assigning a label; rather, it paints a comprehensive picture of your child as an individual. Ultimately, the most effective recommendations are those tailored specifically to your child’s needs, regardless of whether they meet criteria for a particular diagnosis.

If you find yourself in this situation, allow yourself space for your feelings. It’s natural to crave clear answers, and it can be difficult to live with uncertainty. Yet, there are concrete steps you can take:

  • Recognize challenges independently of diagnosis: Throughout history, people have faced real and significant difficulties long before science could provide official explanations. For example, prior to advanced imaging, vision problems caused by multiple sclerosis were often mislabeled as “hysterical blindness” until CT scans revealed nervous system lesions. Similarly, before HIV was identified as the cause of AIDS, individuals suffered and died from the illness without a clear diagnosis. Sometimes, it takes time for science to catch up. In the same way, your child’s needs are real and valid, regardless of whether a formal diagnosis has been made.
  • Advocate for your unique child: Similarly, focus on addressing their specific areas of need, rather than waiting for a label.
  • Seek appropriate support services: There’s no need to wait for a formal diagnosis to pursue executive function coaching, psychotherapy, occupational or speech therapy, or specialized academic support. In some cases, early intervention may even help prevent a difficulty from becoming a full-blown diagnosis.
  • Try to be patient and stay open to change:  Remember that your child is still developing in very significant ways. Consider re-evaluation in a few years, as more information may become clear over time.

Remember, your child is more than a label. The insights from a neuropsychological evaluation can guide you in supporting their growth and well-being, even when there isn’t a specific diagnostic term to describe their unique profile. If you have questions or want to discuss whether a neuropsychological evaluation might be helpful, our team is here to support you.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY, 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 yarns intertwined representing EF and language skills being intertwined and a quote from Olivia Rogers, SLP at NESCA

Executive Functioning & Language: Intertwined and Recursive Systems of Learning

By | NESCA Notes 2022, NESCA Notes 2025

image of yarns intertwined representing EF and language skills being intertwined and a quote from Olivia Rogers, SLP at NESCA

By Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

When we think about learning, we often separate skills into categories – language, executive functioning, literacy, academics, just to name some. But in real life, these systems don’t operate independently. They are deeply intertwined and recursive, meaning they continuously influence, shape, and strengthen one another over time.

What Is Executive Functioning?
Executive functioning refers to the brain’s management system. These skills help students plan and organize ideas, initiate tasks, hold information in working memory, monitor understanding, shift between strategies, and manage time and attention.

What Is Language?
Language includes understanding directions, expressing ideas clearly orally and in writing, narrative organization, comprehension of complex oral and written information, academic language use, and internal self-talk.

How Executive Functioning Depends on Language
Students rely on language to talk themselves through steps, plan written responses, explain reasoning, organize narratives, monitor comprehension, and use strategies independently.

How Language Depends on Executive Functioning
Producing and understanding language requires holding ideas in working memory, sequencing information, shifting between topics, inhibiting irrelevant details, revising messages, and planning written expression.

The Recursive Relationship image showing the recursive nature of EF and language skills
Growth in one area supports growth in the other. Stronger language supports clearer thinking, and better executive skills support more organized language.

The Big Picture
Integrated support helps students explain their thinking, plan before speaking or writing, use language as a strategy, monitor understanding, and become more independent learners. Executive functioning and language are overlapping systems that continuously shape each other. Supporting both together makes learning more accessible, meaningful, and transferable.

At NESCA, we view communication holistically. Our speech language pathologists use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom! For more information on Speech and Language Therapy at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

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 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 2025

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 someone who could head in multiple directions; quote from Dr. Jessica Greene about where to start with recommendations from neuropsychological evaluations

What to Do with All the Recommendations?

By | NESCA Notes 2025

Image of someone who could head in multiple directions; quote from Dr. Jessica Greene about where to start with recommendations from neuropsychological evaluationsBy: Jessica Greene, Psy.D.
Postdoctoral Fellow, NESCA

Your child’s neuropsychological evaluation is complete, and your family now has a greater understanding of your child – and a long list of recommendations. After you review the list, it can feel as though every recommendation is the most important one. How do you know where to start? The steps outlined below are general guidance; your team may recommend a different timeline based on your child’s needs.

Prioritize

Recommendations are meant to provide a roadmap for the next two to three years. Step back and ask yourself, “What is most important for my child and for my family right now?” Choose one to two recommendations that make the most sense and gradually find ways to work them into your routine. Making intentional changes, at a reasonable pace, gives everyone time to adjust. Also, it is much easier to tell whether a strategy, intervention, or service is helping when you try one thing at a time.

Reflect

After you have tried the chosen recommendations for a reasonable amount of time, take a moment to consider your child’s progress. Day-to-day life can make growth easy to overlook, particularly when there are still other pressing needs. But, before returning to your list of recommendations, consider the changes that have occurred. Growth is not always linear, so perhaps your child has made growth in one area, but something new has presented itself. On the other hand, perhaps things have moved forward for the better and there is time to focus on recommendations that were less pressing.

Review

When ready, return to recommendations and consider what to implement next. Again, choose one or two items, so as not to overwhelm yourself or the family system.

Set Boundaries with Others (if needed)

Caregivers often tell me they feel flooded with opinions from everyone they know. While outside input can be helpful at times, it’s also okay to set boundaries. You might simply thank people for their advice and say you have a plan you intend to follow. That response acknowledges their concern without letting you get derailed.

Need Help Choosing a Next Step?

If you are unsure where to start or what to focus on next, reach out to a trusted provider that understands your child’s needs. That may be the NESCA neuropsychologist who completed the evaluation, an outside provider (occupational therapist, counselor, speech-language pathologist), your pediatrician, or a school contact (special education teacher or school counselor). They can help you plan next steps.

If you’d like more details about next steps and who to share the report with, see Dr. Maggie Rodriguez’s post, which outlines practical actions to take after a neuropsychological evaluation. Read her full article here: https://nesca-newton.com/navigating-life-after-a-neuropsychological-evaluation-what-comes-next/.

 

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 road sign with College ahead on it portraying the topic of the blog about college planning with ADHD

College Planning for Families of Students with ADHD

By | NESCA Notes 2025

Image of a road sign with College ahead on it portraying the topic of the blog about college planning with ADHDBy: Julie Weieneth, Ph.D.
Pediatric Neuropsychologist, NESCA

The transition from high school to college brings stress for most families. As a parent of a high school junior, I am currently helping my teen juggle schoolwork, extracurriculars, and all the “must-do’s” for college planning. At times, it feels very overwhelming for me, so I can only imagine how it feels for my daughter. As a neuropsychologist, I often reflect on how neurodiversity, especially ADHD, shapes this journey.

Over the years, I have worked with many bright students with ADHD who have successfully navigated the college planning process. These teens bring unique strengths to the table. When families are able to recognize these strengths, support ongoing areas of need, and seek professional guidance as needed, college planning can become a process of growth for both teens and their parents.

ADHD Strengths in College Planning

  • Creativity and Problem-Solving: Many students with ADHD naturally think outside the box. They approach challenges from fresh angles, which can help them identify colleges, majors, or support services that might otherwise be overlooked. Their creative solutions can make the search process more dynamic and tailored to their needs.
  • Energy and Enthusiasm: Students with ADHD often bring a high level of energy and excitement to new experiences. This enthusiasm motivates them to explore a wide range of colleges, participate in campus tours, and engage with student groups. Their passion can help them stand out in interviews and application essays.
  • Hyperfocus on Interests: While ADHD is often associated with distractibility, many students experience periods of intense focus, especially on topics that truly interest them. This hyperfocus can be a tremendous advantage when researching colleges, preparing application materials, or delving into extracurricular opportunities that align with their passions.
  • Resilience and Adaptability: Navigating the ups and downs of ADHD often builds resilience. Many students learn to adapt quickly, bounce back from setbacks, and persist in the face of challenges. These qualities are invaluable during the college search and application process, which can involve rejection, waitlists, or unexpected changes.

How Parents Can Help

Parents play a key role in supporting their teens’ transition to college. Here are some practical steps:

  • Foster Self-Advocacy: Encourage your teen to understand their needs and practice asking for help. Role-play conversations about accommodations and celebrate their efforts.
  • Find the Right Fit: Focus on colleges that match your teen’s needs, not just prestige. Visit campuses, meet with disability services, and consider factors like class size and available supports.
  • Secure Accommodations: Keep neuropsychological testing up to date, as colleges require documentation. Encourage early use of academic supports and check in regularly.
  • Build Executive Function Skills: Practice time management and organization before college. Gradually let your teen take the lead and consider executive function coaching if needed.
  • Plan for Medication and Health: Help your teen set up prescription management and health routines. Practice independence with gentle reminders.
  • Support Social and Emotional Well-being: Encourage involvement in clubs and normalize seeking help from campus resources. Keep long-term supports in place, and encourage booster sessions with therapists, executive function and real-life skills coaches, tutors, during breaks or through virtual sessions as needed.

Also, it is important to remember to care for yourself! This transition is significant for parents, too. Seek support for yourself as needed.

At NESCA, in addition to neuropsychological evaluations, we offer consultations and executive function and real-life skills coaching. Please feel free to reach out to us if we can help you and your child navigate this process.

 

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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