NESCA

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Neuropsychologist observing the behavior of a child being evaluated

The Importance of Behavioral Observations in Neuropsychological Evaluations

By | NESCA Notes 2024 | No Comments

By: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Neuropsychological evaluations integrate information collected from multiple sources: (1) history and presenting concerns obtained during clinical interviews with a parent/guardian and the patient, (2) information from a review of records (e.g., past testing reports, school plans, such as IEPs or 504 plans, medical documentation), and (3) neuropsychological and psychological test findings. While these sources of information are important components of an evaluation, behavioral observations are essential to truly understanding a child’s strengths and weaknesses.

Behavioral observations are the qualitative observations made by a clinician that help to understand the child’s unique set of strengths and weaknesses. This includes overall impressions of the child throughout the evaluation process, such as their cooperation level and general attentiveness, their mood/affect and interpersonal skills, any nuances noted in their expressive or receptive language skills, and their fine motor abilities. This provides a “big picture” context to help the interpretation of more specific test findings. For example, if a child appears depressed and, as a result, thinks and completes tasks slowly, this can provide context for test scores which indicate processing speed deficits. In addition, these “big picture” behavioral observations can highlight the daily life impact that results from a weakness. For example, a child may be observed having difficulty opening a food container during a snack break which relates to the fine motor weaknesses seen during direct testing. Lastly, observations during unstructured times (e.g., waiting room behavior, separation from parents, social chit chat in between tasks) can often contribute invaluable information that would otherwise not be elicited from structured standardized testing.

Behavioral observation during testing tasks is necessary to look for any factors that may help elucidate the specific strengths or challenges a child may be experiencing. For example, a child may receive a Low Average score on a “Block Design” task in which they are asked to use blocks to recreate a visual-spatial design within a time limit. However, this Low Average performance could occur for many reasons. First, it could be due to a child having a hard time perceiving the correct angles and shapes within the design, suggesting a visual-spatial deficit. Second, a child may answer all items correctly but had done so after the time limit, suggesting a processing speed weakness. Third, a child may make an error as they rush through each item, suggesting difficulties with attention to detail or impulsivity.

Behavioral observations allow the clinician to identify a child’s unique profile of strengths and weaknesses to a greater specificity, which, in turn, allows for more tailored treatment recommendations. For example, knowing a child has a fine motor weakness that results in difficulty opening food containers could suggest a more specific and targeted treatment goal for a school-based intervention plan or private occupational therapy than simply knowing the child scored below age expectations on a fine motor task. In addition, three children who performed similarly on a block design task would require very different treatment approaches (e.g., visual-spatial accommodations, extended time, attention/impulsivity accommodations). As such, good behavioral observations are the key to a comprehensive evaluation that can provide the most tailored treatment recommendations.

About the Author

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

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and 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.

6

Pediatric Neuropsychologist Rebecca Dautoff, Psy.D., Joins NESCA

By | NESCA Notes 2024

By: Jane Hauser
Director of Marketing & Outreach, NESCA

You adapt your approach with neuropsychological evaluations for each individual based on their developmental stage. Tell us about that.

With younger kids, it’s a much more interactive experience. Their attention spans are shorter, so they often need a warmer environment that feels less intimidating. Sometimes it’s getting on the ground and playing with them, other times it is starting testing under a table until the individual feels confident enough to sit at a table. I try to make it feel like a collaborative process.

It ultimately comes down to how you connect with someone. I connect very differently with a four-year-old than I do with a 14-year-old or a 20-year-old.

How do you get older adolescents, who may not be eager to be evaluated, to buy-in on engaging in evaluations?

This can be tricky. Usually, we can find a reason that they are comfortable sharing about why they are being evaluated, and I use that to explain what an evaluation can do to help them with that reason or issue. I try to understand what they want to get out of an evaluation and what it will help clear up for them.

Sometimes parents and adolescents are not aligned. Maybe a parent wants their child evaluated because they think that they have ADHD. The individual being evaluated may agree that they are neurodivergent, but may feel like their symptoms align better with Autism than ADHD. We can work with whatever that individual is feeling, even if it’s different from their parents’ concerns. We take the information and feelings from both the parents and adolescents – as well as input from educators and professional providers – and combine that history with the testing data, our observations during the evaluation, and synthesize it all to identify a diagnosis (when applicable). Then we develop highly personalized recommendations for interventions and hope to partner with the family along the way to support both parents and the adolescent.

You conduct neuropsychological evaluations and also projective testing here at NESCA. What is your approach to projective, or psychological testing?

If you’re questioning major psychiatric diagnoses that often feel very scary and are hard to talk about, projective testing can be very useful. It gives us a way to look at someone’s inner world or emotions, especially when they’re unwilling or unable to talk about it directly.

Describe the most challenging but rewarding individuals you’ve evaluated.

I enjoy working with the kids who think differently from their parents. It can be really rewarding to validate their feelings, explain their concerns to their parents and do some psychoeducation for their parents to get the adolescent or young adult and the parents back on the same page. Getting members of a family to understand each other’s perspectives is a really rewarding experience.

I also enjoy working with families who have gone through some kind of really hard experience, perhaps for a long time – whether that’s a traumatic experience or an adoption. And again, the part that I like so much is the feeling of bringing people back together and giving them some hope for the future.

Finally, I like incredibly complicated cases where there isn’t a clear answer – the ones where it’s a bit of a struggle to figure out or, in some instances, you work with a family as part of a longer-term partnership to gradually see a path forward. It’s not always clear-cut. When you can’t immediately clarify all of the pieces, you need to find a path forward for the family to start out on, revisit that path and potentially change or enhance that path. I like knowing that I can be part of someone’s team for the long term, like I’m joining the family and other providers, who are all working for that child. I’m talking about the ones that aren’t one-offs, rather the ones where we can build lasting relationships on behalf of a child.

You’ve worked in private and public schools and at a clinical treatment center. What brought you to NESCA, and how do you feel your past experiences impact your work with NESCA families?

Having lots of different experiences at different places and settings makes it easier for me to connect with a huge variety of people. I’m very rarely uncomfortable or fazed by the families or individuals I work with, their comments, or experiences, because I feel like I’ve heard so much from so many different people throughout my career.

I enjoy working with adolescents and young adults. Since they spend so much time in school, it has been beneficial for me as a clinician to have spent years working in the school setting. You have that perspective on schools – where they spend more waking hours than even at home. I have a good understanding of how schools work and the social dynamics for adolescents in schools. That has been especially useful in my work as a neuropsychologist.

What brought you to NESCA and why?

In my last position, I was in a mostly administrative role, doing a lot of supervision and teaching, which I really liked, but I missed the clinical work.

I was also looking for more exposure to different ways of doing things.

Since NESCA’s Founder and Director Dr. Ann Helmus is such a phenomenal clinician and is so well-known and respected, it felt like a great opportunity to learn from her. I had also trained as an intern with Dr. Miranda Milana, who is in NESCA’s Plainville office, and she talked a lot about the culture, the people, and how great everyone was. She was right! It’s a very supportive environment.

What I’ve found in the several months that I’ve been with NESCA is that the people are very smart here. I remember coming to one of NESCA’s weekly Case Conferences before I had agreed to join and thinking, “Wow, these people certainly know what they’re doing!” I learned something new in that Case Conference that I hadn’t thought about before, even though I had been practicing for years. I thought that was really powerful. NESCA is a group of professionals who truly love what they do and are so passionate about it. It is impressive to see so many people who have different perspectives and experiences come together to be so skilled at what we do. To be quite frank, I have learned a ton since being here and it hasn’t even been that long!

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents, Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

If you are interested in booking an appointment for an evaluation with Dr. Dautoff or another NESCA neuropsychologist/clinician, please fill out and submit our 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.

11

Perfectly sharpened pencil showing perfectionism

When Perfectionism Is Making Things Imperfect

By | NESCA Notes 2024

Perfectly sharpened pencil showing perfectionism By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

Perfectionism is a personality trait characterized by setting unrealistically high standards for oneself and striving for flawlessness. It often includes having idealized goals that are unrealistically ambitious. Many factors contribute to the development of perfectionism. Living in a culture that values achievement, especially in academics, sports, or arts, and messaging on social media that amplifies idealized standards have contributed to increased anxiety and perfectionism in vulnerable individuals. While striving for excellence can be a positive motivator, perfectionism often leads to negative consequences such as fear of failure, procrastination, and an inability to cope with setbacks.

Perfectionism in children and adolescents can develop due to a combination of genetic, environmental, and psychological factors. Parents with high expectations may unintentionally display criticism and signal that love and approval are conditional on success. Or they become overly involved, shielding their child from failure, discomfort, or risk, even when age-appropriate, and intervening in conflicts, homework, or responsibilities that the child could reasonably handle themselves. Peer comparison, amplified by social media, may also contribute to perfectionism, causing children to feel they must meet unrealistic standards to fit in. Moreover, some children may have a natural predisposition toward conscientiousness, making them more vulnerable to developing perfectionism. They may also have a heightened sensitivity to failure or a strong desire for structure and predictability, leading to perfectionistic tendencies.

While perfectionism can foster determination, high standards, and resiliency, it becomes problematic when the young person experiences adverse effects, such as an unusually intense fear of making mistakes, leading to procrastination or over-checking, rigid thinking, and an overwhelming desire for control, predictability, and the avoidance of uncertainty. The individual may over-commit to activities or struggle with feelings of inadequacy despite their achievements. Perfectionism and anxiety are closely linked, as the drive to achieve flawlessness or meet impossibly high standards is often fueled by fear and worry. Additionally, perfectionism is associated with an increased risk of obsessive-compulsive disorder, depression, and stress.

Intervening to address perfectionism in children is crucial when it begins to negatively impact their well-being, hindering rather than supporting their growth and development. Look for signs such as excessive self-criticism, procrastination stemming from fear of failure, rigid adherence to rules, an inability to tolerate mistakes or overwhelming anxiety related to performance. Intervention should focus on fostering a growth mindset, emphasizing effort and progress over outcome. Encourage self-compassion by helping the child understand that mistakes are inevitable and valuable learning opportunities. Collaborate with them to set realistic and flexible goals, breaking down large tasks into smaller, manageable steps. Parents and educators play a vital role in creating supportive environments that value learning and resilience, praising effort and persistence rather than solely focusing on achievement. If perfectionism significantly impacts the child’s daily life or mental health, a thorough evaluation and professional guidance from a therapist or counselor is recommended. Early intervention and a supportive, understanding approach can empower children to navigate challenges, embrace imperfections, and develop a healthier relationship with achievement.

About the Author

Dr. Cynthia (Cindy) Hess conducts neuropsychological evaluations as a pediatric neuropsychologist at NESCA. Dr. Hess enjoys working with children and young adults with complex emotional and behavioral profiles. She is skilled at evaluating social and emotional challenges as well as a range of learning profiles. Her experience allows her to guide families in understanding the supports and services their child requires to be successful in school.

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, 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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NESCA Adds Pediatric Neuropsychologist Leah Weinberg, Ph.D. to its Team

By | NESCA Notes 2024

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is pleased to welcome Dr. Leah Weinberg to its team of expert neuropsychologists. Learn more about her professional experiences and what she hopes to bring to NESCA and the families it serves.

Tell us about your career path and what made you get into neuropsychology.

My path to neuropsychology was not a direct one. My initial field of interest was in school psychology, a discipline that focuses on the mental health, behavioral, and academic needs of students within the school setting. The program I went to at Fordham University had a focus on testing, but also offered very strong consultation and counseling components. That’s how I got into psychology, broadly speaking. I did my internship at and worked as a school psychologist in a large private school for different age groups. During that time, I worked in early childhood, elementary, and in high school grades. As a school psychologist, I engaged in psychoeducational assessment, provided direct therapeutic support to students, and collaborated closely with educators, parents, and administrators to promote positive student outcomes.

And as a side job during and after graduate school, I dipped my toes into some teaching – assistant teaching, regular classroom instruction, some special education settings, and school counseling, primarily with middle to high schoolers. From there, I got into neuropsychology, which brought together my love of testing and helping children/students – and by extension, their families – by helping to figure out what is going on and how to direct them to the appropriate intervention(s).

I was a post-doctoral fellow at a group practice in the greater Boston area and stayed with them as a pediatric neuropsychologist for a total of 10 years.

What are your areas of expertise in evaluating students?

As far as ages go, I like to work with individuals from age six through the college years or into young adulthood. Regarding the profiles of students I evaluate, I have experience in a little bit of everything, but largely focus on children with executive function and attention deficits. I also evaluate for learning disabilities, including reading, math, and writing challenges, nonverbal learning disability, as well as children with concerns of various types of anxiety, depression, or mood issues. I also see a lot of children with emotional regulation issues, presenting as emotional outbursts, behavioral outbursts, meltdowns, or ADHD-type symptoms.

It’s really interesting to me to determine the cause of the various forms of regulation challenges. It may stem from being born prematurely or could also be related to a disorder or disability. The behaviors that children with regulation challenges exhibit may look similar from one child to another, but no two children are the same. The root cause is unique within each child or individual.

I really enjoy working with these kids and helping their parents or caregivers understand what’s going on with them. It’s often mind-blowing to see their parents or caregivers finally understand that there is a reason behind the difficult behaviors and that they have a chance to support them. You can watch them start to connect the dots or see things start to make more sense to them. It’s like pulling the veil off of something that looks and feels very complex, but through evaluation, we are giving them a path to go down to support the child and mitigate the challenges. This is why I love my job. I can provide clarity to parents and other providers. And with that clarity, we can empower them to seek appropriate and tailored care and support for their child.

What were you looking for in choosing to join the NESCA team?

I was hoping for a more supportive and collaborative environment and with a strong peer group. I wanted to be in a setting surrounded by colleagues who love their jobs as much as I do and who can work well together and independently.

I am hoping to nurture the relationships I have with the families I work with and also with my colleagues. From what I’ve experienced, NESCA is a supportive environment that will assist me in doing my job through its collaborative, enriching peer group, and that benefits the families we serve and strengthens our skills as neuropsychologists. I love learning from the different perspectives, experiences, and insights into schools, providers, and interventions we recommend.

What do you tell parents or caregivers who are hesitant to have their child evaluated?

Often, parents are setting out trying to find answers for their child’s struggles, maybe for the first time. Very frequently, they are unsure of the process and what it all means. They are worried about their child getting a label, what the implications of having a label will be and for how long their child will carry this. They are scared of what they don’t know. Those who have been seeking answers for quite some time may be skeptical that a neuropsychological evaluation won’t deliver the answers they are desperate for.

Parents and caregivers exploring whether to get a neuropsychological evaluation carry a lot of fear, and rightfully so. In my role, I try to put myself in their shoes. They feel as if they are putting their child under a microscope and are unsure and afraid of what we will find. I keep their journey or experiences, which are often frustrating and tumultuous, in mind and educate them about the different ways in which a neuropsychological evaluation can be beneficial. For example, beyond assisting the family in understanding their child’s strengths and weaknesses in a thorough fashion, a diagnostic label may just be the key to giving their child (and them) some relief from their struggles. With a diagnostic label, they may finally access the services needed to help their child realize their full potential as a student, friend, or community member. Our goal is always to make things better for the child.

What have you been seeing in children, teens, and young adults since Covid hit?

I am seeing more emotionally driven scenarios, stemming from the increase in anxiety. I am also seeing kids with more of a mood component to their profiles. In addition, we are seeing an increase in learning disabilities alongside that mood piece. In many cases, it is more difficult to distinguish what exactly is the root cause of the challenges, whether each issue they have exists independently of or is part of another disorder, or which of the issues they are experiencing is at the forefront of the challenges. We also are seeing younger students taking much more time to learn to develop their academic skills, such as reading. Since Covid, there have been more cases involving questions about gender identity

We are also seeing a large population of students who are struggling with those important developmental and educational transitions, such as with the jump from elementary school to middle school and middle school to high school. The time that should have been dedicated to preparing students for these types of milestones was wildly disrupted. These students were left struggling to navigate so much on their own – things like how to work with multiple teachers, how to get around in a new environment and with a different schedule than they were used to. Their transitional preparation was essentially bypassed and children were required to carry out their education in developmentally unsuitable ways that they were not prepared for.

Finally, schools scaled down the level of work so much during Covid, which made it more challenging for the students when they came back to school. Since being back in the school setting, their demands were raised back up. It’s been difficult for students and families to rebound, especially if there is some kind of identified need or challenge with the student. We’re still very much dealing with the ramifications of these shifts.

About the Author

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

If you are interested in booking an appointment for an evaluation with Dr. Weinberg or another NESCA neuropsychologist/clinician, please fill out and submit our 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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Introducing Pediatric Neuropsychologist Sean Hyde O’Brien, Psy.D., ABPdN

By | NESCA Notes 2024

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to welcome Sean Hyde O’Brien, Psy.D., ABPdN, to our team, conducting evaluations in the Newton, Massachusetts office! My interview with Dr. O’Brien offers an opportunity for readers to get to know him, his professional background, experiences and expertise, and his approach to working with children, adolescents, and young adults as a pediatric neuropsychologist.

You covered a broad swath of academic, emotional, and developmental challenges in your career as a pediatric neuropsychologist. Tell us more about that.

I think I’m a good generalist as far as pediatric neuropsychology goes, covering a lot of the high-incidence disorders, like ADHD, autism spectrum disorder, and learning disorders, but there are a couple groups that I really like working with.

What are the groups of children or students you find the most interesting?

I really like kids that are on the high functioning end of the autism spectrum, so I did one of my post-doctoral years at McLean at the Center for Neurointegrative Services, which is a DOE-approved special education school for kids who used to have what was called Asperger’s Disorder, which is now part of the ASD diagnosis. I got to spend a lot of time honing my assessment skills, but also spending quality time getting to know this group of students. They have a special place in my heart.

Another area I enjoy is working with children who came from other countries and may have moved because of war, famine, or simply for better opportunities for their families. They often come to this new country, perhaps not with the best English skills, and a lot of complex developmental and psychiatric challenges. Teasing all of those components apart and helping them acclimate to a new school, culture, and world has been interesting to me.

It takes a lot of thinking on your feet from an assessment standpoint to work with this population. For example, when you evaluate a child who speaks Russian and has only been learning English for six months, you’re not going to be able to do your standard battery of tests to figure out what their cognitive functioning is like. You have to think creatively and find ways to work slightly outside the domain of standard evaluation procedures. I’ve learned so much being with them, watching, and observing them in different settings, and, of course, getting the information from multiple sources, like teachers and parents. Those kids along with those who come from other countries through adoption are the most challenging, but also probably the most rewarding to me.

My wife and I were both adopted, so I come from a family of people who know and are part of the adoption community. I did a lot of research and clinical work involving international adoption. I love working with children who are coming from China, India, Korea, or domestically and their adoptive parents who are trying to figure out how to best support them with the range of strengths and weaknesses that they might have. These are also some of the kids who stick out to me.

Why did you come to NESCA?

I was looking for a change. I’ve been a partner in a private practice that we built from scratch for about 15 years, handling all of the many aspects of running a small business and evaluating students. I felt that the operational and clinical duties became too time-consuming to have a healthy work-life balance. I decided that it was time for a recalibration that would allow me to continue to evaluate children, but not have to stress over all of the other time-consuming operational details.

Throughout my career, I’ve had many NESCA reports come across my desk. They were very well done, and the practice has an incredible reputation. I met with NESCA’s founder and I knew it was the right place. She values the same things that I value – collegiality, warmth, and child-centric care. I was looking for a place where I could do good work and do it in a way that feels good at the end of the day. I found that in NESCA.

What do you feel you can contribute to NESCA families and staff?

The feedback I received over the years is that my ability to connect with children makes me an ally to them, especially those who may be a little resistant to the process. Some kids come in and are scared or angry that they have to be there for an evaluation. I always find a way to let them know this is in their best interest. I will explain what an evaluation will do for them in the end and that I want to work with them to figure out their “operating system” to make life work better for them. Families feel that I’m warm, approachable, and just a nice guy. I make sure that the individuals I evaluate don’t see me as Dr. O’Brien – I’m just Sean, and I’m a “learning detective,” of sorts, who helps figure out what’s going on with them.

I’ve had a number of students who I’ve seen three or so times over the course of the past 15 years. They may have come to me as a struggling six- or seven-year-old and are now in college. It’s the long-term relationships and knowing that the work I did, or that we did together, changed their developmental trajectory and helped them start to feel better about themselves as a learner and/or a person. That’s the piece that keeps me loving the work that I do and feeling young, fresh, and energized. I couldn’t ask for a better job.

What are your thoughts on the field of neuropsychology overall?

We’re a field that is a mixture of art and science. We are students of the brain; not experts, and we are all still learning about how the brain works. That is continuously being questioned, refuted, and remodeled. Since I first started studying neuroanatomy, we have come so far and yet we still know so little.

We can’t become rigid or complacent in the evaluation of children, adolescents, or adults, because that will be the biggest disservice we can give to our clients. We have to always be learning and evolving. Using antiquated models, not being open to new tests or new ways of thinking about things will not help anyone. I have the feeling I will learn a lot of new, creative, proven approaches while I am at NESCA, and that is very exciting to me.

I don’t think you get that kind of ongoing learning and exposure to innovative ways of doing things in many places. Often, neuropsychologists have to go outside of their practices to get that kind of knowledge from colleagues. Having that built in here at NESCA is something I am excited about.

About the Author

Dr. Sean Hyde O’Brien has been providing comprehensive neuropsychological evaluations in the Greater Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To book a consultation with Dr. O’Brien 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.

50

Someone moving freely, symbolizing transition

Five Good Reasons to Choose NESCA for Transition Assessment and Services

By | NESCA Notes 2024

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

Expert Clinicians with Specialized Training
Our team of transition specialists brings decades of experience supporting teens and young adults with a wide range of needs, from mild to complex. As Director of Transition Services, I have closely trained and supervised each of our specialists. Together, we have multidisciplinary expertise spanning guidance counseling, school psychology, special education, occupational therapy, and vocational rehabilitation counseling. This breadth of knowledge allows us to deeply understand each student’s needs as they relate to postsecondary living, learning, training, and working. Additionally, our team collaborates with NESCA’s neuropsychologists and other expert clinicians, ensuring every assessment is thorough, individualized, and aligned with best practices.
Comprehensive, Individualized Approach
We believe transition planning should be as unique as each student we serve. Assessment at NESCA always begins with a thorough intake and record review to build a complete picture of the student’s known abilities and areas of need—and an understanding of what must be uncovered through the evaluation process. We combine formal and informal tools, functional evaluations, and input from students, families, schools, and other providers. We also offer situational assessments in school, home, and community environments. This comprehensive approach ensures we uncover meaningful goals and develop actionable strategies to support postsecondary success.
Clear, Comprehensive Recommendations
Transition assessments lay the foundation for effective transition planning and IEP services. NESCA’s evaluations clearly identify measurable postsecondary goals in the required areas of living, learning and/or training, and employment. We take the time to uncover students’ strengths, preferences, and interests while providing tailored recommendations for the instruction, services, community experiences, and progress monitoring needed to progress toward their goals. Our expertise extends to essential areas, such as planning for age of majority, course of study, and graduation timelines, and we always fully adhere to special education guidelines as independent evaluators.
A Culture of Collaboration and Support
Collaboration is at the heart of NESCA’s approach. Our clinicians meet regularly to share insights and strategies, ensuring every evaluation reflects our collective expertise. We also maintain strong connections with schools, agencies, and community resources, providing families with actionable plans and ongoing guidance. Transition planning requires teamwork, and we want to be active members of our students’ teams. We’re here to support schools and families, whether through team meetings, follow-up evaluations, ongoing coaching, or consultations at key points in a student’s journey.
Empowering Youth, Families, and Schools
At NESCA, we prioritize the student’s voice. We empower students to foster self-determination, independence, and confidence as they prepare for the future. We also recognize the critical roles of families and educators in the process, ensuring their perspectives are included and valued. NESCA’s transition assessments provide not just a roadmap but the tools, understanding, and collaboration needed to move forward with purpose.

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker with over 20 years of experience supporting youth and Kelley Challen headshot young adults with diverse developmental and learning abilities. Since 2013, she has served as Director of Transition Services at NESCA, offering individualized transition assessments, planning, consultation, coaching, and program development. She specializes in working with students with complex profiles who may not engage with traditional testing tools or programs. Ms. Challen holds a BA in Psychology and a Minor in Hispanic Studies from The College of William and Mary, along with a Master’s and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard Graduate School of Education. She is a member of CEC, DCDT, and COPAA, believing it’s vital for all IEP participants to have accurate information about transition planning. Ms. Challen has also been actively involved in the MA DESE IEP Improvement Project, mentored candidates in UMass Boston’s Transition Leadership Program, and co-authored a chapter in Technology Tools for Students with Autism.

To schedule an appointment with one of NESCA’s transition specialists, please complete our 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 (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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NESCA Welcomes Sarah LaFerriere as a Transition Specialist

By | NESCA Notes 2024

By: Jane Hauser
Director of Marketing & Outreach, NESCA

Transition Specialist and Special Educator Sarah LaFerriere, M.Ed., joined NESCA during the summer. We’d like to take the opportunity to formally introduce her and fill you in on her inspiration for getting into Special Education and eventually Transition Services as well as her previous professional experiences, and how she supports families and students here at NESCA.

What led you to special education in general and then to transition services?

From early in elementary school, I remember having peers with disabilities who were often not being included. I would go out of my way at recess or lunch and play or sit with them so they would not feel so alone or different. My teachers would tell my parents that I was very nurturing and inclusive.

I was also personally motivated by one of my brother’s friends, who was severely autistic. My brother invited him to his 9^th or 10^th birthday party, where they played with temporary tattoos among other things. I was a teenager at that time. While there were many areas that were a struggle for my brother’s friend, he somehow figured out how to disable their home alarm system, left his house, and walked to our yard and waited there for a tattoo because he had so much fun with them at the party. His parents were beside themselves, calling the police to report him missing. I remember thinking that I would love to know how his brain works. It was fascinating that he had so much difficulty carrying out functional activities and was simultaneously so determined to get another tattoo, he disabled an alarm system at the age of nine.

I took that interest and just ran with it, volunteering in the life skills room in high school, and because I loved that so much, I became a skills trainer, PCA, and worked for The Arc (now LifeWorks), then held a position at one of the MACI programs at Bridgewater State. That’s where I began my love for working with transition-aged youth.

After I graduated college, I got my master’s through the EXCEL program at Bridgewater State University. As graduate assistant in that program, I taught high school and loved it. I really enjoyed working with older students, helping them navigate the community during their transition to adulthood. That brought me to my work in transition and eventually to NESCA as a transition specialist.

Who do you work with at NESCA?

So far, I’ve been seeing a wide range of students. My specialty area is working with students with more severe challenges. I really enjoy working with autistic students and those with intellectual disabilities, working with them on building life skills. At NESCA, I have had the chance to work with college-bound students who are living with anxiety, ADHD or other mental health concerns.

How would you describe your approach to working with students who are more severely impacted by their disabilities?

I try to connect with them as much as possible and develop a relationship with them based on their interests. Many students with disabilities have very specific interests. I use those interests as a way to make the initial connection with them. Once they see that I have a sincere interest in them and their interests, they tend to feel more comfortable and open up with me. People often tell me that it’s clear that I make strong connections with my students. In my opinion, we would not be able to accomplish nearly as much as we do without that relational approach. It’s hard for students to understand their full potential if the providers they work with can’t make a connection with them.

How do you define self-determination, and why is it such an important part of the transition process?

Self-determination is the ability to advocate for yourself, make decisions, and really learn about yourself – your likes, what you want, or what you don’t want. Self-determination is just so important for students of all ages, but especially for high schoolers and transition-aged youth, because there are so many important decisions and changes coming up for them. Self-determination is actually at the very heart of the transition process.

Self-determination is a big theme in the new Massachusetts IEP format. Why is this change so significant for students on IEPs?

Hopefully, the new IEP format here in Massachusetts will help more students become involved in their IEP process, which is now driven by the vision students have for themselves in all aspects of life after high school. It will hopefully guide schools to support students in building self-determination and independence skills, teaching them how to speak up, advocate, and participate in their own education. I truly hope the new format translates into schools putting a heavier emphasis on helping students successfully be part of the IEP process.

If we build these skills earlier on so students can be part of and contribute to IEP, once they leave school, they will be able to use those skills in life, whether that’s at a job or in the community. Hopefully, they will learn to generalize those self-advocacy skills to help them get what they need or want as they move into adulthood.

Another goal with the new Massachusetts IEP is to involve students in the IEP process at a younger age. Why do you think that is a priority?

Someone put it to me this way, and I think it paints an accurate picture. Think about parents or caregivers planning a party for a child down to every last detail. All the plans have been made; all the invites went out…everything is booked. But then, they don’t actually invite the child to their own party. That’s what we have been doing with students and their IEPs. We make the plans, we invite the providers and teachers, but we don’t ever invite the student to their own IEP meeting. This whole process, this whole document, this whole program is all for them, and our students have no idea of what took place in the meeting and why.

It’s really important for students of all ages to know their strengths and challenges, and have the opportunity to express their own voice throughout the process. Involving students at a younger age shows them how we are all working towards what they are hoping to achieve.

You have worked in a variety of settings from public and private schools to camps and different agencies. How do your past experiences benefit NESCA families?

When I think about all of the people sitting around the table in an IEP meeting, I think I’ve been in almost every one of the spots, with the exception of being a school administrator. I’ve been the teacher, the skills provider, in the paraprofessional role, and in the specialist role. While my own child doesn’t have a disability, just being a parent, I now see things more clearly from the parent point of view as well.

I feel like all my past experiences have led me to this position where I can provide realistic and attainable goals and recommendations to support students throughout the transition process. I know what can be accomplished by teachers and specialists in schools and what may be more of an unrealistic expectation for them to carry out. I understand how swamped they all are and how understaffed schools may be. That knowledge allows me to get creative and develop recommendations that allow students to reach their transition goals by teachers, providers, and parents putting those pieces in place. I can now think from the perspectives of all those roles. It’s not that we are expecting less from teachers or others, but I am able to identify who may actually be a better fit to work on skills with the student. Perhaps some instruction could be accomplished through a skills teacher in the home setting or a specialist at the school other than a teacher, for example.

You recently received a certification to help teach parents, caregivers, and providers to educate students with special needs about topics related to sex. Tell us more about that.

Yes! I’m really excited to work in this area. It’s so important. I now have the opportunity to go into schools and teach administrators or special educators how to teach their students about topics related to their bodies and sex. All too often, students in special education just don’t get taught about sexual safety and what’s going on with their bodies, and they are often some of the most vulnerable people out there. There is also a large percentage of special needs students who are part of the LGBTQ+ community, and it’s so important for parents and care providers to have the language and the knowledge to talk about some of these uncomfortable topics at their child’s level of understanding, whether that’s based on age or ability. I think a lot of families and schools really need support in this area.

Students also have a right to know and understand what’s going on in their bodies and how that may be adding to a lot of their behaviors. When I first became a special educator, I worked with students who exhibited sexualized behaviors, and I was not prepared for that. If a trained special educator was not prepared, parents, who likely have very little training on this topic, may feel like they are at a loss in supporting their kids. We all know kids don’t come with instruction manuals!

If I have the chance to educate students in a way that helps to prevent them from abuse and teaches them how to speak up and advocate for themselves if something inappropriate is going on, I am all for it.

What were you looking for when you came to NESCA and what do you feel like you’ve experienced in the past few months that you’ve been here?

I didn’t expect to learn so much from the people who work here. I knew there was an emphasis on life-long learning here, but I’m amazed at what I have learned and been exposed to in a short amount of time.

I love our weekly Case Conferences where clinicians present some of the more complex cases to gain insight and the perspectives of our colleagues. I get to learn about so many people and different approaches. I have had a lot of exposure to the mental health side of the students we work with and better understanding the connections between mental health and autism, intellectual disabilities, and more severe disabilities. I love learning more about the language, techniques or creative approaches to use with students who are experiencing anxiety or depression.

I enjoy being in a multidisciplinary setting where I can strengthen my knowledge in transition services, while also learning from the neuropsychologists, counselors, and others outside of the transition team.

In any given week, I may be writing reports, attending conferences or observing students in various settings, even at a zoo. I underestimated the new experiences and great connections that I’ve been able to make since coming to NESCA. It’s just been a really great experience.

About the Author

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

To book a consultation with Sarah LaFerriere or one of our many other expert transition specialists, 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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Hands reaching out to each other for help

Busting a Common Therapy Myth

By | NESCA Notes 2024

Hands reaching out to each other for help By: Carly Loureiro, MSW, LICSW
Therapist, Executive Function Coach, Parent Coach

Despite the many benefits of therapy, many people still hesitate to seek it out or see it through when things are seemingly going well. This hesitation can stem from a variety of factors, including societal attitudes, personal beliefs, and misconceptions about therapy. Going to therapy even when you’re not facing a specific problem can be incredibly beneficial for several reasons. Here are some key points to consider:

1. Preventative Mental Health Care

Just like regular physical check-ups help maintain your overall health, therapy can act as a preventative measure for your mental well-being. It provides an opportunity to address smaller concerns before they grow into bigger issues. Regular therapy sessions can help you develop strategies to manage stress, improve emotional regulation, and build resilience. Mental health doesn’t have a “finish line”—it’s an ongoing process.

2. Self-Exploration and Personal Growth

Therapy isn’t just for when you’re struggling—it’s also a space for self-exploration and personal development. For example, your therapist can help you find ways to reignite the creative side of yourself that took a back seat while you worked towards that promotion at work. This kind of introspection can help you lead a more intentional, fulfilling life and deepen your understanding of yourself and others.

3. Building Emotional Tools and Resilience

Therapists can help you build a toolkit for managing a wide range of emotions, from anxiety and anger to sadness and joy. Even if you’re not currently facing any challenges, strengthening these skills can help you navigate life’s ups and downs with greater ease.

4. Improving Relationships

Therapy can also support relationship health. You might not be experiencing conflict, but therapy can help you understand your communication patterns, your needs in relationships, and how to foster stronger, more supportive connections with others.

5. Managing Stress and Building Coping Strategies

Life doesn’t stop being stressful, even if there’s no crisis. Learning how to effectively manage stress, anxiety, or pressure in healthy ways can improve your overall quality of life. Therapy can help you develop coping mechanisms and mindfulness practices that make handling stress more manageable.

6. Increasing Self-Awareness

Therapy can help you become more self-aware by reflecting on your thoughts, feelings, and behaviors. This awareness can help you break old patterns or negative cycles you may not even realize you’re in. It’s a proactive way to improve your mental health before things escalate.

8. Learning to Manage “Normal” Life Struggles

Everyone experiences day-to-day challenges—work stress, relationship dynamics, feeling stuck, or uncertainty about the future. Therapy can help you address these common struggles in healthy ways, equipping you with problem-solving and coping strategies that you can use long-term.

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Even if you’re not facing an immediate crisis, therapy can be a helpful tool for maintaining a strong, healthy mind and enhancing your quality of life. It’s about building the emotional and mental muscle that allows you to better handle whatever comes your way—big or small.

If you are interested in exploring therapy for your teen, young adult, or yourself, let us know by filling out our Intake Form.

About the Author

Carly Loureiro is a Licensed Independent Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Mrs. Loureiro provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood, as well as to parents/caregivers. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, 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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Pile of tangled holiday lights representing holiday stress

Coping over the Holidays

By | NESCA Notes 2024

Pile of tangled holiday lights representing holiday stress By: Carly Loureiro, MSW, LICSW
Therapist, Executive Function Coach, Parent Coach

Home for the holidays isn’t always as it appears in a Hallmark movie. For many NESCA families, the holidays bring considerable anxiety and a fear of the unknown. Whether you have a family member returning home from a residential program or have a child coming home for school/college winter break, changes in environment, schedule, and routine can bring significant unpredictability. Below are some suggestions to feel more prepared as you enter this busy holiday season.

Stick to a schedule: make a loose and casual itinerary so all family members are aware of what can be expected over the holiday stretch. Preview plans and activities with family members to ensure everyone can process what is on the agenda.
Prioritize self-care: Schedule time for downtime & relaxation, exercise, healthy eating, and activities you enjoy, even if it’s just a short break during the day. Some family members may require assistance with coming up with ideas on what downtime looks like for them. Block self-care time and activities in your calendar so you don’t neglect the time needed to recharge.
Say no when needed: Boundaries, boundaries, boundaries! Don’t be afraid to decline external invitations or commitments that will overwhelm you and your family. Or, if it’s decided that one or two family members are best staying back home while others attend these commitments, that is okay too. Do what is best for you.
Manage your time: Don’t bite off more than you can chew! Create a plan for holiday tasks like shopping, cooking, and socializing to avoid feeling rushed. Schedule these plans and tasks in your calendar so that you don’t overbook yourself with other commitments.
Limit social media: Reduce exposure to unrealistic holiday portrayals on social media to prevent comparisons and stress. Let’s not forget that social media is a “highlight reel” of someone’s best moments. No one wants to show the depths of what actually goes on.
Communicate openly:
Talk to family and friends about your needs and expectations during the holidays. Identifying one or two people you can confide in about how you’re feeling will help ease some of that tension that can be hard to carry.
Practice mindfulness:
Engage in meditation or deep breathing exercises to manage stress and stay present. There are great options available on YouTube. Some of my favorite accounts for guided meditation and visualization are The Honest Guys and Dr. Jennifer Andrews.

Lastly, we at NESCA are here for you. If you need support with implementing any of the above, please do not hesitate to reach out and fill out an intake form. It’s never too late or too early to get started!

About the Author

Carly Loureiro is a Licensed Independent Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Mrs. Loureiro provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood, as well as to parents/caregivers. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, 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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Map of Massachusetts with Plainville identified on the map and a quote from Dr. Erin Gibbons

Why Choose Plainville?

By | NESCA Notes 2024

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

NESCA opened in 2007 in beautiful Newton, Massachusetts, which is a central location for many residents of the state, who are coming from different directions. Over the last 17 years, we have expanded both in Massachusetts and beyond to Londonderry, NH, Plainville, MA, and Hingham, MA (our newest location).

Our amazing intake coordinators frequently tell me that when they are talking with new clients on the phone and explain that their evaluation will take place in NESCA’s Plainville location, they commonly hear, “Where is that?!”

So, I am here to extol the many benefits of coming to NESCA in Plainville!

We are conveniently located off I-495 and Route 95. Since Plainville is in the suburban metropolitan areas of both Boston and Providence, there is very little traffic getting to the office. We also have ample free parking.
Miranda Milana, Psy.D. and I both work in Plainville. Between us, we evaluate clients ranging from 12 months to 30+ years of age. We both have extensive experience testing clients who have historically struggled to participate in traditional testing; for example, clients who are nonverbal, behaviorally dysregulated, or medically complex.
We receive frequent referrals for challenging diagnostic questions related to autism spectrum disorders (ASD), mood disorders, or intellectual disabilities and are comfortable taking on these often-complicated cases.
Both Dr. Milana and I evaluate toddlers for autism spectrum disorders in our ASD Diagnostic Clinic in Plainville. Our goal in the clinic is to help provide early detection of autism in children under three-years-old, when interventions are most effective.
Our fantastic occupational therapist, Jessica Hanna, MS, OTR/L works in the Plainville office. She is available for both OT evaluations and treatment. She also allows our testing clients to use the sensory gym during their breaks in their evaluation.
While your child is engaging in testing sessions during their evaluation, there are several stores, such as Target, that are only a 5-minute drive from our office. If you are looking to get some self-care in during their testing, you can even catch a 60-minute yoga or barre class in the plaza next door.
Finally, Patriot Place is a 10-minute drive from NESCA’s office in Plainville. If your child is a football or soccer fan, a visit to Gillette Stadium/Patriot Place is a great way to reward them for their hard work during the evaluation!

We invite you to learn more about the services we offer at NESCA in Plainville, MA, who we serve, and the many benefits of our convenient location. If you have any questions about our Plainville location, please let us know. We are happy to discuss the options for evaluations in Plainville.

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, 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.

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

The Importance of Behavioral Observations in Neuropsychological Evaluations

Pediatric Neuropsychologist Rebecca Dautoff, Psy.D., Joins NESCA

When Perfectionism Is Making Things Imperfect

NESCA Adds Pediatric Neuropsychologist Leah Weinberg, Ph.D. to its Team

Introducing Pediatric Neuropsychologist Sean Hyde O’Brien, Psy.D., ABPdN

Five Good Reasons to Choose NESCA for Transition Assessment and Services

NESCA Welcomes Sarah LaFerriere as a Transition Specialist