When “Attention Problems” Are Not ADHD

By | NESCA Notes 2019

By Jessica Geragosian, Psy.D.
Pediatric Neuropsychologist

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological disruption of the arousal system in the brain resulting in difficulties regulating attention and activity levels. ADHD can present with or without hyperactivity. Children with ADHD often have trouble engaging in expected tasks and maintaining appropriate behavioral control due to problems with inattention and lack of self-regulation. This can result in problems in the home, at school, and in peer relationships.

When concerns regarding attention or activity level are raised by parents or teachers, common practice is to consult with the child’s pediatrician. Parents and teachers might fill out rating scales asking questions like: Does your child have problems paying attention? Does your child have a hard time sitting still? Is your child having problems with learning? Is your child having difficulty following directions at home? When the answers to these questions are “yes,” a diagnosis of ADHD may seem appropriate.

However, there are many cases where inattention and/or impulsive behavior present as a symptom of another underlying problem and are not attributable to a primary attention disorder (ADHD).

The 5 most common misattributions I have seen in my clinical practice as a pediatric neuropsychologist in New Hampshire and Massachusetts are:

  1. Anxiety—When an individual is in a state of “fight or flight,” the brain lacks appreciation for information from the external environment that isn’t critical. When an individual is in a generalized state of anxiety, it is extremely difficult to remain focused and engaged in expected tasks.
  2. Learning disability—A student may have a disability in a core academic area. For example, a teacher may observe a child as being inattentive, when, in fact, they are several grade levels behind in reading. Thus, they cannot access the materials being distributed to the class.
  3. Communication disorder—If a child’s primary deficit is in the way they process language, you can be sure they look inattentive (e.g., not responding accurately to questions, inability to follow directions, etc.)
  4. Autism spectrum disorder (ASD)—Some children on the autism spectrum appear quite inattentive. In my experience, many children with ASD are often more tuned in to their internal environment (i.e., their thoughts and interests) at the expense of the external/social environment (i.e., parent, classroom and social expectations). While this can look similar to ADHD, the treatment approach is quite different.
  5. Other neurocognitive disorder (e.g., Processing speed deficit)—Other cognitive deficits can also make a student appear inattentive. If a student has slow processing speed, for example, the individual may not be able to keep up with the pace of instruction, resulting in an inability to absorb all of the lesson.

Other less common issues can also present as inattention, including trauma, absence seizures, hearing impairment, hallucinations, Tourette’s syndrome, among others. Because the root cause of inattention can sometimes be something very specific and complex, it is important to get a thorough evaluation.

It is also not uncommon for ADHD to present alongside the challenges identified above. In this case, effective intervention requires a simultaneous treatment plan addressing all challenges concurrently.

It is important to get a big picture—and accurate—understanding of a child’s neuropsychological profile in planning effective interventions. Our brains are complex, and one symptom can be common to many different origins. Getting the correct diagnosis the first time helps to put the right treatments in place.

 

About the Author:

Dr. Jessica Geragosian is a Licensed Psychologist in Massachusetts and New Hampshire. She has a wide range of clinical experience – in hospital, school and clinic settings – working with children and adolescents presenting with a wide range of cognitive, learning, social and psychological challenges.

Dr. Geragosian operates under the primary belief that all children want to, and can be, successful. The primary goal of her work is to identify the child’s innate strengths and find any underlying vulnerabilities preventing a child from achieving success. Whether the primary problem is an inability to acquire academic skills, maintain friendships, control emotions, or regulate behavior to meet expectations; she takes a holistic approach to understand the complex interplay of developmental, neurological and psychological factors contributing to a child’s presenting challenges.

Dr. Geragosian earned her doctoral degree from William James University, before completing postgraduate training in pediatric neuropsychology at the Massachusetts General Hospital for Children at North Shore Medical Center, where a focus of her work was neuropsychological assessment of young children with developmental challenges.

 

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

 

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

 

What’s Up, Postdocs?

By | NESCA Notes 2019

NESCA currently enjoys having three pediatric neuropsychology fellows on its roster: Caroline Kleeman, Psy.M., Miriam Dreyer, Ph.D., and Zachary Cottrell, Psy.D, LMHC. NESCA’s postdoctoral positions are two-year engagements allowing clinicians who have completed or are finalizing their doctoral degrees to advance their training and acquire/hone their skills in preparation for their long-term careers.

We recently sat down with two of our fellows to learn more about their postdoctoral experiences now that they have almost reached the one-year mark in their time at NESCA.

By Jane Hauser
Director of Marketing & Outreach

Tell us about your postdoctoral experience at NESCA so far.

Both: As postdocs, we sit in on every phase of an evaluation – from the intake session to the administering and scoring of the tests, interpretation of the results, feedback session with parents, and writing of the report.

We are always working with a supervising clinician during evaluations, and we participate in a training seminar led by NESCA’s Director of Training Dr. Angela Currie. We get feedback from our supervising clinicians throughout every stage in the testing process.

Caroline: I was fortunate to have worked at NESCA as a practicum student in 2016-2017. It’s been great to be back here in a different role. I’ve had the chance to work closely with Dr. Alissa Talamo during my fellowship.

Miriam: I’ve been on board here at NESCA since September 2018, so almost a year now. I worked closely with Dr. Amity Kulis, and now I am working with Drs. Nancy Roosa and Stephanie Monaghan-Blout.

Based on your experiences at NESCA, have you identified a specialty you would like to focus on?

Caroline: Autism has been and remains my area of interest. I also really enjoy working with children with learning disabilities and collaborating with schools to get the right plans in place for the kids we work with. I’ve really enjoyed and benefited from attending school observations and sitting in on Team meetings.

Miriam: Before I went to graduate school, I was a teacher. My area of interest is the intersection of emotional and learning challenges, including executive functioning difficulties and attentional disorders.  In graduate school, my research and therapy training focused on trauma. So, my goal is to combine my clinical and educational experiences to support families in understanding how emotional experiences impact learning in children and adolescents.

 Why did you choose to do your postdoctoral work at NESCA?

Caroline: As I mentioned, this is my second time being a part of the NESCA team. I came back to NESCA for my postdoc work because I valued the collegial environment. I also felt I could benefit from the different clinical staff and their various areas of expertise. It’s such a great experience to work in a practice where someone always knows the answer to my most challenging questions. I really appreciate the model of teaching at NESCA. Because of the apprenticeship model, there’s so much in-the-moment teaching with our clinical supervisors that I benefit from.

Miriam: I was really Interested in the apprenticeship model of training at NESCA as well. It’s a unique arrangement in that postdocs are with a supervising clinician every step of the of the evaluation process. We receive a lot of mentoring here, which is very important to me. I also value the integrated nature of the reports NESCA produces, which portray the sometimes complex kids we see in a nuanced way. Again, this is very important to me in my continued learning.

Both: We get to work with different people here who do different things. It’s given us exposure to so many new areas of neuropsychology that we may not have seen elsewhere. There are a lot of experts here to learn from.

What makes NESCA different? What did you find most beneficial?

Miriam: The structure of NESCA’s training program and the emphasis on continued learning throughout the organization are both so valuable. We frequently have seminars where third-party speakers come in to educate our staff on new areas of psychology and treatments so we all stay current with the latest evidence-based approaches. We also have a weekly case conference where all of our clinicians gather to discuss complex cases and to share resources, knowledge, and experiences to benefit the case at hand. There is a heavy emphasis on learning within the practice, so I am constantly getting exposed to new ideas. I think that’s a valuable and unique asset of NESCA.

Caroline: I absolutely agree with the fact that we are really benefiting from the heavy emphasis on learning and the years of experience our clinicians have. Their willingness to share the knowledge they’ve gained with each other and us is a great benefit to our clients and to my own education. I have also learned so much from our clinicians who attend and bring back such good information from conferences as well as the conferences I’ve had the opportunity to attend.

What’s been your favorite and your most challenging experience so far at NESCA?

Miriam: Each case is unique, so I’ve had lots of exposure to new areas of neuropsychology. Every person who walks in the door presents new opportunities for learning. While this is one of my favorite aspects of NESCA, it is also challenging. With the unique caseloads we take on, there is a lot to learn about the different profiles. As fellows, we do not yet specialize in one area, so we are getting a broad education across domains of neuropsychology. For every new case, there are unique recommendations tailored to that individual that require research, which is an important part of our training.

Caroline: Seeing each child who comes to NESCA as a unique individual is probably my most rewarding and challenging part of being in this practice. Getting to work with some of the more complex profiles out there is exciting to me, but is obviously a challenge, too. There’s always a lot to be learned about each child, and that can take some time to do.

What advice can you share with others looking into this field or who are looking for the right place for their postdoc experience?

Miriam: It’s a great opportunity to be here. My advice is to visit NESCA for an interview, see what it’s like here and learn about the different specializations of the practice’s clinicians. In your search, look for a postdoc position where you get varied training and exposure to a lot of different cases, even if they aren’t in your specific area of interest.

Caroline: Neuropsychology is a very fulfilling career. Every day and every child are different, so it never gets boring. Of course, it can also be frustrating in that there are sometimes barriers to kids getting what they need, whether in school or with community resources not being available. In those moments, you have to be creative and problem-solve. That said, the rewards far outweigh the challenges.

 

About Pediatric Neuropsychologist Fellow Miriam Dreyer, Ph.D.:

Dr. Dreyer enjoys working with children, adolescents and families who come to her office with a wide range of questions about learning, social and emotional functioning. She is passionate about helping children and parents understand the different, often complex, factors that may be contributing to a presenting problem and providing recommendations that will help break impasses – whether they be academic, therapeutic, social or familial.

Dr. Dreyer joins NESCA after completing her Doctorate in Clinical Psychology at the City University of New York.  She most recently provided psychological assessments and comprehensive evaluations at the Cambridge Health Alliance/Harvard Medical School for children and families with a wide range of presenting problems including trauma, anxiety, psychosis, and depression.  During her training in New York, she conducted neuropsychological and psychological testing for children and adolescents presenting with a variety of learning disabilities, as well as attentional and executive functioning challenges.  Her research focused on developmental/complex trauma, as well as the etiology of ADHD.

Dr. Dreyer’s experience providing therapy to children, adolescents and adults in a variety of modalities (individual, group, psychodynamic, CBT) and for a wide range of presenting problems including complex trauma/PTSD, anxiety, depression, ADHD, and eating disorders informs her ability to provide a safe space for individuals to share their concerns, as well as to provide tailored recommendations regarding therapeutic needs.

Before becoming a psychologist, Dr. Dreyer taught elementary and middle school students for nine years in Brooklyn, NY.  She also had an individual tutoring practice and specialized in working with children with executive functioning challenges, as well as providing support in writing, reading and math.  Her experience in education informs both her understanding of learning challenges, as well as her capacity to make specific and well-informed recommendations.

She received her Masters in Early Childhood Education from Bank Street College, and her B.A. in International Studies from the University of Chicago.

About Pediatric Neuropsychologist Fellow Caroline Kleeman, Psy.M.:

Caroline Kleeman comes to NESCA with experience providing evaluations for children with a range of neurodevelopmental profiles.  She has focused on assessing children with autism spectrum disorder, including those presentations accompanied by cognitive delays, language impairments, or genetic disorders.  She also enjoys evaluating children with academic difficulties stemming from learning disorders or attention/executive function disorders.

Ms. Kleeman’s approach to testing recognizes that children are so much more than a list of scores.  Combining her own careful observations with input provided by parents and teachers, Ms. Kleeman strives to differentiate between skill deficits or performance deficits, while also identifying unique strengths.  Additionally, drawing on her applied behavior analysis (ABA) background, Ms. Kleeman looks beyond the individual to identify helping and hindering features of the surrounding environment.  The result is meaningful, highly individualized educational and therapeutic recommendations.

Ms. Kleeman received her Sc.B. with honors from Brown University, where she studied cognitive science.  Focusing on early childhood, she conducted research on the role of sleep (especially naps!) in cognitive development.  After college, Ms. Kleeman worked as a therapist at Nashoba Learning Group, using the tenets of ABA to provide instruction across educational, vocational, behavioral, and adaptive domains.

Bridging between psychology and education, Ms. Kleeman is finalizing her doctorate in school psychology at Rutgers University Graduate School of Applied and Professional Psychology.  Her dissertation is investigating the role that Sesame Street’s autistic muppet, Julia, could play in early childhood social and emotional learning (SEL) programs.  She completed her pre-doctoral internship at the Center for Children with Special Needs in Connecticut, where, in addition to psychoeducational evaluations, she provided ABA therapy and ABA-based reading intervention for children across the autism spectrum.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool 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 one of our expert neuropsychologists, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

When the Worry Bug Makes You Mad: Understanding the Importance of Positive Behavior Plans for Anxious Kids

By | NESCA Notes 2019

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

“Don’t Feed the Worry Bug,” by Andi Green is a wonderful book for children who are anxious or experience a lot of worrisome thoughts. The story is about a monster who constantly feeds his WorryBug, only to find that as he worries more and more, the WorryBug continues to grow until the monster is totally overwhelmed by the emotion. Eventually, he learns to control it. In my practice, I evaluate a number of children with lots of worries…but they don’t actually look worried. Instead, children may appear defiant, hyperactive and aggressive. Why do children overwhelmed with anxiety sometimes become frustrated and angry or have poor behavioral control at home and in the classroom?

Children with anxiety “on the surface” may appear angry, oppositional and defiant to adults. However, these behaviors oftentimes reflect secondary responses to an underlying cause: anxiety. Responses to anxiety can be categorized as “fight, flight or freeze.” As a classic example, if you run into a grizzly bear on a hike, your body’s natural physiological response is to fight, flee or freeze. Your anxiety about the demands of a situation send your body and brain into a state of “threat alert.” Similarly, when a child is worrying about something, is socially anxious, or is feeling nervous about their ability to handle a task, this “threat alert” system is activated and the child’s ability to make well-thought out decisions is impaired. The child may be labeled a “behavior problem” because of the impulsivity, defiance, disruptiveness or aggression (fight mode). Or the child may appear distractible, silly and immature, or avoidant of challenging tasks (flight mode). An anxious child may also show difficulties shifting gears/transitioning, problems letting go of events, or seem unmotivated or apathetic (freeze mode). It is also not uncommon for children with anxiety to have challenges demonstrating appropriate social skills, such as problems with insight into how their behaviors may affect others. They may also experience challenges reading the nonverbal and verbal cues in their environment because their brain is “soaked” with high arousal, immobilizing their capacity to apply logic to everyday situations. How do we help children manage their anxiety and the resulting behavioral challenges from that anxiety?

A neuropsychological evaluation can provide insights into your child’s behavioral challenges to determine if there may be an “underlying cause,” such as anxiety, (or other causes such as learning disabilities, depression or poor information processing) which are driving weak emotional and behavior control. Once identified, a neuropsychologist can provide guidance on the most effective interventions for a child at school and at home.

In my experience, one of the most important interventions for a child who experiences anxiety and secondary behavioral challenges is the development of a Positive Behavior Plan at school, which can then be included in a child’s IEP. However, many children with anxiety do not respond well to traditional behavioral reward systems that solely focus on increasing or decreasing behaviors (e.g. follow directions, sit calmly, keep your body safe, etc.), as these systems do not teach the child the self-regulation skills necessary for controlling emotional and behavioral responses. Instead, an effective Positive Behavior Plan for a child with anxiety includes behavioral targets or “goals” that focus on the attempt at coping strategy application. Importantly, a child with anxiety should be rewarded for trying to use a coping strategy, as it will take time, practice and reinforcement before a child develops the capacity to apply coping strategies consistently and successfully.

Sample coping strategies that a child should be taught by a special educator, counselor or other specialist include “taking deep breaths, jumping jacks, taking a break, using words to say how I feel,” or other self-regulation tools. When the goals of a Positive Behavior Plan focus on using a coping strategy before or during moments of distress rather than a plan that is tied to increasing or decreasing specific behaviors after they occur, a child builds independent capacity to appraise and react appropriately to physical and emotional responses in the classroom and the community. Children learn the signs (e.g. in their body, mind and in their environment) that the WorryBug is approaching, and feel better equipped, confident and more in control of their emotions and behaviors. For more information on how to appropriately develop Positive Behavior Plans for children with anxiety, “The Behavior Code” by Jessica Minahan and Nancy Rappaport is an excellent resource for parents and educators.

When the “WorryBug” or anxiety makes kids mad, mean and aggressive, a comprehensive and thorough neuropsychological evaluation can determine how to best tackle the anxiety “beneath the surface” through therapeutic and educational interventions. A neuropsychological evaluation can also direct the development of strategic Positive Behavior Plans that are individualized and appropriate for the child’s home and school environment.

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

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

 

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

 

Got Complicated? NESCA’s Newest Pediatric Neuropsychologist Wants to Test Your Child. Find Out Why!

By | NESCA Notes 2019

Pediatric Neuropsychologist Yvonne Asher, Ph.D., joins NESCA on June 3, servicing clients in the Londonderry, New Hampshire and Newton, Massachusetts offices, and is scheduling new clients now. We sat down with Yvonne to learn more about her, what her passions in neuropsychology are and why she joined NESCA.

 

By Jane Hauser
Director of Marketing & Outreach

NESCA has 15 neuropsychologists who test a wide range of individuals. Tell us about your past professional experience and the types of clients you most enjoy serving.

I love working with children with complex profiles where challenges and diagnoses aren’t easily made or identified. This is the group of kids I worked with most often when I was with Mass General Hospital’s Lurie Center for Autism. It’s also incredibly rewarding to work with kids who aren’t able to communicate in a traditional manner—they may be too young, too impaired or potentially non-verbal. Many people think these individuals are too difficult to work with in testing. Using data to better understand their strengths and weaknesses is my passion, and I love to help them tell their stories through the assessment process.

It sounds like you enjoy working with complex kids. Can kids who have limited verbal skills and/or behavior challenges be tested?

Yes! Sometimes these children can be labeled in a punitive or negative way, such as being “uncooperative” or “untestable.” I don’t believe that anyone benefits from these kind of labels. It’s my job as the psychologist to be creative so that we can get the necessary data to understand them. I try to ease parents’ minds by reassuring them that I’ve seen many of these children before. And, if I haven’t frequently seen a particular complex profile, I’m lucky to have wonderful colleagues and resources to collaborate with on such cases.

For example, I worked with one very sweet, four-year-old child who had severe communication issues.  The parents and his pediatrician questioned whether he had autism. Since he had incredibly limited verbal skills, we altered all of the assessment tasks, using some non-verbal assessments and creatively modifying others to complete the testing. We noted that everything in the assessments—aside from his language—was on track developmentally. Prior to testing, everyone was pointing toward autism as the diagnosis, but he actually had a severe expressive/receptive language delay. His parents had figured out some tricks to communicate with him, but the world was a very scary place to him. He didn’t understand what was going on and primarily used gestures and facial expressions to communicate. That, unfortunately, only got him so far. As you can imagine, these challenges and frustrations led to a very stressful environment for the entire family. We recommended intensive speech therapy to help develop his communication skills, providing the family with a clear path forward.

You were a teacher before becoming a neuropsychologist. How do you feel your past experience as an educator enhances your work as a pediatric neuropsychologist?

I have a lot of experience working in public and charter schools. I was also a preschool teacher before graduate school, where I found the children to be endlessly funny, creative and just awesome! This experience is, in part, what fuels my desire to work with younger children who are experiencing challenges.

Having that educational experience is so valuable for the families at NESCA. I’ve been in special education and can help parents understand the process and landscape every step of the way—from an initial concern and assessment to getting an IEP and to thinking about high school placement and transition to adulthood.

The school experience also helps me to relate to the teachers, since I’ve been one and know how to partner with them to help students. We always help our families and push for what’s needed, but it’s helpful to also understand the constraints of the school setting. Knowing the constraints won’t change our recommendations, but it’s helpful in providing recommendations that will be implemented.

Why did you opt to move from the school setting to neuropsychology?

While I loved working in the school setting, I found that I didn’t get the chance to work as closely with families as I wanted. While families were there for school meetings, I’m looking to work with and serve the whole family system. I enjoy taking a close look at why children are having particular challenges, whether there’s a diagnosis that can be identified, and determining what school or path best fits a child and their family. I like taking the time to talk with parents and educators, giving each of them the chance to talk about the child, and to ask questions and make a plan for the child and their family. With really young kids, this is often just a first step, and I am excited to work with families long-term and help them through future hurdles.

What is so special about working with young children and their families?

Being a family’s first introduction to mental health is so meaningful. I tend to work with families who may be noticing that some milestones or behaviors are a bit off, or when they may first be considering a neuropsychological evaluation or other assessments. I like to find those parents who are asking, “What do you think it could be?” I truly enjoy giving these parents insight into their child, and providing exposure to and help along their path in mental healthcare.

Why did you opt to work in a group practice, like NESCA?

During my postdoctoral work, I really came to value the consultation with and supervision from other psychologists. I thought about going back into the school setting, but school psychologists are typically the only ones in that role at their school, or even their district. I appreciate the ability to put heads and knowledge together as colleagues. Doing so, on behalf of our clients, can help us to frame a case or intervention in a different way. Being able to bounce ideas or recommendations off of each other and using the combined experiences, knowledge and referral resources of other neuropsychologists brings so much to clients, families and individuals with challenges. NESCA, in particular, offers a very supportive environment in which to work. That can be felt by co-workers as well as the families we serve.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool 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 Dr. Yvonne Asher, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

Why are they called “Soft” Skills?

By | NESCA Notes 2019

By Kathleen Pignone, M.Ed., CRC
Transition Specialist

If they are soft, why are they so crucial in this hard, cruel world? As a transition specialist, I meet with young adults and their parents on a daily basis. All parents want to know what is that missing piece for child to really succeed after high school? What should my priorities be? Is the right college more important than the right internship or vise versa? I often hear the saying, “I remember in my day, you just dusted yourself off and kept going. Why is this new generation struggling?”

While I don’t have an answer to those profound questions, I can offer some go-to skills that will support our young adults as they transition from high school to college, the world of work and the great beyond…soft skills—those intangible, hard-to-pin-down skills that we all know we need to succeed, but are so hard to teach. As a wise practitioner once told me, “Just because it is simple, it doesn’t make it easy.” While it’s critical to teach, prepare and equip our students with the necessary skills for academic success, soft skills can be just as important in many instances. Young adults need a balance of academic, executive functioning, communication and soft skills to set themselves up for success in their multi-faceted life after high school. These soft skills can make the difference between candidates competing for college acceptance and job opportunities.

I also like to refer to these skills as the job keeping and high achieving skills. Strong foundational academic, planning and team-building skills are necessary for success, but these soft skills are the subtle differences observed in the student chosen for that internship by the professor and recognized in the entry-level employee who quickly advances to the mentor employee.

In my practice, I am witness to amazing, capable, energizing and unique young adults, who are unaware of the many talents and strengths they already possess. I work to coach, teach and persuade them that these soft skills are in there, but are struggling to make an appearance. The key is identifying them and knowing when to call on them in stressful times. As a transition specialist, I offer the young people I meet with the opportunities to name and own these skills within themselves. For example, when a teenager is struggling with school, but shows up every day, I introduce them to their “grit,” their get-up- and-go and “try again” skill.  By identifying skills that may just be lying dormant or unrecognized, I offer them a chance to see that they have an innate strength that has both a name and a purpose. These skills are not only necessary, but are transferable to all aspects of their future lives. Their internal grit pushes them to go to class when their roommate is sleeping in and go to work even though they have a cold and could call out sick.

By definition, students ready to transition from high school are at an age and stage of curiosity, exploration, hope and optimism. But they may easily miss out on identifying these characteristics as strengths and skills, if we do not point it out and celebrate it with them. When they are resisting rules and boundaries, they are employing their skills of curiosity and exploration. When they want to protest against inequity in this unfair world and are perceived as naive and inexperienced, I praise their hope and optimism. We talk about how these soft skills are integral to their success as an adult and will serve them as they continue to grow and learn.

Young adults in our current society have no other option than to be flexible and adaptable. Technology is constantly updating and changing, forcing them to move forward or be left behind. Their resilience in handling all that social media exposes them to on a daily basis is admirable. I wouldn’t have stood as tall and strong as they do with such public scrutiny.

As we prepare our young adults for life after high school, let us always take the time to see, name and recognize the strengths and soft skills they show us. We have the opportunity to observe and learn from them and value these skills so that they may offer themselves as resources to their community. The balance necessary to teach young people how to manage an interdependent world as an adult is complicated. It is exciting and energizing to witness young people find these strengths within themselves, helping them to conquer that great big world.

 

About the Author:

Kathleen Pignone, M.Ed. CRC is a deeply knowledgeable and experienced transition specialist. Prior to her tenure at NESCA, Ms. Pignone was the Career Development Director at Bay Cove Academy for 15 years, providing students with classroom and real-world employment skills training, community job placement and on the job employment-training. She has also worked at Massachusetts Department of Secondary and Elementary Education and privately as a vocational rehabilitation consultant. As a certified rehabilitation counselor, Ms. Pignone brings unique expertise carrying out vocational assessment and employment planning for adolescents and young adults as well as supporting local school programs. In addition to fortifying NESCA’s premier transition assessment services, Ms. Pignone engages in person-centered planning with teens and young adults, consultation and training for parents, providers and schools, and community-based coaching services.

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

To book a transition assessment or consultation with Kathleen, please complete NESCA’s online intake form

 

Understanding Chinese Medicine on a Deeper Level

By | NESCA Notes 2019

Breaking down a common pathology and get it in balance this spring

By Holly Pelletier, L.Ac.
Licensed Acupuncturist

If you are alive today, chances are you have some form of one of the most common Chinese medical diagnoses, Liver Qi stagnation. Let me break down this complex, and presumably new, terminology.

Liver (LV)—In Chinese medicine, all of the meridian systems are named after organs in the body. When we talk about Liver, Spleen or the Heart, for example, and you see it with a capital letter, the scope of the word’s meaning is much larger. When you see Liver in this post, know that it means the energetics of the organ as well as the organ itself. This includes the meridian system, the emotional connection and the actual physical lines in the body the meridian comprises—in this case, the inner leg line or your adductor muscles.

Qi—Qi = Energy (roughly). Everything is Qi, just like everything is energy—physics taught us this, and, well, there is no arguing with physics!

Stagnation—This one is simple. Stagnation simply means the stuck-ness of something/that something is not moving.

Pathology—A pathology is an imbalance in your system. Altogether, Liver Qi stagnation pathology is an imbalance caused by something not moving along your Liver meridian.

Now that you know the breakdown of the pathology, how do you know if you have Liver Qi stagnation? Let’s look at some common signs that might signal you have some (or a lot) of this imbalance.

Possible symptoms

Irritability, depression, displaced anger, tight muscles, pain anywhere in the body, restlessness, PMS, headaches, irregular and/or painful periods, constipation, inappropriate anger, frustration, abdominal pain/discomfort, mood swings, sighing, sensation of a lump in the throat, excessive sleep or hiccups. 99% of individuals have at least one of these common imbalances on a regular basis.

What causes LV Qi stagnation?

Stress and lack of movement are two BIG players, and the Liver organ system is actually most susceptible to imbalance in the Springtime. During spring, the above-mentioned symptoms can flare more easily. To take care of this organ system, now is the time to pay more attention to it, before we are fully into the spring season.

Why is it important to pay attention to this?

Understanding how your body works and how the seasons affect us is the first step in your own personal health journey. This is one of the foundational principles of Chinese medicine as a preventative means to wellness.

When the Liver is in balance, it is a strong force to be reckoned with. You’re more likely to experience a lot of forward progress, determination and healthy amounts of focus and clarity in completing a particular “job” (think of a job as dreams, hopes, desires).

Unfortunately, many people have the mindset of, “If I’m not sick, I’m healthy.” The problem with that is we are not trained to see symptoms of early illness or disease. For the most part, we do not know how to correct imbalances early on or properly deal with emotions—i.e. not pushing them down or not taking them out on those who do not deserve it. We don’t know how to tap into the energy of the body and world around us to create an environment and a lifestyle conducive to optimal health. We will have pain and brush it off, or a nagging headache and say that’s normal, when in reality these are symptoms our body is trying to tell us about an imbalance! We need to learn to listen and to tap in EARLY if we want to live a healthy, disease-free life.

What’s more is that a MAJOR cause of disease is stagnation. There is usually some form of stagnation in every illness or ailment, and the Liver is the organ system in charge of clearing, moving and breaking up stagnation.

3 Easy Tips to Balance your Liver Qi this Spring!

1. Move!

The best way to take care of your Liver and harness the energy of this organ system is to move your body. There is so much flexibility with this—whatever you like to do to get moving is A-OK. Try walking, biking, yoga or dancing! Anything goes…just get going TODAY!

If movement and exercise is totally out of your lifestyle at the moment, start with small tricks like taking the stairs or parking further away so you have a longer walk through the parking lot!

2. Let emotion out in a healthy way!

When I first did therapy, my therapist introduced me to a “rage room.” It took me about three years to actually use it, but when I did, I felt amazing! My rage room back then consisted of a punching bag that we hit with a bat, but there are so many ways to release pent up emotions so they don’t stagnate and lead to disease.

Some easy and accessible examples are:

  • Scream while alone—in the car, woods or at your house when no one else is around. Note: If you are thinking about this in terms of your child, which undoubtedly many of you are, it is good to encourage them to let out emotion. Help them find a safe space they can do it in.
  • Jump up and down, shaking out your limbs (really effective)
  • Run or jog
  • Practice Vinyasa Yoga
  • Write a “rage page” in your journal where you get all of your feelings out (Note: the secret to this is that you must throw the page away after and never look back at it again. We are letting things out, NOT trying to dwell on them more).
  • Take an exercise class, like kickboxing

3. Get acupuncture, or at least acupressure!

Schedule an acupuncture session with a licensed practitioner—stick to an acupuncturist and not someone who just does “dry needling,” which doesn’t offer the benefits of a well-rounded treatment that addresses your root pathology, whether that be Liver Qi stagnation or something else.

If that is not in the cards for you, start tuning in to your own body. Begin with self-massage—the feet and hands are good places to begin—between the webbing of the fingers and the toes, in particular, and assess for stagnation. How can you tell if there is stagnation? If there is pain, sensitivity, built-up heat or cold, or numbness/tingling.

As you start to become intuitive with your own body, remember: Pain = Stagnation = Energy not flowing = built-up accumulation = disease at some point in the future. Start to get friendly with your own energy and begin to understand your body more!

 

About the Author:

Holly Pelletier, licensed acupuncturist, has been working with children, adolescents and young adults, in many different capacities since 2004. Prior to treating youth with acupuncture, she worked as a teacher, coach and mentor. She especially enjoys working with young people and acupuncture because of their speedy response time and genuine excitement about this form of medicine.  For more information about acupuncture at NESCA and our new ‘Acupuncture & Mindfulness’ program for teens, please email Holly Pelletier at hpelletier@nesca-newton.comFor more blog posts by Holly check out her personal blog: www.holisticallyinspired.org.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool 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 Holly or other Integrative Treatment providers at NESCA, please fill out the intake form and note that you would like to see Holly.

Visual Skill and Academic Success – Looking Past 20/20 Vision

By | NESCA Notes 2019

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach

When a school nurse pulls a child into his or her office to complete a basic eye screening, he or she may write, “20/20 vision in both eyes. No visual concerns.” This child has successfully looked at an eye chart and read the letters; demonstrated the ability to look straight ahead, from an appropriate distance without things becoming blurry or illegible; and demonstrated visual acuity, or the ability to see with acceptable clarity.

But does this necessarily mean there are no concerns?

Visual acuity measures whether a stimulus is being seen – not necessarily if the information is truly being understood. The visual system is a complex part of the central nervous systems that incorporates the eyes, ocular pathways and brain to produce and interpret sight. It requires consistent communication between all of these individual anatomical pieces, the vestibular system and the skeletomuscular system. Essentially, vision is complicated and messy and requires many many different skills.

Breaking It Down

In terms of visual skills needed for academic success, we often break things down into three main areas: ocular motor control, visual perception and visual motor integration.

  • Ocular motor control describes the ability to physically move the eyes using the 9 ocular muscles. It encompasses the ability to track an object across a screen or a line of text across a book, or the ability to look up at the board and then quickly refocus on a sheet on paper on the desk. Imagine trying to watch a basketball game without the ability to track the ball across the screen smoothly. It quickly becomes tiring and frustrating. Occupational therapists often refer to these specific eye movements with technical terms, such as visual saccades, pursuits, convergence/divergence and accommodation. But in essence they describe eye movement.
  • Visual perception or visual processing is in many ways more nuanced. It focuses on the brain’s ability to organize, interpret and fully understand the information it receives from the eyes. Two main skills needed at school are visual figure ground and visual closure.
    • Visual figure ground is the ability to discern relevant information from a busy or cluttered background. A student with visual figure ground difficulty may not be able to search a busy white board and find a homework assignment. These students may also be visually overwhelmed by a worksheet with 20 math problems, but successful with the same problems presented individually.
    • Visual closure is a skill that specifically helps with reading efficiency and fluency. It is the ability to identify or visualize a complete form or picture when given incomplete visual information or when only a small piece of the image is shown. Visual closure allows us to read a sentence quickly without stopping to decode each individual letter. It is aslo oen raeosn taht mnay pelope can raed setneces wtih julmbled up ltetres. We recognize the form, not simply the sequential letters.  :  )
    • Visual closure plays a role in sight words and reading partially-covered papers or street signs in the community. While there are many more important visual perception skills, these two examples have functional, measurable effects in the classroom setting and are commonly identified through occupational therapy testing.
  • Visual motor integration (VMI) describes the ability to use all of these foundational visual skills in conjunction with foundational motor skills. It is the ability to interpret visual information and produce a precise motor response. In the classroom, this affects a student’s ability to copy shapes, produce legible handwriting and use scissors to cut along a line. Not only can these things be difficult, they can be exhausting as a child tries to use all of these skills at once.

While all of these visual components have multiple layers and intricacies, it is important to simply acknowledge that there’s more than the eye can see when it comes to vision. A child who “can’t see the board,” but has 20/20 vision, may just be visually overwhelmed. A child who looks at a page full of small block text and immediately gives up may not have the visual skill to read across a line. And a child who is learning to read beautifully, but still has difficult forming the letters in his name may have poor visual motor integration. Fortunately, there are many interventions and accommodations that can help build on and develop these skills further to foster confidence and success in the class and community.

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.

 

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

 

Music and the Mind – Musicianship Impacting Executive Functions

By | NESCA Notes 2019

By: Zachary Cottrell, Psy.D., LMHC

Pediatric Neuropsychology Fellow, NESCA

At NESCA, we work with many children with ADHD and issues with executive functions. Fortunately, there is a wide variety of interventions that can be used to aid executive function development, such as martial arts, aerobics, yoga, mindfulness and cognitive-behavioral therapy. However, another option to keep in mind is learning a musical instrument. Most children are naturally drawn to music, and recent research suggests that musical training can positively influence the development of executive functions.

In 2014, Dr. Nadine Gaab at Boston Children’s Hospital found that adult musicians had stronger working memory, greater cognitive flexibility and verbal fluency than non-musicians. Child musicians showed better verbal fluency and faster processing speed than non-musicians. fMRI scans showed that child musicians have more activation in the frontal regions of the brain – the home of executive functions – than non-musicians. Dr. Gaab’s study concludes that children who study music have stronger executive function skills and that studying music may build those skills. For the full details and results of the study, a link is provided below.

In another 2014 study, Dr. James Hudziak at the University of Vermont found that playing a musical instrument was associated with more rapid cortical thickness maturation within the areas of motor planning and coordination, visuo-spatial ability, and emotion and impulse regulation, the latter being correlated with increased executive functions. For the full details and results of the study, a link is provided below.

So, what do these studies really show us? Basically, learning a musical instrument can improve and strengthen our executive functions, such as planning and organizing, working memory, processing speed, task management and initiation as a whole. Musical performance requires a high level of active engagement, which leads to less off-task behaviors. While engaging in music, the individual is more likely to be practicing such skills as attending, inhibiting and shifting. Additionally, musical training involves significant demands on working memory for processing auditory, visual and tactile cues simultaneously. Working memory is required for learning any complex activity, such as understanding language. There are plenty of research studies that show correlating executive skills in musicians and bilinguals.

In my experience as a therapist and when teaching music, these skills are highly translatable to other forms of learning. Music is not only rewarding and fun, but is also effective in developing and improving executive functions. Below are some links for further reading and exploration.

 

 

Book:

This Is Your Brain on Music: The Science of a Human Obsession, by Daniel J. Levitin

Articles:

Investigating the impact of a musical intervention on preschool children’s executive function (Bowmer, et al., 2018)

References:

Behavioral and neural correlates of executive functioning in musicians and non-musicians (Dr. Nadine Gaad, et al., 2014)

Cortical thickness maturation and duration of music training: health-promoting activities shape brain development (Dr. James Hudziak, et al., 2014)

 

About the Author: 

Formerly a therapist, Dr. Cottrell has extensive experience working with children, adolescents and emerging adults as a therapist, behavioral health consultant and evaluator in community, college, private practice and hospital settings. At NESCA, he provides thorough and in-depth neuropsychological evaluations to support youth to not only develop, but also to maximize, their potential. Dr. Cottrell is a graduate of William James College, participating in the Doctorate of Psychology in Clinical Psychology Program. Dr. Cottrell also has 25 years of experience with the guitar, performing and teaching music. 

Dr. Cottrell recently completed a 2 year APA internship placement at North Shore Medical Center (Salem, Mass.) where he was immersed in the world of neuropsychological, personality, psychological and educational testing at the Neuropsychological Assessment Center at MassGeneral for Children. While there, Dr. Cottrell’s work predominantly involved providing evaluation and consultation to children, adolescents and adults with ADHD, ASD, learning disabilities and other neurocognitive developmental and behavioral concerns in addition to providing psychological evaluations to adult patients considering bariatric surgical procedures.

 

To book an evaluation with Zachary Cottrell one of our expert neuropsychologists, complete NESCA’s online intake form

 

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

8 Tips You Need to Know about SAT and ACT

By | NESCA Notes 2019

 

By: Dina Karlon, M.A.
Transition Specialist, NESCA

Starting to think about the college admissions/testing process? It can be costly and confusing, so we’ve compiled some tips to help you navigate the testing landscape.

Tip 1 – SAT or ACT – Which test should a student take? Most colleges will take either, but there are differences to the tests. SATs, which were revamped a few years ago, has Reading, Math and Writing, while the ACT adds a Science section. SAT questions assess problem-solving abilities, while ACT questions are more fact-based, similar to school testing. Typically, SATs use much higher-level vocabulary than the ACT. The ACT tests math concepts through trigonometry, while SATs stop at geometry. SAT divides its scores into two areas – Reading/Writing and Math, with a perfect score of 1600 (800 for each). ACT scoring is based on 4 sections that are averaged into a composite, with a perfect score of 36. While SAT is more well-known by many New Englanders, the ACT is taken slightly more often, having gained popularity in the past 5 to 10 years. A student may prefer one test over the other if the individual:

Still not sure which one to take? Visit the tests’ websites to take/score a practice test. See which one may be better through this conversion chart: https://www.studypoint.com/ed/sat-act-concordance/.

Tip 2 – SAT Subject Tests – In addition to the general SAT, students can register for tests in specific subject areas. There are 20 specialized tests, and an individual would usually only take 2, if any. Most colleges do not require them, although a student may take them to demonstrate a strong interest or aptitude in a subject or area of passion. For example, a bilingual student could demonstrate proficiency in a language. Subject tests could be a way for students to strengthen their application among similar candidates. If a student wants to major in a science, a strong score on a science subject test could set that person apart from others.

Tip 3 – Apply Early – Standardized testing is pricey, and hidden costs can creep up. Register early to avoid late or waiting list fees. Doing so also allows students to reserve a slot at their own school (if offered there). Whether students are neuro-typical or not, there is comfort in taking tests in one’s own school. For students with anxiety, it is very important, as familiarity with their environment can reduce anxiety.

Tip 4 – Vouchers – Visit SAT and/or ACT sites to determine eligibility for test fees being waived through a voucher. Work with high school counselors to obtain a waiver.

Tip 5 – Costs – There are registration fees for standardized tests. The current fees for the exams are:

There’s good news for New Hampshire residents. A few years ago, the SAT replaced the New England Common Assessment Program (NECAP) as the state test for high school juniors. Therefore, all juniors have the opportunity to take one free SAT. Factor this in for next year, as the deadline to take the test is in March.

Tip 6 – Free Test Scores Sent to Colleges – To lower costs, take advantage of having 4 free test scores sent to colleges. When you register to take both the SAT and ACT, students have the option to send up to 4 tests to 4 colleges at no charge, saving $52 ($13 per test) for the ACT and $48 ($12 per test) for the SAT. Individuals have up to nine days after taking the SAT test to register for score reports. It’s best to sign up for them when you register as it’s easy to forget to do so after. Some students may not opt to do this because they want to see their scores before they are sent to colleges. The benefit of sending them with the SAT is – regardless of your scores – if taken again, a person’s entire history will be sent to colleges where they take the highest score from each section. For example, if a student scores a 400 on English and a 500 on Math in April, then chooses to retake the test in October and scores a 500 on English and a 400 on Math, the school will take the two 500 scores for a total of 1000. If a student is very unhappy with a score on a particular day and they don’t want a college to see that score, students can research whether the schools they are applying to will accept score choice. While this may be an option, it will incur an additional fee. In general, I recommend sending all of the scores and letting the admissions team select the highest. With ACT, score histories are not sent to colleges. Instead students pick a specific test date’s scores to send. Unlike the SAT, if a student gets a higher score in separate sections on various test dates and wants the colleges to see the scores from each test date, they will have to pay for each test date’s score to be sent.

Tip 7 – Accommodations – The process for requesting accommodations and when to apply for them is different for each test. Check the SAT and ACT websites for exact processes for each. Here are some tips:

– Apply early as it can take up to 7 weeks to hear which accommodations are approved. Accommodation request applications may be due at the time one registers for the test – or even before.

– Students should talk with their SAT/ACT school representative about accommodations. While ACT only accepts requests through students’ schools, SAT allows students to apply for accommodations independently. I recommend working with the Accommodations Coordinator at the high school (school counselors will know who this is).

– It is up to SAT and/or ACT if they will allow students accommodations, not the high school.

– Once accommodations are determined for a school year, students can take the test several times (though it’s not recommended to take it several times each year) and not have to reapply for accommodations. SAT accommodations last for one year after high school graduation.

– Lists of accommodations and procedures for requesting them are at: https://www.understood.org/en/school-learning/partnering-with-childs-school/tests-standards/how-to-apply-for-sat-and-act-accommodations.

Tip 8 – Test-optional Schools – Some of us just don’t test well and are terrified of taking such tests. If a student doesn’t feel standardized tests reflect their academic ability and don’t want them considered in their admissions application, consider applying to test-optional schools. These schools review admission materials (transcript, recommendations, etc.) to determine if a student is a good fit for their institution. Here is a list of test-optional schools: https://www.fairtest.org/university/optional.

References

SAT website: Collegeboard.org

ACT website: ACT.org

https://www.understood.org/en/school-learning/partnering-with-childs-school/tests-standards/how-to-apply-for-sat-and-act-accommodations

https://www.understood.org/en/school-learning/choosing-starting-school/leaving-high-school/sat-or-act-how-to-know-which-is-best-for-your-child

https://www.huffpost.com/entry/differences-between-the-s_b_3451049

 

About the Author: 

Dina DiGregorio Karlon, M.A., is a seasoned counselor who has worked as both a school counselor and vocational rehabilitation counselor, guiding and coaching students and adults through transitions toward independence in both college and the working world. With NESCA, she offers transition assessment services in Londonderry, New Hampshire as well as transition planning consultation and coaching to students and families throughout New England.

 

To book an evaluation with one of our expert neuropsychologists, complete NESCA’s online intake form. To book Transition Services in N.H., ask for Dina Karlon. 

 

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

Staying Values-driven During Growth: A Director’s Update

By | NESCA Notes 2019

By: Ann Helmus, Ph.D.
NESCA Founder/Director

It’s finally Spring here in New England – and we are seeing signs of growth and emergence from the winter. At NESCA, we’ve had our own exciting growth over the past few months:

  • In Londonderry, N.H., we brought Dina Karlon on full-time as a Transition Specialist, guiding students and young adults to their next life transition – moving from high school to college, taking a gap year, finding the right residential living environment or entering the workforce.
  • We opened a new office in Plainville, Mass. to serve clients in South Eastern Mass. and Rhode Island communities, with Pediatric Neuropsychologists Reva Tankle and Erin Gibbons available to take on evaluations in the region.
  • Dot Lucci joined our practice to direct our Consultation Services to families, schools, school districts, colleges and universities, businesses and community groups and agencies in Mass., R.I., and N. H.

While growth within an organization is exciting, it’s not without its risks. In previous work experiences, I’ve seen once thrilling and uplifting growth changes turn to a loss of values and culture, and confusion about an organization’s vision. With the recent growth NESCA has experienced, it’s led me to pause and reflect on who we are as a team.

At our core, we are a neuropsychological and educational services organization whose clinicians and practitioners are passionately driven both individually and as the NESCA team to do their best to help children, adolescents, young adults and their families get the information and support they need to be their best. We hire truly committed and dedicated neuropsychologists who want to live, eat and sleep neuropsychology. We take the time to work with families and individuals to unravel stories, dig into their concerns or struggles and identify the correct diagnosis/es (if warranted). Each clinician takes the time to develop relationships with individuals, often through multiple evaluation meetings, school or community observations and talking to stakeholders in the individual’s life to get a complete picture of each and every individual we evaluate. We aren’t about churning out reports or handing off evaluations to less experienced clinicians. Yes, we get reports out in a timely and expected manner, but not at the expense of doing what’s right and being thorough.

We value continued education and strive to stay up on the latest evidence-based treatments. We frequently invite professionals in to meet with our team and present on new resources, treatments, etc. We are always learning through formal continued education courses, the speakers we host, and most importantly, our own NESCA team.

The NESCA team is comprised of dedicated professionals who have grown their networks over the course of many years, both in discipline and geography, and use these connections to benefit our clients. If one of our clinicians is challenged with identifying the right camp, therapist, or other resource for a client, chances are very good that one of our clinicians has built – not just a knowledge base of referrals to recommend – but relationships there as well. If there is a particularly challenging case, our clients benefit from our entire team of experienced clinicians’ insights, ideas, recommendations, perspectives, experiences and resources to help. In fact, we meet on a weekly basis as a team to discuss these cases and come to the best conclusions and recommendations as a cohesive team. That’s why we can take on the difficult, complex cases and come out with the right diagnosis/es and recommended next steps and strategies.

We’ve carefully built and nurtured a work environment where we all feel supported by each other and by the company. NESCA’s staff knows that they aren’t being pushed to rush through neuropsychological evaluations to get the next client in the door. That would only be penny-wise and pound-foolish and would completely fly in the face of our values-based principles that guide our work daily.

Our staff – both new to NESCA and those who have been with us for years, if not from our inception – know they have my full support to conduct the best, most thorough and comprehensive evaluations. This is how we get to know, develop and foster relationships with our clients for years, all the while helping them succeed academically and in life. I’m proud to say that many of our staff clinicians and clients have been with NESCA for many years. As we grow, we will continue to evaluate the efforts we are putting forth to not just maintain but enhance who we are and what we do here at NESCA.

 

About the Author: 

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

 

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists, complete NESCA’s online intake form. To book an evaluation in Plainville, ask for Reva Tankle on the intake form. To book Consultation Services, ask for Dot Lucci. To book Transition Services in N.H., ask for Dina Karlon. 

 

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