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11

What Could It Be: ADHD or Anxiety?

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

Many of my clients find NESCA after experiencing years of difficulty, whether at school, at home, or in the community. They have often been evaluated previously but still do not clearly understand what underlies their challenges. When clients struggle for years, they have often received a variety of diagnoses. The DSM-V provides diagnostic criteria that label a person’s experience due to developmental concerns, learning differences, or psychiatric problems. In essence, diagnoses are a simplified way to describe complex, ever-changing, multi-layered differences and are difficult to pin down with a single term. One of the most challenging diagnoses for a neuropsychologist to make, and a person to live with, is attention-deficit/hyperactivity disorder (ADHD).

ADHD is diagnosed when an individual displays difficulty directing and sustaining their attention to the extent that it negatively affects functioning across multiple domains. They may be distracted by internal processes resulting in daydreaming or struggle to filter incoming sensory information in the environment. For example, sounds, lights, and feeling too hot or cold. Because the regulatory part of their brain is not fully developed, they are more likely to become distracted. ADHD can be tricky, though, because there are many other explanations for why someone struggles with attention that may seem like ADHD but are not. This article focuses on similarities and differences between ADHD and anxiety in children.

When a child is anxious or stressed, whether about getting a good grade, disappointing a teacher or parent, or how he/she is getting home after school, this takes her mind off instruction, work, and social interactions. The result is inattention, but not due to ADHD. Individuals with anxiety may hyperfocus on worry, limiting attention to other information. Furthermore, it is common for children with ADHD to experience anxiety; however, it is most often a consequence of poor attention regulation rather than a cause of inattention. Both conditions can be associated with procrastination, but the basis for delaying work differs. The child with ADHD may struggle with initiating a task, while the child with anxiety may be preoccupied with anticipation about how well she will perform. At times, anxiety and ADHD present so similarly that it can be difficult to distinguish one from the other.

As you can see from the graphic below, there is a tremendous overlap in symptoms between ADHD and anxiety, making a comprehensive evaluation necessary to make an informed diagnosis.

Humans are complex, and a single diagnosis rarely captures their emotional and behavioral challenges.

 

References:

Essentials of ADHD Assessment for Children and Adolescents, First Edition, by Elizabeth P. Sparrow and Drew Erhardt, Wiley, 2014

 

About the Author

Dr. Cynthia Hess graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

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

 

41

Age of Majority: Preparing Students to Make Special Education Decisions as Adults

By | Nesca Notes 2023

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

One of the exciting aspects of being a transition specialist who evaluates and provides consultation to students and schools across the country is that transition services are dictated by the Individuals with Disabilities Education Act (IDEA 2004), a federal law. Students have similar rights across all 50 states regarding how their IEPs must prepare them for postsecondary learning, living, and employment experiences. However, there are additional rights and responsibilities related to special education that are dictated by state laws and regulations. Age of Majority and the Transfer of Rights to students is one of these issues that varies from state to state.

At the Age of Majority, or the age of legal adulthood, in each state, young adults are granted certain legal rights (e.g., voting, marrying, opening a credit card, signing contracts). Each state determines which rights will transfer to young adults within their state. IDEA 2004 gives states the right to transfer educational decision-making rights to students who have reached the Age of Majority—this means that all of the educational rights previously accorded to parents/guardians may transfer directly to the student. The Age of Majority is 18 in most, but not all, states.

In states that transfer educational rights at the Age of Majority, school districts are required to provide notice to parents and students ahead of time so that families are not surprised that the parents’ rights will transfer to the student. Additionally, at least one year before the student reaches the Age of Majority, the student’s Individualized Education Program (IEP) needs to include a statement indicating that the student was informed of their rights under IDEA.

There are exceptions to the Transfer of Rights when a student has been determined to be “incompetent” under state law—this often involves a parent/guardian taking partial or complete guardianship of the student. Students may alternatively have a Power of Attorney drawn up so that a parent can continue to represent their educational interests. States may also have their own processes for electing decision-making when the student reaches the Age of Majority. For example, in Massachusetts, students who have turned 18 are presented with a choice to take over decision-making, share decision-making with a parent or other willing adult, or delegate decision making to their parent or another willing third party; They sign a document indicating their elected choice on or after their 18th birthday.

There are many educational rights that a student may assume when they reach the Age of Majority. Some of these include receiving notice of IEP meetings, consenting to evaluation, placement, and/or an IEP, deciding to drop out of school, or deciding to accept a diploma and end eligibility for transition services. Parents and educators can help students prepare for the Age of Majority and Transfer of Rights ahead of time. Pacer’s National Parent Center on Transition and Employment has put together a handout with tips for doing this important work. Some of the tips are included within my longer list of preparatory activities below:

  1. Start building choice-making and decision-making skills as young as possible.
  2. Teach students about the IEP process in elementary or middle school.
  3. Encourage students to observe and participate in IEP meetings.
  4. Allow students to invite preferred educators, family members, and community members to IEP meetings for support.
  5. Role-play IEP meetings prior to participation.
  6. Begin talking about Transfer of Rights when students first begin attending IEP meetings.
  7. Prior to reaching the Age of Majority, talk about how the student thinks they will want to make decisions across areas of life—What decisions do you want to make totally alone? What decisions do you want to make in collaboration with others? What decisions do you want other people to make for you?
  8. Help students to develop good working relationships with school personnel and team members.
  9. Stay involved in the IEP process even after a child reaches the Age of Majority—but allow the student to be the primary participant in the development of their IEP.

For parents or guardians who suspect that a child will not be competent to handle educational decision-making, it will be important to consult with clinical and legal experts well in advance of the child reaching the Age of Majority. It is also important to keep the IEP team informed regarding any legal proceedings or arrangements that may impact educational decision-making. With that said, many students who are not competent to manage complex medical or financial decisions can be strong participants in their educational processes and transition services. For tools that you can use to help educate students regarding the IEP process, please check out the video and document resources from imdetermined.org. For tools that you can use to explore decision-making and supported decision-making as students approach adulthood, please review these resources from Charting The Lifecourse.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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, call 617-658-9800 or complete our online Intake Form.

8

Why Does My Child Have to Read 20 Minutes Per Night After Being in School All Day?

By | NESCA Notes 2021

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Reading 20 minutes per day has been shown to have many positive benefits. Did you know…?

  • Children who read 20 minutes a day/5 days a week are exposed to 1.8 million words in one school year. Compare this to students who read 5 minutes per day – they will be exposed to 282,000 words per school year.
  • Reading helps foster empathy – a child experiences “walking in someone else’s shoes.”
  • Children are exposed to different ideas and cultures.
  • Reading also improves critical thinking.
  • Reading increases knowledge of correct syntax and grammar, along with robust vocabulary knowledge, resulting in improved writing skills.
  • Students who read 20 minutes per day score significantly higher on standardized tests of reading.
  • Reading with your child, or having them read independently before bed, can help them to relax and wind down from their day.

It is important to recognize that despite all our good intentions, sometimes students are reluctant to read on their own. This reluctance can come from different reasons, such as difficulty reading, not yet knowing the types of books they would enjoy, or even that they would simply rather be playing video games or be on social media. To help make reading more attractive to your child, there are several things you can try:

  • Let the child choose what they are reading – help them find books that are about an area of high interest to them (anything from sports to fashion to history – all is fair game!).
  • If the book they are interested in is above their reading level, you can read to them (model the page) and then have them read it back to you.
  • Allow them access to audio books, and they can follow along with the text.
  • Encourage different types of reading material (comics, graphic novels, magazines, traditional books, etc.).
  • Look for book series – once they enjoy one, they will often want to read the rest!

Getting your child to read is not always easy. However, allowing them to read high interest material, asking them questions to help them interact with the text, and modeling that reading can be fun is a great start!

If your child demonstrates difficulties improving their reading skills, reach out to their teacher and discuss if there are any underlying concerns (visual issues, such as difficulty tracking; reading challenges, such as reduced phonemic awareness, etc.). If you continue to have concerns, consider having your child evaluated by a reading specialist or pediatric neuropsychologist to ensure that such an important skill is supported and developed as your child continues through school and beyond.

Sources

https://www.honorsgradu.com/importance-of-reading-20-minutes-a-day/

The Surprising Benefits of Reading 20 Minutes a Day

https://www.k12reader.com/why-read-20-minutes-a-day/

https://www.understood.org/articles/en/14-ways-to-encourage-your-grade-schooler-to-read

 

About the Author

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

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

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

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

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

She is the mother of one teenage girl.

 

To book a consultation with Dr. Talamo 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, 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.

11

Boredom: The Good, the Bad, and the Ugly

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

According to the APA Dictionary of Psychology, boredom is defined as:

A state of weariness or ennui resulting from a lack of engagement with stimuli in the environment. It is generally considered to be one of the least desirable conditions of daily life and is often identified by individuals as a cause of feeling depressed. It can be seen as the opposite of interest and surprise

In an APA podcast called Speaking of Psychology, Erin Westgate, PhD, a psychologist who studies boredom, suggests that boredom is an unpleasant emotion similar to anger, sadness, fear, and pain. In her efforts to understand and define boredom, Dr. Westgate explored the ways in which attention and meaning affect emotions and explain boredom. She opines that boredom may result from one’s inability to sustain attention, which may occur either when a task is too easy or too hard. It may help to understand why students describe a less preferred subject (e.g., math) as boring. Boredom may also be due to a sense that what we are doing lacks meaning. In both instances, the mind wanders and we are faced with that sense of being alone with our thoughts. Dr. Westgate notes that some thoughts are more engaging than others, and there are certain conditions under which people enjoy or do not enjoy their own thoughts. It has become increasingly difficult for people to sit and think, and consequently they search for ways to escape or avoid the boredom that results. However, boredom is not all bad. Like many things in life, it depends on how we manage it.

Similar to other negative emotions, boredom alerts us that something is wrong in our body, and it is human nature to want to escape or avoid it. When escape and avoidance become the only method to cope with boredom, individuals may begin experiencing chronic boredom, which can be detrimental to emotional and physical wellbeing. When boredom becomes chronic, it no longer works as a useful signal. Boredom can be more impactful than loneliness and is often mistaken for loneliness. When boredom is not well managed, it can lead to depression and self-destructive behaviors, such as self-harm and addiction. As alluded to above, the ability to sit with our thoughts and feelings without trying to avoid or escape them has become increasingly difficult. Perhaps related to the ease with which they can be avoided; for example, when our body sends out the first signal of discomfort, we can distract ourselves by reaching for our phone. An article in TIME magazine stated:

We’re trying to swipe and scroll the boredom away, but in doing that, we’re actually making ourselves more prone to boredom, because every time we get our phone out we’re not allowing our mind to wander and to solve our own boredom problems, Mann says, adding that people can become addicted to the constant dopamine hit of new and novel content that phones provide. Our tolerance for boredom just changes completely, and we need more and more to stop being bored.

Relying on electronics is only one example of a way to avoid and escape the discomfort of boredom. It is highly reinforcing because, in the short-term, it works. However, when it is one’s only tool in the toolbox, it may quickly undermine their ability for learning to manage uncomfortable thoughts and feelings and use them for creating positive change. Therefore, it is necessary to find a positive, opposite behavior to replace the maladaptive behavior. This often leads to an increased sense of purpose and agency, and improved self-esteem and self-concept.

Children and adolescents often complain about being bored, and while boredom is uncomfortable, it can also help to develop skills, creativity, and boost self-esteem. Once boredom sets in, it can be difficult for children to shift their attention to find meaning when confronted with the discomfort of boredom. According to an article published by the Child Mind Institute, boredom can be a great way to teach children how to manage frustration and regulate emotions when things are boring or not going their way. It is not that boredom teaches the skills, but rather it is what they do when faced with boredom. There are many strategies outlined in the article to help parents nurture skills when their children are bored. In general, be aware that behaviors may be attention-seeking, and therefore, should not be reinforced. Otherwise, boredom offers an opportunity for children to do something meaningful that benefits them and those around them. When properly managed, it spurs creativity and innovation. Along the way, it is important to be realistic and recognize that there will be failure, and learning to manage the discomfort of failure is an added bonus.

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

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

 

1

Understanding and Identifying Organizational Challenges

By | Nesca Notes 2023

By Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

When clients come for neuropsychological assessment, a domain of skills that is commonly assessed is executive function. Executive function is a complex set of cognitive and self-management skills that allow for efficient, goal-oriented problem solving and task completion. These skills do not speak to how smart someone is, or whether or not they will achieve a goal. Instead, they speak to the ease with which one works toward their goal – Is their path a nice straight road from beginning to end? Or was it a zig-zagging route filled with stops and starts, redos, and confusion?

Executive function is a broad domain containing many different skills, such as planning, working memory, self-monitoring, impulse control, and organization. This last skill – organization – is one that can be commonly misunderstood. That is likely because people often focus on behavioral organization, meaning whether someone keeps their things in order. While a tidy bedroom and neat locker make it easier to find things, there are other aspects of organization that can have a much greater impact on learning, task completion, and daily functioning. From a neuropsychological standpoint, there are three aspects of organization that should be of focus, including:

  • Behavioral Organization. As noted above, this is the aspect of organization with which people are most familiar. It can be thought of as your “organization of stuff” skills. At home, this may be keeping an organized bedroom, putting things away when done, and knowing how to find things when you need them. At school, this may involve keeping a neat locker or desk, having color-coded binders for your classes, or turning in assignments once you’ve completed them. Individuals who struggle in this area may often lose their belongings, fail to turn in completed tasks, or frustrate their parents with their messy rooms.
  • Organization of Information. This is the organizational skill that is often of most focus within neuropsychological assessment. This is a cognitive aspect of organization, meaning others cannot necessarily observe when someone struggles in this area. This aspect of organization speaks to one’s ability to process information in a manner that appreciates both the details and how they integrate into a “big picture.” This skill is very important for learning, allowing you to consolidate information into memory in a manner that is connected and organized, which makes it much easier to remember and retrieve later on. Think of this as the filing cabinet of the brain. Organization of information and ideas is also important for reading comprehension as well as written expression, including prioritizing ideas and pulling them together in a cohesive manner. Individuals who struggle in this area may be overly detail-focused, missing main ideas or struggling with abstraction. They may also become easily overwhelmed by information, not knowing what is most relevant, which may result in difficulty planning, executing, and drafting writing assignments.
  • Organization of Time. A.K.A. – time management. This organizational skill requires you to both recognize the end goal while also being able to break the task into smaller steps that can be accomplished over a short or long span of time. It requires a recognition of how long each step may take and how to balance such requirements within life’s other time constraints. Individuals who struggle in this area may appear to procrastinate, though the true challenge may lay in difficulty estimating time or understanding how to break things down and create the road map from “here to there.” This is often a person who may be misunderstood as lacking motivation, given their difficulty initiating and completing tasks, though their lack of execution actually stems from difficulties organizing information and time.

Quite often, individuals with organizational challenges do not struggle in all three of the above areas. A child may appear fastidiously organized, with an impeccably organized room and diligent notes; however, they may be relying on this excessive behavioral organization as a means for compensating for hidden challenges with informational organization. They may not know what is most important, so they study excessively for tests or over-include information in their essays. To the observer, they look astute; however, they are cognitively over-extending themselves. As already noted, organizational challenges may also present as the “unmotivated” student, as long-standing difficulty knowing how to break down tasks and manage time may have resulted in helplessness. This is why neuropsychological assessment is often an important tool for understanding and supporting these students – as the underlying challenges may not be behaviorally observable. Positively, executive function skills can be taught to address any of the above concerns, but interventions will always be most effective when the areas of need are clear.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

9

What Is Projective Testing and Why Might My Child Need It?

By | NESCA Notes 2022

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

There can be a great deal of confusion about what kind of testing you want for your child. No wonder when we have so many options – neuropsychological testing, psychoeducational testing, speech and language testing, occupational therapy testing, personality testing, and psychological testing. The part that can be incredibly challenging is that these labels often involve overlapping test measures, meaning that the assessor may choose the same specific tasks that might fall into most or all of these categories. Take cognitive assessment using IQ tests which can be used by a psychologist conducting psychological, neuropsychological, or psychoeducational testing. Another layer of confusion is added for parents when one considers that many professionals in schools or medical practices are also confused and interchangeably use these labels. In an effort to demystify the process, I want to tackle a common question: what is projective testing and why might my child need it?

Projective testing provides psychologists with very specific and unique insight about a person’s thinking habits and processing. Unlike cognitive or academic tests, projective tests do not have a “right answer.” So, projective testing is not going to ask a child to solve a math problem or define a word. It is not going to test how quickly they can name vegetables or see how skilled they are at shifting between sets of the rules. The overall goal of projective testing is to figure out how a child, teen, or adult responds to an ambiguous situation. This means, we ask people to project their brain habits (thinking style, way of interpreting the world, way of processing emotions, way of viewing self and others) onto a situation when it is not clear that there is a “right” or “wrong” answer. A person must use their problem-solving and emotion regulation skills in action. Examples of projective tests include the Rorschach inkblot test, story-telling tasks (e.g., the Thematic Apperception Test or the Roberts Apperception Test), drawings, and incomplete sentences. Projective tests take additional time to administer and usually longer to score, so they are scheduled as separate visits at NESCA.

Why might you use a projective test? There are some situations where projective testing is incredibly useful, such as when a diagnosis of a thought disorder (e.g., psychosis) is in question. It is also very useful for questions of trauma, attachment, anxiety, or mood disorder. Projective testing is also incredibly useful when psychiatric symptoms are confusing. Take the example of someone who is a perfectionistic or very guarded about their symptoms. A person with this profile is very likely to read a question that says, “I am very anxious,” and answer no. However, projective testing can see if there are themes of anxiety by considering how a person responds to an ambiguous situation. Take another example of someone who leans in the other direction and reports many symptoms that overlap with many diagnoses. In this case, many symptoms are endorsed as “yes.” Projective testing can help to provide clarity to narrow down the list, especially without an obvious answer. In both of these cases, it is helpful to access a person’s unconscious brain habits as a key to understanding a person’s functioning.

When would you not use projective testing? I do not use projective testing when my referral question does not need it. For example, a question of a learning disability or ADHD does not require projective testing. Using projective measures would be inappropriate, time consuming, and potentially stressful for a person when it is not needed. Similarly, projective testing is not often used in individuals with Autism Spectrum Disorder as there is little research about how neurodivergent populations respond to the ambiguous stimuli. I also do not use projective testing if neuropsychological testing suggests that a person has an intellectual disability or struggles in their visual processing skills (e.g., NVLD) since many of the projective measures (e.g., Rorschach, story-telling, drawings) use a visual stimulus card. In those cases, it would be inappropriate to assume that a response reflects a person’s emotional processing when it would really be about their visual processing.

Projective testing is incredibly informative and, like other neuropsychological tools, should only be utilized by professionals who are trained to administer and interpret these tests. Since it is not as simple as a correct single answer on an answer key, it is critical that these procedures are administered by psychologists with the advanced training to use and interpret the information. And, like all of our measures, the results gathered using projective measures are data points that are combined with other data points. The performance on one test or demand does not dictate the entire conclusion. A strong and comprehensive assessment will use projective test data as part of a larger understanding of your child. Information gathered in projective testing can highlight important strengths for your child and contribute helpful information to drive treatment.

NESCA has several clinicians who are highly trained and skilled at administering projective testing. If you have questions about projective testing and whether your child needs it, let us know by filling out our online Intake Form.

 

About the Author

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

 

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

10

How Do I Know If My Child Needs Early Intervention?

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

During the first few years of life, parents and caregivers are often tracking baby’s exciting first milestones, such as their first steps or first words. Routine well-child visits at the pediatrician’s office will often include the doctor asking what new skills you have noticed since baby’s last visit—Are they sitting unsupported yet? Crawling? Saying Mama or Dada? It can be stressful when your child is not yet meeting their milestones. It can be especially challenging when you notice they may be behind their peers at childcare or when around same-aged children at family functions.

The Centers for Disease Control and Prevention is a great resource to utilize as reference for what is expected of children by age. You can access more information here: https://www.cdc.gov/ncbddd/actearly/milestones/index.html or through their developmental milestone checklist.

What are age-appropriate milestones?

At a glance, several notable milestones listed by the CDC are as follows:

6 months:

  • Recognize familiar caregivers
  • Reach for toys/objects of interest
  • Roll from their belly to their back

9 months:

  • Respond when you call their name
  • Smile/laugh in response to interactive games, such as peek-a-boo
  • Babble (mama or dada)
  • Bang objects together
  • Sit on their on

1 year:

  • Call their parent by name (e.g., mama or dada)
  • Pull themselves up to stand
  • Walk while holding on to furniture

18 months:

  • Point to show you something interesting
  • Following one-step directions
  • Imitating your actions (e.g., putting on makeup, vacuuming, hammering)
  • Walking unassisted
  • Climbing on and off couches and chairs without support

2 years:

  • Look to you for your reactions in new situations
  • Putting two words together, such as “more milk”
  • Using gestures like nodding/shaking their head
  • Running
  • Eating with a spoon

Should you have any concerns regarding your child’s development, talk to their pediatrician! Your baby may qualify for a referral to Early Intervention (EI), which can help them to gain the appropriate skills in a way that supports you, your child, and your family.

What is EI?

EI is a federal grant program that was established in order to identify children at risk for developmental delays and to help families meet their children’s needs and maximize their potential. EI serves children ages 0-3 and provides a multitude of services depending on a child’s needs. Referrals for EI can be made by caregivers and/or providers for children who are exhibiting delays in their developmental milestones OR for children who have a medical condition that places them at risk for a developmental delay. EI referrals can be made as early as birth for medical conditions, such as prematurity, low birth weight, and Down syndrome. Many children receive referrals for EI from their parents, pediatricians, and/or childcare providers when there are observable delays in meeting speech milestones, motor milestones, speech milestones, and/or social milestones.

Who qualifies for EI?

Once referred to EI, your child will likely undergo a developmental evaluation. They will qualify for services if they have a diagnosed medical condition with a risk for developmental delays OR a delay in one or more areas of development of at least 30% OR a delay in one or more areas at least 1.5 standard deviations below the norm OR there is a questionable quality of skills based on the informed clinical opinion of the multidisciplinary team. Children can also meet criteria if there is a risk for delays due to four or more child or family risk factors (e.g., NICU stay, feeding challenges, chronic illness of a caregiver, lack of social supports for the caregiver).

At the end of the day, you know your child best. If you have concerns, reach out to their pediatrician. You can also reach out to a local EI provider on your own. In MA: https://www.mass.gov/info-details/ei-program-contact-information. In NH: https://www.dhhs.nh.gov/family-centered-early-supports-services.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

 

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. Miranda Milana, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

39

So, You Are Taking a Leave of Absence from College—Now What?

By | NESCA Notes 2022

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

Almost 75% of college students reported moderate to severe psychological distress during the 2020-2021 school year (National College Health Assessment, American College Health Association, 2021). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. In the weeks leading up to Thanksgiving, my appointment calendar consisted primarily of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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, call 617-658-9800 or complete our online Intake Form.

16

Technology to Relieve Holiday Stress – Really?

By | NESCA Notes 2022

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Counseling Services, NESCA

During this holiday season, life for most people gets a bit more hectic. Many of us feel more stressed, busy, and overwhelmed with everyday life as well as preparing for the holidays. Our children are stressed as well, as they feel our stress. Older students feel the end of semester stress of papers being due and final exams looming.

A client, who is a college student, called me the other day and said, “I am just so stressed and angry, I couldn’t wait ‘til my appointment. I am angry at nothing and everything. I am being hard on myself and others.” I reflected on these feelings, and we discussed that, at this time of year, many people feel more stress and have a “shorter fuse.” I reminded him that being angry at himself for being angry wasn’t the solution/remedy; that just intensifies the feeling. Instead, we talked about normalizing his feelings, remembering to focus on his breath, and have compassion. When we focus on our breath, we shift our attention away from the thoughts and feelings that make us spiral. This client plays video games, so introducing him to stress management apps/games was a “no brainer.” I reminded him to use the app at least once a day for a few minutes, especially during this holiday season. This practice helps him and can help all of us to establish a new habit of stress reduction to help us remember how to focus on our breath and shift our attention.

Since most adults and children are using technology daily, let’s focus on spending some of that screen time for managing our mental health and stress levels. Experiment with free versions of apps and find one that resonates with you or your children, then practice it every day. Make it a part of your daily routine for at least 5 minutes. Pick the time that works for you. It is something that can even be done as a family. We establish routines for reading at night, let’s establish a routine of stress management at night, whether it’s an app or another method. Prioritize the time; it will make all your lives better! This habit and skill development will ultimately help us develop stress management skills and be able to use them when we are stressed. The development of these skills also helps us feel less stressed in general. Instead of feeling stress during the holidays, let’s feel the joy, love, and gratitude that abounds.

Listed below are a sampling of several stress management apps related to mindfulness, emotional recognition and regulation, and anxiety/depression to help you and/or your children manage the stress of the upcoming holiday season. Hopefully one of them will resonate with you and your children so that you all may experience more resilience and peace when stress does happen.

Headspace (Children through Adult) is a mindfulness/meditation app that helps people reconnect with their breath. Headspace for Kids focuses on five areas: Calm, Focus, Kindness, Sleep, and Wake Up.

Calm (Children through Adult) is an app that focuses on mindfulness, yoga, guided meditation, breathing programs, improving focus, calming and relaxing music, and more.

Insight Timer (Children through Adult) is an app that includes lessons/classes, talks, music, and more on a variety of topics, such as mindfulness, stress reduction, achieving better sleep, anxiety, yoga, and other areas.

Super Better (Age 13 through Adult) is an app that uses games to build resilience, change mindset, emotional control, mental flexibility, achieve goals – even with challenges – and helps with anxiety, depression, chronic pain, and more.

Mindshift CBT (Teens through Adult) is an app that focuses on anxiety reduction, including worry, perfectionism, social anxiety, panic, phobias, and more.

Breathe2Relax (Teens through Adult) is an app that focuses on diaphragmatic breathing and stress reduction.

Smiling Mind  (Ages 7 through 18) is part of a broader collection of tools/curriculum that focuses on mental health for children and adults (teachers and parent). It focuses on mindfulness, deep breathing, body scan, gratitude, and more.

Positive Penguins (Ages 4 through 11) is an app that helps children understand how their feelings and thoughts are connected and to develop more positive thinking.

Resilient Family, Happy Child (Ages 4 through Adult) is an app that uses simple mindfulness- based movement to support the development of resilience and self-regulation.

Mightier (Ages 6 through 14) is a biofeedback tool that uses a heart sensor to help children understand their emotions and teaches them calming strategies.

HeartMath (Ages PreK through Adult) is a company that has many tools, games, music, curriculum, books, and more that focu on stress reduction. They have biofeedback apps and desktop computer versions for single users, classes, or multiple clients. They all use a heart sensor. Inner Balance is the app it uses within the program.

DreamyKid (Ages 9 through 18) is an app that uses guided visualizations, meditations, and affirmations related to mindfulness.

WellBeyond Meditation for Kids (Ages 4 through 8) is like DreamyKid but is geared towards younger kids with guided meditations, visualizations, and breathing exercises.

Breathe Think Do Sesame (Ages 2 through 5) is an app that helps children learn deep breathing, problem solving, an emotional vocabulary, positive thinking habits, and more through guided meditations, visualizations, stories, breathing exercises, and more.

Mindful Powers for Kids (Ages 5 through 10) Through play, games, stories, and more, kids learn about emotions, mindfulness, positive thinking, body scanning, and more. It uses Acceptance and Commitment Therapy (ACT) as a guiding principle of its platform.

 

About the Author

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

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

 

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

 

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.

 

6

Low Motivation-based Procrastination: Tips for getting over the hurdle

By | NESCA Notes 2022

By: Lyndsay Wood, OTD, OTR/L
NESCA Transition Specialist & Occupational Therapist

Procrastination is affecting a lot of us these days. There is a wide variety of reasons that people put things off until the last minute. In a previous blog, I discussed tips for anxiety-based procrastination which you can read here. Today I would like to talk about procrastination related to low motivation.

Have you ever had a day where you cannot get off the couch, and you want to keep binge watching your favorite show? Or, maybe you have noticed your child cannot seem to get off TikTok to do their homework. These are all examples of procrastination as a result of low motivation.

It can be extremely challenging to find the motivation to do things we don’t want to, especially when it means transitioning away from the things that bring us joy. You may have noticed this getting worse as the weather turns colder and the sun sets earlier each day. Many people find that their mood and motivation hit a low during these fall and winter months. So, how do you overcome this feeling?

Here are five strategies to get over the procrastination hurdle when motivation is low.

1. Momentum Stairs – Do you remember learning about Newton’s Laws of Motion? The Law of Inertia says an object at rest will stay at rest, and an object in motion will stay in motion. Makes sense, right? If you have been sitting still and engaging in an activity you enjoy (I’m looking at you, Netflix), it can be extremely difficult to transition to the task you have been putting off.

Sometimes, the best thing to do is to start with an activity that is more enjoyable just so you can get moving. For example, if you need to write a paper, but you can’t get off the couch, build your momentum by making yourself a cup of tea. That gets you off the couch and away from the TV, and once you are up, maybe you complete a small chore that isn’t too difficult (watering your house plants, wiping the counter, etc.) then you can move on to start writing your paper.

To initiate that movement, it is easiest to start with something easy and work your way toward the task that you have been procrastinating. Some folks find it helpful to picture a set of stairs; the activity they enjoy is at the top and the uninteresting task is at the bottom. You must take small steps down the stairs to build momentum toward the activity at the bottom of the stairs.

2. Habit Stacking – Habit stacking is a great strategy to help build routines out of existing habits and overcome low motivation. Once a routine is in place, it takes a lot less energy and motivation to complete those regular activities since they have become automatic.

The principle behind this strategy is that you slowly add to existing habits until you have formed a routine. For example, let’s say you eat breakfast every morning, but have not been good about taking your vitamins. By habit stacking, you could start taking your vitamins every day as soon as you finish breakfast, thereby accomplishing two things much more easily than having to remember to take your vitamins separately later in the day.

It may be helpful to place your vitamins in your pantry so there is always a visual reminder when you are making breakfast. Stacking habits in this way can make it much easier to form new routines that help you get past low motivation and accomplish bigger goals.

3. Reduce Barriers – Another helpful strategy for low motivation is to reduce the barriers needed to start the activity. Sometimes it can feel overwhelming to think about cooking that homemade meal you have been wanting to try, or to deep clean an area of your house that you can never get to. That results in low motivation, and the best way to overcome it is to reduce any barriers to initiating the activity.

One suggestion is to take all the materials you will need to complete the task out the day or night before. That can help reduce the barriers to getting started when you are feeling tired later in the day. You could also create checklists for yourself to reduce the cognitive load for certain chores. For example, a house cleaning checklist. Follow this checklist each time you have to clean so that you do not need to use as much brain power. When you can reduce the barriers to starting an activity, it will be so much easier to get up the motivation to complete it.

4. Pairing – Try pairing an activity you must do with something you enjoy doing. When motivation is low, sometimes the only way we can get ourselves up and moving is by combining the activity we have been putting off with something enjoyable. The key to making an effective and lasting pair is to ensure you only engage in the specific fun activity while completing the unpreferred task.

For example, if one of your goals it to take a daily walk to improve your health, but you cannot find the motivation to do it each day, it might help to pair it with a new audiobook that you are really excited about. Only allow yourself to listen when you are walking because that will transform the walk itself into a reward, and you will likely stop dreading it.

5. Five-minute Max – The five-minute max strategy is excellent for low motivation – and it’s easy to accomplish. Set a five-minute timer and start the activity you have been putting off. Tell yourself that you can stop the activity after five minutes. More than likely, once you start, you will be able to keep going, but you have the option to stop after just five minutes. Knowing that you only have to work for five minutes can help when motivation is low and make a task seem a lot less exhausting.

There is no perfect strategy that works for everyone in every situation, but adding these strategies to your toolbox can help you experiment with which methods work best for you. See if you can find just one tool to help you in those moments when low motivation is impacting your ability to get moving.

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

 

To book coaching and transition services at NESCA, 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, 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.

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