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

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

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Image of a student struggling to write and a quote from Alissa Talamo, Ph.D.

Why Does My Child Struggle With Writing?

By | NESCA Notes 2026

Image of a student struggling to write and a quote from Alissa Talamo, Ph.D.By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

A concern I often hear from parents is that their child is bright, creative, and articulate—able to express ideas clearly in conversation—but gets “stuck” when asked to put those same thoughts into written form. Instead of demonstrating the full extent of their knowledge, these children often write just enough to complete the assignment, leaving teachers and parents wondering what’s holding them back.

Difficulties with written expression can arise for a variety of reasons. For some children, an expressive language disorder makes it challenging to find the right words and organize their thoughts on paper. Others may have fine motor difficulties, making the physical act of writing laborious and frustrating. Children who struggle with spelling often limit themselves to simple words, even if their spoken vocabulary is much richer. These challenges are relatively straightforward to identify, but there are many children who don’t fit these patterns—children who seem to have all the necessary skills yet still find writing to be an uphill battle.

In these cases, neuropsychological testing often confirms what parents already suspect: the child is intelligent, insightful, and capable of high-level thinking, but something is interfering with their ability to express themselves in writing. One of the most common underlying issues is difficulty with executive functioning. Executive functioning is a set of mental skills that includes planning, organization, time management, working memory, attention control, task initiation, self-monitoring, impulse control, emotional regulation, cognitive flexibility, goal setting, and problem-solving. Writing is a uniquely demanding task because it requires the simultaneous use of many of these skills. To write effectively, a student must generate ideas, organize those ideas, keep track of them in working memory, and attend to mechanics like spelling, punctuation, and grammar—all at the same time. It’s no wonder that writing can feel overwhelming!

The good news is that once a child’s specific areas of weakness are identified, there are many strategies and supports available to help them improve their writing skills. Executive functioning tutoring can be especially beneficial, teaching students how to use graphic organizers (such as compare/contrast charts, part/whole relationships, or cause/effect diagrams) and writing templates to structure their thoughts. Tutors can also help students develop strategies for catching mistakes that result from inattention to detail, such as errors in grammar, spelling, or capitalization. In addition, tailored recommendations can be made for in-class support, allowing the student to build their writing skills in a supportive environment.

Why Neuropsychological Testing Can Make a Difference

If your child is struggling with writing, neuropsychological testing can be an invaluable tool. This comprehensive assessment goes beyond surface-level observations to identify specific strengths and weaknesses in cognitive, language, motor, emotional, and executive functioning skills. By pinpointing the root causes of writing difficulties, neuropsychological testing provides a roadmap for targeted interventions and accommodations. With the right supports in place, children can overcome barriers to written expression, gain confidence in their abilities, and more fully demonstrate their knowledge and creativity—both in school and beyond.

 

About the Author

Alissa Talamo headshotWith 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 daughter.

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

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

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Image of a sign saying, "You Belong Here."

Is Inclusion Enough?

By | NESCA Notes 2024

Image of a sign saying, "You Belong Here."By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

In the United States, we have federal and state laws that support individuals with disabilities: The ADA, IDEA, Section 504 of the 1973 Rehabilitation, Chapter 766, Chapter 688, and more. Each of these laws supports the inclusion of individuals with disabilities at school, in employment, and in the community by mandating wheelchair ramps/automatic doors, mainstreaming children with special needs into general education classrooms, assistive technology for an individual at a workplace, and more. We have made many strides in including people with disabilities; yet there is still a long way to go.

In education circles, the word inclusion has effectively replaced the term mainstream. By definition, inclusion means placing students with disabilities in regular or “mainstream” settings along with their “non-disabled” peers, focusing on the “physical integration” of children with disabilities rather than, what was more common at the time – placing them into separate, segregated or “self-contained” settings with other “disabled peers.”

Inclusion embodies a shift from just physical inclusion/integration to a broader definition that promotes equal access and support for all children, creating an environment that promotes the success of every student regardless of ability (Karlsudd, 2017). Inclusion, at its best should offer universally designed environments/curricula, specialized supports, services, accommodations, modifications, and differentiation in instruction, and more, as all students – whether identified as “special needs” or typical – are unique in their learning profiles.

Education lecturer and researcher Gregor Maxwell, 2018, describes in a published article, three perspectives on inclusion. They are:

  • The Compensation Perspective is like the deficit model or medical model which emphasizes a child’s impairment or limitation as the reason for exclusion. It focuses on Identifying the limitation/deficit and remediating it through individualized accommodations and supports that enable the student to be included.
  • The Critical Perspective is comparable to the Social Model of Disability in that it identifies the problem within the broader context of the environment, and the focus is on changing policies, structures, and attitudes about disability and inclusion.
  • The Dilemma Perspective is a critique of the Compensation and Critical Perspectives. It emphasizes that meaningful participation is central to inclusion, and that inclusive practices need to recognize and celebrate the diversity of all children regardless of whether they have a disability or not. Participation is defined as the involvement in life situations with family, same-aged peers, and other community members, and is distinct from inclusion, according to the International Classification of Function, Disability, and Health (ICF) of the World Health Organization.

While individuals with disabilities are being included and participating in schools, in employment settings, and in the community, there still seems to be the lingering question of, “Is inclusion and participation enough?” Do individuals with disabilities feel valued and honored for who they are? Are their strengths being recognized (ideally, the new Massachusetts IEP form should help with this)? Do they feel like they are “one of the gang,” like they belong/fit it and have friends? Having worked in many public schools, I think many students with disabilities are participating in inclusion activities but don’t feel like they belong nor are valued for who they are.

Erik Carter, professor of Special Education at Vanderbilt University, has studied inclusion and belonging for many years. He concludes, “Where we once pursued integration, we now talk about promoting inclusion. But my sense is that both terms fall short of what really matters most. People want to be more than merely integrated or included. They want to experience true belonging.” In more recent years, schools have been focusing on social and emotional learning (SEL), yet many students with and without disabilities still feel isolated and like they don’t fit in/belong. Belonging, feeling valued for who one is and being recognized for one’s strengths, is more significant than inclusion. It is at the very core of who we are as humans; it is a basic need. Let’s help our special needs students feel that they belong. Let’s hope that as the new MA IEP, with its focus on student strengths and participation, will be afford us the opportunity to focus on what truly matters…a sense of belonging for all of our students.

For more information and helpful handouts about Erik Carter’s approach, visit: Progress Center Reflecting on our Practice: Ten Ways Schools Can Foster Belonging Among Students With and Without Disabilities https://promotingprogress.org/sites/default/files/2022-02/Fostering_Belonging_Handout.pdf

 

Resources

Erik Carter https://www.erikwcarter.com

Karlsudd, P. (2017) The Search for Successful Inclusion. DCID, 28(1), 142-160.

Maxwell, G.R. Granlund, M. & Augustine, L. (2018) Inclusion through participation: Understanding participation in the international classification of functioning, disability, and health as a methodological research tool for investigating inclusion. Frontiers in Education, (3), Article 41, 1- 16.

 

About the Author

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

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

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

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

 

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Visuals of a covid and pregnancy test not the same as the visual with a child being tested; quote from Dr. Ann Helmus

Test Results Are Not The Answer

By | NESCA Notes 2025

Visuals of a covid and pregnancy test not the same as the visual with a child being tested; quote from Dr. Ann HelmusBy Ann Helmus, Ph.D.
Founder & Director, NESCA

A few days ago, a routine blood test showed high cholesterol. My doctor was concerned and suggested I start on a life-long medication.

But here’s what was missing from that recommendation:

Six weeks earlier, I had Covid. When I tested negative, I launched into a grueling stretch of all-day meetings, international travel, public speaking, and disrupted sleep. I never fully recovered.

At the time of my blood test, I was still in a post-viral fatigue phase, which is known to increase cholesterol. All other medical tests showed normal results. Instead of looking at the pattern of test results, my doctor focused on the one abnormal value, which likely reflects my lack of adequate recovery from Covid and travel stress, not an underlying problem with cholesterol.

This experience illustrates an important principle in neuropsychological evaluation: An individual test result rarely speaks for itself. It must be interpreted in the context of other results, history, and clinical observation.

There is no test for ADHD or for ASD or for LD or any of the other conditions that we see. There are only data points to be connected. There is no single test result that can explain: why a child is struggling, what the underlying issue is, or the type(s) of support that will help them thrive.

Those answers come from interpretation that involves:

  • Deep developmental history-taking
  • Pattern analysis across multiple measures
  • Direct clinical observation
  • Integration of cognitive, emotional, academic, and behavioral data
  • And years of diagnostic experience

A neuropsychological evaluation is not like a Covid test, the results of which can be easily interpreted by a layperson. Neuropsychological testing results need to be carefully analyzed and interpreted by a highly trained professional relying on their experience and clinical judgement to determine the meaning of the results, and, most importantly, what they mean for treatment.

When interpretation is shallow, children are likely to be improperly diagnosed, which leads to:

  • Wrong educational placements
  • Inappropriate medications
  • Mismatched interventions
  • Years of frustration for a child who was misunderstood

A high-quality evaluation does not simply label. It provides a proper explanation that leads to meaningful intervention. We don’t treat numbers. We don’t treat checklists. We don’t treat isolated test results. We treat human beings.

 

About the Author

NESCA Founder and Director Ann Helmus, Ph.D., is a licensed clinical neuropsychologist who has beenAnn Helmus headshot practicing neuropsychology for 35 years and has been director of NESCA’s Neuropsychology practice for nearly three decades, continuously training and mentoring  neuropsychologists to meet the highest professional standards.

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

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

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An Occupational Therapist’s Perspective – How AI Can Support Teens and Young Adults with Life Skills

By | NESCA Notes 2025

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

There is constant discussion in the media about artificial intelligence (AI) technology and the impact it will have on the world. With the availability of ChatGPT and other AI technologies, the way we work, learn, and live will change significantly. While change can be difficult – and there are often many considerations to make before adopting a new technology system – ChatGPT and other AI platforms are useful tools that can support different aspects of life when used properly. Specifically, they may be very helpful in developing and supporting life- and transition-related skills for teens and young adults. Here are several ways that AI tools can support independence with real-life skills.

1.Meal Planning and Grocery Lists: Often meal planning can be daunting, and it heavily relies on strong executive functioning skills. To make this process easier, AI technology can be utilized. Simply tell ChatGPT that you would like a meal plan for the week (or any amount of time you desire), and it will create a specific meal plan and provide the grocery list if requested. It will also break down the nutritional value if requested. You can input dietary restrictions or any special considerations, and ChatGPT will create a plan in seconds. Below is an example of the prompt I provided and the response I received.

Prompt I input: Create a one-day vegan meal plan with a grocery list. Make sure it is high in protein.

Response from ChatGPT:

Breakfast:

  • Tofu Scramble with Spinach and Mushrooms
    1. 1 block of firm tofu
    2. 1 cup of spinach
    3. 1 cup of sliced mushrooms
    4. 1 tbsp of olive oil
    5. 1/4 tsp of turmeric
    6. Salt and pepper to taste
    7. 2 slices of whole grain toast

 Snack:

  • Apple and Almond Butter
    1. 1 apple
    2. 2 tbsp of almond butter

Lunch:

  • Quinoa and Black Bean Salad
    1. 1 cup of cooked quinoa
    2. 1/2 cup of black beans
    3. 1/2 cup of diced bell peppers
    4. 1/2 cup of diced tomatoes
    5. 1/4 cup of chopped cilantro
    6. 1/4 cup of diced red onion
    7. 1 tbsp of olive oil
    8. 1 tbsp of lime juice
    9. Salt and pepper to taste

 Snack:

  • Roasted Chickpeas
    1. 1 can of chickpeas
    2. 1 tbsp of olive oil
    3. 1 tsp of paprika
    4. 1/2 tsp of cumin
    5. Salt and pepper to taste

 Dinner:

  • Lentil and Vegetable Stir Fry
    1. 1 cup of cooked lentils
    2. 1 cup of mixed vegetables (broccoli, carrots, bell peppers, etc.)
    3. 1 tbsp of olive oil
    4. 1 tbsp of soy sauce
    5. 1/2 tsp of garlic powder
    6. Salt and pepper to taste
    7. 1 cup of brown rice

 Grocery List:

  • Tofu
  • Spinach
  • Mushrooms
  • Whole grain bread
  • Apple
  • Almond Butter
  • Quinoa
  • Black beans
  • Bell peppers
  • Tomatoes
  • Cilantro
  • Red onion
  • Olive oil
  • Lime juice
  • Chickpeas
  • Paprika
  • Cumin
  • Lentils
  • Mixed vegetables
  • Soy sauce
  • Garlic powder
  • Brown rice

This meal plan provides approximately 90 grams of protein, which is well above the recommended daily intake for most people.

 

2. Role Playing Social Scenarios: ChatGPT can create role playing scenarios to help teens and young adults navigate challenging or new social situations. This can help teens figure out what wording they may want to use and what someone may say in response to prepare for an interaction. Below is an example of a role play created by ChatGPT to practice social introductions.

Prompt I input: I am trying to make friends. What is a good way to introduce myself to a classmate? What might she say back? Can you create a role play?

Response from ChatGPT:

Role Play:

You: Hi there! My name is Jane. What’s your name?

Classmate: Hi, Jane! I’m Sarah.

You: Nice to meet you, Sarah! How’s your day going so far?

Classmate: It’s going pretty well, thanks for asking. How about you?

You: It’s going pretty good too. I’m excited to be in this class. What do you think about it so far?

Classmate: Yeah, me too! I’m really interested in the subject matter. What about you?

You: Same here! I think it’s going to be really interesting. Hey, do you want to grab lunch together sometime this week and chat more about the class?

Classmate: That sounds great! I would love to. How about Thursday?

You: Thursday works for me. Let’s plan on meeting in the cafeteria at noon?

Classmate: Perfect. I’ll see you then!

You: Great! Looking forward to it. See you on Thursday, Sarah.

Classmate: See you then, Jane!

 

3. Writing Professional Emails: Many teens and young adults struggle with composing professional emails. Determining what to say and making it professional can be very difficult for folks who struggle with social pragmatics, written language, anxiety, and executive functioning. When provided with a prompt, ChatGPT can help support this skill. Below is a sample email composed by ChatGPT to ask a professor for an extension on an assignment because the student has been sick.

Prompt I input: Write a professional email to my professor asking for extended time on a project because I am sick.

Response from ChatGPT:

Subject: Request for an Extension on Project Submission

Dear Professor [Name],

I am writing to request an extension on the project submission deadline, which is due on [date]. Unfortunately, I have been unwell for the past few days, and I have been unable to work on the project as planned. I am currently under medication and resting to recover fully.

I am aware that the project is a crucial part of our coursework, and I understand the importance of meeting the deadline. However, given my current health condition, I am finding it challenging to complete the project on time. I am hoping that you can grant me an extension of [number of days] days to submit the project.

I assure you that I will utilize the extended time to work diligently on the project and submit it as soon as possible. I am willing to accept any penalty that comes with the late submission, and I am committed to ensuring that the quality of my work is not compromised.

Thank you for considering my request. I appreciate your understanding and support during this challenging time. Please let me know if you require any further information or clarification.

Sincerely,

[Your Name]

 

4. Job Applications: ChatGPT can provide a significant amount of support around job applications. ChatGPT can create a resume template, provide cover letter examples, outline a cover letter, and create sample interview questions. Below is a sample outline created by ChatGPT for a cover letter to Starbucks.

Prompt I input: Create an outline for a cover letter to Starbucks

Response from ChatGPT:

Introduction

  • Briefly introduce yourself and express your interest in working for Starbucks

Relevant experience and skills

  • Highlight any previous experience or skills that would make you a good fit for the company
  • Mention any experience working in customer service or the food and beverage industry
  • Emphasize your ability to work in a fast-paced environment and handle multiple tasks at once

Passion for coffee and the Starbucks brand

  • Discuss your love for coffee and how it has influenced your desire to work for Starbucks
  • Mention any knowledge you have about the company’s values and mission

Availability and willingness to learn

  • State your availability to work and any flexibility in your schedule
  • Express your eagerness to learn and grow within the company

Closing

  • Thank the reader for considering your application and express your excitement for the opportunity to join the Starbucks team.

These four examples are just a few of the many ways that AI can help support our teens and young adults with real-life skills. As with anything that is computer-generated, it is important to teach our teens and young adults to review the output and modify information for their needs, match their own voice, and make it their own. It is exciting to see how these methods will evolve and be utilized to supplement and support learning and independence in the future.

 

Note: it is important to make sure to check school/company policies around AI use prior to using the technology and to remember that AI is not human and therefore may not afford the “human touch” that is still essential.

 

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. 

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

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Image of an adult looking at a tablet with a child and a quote from Dr. Hernandez Medellin

Looking for the Best Holiday Gift?

By | NESCA Notes 2025

Image of an adult looking at a tablet with a child and a quote from Dr. Hernandez MedellinBy Luisa Hernandez Medellin, Psy.D., PMH-C
Pediatric Neuropsychologist, NESCA

I have three children, ages 7, 13, and 20. I have seen most consoles from the past two decades, from the Wii U to the PS5, including a couple of Nintendo DS versions and X-Boxes. I have purchased Minecraft swords, mini kitchens, baby dolls, Little People, tablets, costumes, skateboards, Rubik’s Cubes, bikes, Pokémon cards, Ninja Turtles, makeup sets, Robux, Battle passes, and phones. And every year, I get the same mixed feelings about the value of gifts, their meaning, and their purpose, especially when it comes to electronics.

As a pediatric neuropsychologist, I want my children to get toys and games that are fun and instill curiosity and creativity. I want their gifts to encourage them to learn new skills, go outside, and play with other kids, but I also understand that some of the skills they learn now will be different from the ones we learned as we grew up.

Online group games can teach kids how to play as a team, communicate with others, assign and/or accept roles, strategize, and reach a common goal. Supervised and monitored by adults, video games can also teach them discipline, limits, and boundaries. How? Because even if they are teenagers, our kids need to learn that using electronics is a privilege, not a right. They need to be monitored regarding the content of their games, their online conversations, and the impact of their actions in the digital world. To use their devices, parental controls must be enabled, and their game’s rating must be appropriate for their age. Their Discord account – if allowed one – must be accessible to the parents for them to check it as needed. The older they get, the “spicier” the conversations. But that also opens the door to having more thoughtful and meaningful conversations with them about cyberbullying, racism, discrimination, sexting, and pornography, as well as where you stand regarding family values, ethics, morals, and life in general.

The same is true of phone use and social media. Research says that having access to social media before the age of 16 has a major negative impact on self-esteem, body image, and mental health – especially in girls – as unfortunately, the algorithms feed them negative ideas and unrealistic expectations about their bodies, as well as relationships, making them more prone to depression and anxiety. While the emotional effects on boys are typically not as severe, the free access to the virtual world tends to expose them to sex, pornography, drugs, and aggressive content earlier, if social media is not supervised.

Therefore, if you ask me, and all the other concerned parents and social scientists, I would not recommend giving kids a smartphone until they are 12-13, depending on their level of maturity and the level of honest communication with each other. And once they have one, the apps downloaded to their phones must be approved by their parents (both iPhones and Androids let you create that set-up). Likewise, their access to YouTube, Instagram, Snapchat, etc., must continue to be monitored by parents until they are adults. The misuse of devices and social media should have consequences and must not be taken lightly. If, as a parent or caregiver, you would not allow certain behavior or vocabulary in person, it should not be allowed in the virtual world either.

Here are other factors to consider when deciding when your child is ready for a smartphone:

  • Child’s maturity: Assess your child’s responsibility, self-control, and ability to handle the device’s features and potential social pressures.
  • Need for communication: Consider if the child needs a phone for safety and communication due to independence (e.g., biking to school, after-school activities).
  • Alternatives to a smartphone: Before getting a smartphone, consider alternatives like a basic phone or a smartwatch with tracking and communication features but without internet access.
  • Wait Until 8th pledge: A movement called “Wait Until 8th” encourages parents to delay giving children smartphones until at least eighth grade, with the support of other families to reduce peer pressure.

Now, for the younger ones, I also have a word of caution for the use of tablets and other devices. Research shows that children under two should not be “plugged” into a tablet, as it reduces socialization time and may affect language development. With supervision, including limiting the time of use, after age four, children could use it for specific educational games and to watch videos for short periods. All tablets allow you to set up parental controls as to what they can do/watch, and for how long, so parents… learn to use them. And please, make sure you do not set up an Apple account/number with free texting or FaceTime on your child’s tablet, as it would pretty much work the same way as giving them a smartphone.

I once read that the best holiday gift a child can get is the one that comes accompanied by a caring adult – and I think that is still true for all electronics. The world we grew up in no longer exists, and this era requires involved parents who are willing to learn, guide, set limits, and model responsibility and integrity while having fun with the new technologies at hand.

 

Headshot of NESCA Pediatric Neuropsychologist Dr. Luisa Hernandez MedellinAbout the Author

As a bilingual pediatric neuropsychologist, Dr. Hernandez Medellin conducts comprehensive and culturally sensitive neurodevelopmental and neuropsychological assessments, comprehensive diagnostic evaluations, and effective care plans, providing appropriate recommendations for the client’s school, home, and the community. She specializes in the identification and assessment of neurodevelopmental disorders such as Autism Spectrum Disorders, ADHD, developmental and learning disorders, and their co-occurrence with anxiety and mood disorders. She also works with children and young adults with acquired brain injuries, epilepsy, brain tumors, strokes, general medical conditions, and genetic disorders affecting the nervous system. She is a native Spanish-speaker, passionate about serving the eclectic and vibrant South Florida community, as well as international patients looking for high-quality and compassionate care.

To book evaluation services at NESCA in Coral Gables, Florida, complete NESCA’s online intake form. 

To book a neuropsychological evaluation or other services at NESCA’s New England offices, complete NESCA’s online intake form. 

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

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Image of kids helping to cook in the kitchen and a quote from Dr. Yvonne Asher

Kids in the Kitchen

By | NESCA Notes 2025

Image of kids helping to cook in the kitchen and a quote from Dr. Yvonne AsherBy: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

Cooking Thanksgiving dinner usually takes me about 8 hours by myself. With help, it’s closer to 12. But my kids LOVE to help. They always want to mix and pour and measure and dump ingredients hour after hour, standing beside me on a wobbly kitchen chair. I’ll leave the question of safety – you know your child best in that respect – except to say that the heavily marketed “Montessori style” kitchen tools are pretty great. Instead, I want to talk about the neurocognitive benefits of helping with cooking. There are other, wonderful benefits – bonding, sharing memories and family stories, creating traditions – but those probably do not require a neuropsychologist to opine on.

First and foremost, cooking is science and math. Actually, a ton of math. Addition, subtraction, multiplication, division, fractions, and more. Having company? We probably need to double our usual brownie recipe. Only Aunt Sue and Jimmy like cranberry sauce? Let’s halve that one. We need one and a half cups of flour for this pie crust, but only the one-quarter cup measure is clean. How many quarter-cups will we need? For science, we have states of matter, heat transfer, and chemical reactions. Why do carrots turn green in carrot cake? How do baking soda and vinegar get a chocolate cake to rise? What makes those dinner rolls so fluffy? The age of your child is (almost) irrelevant – younger children are intrigued by more basic concepts, and older ones can understand more complex and nuanced ideas. When I was a preschool teacher (long before my current career), I can still remember the wide eyes of my barely 3-year-old pupils when watching heavy cream turn into butter, yeasted dough turn into bread, and disparate ingredients turn into delicious cookies.

There is also a tremendous amount of executive functioning in cooking and food preparation. As anyone who has hosted a meal or, frankly, just tried to get dinner on the table before 9pm, will know, planning is crucial. Holding information in mind (working memory), organizing, setting smaller goals in the service of larger ones, tracking progress through multiple tasks, and checking one’s work are all vital to ending up with a special meal (did you remember to put the butter in the mashed potatoes???). If anyone in your crowd has particular eating requirements (babies learning solids, allergies, vegan/gluten-free diets, etc.), the executive functioning demands are ratcheted up by a lot. And, if you are the kind of person who sets an elaborate table with décor and such (my kids are lucky if I remember to grab a tablecloth), you have even more planning, organizing, and task management to do.

Last, but most certainly not least, learning to plan menus, shop, prepare food, cook, and bake are phenomenal life skills. Life skills are vital for everyone, but especially for individuals with developmental disabilities. Strong, confident mastery of life skills is critical for adolescents and young adults to achieve independence. I’m still patiently awaiting the day that one of my kids can cook dinner all by themselves, but I will be immeasurably pleased and proud when they do.

It is a commitment to have kids help in the kitchen. They make unbelievable messes (I never knew how many places powdered sugar could end up), ruin dishes with expensive ingredients, and most certainly introduce germs into food (even with the best of handwashing practices and “DON’T TOUCH YOUR FACE” admonishments). But this is the space between ideal and real that we can inhabit in service of teaching. Yes, it will take longer. Yes, things you envisioned may absolutely not happen (or not happen the way you hoped). Yes, it will be a crazy amount of work for you. Yes, you may need an extra grown up to actually help while your child “helps.” (You can, of course, designate certain dishes or elements of dishes as appropriate for “help” and others “just for grownups.”) But this is an incredible opportunity to help your kids learn math, science, executive functioning, and life skills in ways that are meaningful, filled with love, and built in to the fabric of their lives.

 

About the Author

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

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

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

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

 

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

 

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

 

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Dot Lucci and Dr. Ann Helmus consulting internationally

Advancing Inclusion and Education Internationally

By | NESCA Notes 2025

Dot Lucci and Dr. Ann Helmus consulting internationallyBy Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Expanding on NESCA’s previous work in the Philippines and other Asian countries, this October, NESCA’s Founder and Director Dr. Ann Helmus and I widened NESCA’s outreach and education around the world, traveling to Central America, specifically Honduras, Nicaragua, El Salvador, and Costa Rica.

During our time in Central America, we presented multiple full-day workshops to various educational

NESCA’s Dot Lucci and Dr. Ann Helmus with a group of Central American Principals at the Association of American Schools of Central America Conference

professional and administrative audiences at the Association of American Schools of Central America conference, the Elementary Principals Conference, and at individual schools. The full-day workshops included information about: the presentations and diagnosis of various conditions, such as ADHD, ASD, SLD, anxiety, etc., how to best serve these students in general education classrooms, and the most current thinking on specific interventions and curriculums.

Along our journey, Dr. Helmus also presented to parents in Nicaragua and Honduras, discussing what exactly makes a high-quality evaluation, what an evaluation should include, and how to integrate all the findings to produce individualized recommendations for students.

On this trip, our consultations consisted of onsite visits that provide professional development, modeling, direct service of instruction/ongoing virtual consultation, and the sharing of resources and tools. We help these teams develop or enhance their programs and systems aimed at supporting students with special needs. While much of this work pertains to educational programming, it also involves expanding the mindsets of some teachers about neurodivergent students, who may require additional time and effort than typically developing students. In our work, we are helping teachers to recognize students’ disabilities, how they present, and how to work with the various challenges while identifying and capitalizing on their strengths.

Consulting internationally allows us to share our knowledge and expertise of neuropsychological assessment and educational practices with schools and families abroad, where resources may be scarce or non-existent. While each country has special education laws pertaining to inclusion, when children struggle in these classrooms, there are unfortunately limited resources for them. Many of these students are expelled and do not receive an education due to aberrant behavior. There are some separate “special education” schools, but these are also limited in their ability to educate neurodivergent children. In all of these countries, the training of teachers in special education is not in-depth, which is why NESCA was there to support their efforts. This work is vital to the improvement of the education of all students and especially those with special needs.

With very few – if any – related service professionals in this region (i.e., neuropsychologists, SLPs, OTs, etc.), many students go without direct services or travel to Miami for evaluations and care during the summer months. Because of the lack of supports in this region, we noticed more clients over the past several years traveling to Boston for evaluations and services. This is one of the reasons NESCA opened an office in Miami, more conveniently offering better supports and services for our Central American clients.

We look forward to continuing this consultation work with schools, organizations, etc., while also making big differences for families on a more individualized level, educating them on how they can support their children.

Our work in international schools and families is rich and rewarding, and is making big differences.

 

About the Author

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

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

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

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

 

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Image of a child appreciating nature around them along with a quote from Dr. Manning

Growing Grateful Kids

By | NESCA Notes 2025

Image of a child appreciating nature around them along with a quote from Dr. ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

Growing Grateful Kids: Tips for Fostering Resilience Through Gratitude

Gratitude, or the quality of being thankful and the readiness to appreciate the good in life, is especially important for youth today. It helps promote resilience, emotional well-being, and positive relationships in an increasingly complex and fast-paced world. By fostering gratitude, young people can develop a stronger sense of self-worth and perspective, empowering them to navigate challenges with optimism and empathy. Parents and caregivers play a vital role in helping children and teens develop the practice of gratitude. Research in resilience and positive psychology consistently shows that practicing gratitude helps individuals overcome adversity, enhances everyday well-being, improves mood, and strengthens interpersonal relationships. Cultivating gratitude can also enhance emotional regulation, social skills, and academic performance.

Why Gratitude Matters for Resilience

Our brains adapt and change in response to what we consistently notice and value in our environments. Encouraging youth to attend to and emphasize positive experiences helps strengthen neural pathways that make it easier for them to recognize the positives and protective factors in their lives. This supports well-being and contributes to better mental and physical health (improved immune function, better sleep, reduced cortisol levels).

Studies show that children and teens who practice gratitude regularly experience increased happiness, life satisfaction, and positive emotions. They also report fewer negative emotions and lower rates of depression and anxiety. By focusing on what is present and positive, rather than what is missing, gratitude helps youth cope with challenges and stress in healthier ways.

How Gratitude Builds Resilience and Well-being

  • Emotional regulation: Practicing gratitude engages brain regions involved in emotional processing, helping children manage difficult feelings and recover from disappointment more efficiently.
  • Social connection: Gratitude strengthens empathy and prosocial behavior, making it easier for children to form and maintain relationships with others.
  • Coping skills: Focusing on positive aspects of situations, particularly during tough times, helps children find meaning and hope, buffering against stress and adversity.

Evidence-Based Ways to Build Gratitude in Daily Life

Incorporating gratitude practices into everyday life does not need to require a major time commitment or dramatic changes to your schedule. Gratitude can be woven into everyday routines through simple, meaningful shifts in daily practices:

  • Mealtime gratitude: During meals, take turns sharing one thing each family member is grateful for, big or small. Regular sharing of gratitude strengthens family bonds and increases positive emotions.
  • Finding silver linings: During challenges or setbacks, gently help children identify a lesson learned, a person who helped, or a small comfort. This reframing fosters adaptive coping.
  • Mindful moments in nature: Encourage children to pause and notice something pleasant in their environment, such as a flower in bloom or a bird chirping. Bringing attention to the present moment and combining mindfulness with gratitude can help reduce anxiety and improve mood.
  • Expressing thanks: Encourage thank-you notes, drawings, or messages to teachers, friends, or relatives. Expressing appreciation and being thoughtful of others builds empathy and fosters deeper social connection.
  • Bedtime reflections: End the day by naming three good things that happened. This simple habit can improve sleep quality and increase optimism.

Modeling Gratitude: The Parent’s Role

Children learn gratitude best by observing adults around them. Consistently expressing appreciation and integrating these or similar practices into the daily routine helps make gratitude a family value.

Research-backed strategies include:

  • Verbalizing appreciation: Let children hear adults thank others and explain why their actions mattered to them.
  • Acknowledging effort: Thank children for their hard work, kindness, or cooperation, not just when positive outcomes have been attained.
  • Sharing personal gratitude: Reflect openly on moments from the day that inspire thankfulness.

These small acts show children that gratitude is an everyday mindset, not something reserved for special occasions or major achievements.

Tools to Record and Share Gratitude

Making gratitude tangible can help children and teens integrate it into their lives. A few examples of simple ways to record what we are grateful for include:

  • Gratitude journals: Writing down daily reflections has been linked to increased happiness and decreased depressive symptoms in youth.
  • Digital apps: Online apps like Grateful or Happyfeed can make it easy for teens to track positive moments throughout the day and reflect back on moments of gratitude over time.
  • Gratitude jars: Fill a jar with notes of things that went well, things you appreciate, or things you are looking forward to. Read them together as a family at the end of the week or month.
  • Photo projects: Encourage older kids (and help younger kids) to capture one photo a day of something they appreciate.
  • Family gratitude boards: Post sticky notes with moments of thanks for everyone to see.

Planting Seeds of Resilience for the Future

Much like strengthening a muscle, gratitude is a skill that grows stronger with practice. Creating opportunities to notice and name what is good and supportive builds happier, healthier children and nurtures resilient, thoughtful young adults who can find meaning and hope even in difficult times.

Gratitude does not mean ignoring life’s challenges. Rather, it is about recognizing the positive, fostering connection, and building the emotional strength to navigate whatever comes their way.

Integrating gratitude practices into daily life gives children a lifelong gift: the ability to find joy, connection, and resilience, no matter what the world may bring.

 

References:

Basit, A., Ali, R., Rahman, S., & Shah, A. A. (2024). Exploring how the practice of gratitude can strengthen interpersonal relationships, enhance mental well-being, foster emotional resilience, and promote greater social connectedness and cooperation. Review of Education, Administration & Law, 7(4), 427-441.

Bohlmeijer, E. T., Kraiss, J. T., Watkins, P., & Schotanus-Dijkstra, M. (2021). Promoting gratitude as a resource for sustainable mental health: Results of a 3-armed randomized controlled trial up to 6 months follow-up. Journal of happiness studies, 22(3), 1011-1032.

Klibert, J., Rochani, H., Samawi, H., Leleux-LaBarge, K., & Ryan, R. (2019). The impact of an integrated gratitude intervention on positive affect and coping resources. International Journal of Applied Positive Psychology, 3(1), 23-41.

Kurian, R. M., & Thomas, S. (2023). Gratitude as a path to human prosperity during adverse circumstances: a narrative review. British Journal of Guidance & Counselling, 51(5), 739-752.

Zainoodin, N. N., Hutasuhut, I. J., & Bakar, M. A. A. (2021). Gratitude and its relationship to resilience and academic performance among university students. Journal of Cognitive Sciences and Human Development. Vol, 7, 2.

 

About Dr. Madeline Manning

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

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

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

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Picture of a teen with a disability at work getting assistance

How Occupational Therapists Can Support Neurodivergent Teens and Young Adults with Self-Regulation in the Workplace

By | NESCA Notes 2025

Picture of a teen with a disability at work getting assistanceBy: Lyndsay Wood, OTD, OTR/L
NESCA Executive Function and Real-life Skills Program Manager

Self-regulation is a critical skill for anyone entering the workplace, but for neurodivergent teens and young adults, it can be particularly challenging. These individuals may face overstimulation, burnout, emotional dysregulation, and many other unexpected challenges in the work setting. Occupational therapy (OT) can play a pivotal role in helping these young adults develop the tools they need to thrive in a work environment.

What is Self-Regulation, and Why is it Important?

Self-regulation refers to the ability to manage your emotions and state of arousal in order to meet the demands of your environment. In the workplace, self-regulation is essential for staying calm under pressure, responding appropriately to feedback, and managing the various sensory and social demands of the job.

For neurodivergent teens and young adults, challenges may arise when dealing with unexpected changes, new work tasks, over or under stimulation of the sensory system, or complex interpersonal workplace dynamics. Learning to regulate within the context of these challenges can make the difference between a successful work experience and one that leads to frustration, anxiety, burnout, or job termination. Below is a list of three different ways occupational therapists can support teens and young adults with self-regulation in the workplace.

Developing a Personalized Self-Regulation Plan

One of the most effective ways to support workplace success is through the development of a self-regulation plan. This plan is individualized to each person and can serve as a guide for both the individual and their supervisors or co-workers. Here is a breakdown of essential items to include within the plan.

  1. Strengths

Before diving into potential challenges, it’s important to highlight strengths. What skills does the individual already possess that can help them succeed in the workplace? For example, a teen with an autism spectrum disorder (ASD) might have exceptional attention to detail, while a young adult with Attention-Deficit/Hyperactivity Disorder (ADHD) may excel in creative problem-solving. Identifying these strengths helps boost confidence and serves as a foundation for skill building.

  1. Triggers

Triggers are external or internal factors that can lead to dysregulation. These can include:

  • Sensory triggers: Bright lights, loud noises, hot rooms, specific textures, etc.
  • Emotional triggers: Criticism, frustration, misunderstandings
  • Cognitive triggers: Task-switching, or multi-tasking demands, large quantities of information being given verbally

A key part of OT intervention is helping the individual recognize their personal triggers, because understanding triggers can help prevent or minimize dysregulation.

  1. Develop Preventive Strategies

Once triggers are identified, the next step is to create strategies to prevent dysregulation before it happens. These strategies might include:

  • Environmental modifications: Wearing noise-canceling headphones, keeping fidgets at your desk, requesting a desk near a window for natural light, adjusting the workload to prevent overwhelm, or bringing a therapy animal to work
  • Routine adjustments: Incorporating short, frequent breaks during the workday, using visual schedules and reminders to manage tasks more efficiently, or requesting that work tasks be provided in writing
  • Emotional prep: Practicing self-talk or role-playing scenarios that may be challenging, engaging in daily mindfulness activities, spending time doing an activity that improves your mood prior to a work shift
  • Medication: Ensuring essential medications are taken daily at a consistent time

By establishing preventive strategies, individuals can feel more in control and reduce the likelihood of becoming overwhelmed.

  1. Create In-the-Moment Strategies

Even with preventive measures in place, there will be moments when the individual feels dysregulated. Developing in-the-moment strategies is critical to managing these situations effectively. Some in-the-moment strategies include:

  • Breathing techniques: Deep breathing exercises to help calm the nervous system and lower anxiety in stressful situations
  • Distraction: Watch a funny or calming video on your phone for a couple of minutes to help your brain reset
  • Physical movement: Taking a short walk or doing some discreet stretching at the desk can help release built-up tension
  • Taking a break: Request or take a 5-minute break from your work tasks to reset

These strategies should be easy to access and implement in the workplace, allowing the individual to regain control without disrupting their workflow.

Building a Toolbox of Sensory Strategies

Sensory regulation is a key part of self-regulation, particularly for neurodivergent individuals. Occupational therapists can help teens and young adults build a sensory toolbox that includes items or activities to help them self-soothe and regulate their sensory systems. Examples of sensory tools might include:

  • Fidget tools for tactile input
  • Aromatherapy oils or scented items to calm or refocus
  • Weighted blankets, heavy work, or pets on the lap (if the work environment allows) for proprioceptive input
  • Noise-canceling headphones or earplugs to manage auditory input

The goal is for the individual to have access to sensory supports that can be used in non-disruptive way while at work. These tools can be critical in maintaining focus and emotional regulation during the workday.

Building Self-Advocacy Skills

An essential part of successful self-regulation in the workplace is the ability to advocate for one’s own needs. Many teens and young adults have a difficult time with this skill, but occupational therapists can help individuals build the skills and confidence they need to successfully advocate for themselves in the workplace. Self-advocacy involves:

  • Knowing one’s needs: The individual should have a clear understanding of their strengths, challenges, and what accommodations are most beneficial. It is extremely beneficial to create a document that the individual can access and update throughout their lifetime that details all of this information.
  • Communicating needs: Learning how to express these needs clearly and assertively to supervisors or co-workers is crucial. This may involve requesting a quieter workspace or asking for a sensory break during particularly stressful tasks. Role-play is often a helpful tool to practice these communication skills.
  • Setting boundaries: Advocating for one’s needs also includes setting personal boundaries to avoid burnout. This could mean learning to say “no” to additional tasks when overwhelmed or asking for extra time to complete certain projects.

Occupational therapy can support the development of these communication skills through role-playing, practicing real-life scenarios, and building confidence in expressing needs.

Conclusion

Occupational therapy can play a crucial role in supporting neurodivergent individuals with self-regulation in the workplace through the development of an emotional regulation plan, the building of a sensory toolbox, and the development of self-advocacy skills. With these tools in place, individuals are empowered to manage their emotions, arousal, and sensory needs, leading to greater success and fulfillment in their professional lives.

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, Vermont-based Executive Function and Real-life Skills Program Manager, 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.

Dr. Wood accepts Vermont- and Massachusetts-based transition and occupational therapy assessments. Her in-home and community-based coaching services are available in the greater Burlington, Vermont area. Dr. Wood can accept virtual coaching clients from both Massachusetts and Vermont.

 

To book coaching and transition services at NESCA, complete NESCA’s online intake form. 

 

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

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Image of pencils lined up perfectly, as a sign of OCD, along with a quote from Dr. Alison Burns

When Worry Becomes a Cycle: Understanding and Treating OCD in Children

By | NESCA Notes 2025

Image of pencils lined up perfectly, as a sign of OCD, along with a quote from Dr. Alison BurnsBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Obsessive-Compulsive Disorder (OCD) causes strong, unwanted thoughts or worries called obsessions or intrusive thoughts. These intrusive thoughts can be about a wide range of things—such as fears of germs/getting sick, something bad happening to loved ones, or making a mistake. These thoughts can be very upsetting and hard to ignore, even when the child knows they don’t really make sense. The anxiety caused by these intrusive thoughts can feel overwhelming and can take up a lot of mental energy.

To cope with these thoughts, children with OCD often develop compulsions—repetitive actions or mental rituals that they feel they must do to feel safe or to stop something bad from happening. These might include excessive cleaning, checking, counting, arranging items in a certain way, or asking for reassurance repeatedly. While these behaviors may temporarily relieve anxiety, they tend to reinforce the cycle of OCD and make it harder to break over time. Parents might notice their child spending a lot of time on these routines, getting very upset if interrupted, or struggling to keep up with school or social activities.

The good news is that OCD is treatable. The most effective therapy for children is a form of cognitive-behavioral therapy (CBT) called Exposure and Response Prevention (ERP), which helps them face their fears gradually while learning not to rely on compulsions. The Supportive Parenting for Anxious Childhood Emotions (SPACE) curriculum is a parent-focused program designed to help caregivers reduce accommodations of a child’s anxiety or OCD behaviors and promote healthy coping skills. Lastly, medication can also help reduce symptoms.

OCD must first be properly differentiated from other disorders that have overlapping symptoms, such as anxiety, autism spectrum disorder, or tic disorders. Anxiety disorders involve persistent worry, fear, or nervousness about real-life situations, whereas OCD is characterized by a cycle of obsessions and compulsions that the person feels compelled to perform. OCD and autism spectrum disorder can both involve repetitive behaviors or strict routines, but they differ in motivation, awareness, and broader patterns. In OCD, behaviors are driven by anxiety or fear. In autism, repetitive behaviors or routines are often comforting, sensory-driven, or based on special interests. Tics are sudden, brief, involuntary movements or vocalizations—such as blinking, throat clearing, or jerking—that are often preceded by a physical urge and relieved temporarily by performing the tic. While both tics and OCD can appear repetitive, tics are automatic and not driven by specific fears or beliefs, whereas OCD behaviors are purposeful responses to obsessive thoughts and aim to relieve anxiety. A comprehensive neuropsychological assessment will utilize a combination of interviews, observations, and standardized tools to understand the nature and impact of symptoms to ensure an accurate diagnosis and treatment plan.

 

About the Author

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

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

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

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