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adhd

Apr 24
10

Shouldn’t We All Get Neuropsychological Evaluations, Then?

By | Nesca Notes 2023

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

One frequent question I have been asked by parents following a neuropsychological evaluation is, “Wouldn’t this process be helpful for everyone?” This tends to come up around the issue of disclosing results of an evaluation to children and teenagers and helping them better understand “how their brain works.” Many families with whom I have had the privilege of working come back months or years later with siblings of an initial client, noting that the process was so valuable the first time, they are hoping for a similar experience for their other child or children.

So, should we all get neuropsychological evaluations? Largely, I think this question is motivated by parents who are eager to help their children understand their own strengths and weaknesses. This is a wonderful goal, as self-understanding is one of the most valuable and lifelong gifts we can give our children.

In my experience, many people come to this kind of self-understanding naturally, over time, through experiences in adolescence and young adulthood. In particular, experiences that involve more independence in living and learning promote this kind of understanding. During childhood, we may learn our relative skill among family members (“I’m good at soccer, and my sibling is good at piano”), but these relative differences may not hold once we leave our family of origin. Many people venture out into the world and find that, compared to their peers, they are actually quite skilled at getting groups of friends together, doing everyday math, putting their thoughts down in writing, or staying organized. These real-world strengths often reflect the strengths that could be found through formal evaluation. As we gain self-understanding, we may be prompted to enter certain professions, take on particular hobbies, or pursue friends and partners with specific traits.

A neuropsychological evaluation can “speed up” the process of self-understanding, giving some young people a head start on the identity formation process that naturally occurs during adolescence. For some, this head start is vital – their brains are structured in ways that present clear, observable differences between them and their peers. This may be the case with diagnoses like autism spectrum disorder, a learning disability, or ADHD. For these individuals, the feedback from a neuropsychological evaluation can (under the best of circumstances) stave off feelings of inadequacy, negative self-esteem, and shame, helping a young person to recognize the deeply important strengths that are present alongside their more observable challenges. In these cases, a neuropsychological evaluation is not only for self-understanding, but also for self-compassion. Our goal as neuropsychologists in these cases is not just to help the child or teen understand themselves, but also to be gentle and kind with how they view their difficulties. Our hope is that, when these individuals venture out of their families and into the broader world, they are able to show resiliency in the face of the obstacles that will almost certainly be present.

 

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 practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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

 

Mar 27
5

Getting to Know NESCA Pediatric Neuropsychologist J. Michael Abrams, Ph.D.

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach

I recently spoke with J. Michael Abrams, Ph.D., pediatric neuropsychologist practicing in NESCA’s Londonderry, New Hampshire office. Dr. Abrams joined NESCA last fall. Take a few minutes to learn more about him in today’s blog interview. 

How did you became interested in neuropsychology?

Back in the mid-80s, I worked at McLean Hospital, in the Child & Adolescent Inpatient program. They had an educational program set up for the kids that was run by psychologists who were embedded in the classrooms. There was a fair amount of test development going on at that time that used a lot of materials to build executive function and cognitive skills among the students. I was always interested in education and special education, but it was this experience that changed my career mindset toward psychology. So, I went back to school to study psychology.

Tell us about your career journey.

I always wanted to work with children and adolescents. That desire stemmed from my initial interest in special education and education in general, and I was on that path. I spent about seven and a half years at McLean, with the first couple of years working on an inpatient unit. Then I transferred to the psychologist-run education program, where I was a classroom educator.

After switching to psychology, my original clinical interest was with children who had experienced abuse and neglect and those who were involved in children’s eyewitness testimony. The focus was on how the experiences they had been through affected their memory, attention, and cognitive development. The more I worked with children and adolescents, the more I recognized how these neuropsychological factors impacted all aspects of their lives. It became much more than what I saw in the context of a legal case; instead, I saw how their experiences affected the management of themselves, their image of themselves, their hopes and aspirations, etc. I became really interested in how their neuropsychology intersected with their opportunities and experiences.

What segment of children and adolescents do you primarily work with? What is your specialty area?

I am particularly interested in working with children from age eight through 14, when their cognitive development is really taking off and they are trying to master this whole new set of skills. This time is filled with questions and challenges concerning self-esteem, mood, relationships, family relationships, etc. It’s a time when they are asking themselves what they are good at, where they struggle, and what those strengths and challenges say about them as a person. There is a great opportunity to have a big impact on kids in this age range. It’s such a gift to allow them to see themselves as successful and have that lead to future success.

What do you find most rewarding and most challenging about your profession?

The rewarding part is two-fold. The first is the interpersonal emotional piece. On a personal level, it’s rewarding to be able to contribute to other peoples’ success, whether it’s the clients, the practice, or the field overall. The second piece is more personal and intellectual. It’s intellectually stimulating to be able to integrate all of the information we gather or identify about a person, and to be able to communicate those findings or revelations to a child and their parents or caregivers. The intellectual reward lies in the ability to effectively communicate a child’s cognitive complexity in a way that they understand and can use to help reach their goals.

The challenging part has to do with the mental health landscape overall. As someone who is involved in neuropsychological assessments, it can feel like operating within a silo in the overall landscape. So many of the systems, such as insurance and education, are not set up for seamless collaboration with psychology practices or other areas of behavioral health. Unfortunately, this can make getting the appropriate mental health care or educational/therapeutic interventions a cumbersome, sometimes adversarial process. It’s the frustration that accompanies the much larger, more overarching need to develop a genuine collaboration among all the pieces within the health and mental health care settings.

What interested you about NESCA?

I was drawn to the opportunity NESCA provides to interact with other psychologists and affiliated clinicians on an ongoing basis. Professionally, I am not operating in a silo. At NESCA, there is more regular consultation and collaboration on how to put together a comprehensive and coherent plan for these kids. I was very excited to have a team of highly qualified, very experienced professionals, within the same organization, who can provide a range of supports and services for the kids we work with. Having this as a resource is a great opportunity for our clients and our staff, alike.

 

About Pediatric Neuropsychologist J. Michael Abrams, Ph.D.

Dr. J. Michael Abrams has over 30 years of experience in psychological, educational, and neuropsychological assessment and psychotherapy in various settings. A significant aspect of Dr. Abrams’ continuing interest and experience also includes the psychological care and treatment of children, adolescents, and young adults with a broad variety of emotional and interpersonal problems, beyond those that arise in the context of developmental differences or learning-related difficulties.

 

To book a neuropsychological evaluation with Dr. Abrams in Londonderry, NH, or to book with another expert NESCA neuropsychologist, 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, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Mar 20
6

Why are Some Youths More Susceptible to Anxiety and Anxiety Disorders?

By | Nesca Notes 2023

By: Ferne Pinard, Ph.D.
NESCA Pediatric Neuropsychologist

Anxiety disorders are one of the most commonly diagnosed disorders in childhood and adolescence. According to the Centers for Disease Control and Prevention (CDC), 9.4% of children aged 3-17 years (approximately 5.8 million) were diagnosed with anxiety between 2016-2019. These numbers have increased significantly during the COVID-19 pandemic. Some studies estimate that the prevalence of child and adolescent anxiety disorders nearly doubled during the pandemic.

Why are some individuals more susceptible to anxiety than others? The development of anxiety and anxiety disorders during youth is not simple or straightforward but involves complex interactions among the following variables:

  • Temperament: Children with the behavioral inhibition temperamental style described as timidity, shyness, and emotional restraint when with unfamiliar people and or in new places are more likely to develop anxiety disorders.
  • Parent-child Attachment: Children who did not experience a trusting and secure parental bond, but received inconsistent responses from caregivers and are preoccupied with the caregiver’s emotional availability (Ambivalent attachment) are at increased risk for developing an anxiety disorder.
  • Parental Anxiety: Children with anxious parents are at higher risk of developing an anxiety disorder. This relation is partly influenced by genetics. The risk of developing specific anxiety disorders has been associated with various genes. These can be passed to the child, thereby increasing their genetic vulnerability to anxiety disorders. However, parental behavior and practices are also important in understanding this link.
  • Parenting Behavior/Practices: When parents model anxious, overcontrolling, or demanding behavior, their children are more reluctant to explore new situations and display more avoidance behaviors.
  • Adversity: Trauma, negative/stressful life events as well as low socio-economic status are also risk factors for childhood anxiety. The more adverse life events an individual experiences in childhood, the greater the likelihood that they will develop an anxiety disorder. They also experience higher levels of anxiety.
  • COVID-19: The combination of social isolation and lack of support networks increased anxiety among youth during the COVID-19 pandemic.
  • Bullying: Being the victim or perpetrator of bulling is also associated with anxiety symptoms later on in life
  • Externalizing Disorders: Adolescents with early externalizing disorders are at increased risk for later anxiety disorders. Attention Deficit/Hyperactivity Disorder (ADHD), in particular, is a significant risk factor.
  • Sleep: Sleep disturbance often predicts the emergence of anxiety disorders.
  • Cognition: Maladaptive cognitive responses (e.g., inability to tolerate distress, negative beliefs about uncertainty, avoidance of new/unfamiliar people/things, and repetitive negative thinking) are associated with impaired emotion regulation and a greater risk of developing anxiety disorders.

Supportive relationships with family and peers as well as problem-focused coping strategies can guard against anxiety disorders. Problem-focused coping refers to strategies that directly address the problem to minimize its effect.

Parents, caregivers, and other adults involved can also help by:

  • being aware of the signs of anxiety
  • being mindful of expectations set for children and teens
  • encouraging participation in sports teams, clubs, community- or religious-based groups
  • supporting a healthy lifestyle, including a nutritious diet, exercise, and adequate sleep
  • providing access to support services

 

References:

Donovan, C. L., & Spence, S. H. (2000). Prevention of childhood anxiety disorders. Clinical psychology review, 20(4), 509-531.

Vallance, A., & Fernandez, V. (2016). Anxiety disorders in children and adolescents: Aetiology, diagnosis and treatment. BJPsych Advances, 22(5), 335-344. doi:10.1192/apt.bp.114.014183

Warner, E. N., & Strawn, J. R. (2023). Risk Factors for Pediatric Anxiety Disorders. Child and Adolescent Psychiatric Clinics. Published: February 26, 2023 DOI: https://doi.org/10.1016/j.chc.2022.10.001

 

 

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

Dr. Pinard provides comprehensive evaluation services for children, adolescents, and young adults with learning disabilities, attention deficit/hyperactivity disorders (ADHD), and psychiatric disorders as well as complex medical histories and neurological conditions. She has expertise in assessing children and adolescents with childhood cancer as well as neuro-immunological disorders, including opsoclonus-myoclonus-ataxia syndrome (“dancing eyes syndrome”), central nervous system vasculitis, Hashimoto’s encephalopathy, lupus, auto-immune encephalitis, multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and acute transverse myelitis (ATM), and optic neuritis.

To book a neuropsychological evaluation with Dr. Pinard or another expert neuropsychologist 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; Londonderry, New Hampshire; and Coaching and Transition staff in greater Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Mar 13
10

How Can a Neuropsychological Evaluation Help?

By | Nesca Notes 2023

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Recently I met with a family seeking a neuropsychological evaluation for their daughter. After talking about their reasons for pursuing testing, the parents asked me, “So…do you think this will help? Is this type of testing what our child needs?” It’s an important question and one I’m sure many families wonder about but don’t always ask. A comprehensive neuropsychological evaluation can be of tremendous value, but the process requires time and energy as well as a financial investment, so it makes sense to consider this question carefully.

Though it may be surprising to hear this coming from a neuropsychologist, the answer to the question of whether to have a child evaluated is not always clear-cut. For instance, parents sometimes wonder if there is practical benefit to seeking testing when a child or adolescent already has a diagnosis but there are questions about its accuracy. Consider the following scenario as an example. A child with issues regulating attention and with weaknesses in social skills has a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Her therapist has raised the question of whether a diagnosis of Autism Spectrum Disorder (ASD) might better explain the issues the child is facing. Inattention can be present in both ADHD and ASD, and both conditions can result in social difficulties. Especially if a child is already receiving appropriate services, does the diagnostic label matter, and is it worth pursuing formal assessment?

There are valid arguments to be made in favor of seeking an evaluation in this type of situation and valid arguments to support choosing not to invest in an assessment.  In such a scenario, I would encourage a family to consider the following questions:

  • Will diagnostic clarification address unanswered questions that previous diagnoses have not fully addressed?

Sometimes an established diagnosis partially explains a child’s issues but there are lingering questions about other aspects of a child’s presentation. If a different or additional diagnosis could fill in the gaps, it may be worth assessing.

  • Could testing help identify your child’s unique pattern of strengths and weaknesses?

Especially when an existing diagnosis has been made without testing (for instance by a therapist or physician), there may be important aspects of a child’s neuropsychological profile that have not yet been identified. For instance, individuals with Autism Spectrum Disorder share certain key features, but they also differ in significant ways. A diagnosis alone cannot capture the nuances of an individual child’s strengths and weaknesses, while a full neuropsychological evaluation can more fully describe a child on an individual level.

  • Will understanding the root of the problem help guide recommendations?

NESCA’s clinic director compares a child’s observable difficulties to the “tip of an iceberg.” There are inevitably hidden underlying factors, and discerning these can be important in determining how to address the issues that are visible on the surface. For example, problems with social interactions can arise from deficits in social communication (e.g., difficulty interpreting facial expressions), as seen in Autism. Alternatively, a child with ADHD may encounter social challenges because they have trouble paying attention to relevant social cues or because impulsivity leads them to behave inappropriately. Someone with social phobia may have few relationships because their anxiety drives them to avoid social interactions. Effective intervention in each of these cases requires a nuanced approach that targets not just the surface issue but the factors underlying it.

  • Will establishing a particular diagnosis open up opportunities for additional support and resources that may be important?

In some cases, there are specific resources that are available to individuals with particular diagnoses. For instance, in Massachusetts, individuals with a diagnosis of Autism Spectrum Disorder or Intellectual Disability may be eligible to receive services through the Department of Developmental Services. If qualifying for such services could be beneficial, diagnostic clarification may be important.

More broadly, the internet and social media have allowed people with shared diagnoses to connect in new ways. The opportunity to connect with others experiencing similar difficulties can be invaluable, and online communities can provide a sense of support, educational information, and practical resources for children and parents alike.

The answers to these questions and to the bigger question of whether to seek neuropsychological evaluation will be different for different families. There are many factors to weigh in making the decision to seek testing. If you are considering an assessment for your child and need additional information to make an informed decision, answers to frequently asked questions about neuropsychological evaluation can be found on NESCA’s website.

 

About the Author

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

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

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

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

 

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

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

Feb 27
5

Meet Jasmine Badamo, MA, NESCA Executive Function Coach

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach

This week, I had the pleasure of talking with Jasmine Badamo, MA, an Educational Counselor and Executive Function Tutor here at NESCA. While Jasmine has been with NESCA for quite a while on a per diem basis, she officially joined our team on a full-time basis within the past few months. Our clients and staff have enjoyed getting to know her, so we’d like to introduce you to her as well.

What brought you to the education field?

In college, I majored in science, but took a different turn when it came to my career path. After I graduated from college, I took a job teaching English abroad. During that time, I realized that I was far more interested in—and better at—teaching than I was in science. This experience solidified for me that education was really where I wanted to take my career. When I was back in the U.S., I earned my Master’s in TESOL (teaching English to speakers of other languages) at CUNY Hunter College. While in the TESOL program, I also became very interested in special education.

How did you learn about the need for Executive Functioning (EF) tutoring or coaching?

During my time in the TESOL program, I noticed there was a lot of overlap among students in the TESOL program and those in special education—there was a need for individualization among both sets of students. During this time, I learned how to modify a curriculum to be appropriate for each unique learner. I went on to work in a school-based special education setting for three years. Here is where I realized that a lot of the underlying needs of students in special education stemmed from their EF challenges.

When I was studying for my special education license, Executive Functioning wasn’t really even a thing yet; there was a concept, but no real name for it. Once it was given a name and there was more of an understanding about it, everything clicked for me. When I learned that I could make EF the focus of a job, I got really excited. I dove in headfirst and immediately started expanding my coursework in that area.

Executive Function covers a lot of territory. Where did you start?

While I was working toward my professional certificate with Landmark College, I was also working as a 4th grade special education teacher. When Covid hit, we all immediately saw the need for putting those EF coaching skills to really good and frequent use in helping our students to transition to remote education. We were able to help our students find functional, realistic, manageable tools to make their life less stressful while learning from home.

What about NESCA did you find attractive?

I was looking to focus a little more on EF outside of the elementary school setting. I found NESCA through a connection I made at Landmark. With NESCA’s EF and Real-life Skills Coaching Program, I was able to offer tutoring to a more diverse population among a wider range of ages, which was exciting to me. Being a part of NESCA’s coaching program also allowed me to really focus in on teaching EF skills, which is where my true interest lies.

How would you describe what you do to those who may not know much about EF?

I initially say that I am kind of like a special education tutor who helps people with study skills and life skills. I work closely with individuals who struggle with organization, time management, and focus to build skills in those areas to make things easier for them to do on their own. I often work with people who have characteristics of Attention-deficit/hyperactivity disorder (ADHD), Autism spectrum disorder (ASD), or a learning disability.

How do you do tutor students in EF?  

It all comes down to individualization. I spend a good amount of time focusing on getting to know a person in the beginning. I try to identify the biggest stress point or disconnect in their life. Together, we develop strategies to tackle those stressors in a way that works for them. We may come up with a bunch of potential strategies, but finding the ones that are realistic for them to maintain independently is the key to success. Once we identify and practice those, we remove the scaffolding bit by bit, giving them the independence they desire.

What is the favorite part of your job?

I love to figure out something that will have a positive impact on a student…that moment when we crack the code! It’s amazing to be able to use my knowledge in a way that can be directly meaningful to someone else in their life.

What do you find most challenging?

The fact that everything I do with each student is totally individualized can be challenging. There’s no script to go off of, and it takes a lot of trial and error to find what you’re looking for. You so desperately want to help the person and ease their struggles. Even if you find the right way to build an EF skill, it still takes a lot of time and patience. Teaching the student to also be patient with themselves during this time can be a challenge. But it’s so worth it!

Are there other areas of EF you’d like to focus on?

A lot of the strategies that can be used with students who struggle with EF are designed for neurotypical people. Often the tier one interventions that work for neurotypical individuals are not really tailored for them. That means we have to find creative ways to support these students while still honoring who they are. We can’t change the world for them, but they need to be able to navigate through it. And yet, we don’t want them to have to change the person who they are. It can be difficult, so I’d love to work on identifying more strategies and tools that may be good options for my specific students. I’d like to help them to find a better balance between the way the world works and the way their brain works.

Tell us what you’ve found rewarding about your work at NESCA so far.

I truly love getting positive feedback from my students’ parents. I am so validated by how appreciative they are that I “get” their kid. Sometimes my students tell me, but more often than not, I hear this feedback from their parents.

Unfortunately, a lot of kids with EF struggles are on the periphery with friends or academics. It’s great to be able to tell them there’s nothing wrong with them and guide them to having more self-compassion and self-empowerment. I strive to let my students know that we all have EF struggles. Life is one giant EF demand on us, and it’s a good thing to seek out support to help manage those demands. We put so much pressure on ourselves to manage it all, but it’s okay to get guidance, support, or a boost from someone else.

 

About Educational Counselor & Executive Function Tutor Jasmine Badamo, MA

Jasmine Badamo, MA is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

 

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach 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, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Feb 20
3

Neuropsychological Evaluations at Different Stages of Childhood & Adolescence

By | Nesca Notes 2023

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

Having been at NESCA for more than 11 years, I have been fortunate enough to follow many clients throughout their childhood. In some cases, I have conducted two or three neuropsychological evaluations on the same student at different points in their life. After their first experience with an evaluation, parents will often ask, “Will we need to do this again?” or “How often should we get evaluations?”. As is the case for most things, the answer is different for every child depending on their needs. When determining how often to seek an evaluation, it might be helpful to think about what information you are trying to gather depending on the child’s age.

Preschool (2-5)

  • Concerns about developmental delays (not meeting milestones)
  • Concerns about autism spectrum disorder (ASD)
  • Transition from Early Intervention into preschool
  • Transition from preschool to kindergarten

Elementary School (5-10)

  • Concerns about academic skills – assess for dyslexia, dysgraphia, dyscalculia, or other specific learning disability
  • Why is the student not making expected progress in school?
  • Concerns about attention and executive functioning (possible attention-deficit/hyperactivity disorder (ADHD)
  • Concerns about ASD (if not already diagnosed)
  • For children who already have an identified disability – need to monitor progress
  • Plan for transition to middle school

Middle School (10-14)

  • If this is the first neuropsychological evaluation – it is usually because the child did okay in elementary school but is now struggling with increased demands in the areas of academics, executive functioning, and social
  • For students with a previously identified disability – need to monitor progress
  • Plan for transition to high school

Early High School (14-16)

  • Monitor progress – how is the student managing increased demands of high school?
  • Mental health – emerging concerns about anxiety and/or depression
  • Start planning for postsecondary transition
    • Is the student on track to graduate in 4 years?
    • Does the student need programming beyond 12th grade?

Late High School (16-18)

  • Heavy emphasis on postsecondary transition planning
  • Do we need to work on vocational skills?
  • If the student is college-bound – determine whether any accommodations will be needed
  • If the student is not going to college – what is next?
    • Remain at high school with ongoing special education services
    • Gap year
    • Young adult transition program for students with disabilities
  • Consult with transition specialist to help with planning

Early Adulthood (18+)

  • If the student is in college – do they need additional supports?
  • If the student is still accessing special education services – where should we be putting the emphasis?
    • Academics
    • Vocational
    • Life Skills
  • For students with developmental disabilities, need to plan for adult services
    • Should the parents seek guardianship?
    • Is the student eligible for DDS or other adult service agencies?
    • What resources are available to the family?
  • Combine with transition specialists to help navigate adult services

 

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

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

Feb 06
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.

 

Nov 21
10

Paying Proper Attention to Inattention

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

One of the most common referral questions I see in my work as a neuropsychologist is, “Does my child have ADHD?” When a child has trouble focusing, Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the first things that comes to mind, and for good reason. However, ADHD is only one potential underlying cause of inattention. In fact, there are many cases in which attentional difficulties are present as part of another underlying issue. Some of these include:

  1. Anxiety—On a physiological level, anxiety involves activation of the “fight or flight” response. This adaptive process is designed to alter attention in order to prioritize survival. When the brain senses a threat, it tunes out everything else so it can focus on dealing with the danger at hand. This is extremely useful when the threat is something like a wild animal chasing you. In that case, you need to momentarily shift all of your attention to survival. It’s the worst possible time to be distracted by anything that could divert your attention from escaping a dangerous situation. But when students are anxious, especially for extended periods of time, the same process can make it difficult to focus on day-to-day tasks, including learning.
  2. Learning Disorder—Students who lack the academic skills to engage with the curriculum can appear to be simply not paying attention. If a student’s reading skills, for instance, are several grade levels below expectations, they won’t be able to actively engage with written assignments or materials in class.
  3. Communication Disorder—Deficits in receptive and/or expressive language often manifest in ways that mimic inattention. If a child cannot grasp what is being communicated, they will have significant difficulty following verbal instructions, answering questions, and retaining important information. This can easily be misinterpreted as a sign of an attentional issue when, in reality, the underlying problem has to do with communication.
  4. Autism Spectrum Disorders (ASD)—Many individuals on the Autism spectrum tend to be more attuned and focused on internal experiences (e.g., their own thoughts and specific interests) than to the external environment. As a result, they can miss important information, ranging from social cues to expectations communicated at home or within the classroom.
  5. Other neurocognitive disorders—Weaknesses in other cognitive functions, particularly those we refer to as “cognitive proficiency” skills (e.g., processing speed) and executive functions (e.g., working memory, organization) can also result in apparent inattention. Students who cannot process information quickly are sometimes unable to keep up with the pace of instruction, which causes a diminished ability to comprehend and retain information. Similarly, students who cannot hold information in working memory or organize ideas and concepts can demonstrate reduced comprehension.

There is a range of other issues that can contribute to children or adolescents appearing inattentive. Some of these include trauma, absence seizures, hearing impairments, thought disorders and/or hallucinations, and Tourette’s Syndrome. It is important to thoroughly evaluate the potential causes of inattention and to consider an individual’s full history and presentation.  Because different underlying issues will necessitate different treatment approaches, getting to the root of the issue can be tremendously important.

 

About the Author

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

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

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

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

 

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

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.

Oct 10
4

The Importance of SMEDMERTS

By | NESCA Notes 2022

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

While supporting a friend who was recently diagnosed with bipolar disorder, I have come to appreciate how challenging it is for people with this disorder to maintain a stable mood state. One of the most helpful resources I discovered in my search for information to help me support my friend was a TEDx talk by Ellen Forney, an author who has successfully managed her bipolar disorder for two decades by following SMEDMERTS, an acronym for: Sleep, Medication, Eat Well, Doctor/therapy, Mindfulness/Meditation, Exercise, Routine, Tools (coping), and Support System. I was struck that only 25% of the solution for managing her mental illness involves the mental health system: medication and doctor. The bulk of her treatment system relates to lifestyle choices.

While attention to SMEDMERTS is important for all of us, especially in these stressful times, consistent focus on these lifestyle choices is particularly critical for the many children and adolescents who we see at NESCA presenting with anxiety, mood disorders, ADHD, and behavioral issues. Most of us struggle to achieve our daily goals for sleep, diet, meditation, exercise, sticking to a routine, practicing adaptive coping strategies, and nurturing our support system, even though we know how much better we feel and how much better our children function when we are focused on SMEDMERTS in our daily life. While the impact of medications and doctors on functioning is largely outside of our control, we can control our lifestyle choices, which are critical to the success of managing any mental health issue.

How can we help the children in our lives to embrace SMEDMERTS?

  • Modeling it for them. As Robert Fulgham said, “Don’t worry that your children never listen to you; worry that they are always watching you.”
  • Praising their efforts. Offer positive feedback, such as, “Great idea to get up early to go for a run,” or, “I like how you called a friend when you were upset to get some advice.”
  • Enlisting the help of a coach. NESCA offers real-life skills coaching, executive functioning coaching, and health coaching to help children, adolescents, and young adults build and maintain habits to support positive lifestyle choices.

Health coaching is available to parents of NESCA clients who are seeking support in developing positive health habits, such as exercise, diet, stress management, and meditation.

If you are interested in coaching services at NESCA to support your quest for SMEDMERTS, please contact Crystal Jean: cjean@nesca-newton.com or fill out our intake form at www.nesca-newton.com.

 

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

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

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

To book an evaluation with one of NESCA’s many expert neuropsychologists, complete NESCA’s online intake form. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, 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.

Aug 29
3

What Do We Mean by Individualized Neuropsychological Evaluations?

By | NESCA Notes 2022

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

Previous blogs in our recent series addressing frequently asked questions during the intake process, have covered the important differences between school-based testing and an independent neuropsychological evaluation. A neuropsychological evaluation should always be comprehensive, meaning that it covers various aspects of the student’s learning profile: cognition, language, memory, attention, and social-emotional functioning. However, the evaluation should also be individualized. Essentially, a good evaluation should aim to answer the questions that are specific to that student, not just a cookie-cutter list of tests.

Prior to starting testing, the clinician reviews any previous records and holds an intake appointment with the student’s parents or caregivers. Through this process, the clinician gathers information about the student’s early developmental history, medical background, and current challenges. If the student is already receiving services – either privately or through the school district – that is also important information. All of this helps to shape the “Referral Questions” for the evaluation. In some cases, the questions are very specific; for example, “Does my child have dyslexia?” or “Does my child have ADHD?” In other cases, the question is less defined, such as when we are asked “What is going on with my child and how do I help them?”

We often get asked by parents or caregivers if their child can have all of the tests available performed during their child’s neuropsychological evaluation. As clinicians, we understand that temptation. An evaluation is both an investment of time and money for the parents or caregivers. But neuropsychological evaluations are a lot of work for children, so we want to be sure to tailor the tests to what is actually going to yield beneficial findings for them or will help answer the referral question.

Some families request the list of tests that will be included in the evaluation. Unfortunately, this is not always possible until after testing is underway. Following the intake process, the clinician starts to develop the “battery” – the specific tests that will be administered to the student. Most clinicians have a skeleton battery of tests that they include for every client – an intelligence test, some academic tests (reading, writing, and math), and tasks that assess skills, such as language, memory, and attention – as described above. The clinician then fills in the testing battery based on the specific questions for that student. For example:

  • An evaluation designed to test for dyslexia should include several tests of reading as well as tests that look at very specific skills related to reading (e.g., phonological processing). When there are no concerns about reading, this aspect of the evaluation would be briefer.
  • An evaluation designed to assess for autism spectrum disorder should include a variety of tasks that examine social communication and reciprocal social skills. These types of tasks would likely not be included for a student who has never had any challenges in the social domain.

If a school district or another provider is asking for the list of tests that will comprise the neuropsychological evaluation, please talk to your clinician about this during the intake process. The final list might not be available until testing is complete, but this is definitely something that your clinician can provide as soon as possible.

 

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton 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.