Tag

adhd

When “Attention Problems” Are Not ADHD

By | NESCA Notes 2019

By Jessica Geragosian, Psy.D.
Pediatric Neuropsychologist

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

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

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

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

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

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

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

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

 

About the Author:

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

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

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

 

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

 

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

 

A Tale of Two Social Styles: Classical and Jazz Socializers (Republished from Nov. 27, 2017)

By | NESCA Notes 2018

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

I work with a number of parents concerned about the quality of their child’s social life.  Lamenting that their child has no true friends, many parents I see note that that their child doesn’t “hang out” with peers.  However, when asked about how their child does spend time with peers, many parents report that their child is involved in several different structured after-school activities, such as a church youth group, scouting, or a gaming club.  In other words, while not getting together with peers in less structured settings, these students often do, despite parent misgivings, have satisfying social lives.

I find it useful to think about socializers as lying in one of two camps: Jazz and Classical.  Jazz socializers are all about improv.  They’ll head downtown with a friend and see where the afternoon takes them, invite a friend over with no particular plan or agenda, or wander the mall in a herd.  They care little about predictability and in fact relish spontaneity and surprise.  Classical socializers, by contrast, are most comfortable with structure.  They crave predictability, wanting to know the specific parameters of a social activity, including the start and end times, the purpose, and the rules of engagement.  Classical socializers, then, tend to do best with organized social activities.

It’s important to note that one type of socializing is not better than the other; it’s about a match.  I say that as many parents of Classical socializing children worry that their children will grow up to be friendless and alone.  To those concerns, I observe that there are plenty of socially-satisfied Classical socializing adults: they have their book club the first Monday of every month, poker night every other Thursday, weekly chorus practice, and bar trivia on Wednesdays.

Thus, rather than trying cram to their Classical socializing child into a Jazz paradigm – which in fact runs the risk of leading to more social isolation due to anxiety stemming from the mismatch – I encourage parents to embrace the kind of socializer that their child is.  For parents of Classical socializers, that means supporting their child’s social satisfaction and growth through the encouragement of their participation in a variety of structured after-school activities (of course without over-scheduling).  In addition to giving their children a chance for a rich and rewarding social life now, participation in such activities serves as an important practice and preparation for adult life, as in college and as adults in the working world, that is how Classical socializers will be most socially satisfied.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick 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, MA, 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.

 

Dr. Ryan Conway on Parent-Child Interaction Therapy

By | NESCA Notes 2018

 

By:
Ashlee Cooper
NESCA Marketing and Outreach Coordinator

 

PCIT was first developed in the 1970’s. How did you become interested in this treatment?  

My first exposure to PCIT was in graduate school, in a course through my doctoral program that covered evidence-based therapies for childhood externalizing disorders, including ADHD and disruptive behaviors. I was immediately intrigued by the methodology given my interest in providing behavior therapy to young children and supporting parents.

What training is involved for a therapist who wants to provide PCIT?

PCIT training for therapists is highly structured and time intensive. It includes in-person training and live practice with PCIT Master Trainers, as well as ongoing consultation to ensure treatment is being delivered effectively.

Who is the target audience for this treatment?

PCIT is for young children, ages 2-7, along with their caregivers. It is an empirically supported therapy for children who demonstrate emotional challenges and behavioral problems (e.g., noncompliance, aggression). Some children might have a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and/or Oppositional Defiant Disorder (ODD), although it is not necessary to have a formal diagnosis in order to participate in treatment and get help!

How does PCIT work?

PCIT is a dyadic treatment, in which parents and children participate together. It is delivered in weekly 60-minute sessions that progress through two treatment phases. In PCIT, parents learn specialized techniques to improve interactions with their children and effectively manage their behaviors at home. What is unique about PCIT is that the therapist coaches parents in real time, where the therapist is able to observe certain behaviors and interactions while offering immediate feedback, which is then continuously practiced at home in between sessions.


Video Link: Dr. Conway explains PCIT

 

Can you speak more to the two phases of PCIT? Why is it important to complete the first phase before moving on to the second?

As mentioned in the video above, PCIT has two phases. The first phase is called Child Directed Interaction (CDI), in which caregivers learn and practice new parenting techniques in the context of playing with their child. However, even while playing, parents are practicing essential behavioral techniques for children who tend to have self-regulation challenges, such as giving lots of attention to positive behaviors and learning to ignore negative behaviors. CDI helps to promote positivity in parent-child interactions, which then sets the foundation for the second phase, called Parent Directed Interaction (PDI). The focus of PDI is teaching parents how to give effective commands and learning specific techniques to increase child compliance at home and in public settings.

What are some of the program goals? How long does it take to complete treatment?

Goals of PCIT include reducing challenging child behaviors, increasing child social skills and cooperation, improving the parent-child relationship and decreasing parental stress.

PCIT is time-unlimited, meaning that families remain in treatment until caregivers have mastered certain skills and child behaviors fall in the more typical range of development. While treatment length varies, given its structured, skill-based and targeted design, families typically graduate from treatment in about 12 to 20 sessions. Keep in mind that the length of treatment depends on each family’s specific needs, as well as other factors (e.g., regular attendance, completion of home practice in between sessions, and the intensity of the child’s behaviors at the onset of treatment).

When talking about PCIT, I have heard you say that parents are “not the problem, but part of the solution.” What do you mean by this?

Yes, I heard this once from a PCIT Master Trainer and it has stuck with me ever since! In PCIT, parents essentially are the agent of change in improving their child’s behavior. By promoting warmth in the parent-child relationship, learning new ways of relating to their child and employing both a consistent and predictable approach, parents are able to get back to enjoying their child again.

What advice do you have for families who may be considering this treatment?

There are many behavioral parent training programs out there, so it can be helpful to speak to a professional to determine which might be best for your family. While many parenting programs teach similar skills, PCIT is so effective because it emphasizes in session learning and practicing of skills through coaching, as opposed to separating learning in session and practicing at home. This process enables caregivers to feel increasingly equipped and confident in their parenting, after sometimes feeling defeated about ongoing behavioral challenges dealt with at home.

Are there any additional references to learn more about PCIT?

Yes, absolutely! Please check out my prior blog post about PCIT here: https://nesca-newton.com/pcit/ You can also visit PCIT International’s website (www.pcit.org) for additional information.

If parents or guardians would like to speak to you more about PCIT, how can they reach you?

I would be happy to speak with any caregivers who are interested in PCIT and/or wondering if the treatment would be a helpful next step. I can be reached at rconway@nesca-newton.com or (617) 658-9831.

 

Ryan Ruth Conway, PsyD
Clinical Psychologist

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

 

 

 

 

 

 

 

 

 

 

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

 

Blog Update: Intensive Therapy

By | NESCA Notes 2018

By: Ryan Ruth Conway, PsyD
Clinical Psychologist, NESCA

Earlier this month, the New York Times published an article about intensive therapy, a type of treatment that is more accelerated and condensed than traditional once weekly therapy. The author described a “new wave” of therapy programs popping up around the country designed to help clients with all types of anxiety experience relief more quickly. The article cited new research to explain the growing popularity of concentrated treatment, which shows that the approach is generally just as effective, and in some ways more effective, than longer-term care for both children and adults. Also noteworthy is that fewer clients dropped out of the intensive treatment, which suggests that clients are more likely to “stick with” therapy when it is delivered in a shortened, consistent format.

In short-term therapies, clients have the opportunity to practice using newly learned skills to face their fears in all different situations and environments that elicit anxiety. For instance, a client with social fears might be instructed to order for himself at a restaurant, ask a stranger for directions or purposely do something embarrassing in public. By practicing daily in session and also for homework, you see a lot of carryover from day to day and faster acquisition of skills, which is a huge confidence booster! Exposure and Response Prevention (ERP), a technique often used in Cognitive Behavioral Therapy (CBT), helps clients approach anxiety-provoking situations and learn that anxiety eventually habituates, or dissipates, on its own over time, and those other behaviors they have been using to manage their fears (e.g., excessive washing, checking, seeking reassurance from parents or avoidance) are neither helpful nor necessary.

NESCA offers intensive CBT “boot camps” for children and adolescents with anxiety, including (but not limited to) social anxiety, phobias, OCD and generalized anxiety. NESCA clinicians thoroughly enjoyed helping clients build coping skills and feel better through intensive treatments this past summer, and received a positive response from children and their families! Our treatment programs are individually tailored for each client and also include parent sessions in order to teach caregivers the tools they need to best support their child. Summer or school breaks can be the perfect time to focus on mental health without the distractions of the academic year or other extracurricular activities.

To learn more about intensive therapy and NESCA’s program visit: http://www.nesca-news.com/2018/03/intensive-cognitive-behavioral-therapy.html

For any questions about NESCA’s intensive treatment program or to sign up please contact Ryan Ruth Conway, PsyD at rconway@nesca-newton.com or (617) 658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

 

 

 

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

PCIT: Improving Child Behavior, Transforming Parent-Child Relationships

By | NESCA Notes 2018

photo from pcit.org

 

By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

First developed in the 1970’s by Sheila M. Eyberg, Ph.D., Parent-Child Interaction Therapy (PCIT) is a scientifically proven treatment program for young children (ages 2-7) who display challenging behaviors (e.g., noncompliance, defiance, temper tantrums, aggression) and difficulty regulating their emotions. PCIT therapists work with both the child and the parent together. Goals of treatment are to develop warmth and positivity in the parent-child relationship and teach parents how to effectively deal with behavioral problems both at home and publicly. While this efficacious treatment has been around for almost 50 years and is practiced both nationally and internationally, it is not widely known amongst parents and professionals in Massachusetts.

 

The video above provides brief illustrations of the treatment in action at the University of Miami’s PCIT program. Watching the video, you will see clips of a PCIT therapist “coaching” the parent through a one-way mirror, as the parent listens to the therapist’s instructions about interacting with his or her child through an earpiece while they play. PCIT is unique in that it is “in vivo,” or in real time, which helps the therapist directly observe parent-child interactions and also greatly enhances the caregiver’s learning of new skills that promote positive behaviors in children.

The video depicts the first phase of PCIT treatment called Child-Directed Interaction (CDI), which is the relationship enhancement phase. In CDI, parents follow the child’s lead in play while practicing specialized parenting skills. One of the skills applied by the parents in the video is praise. But not just any praise – this is labeled praise (e.g., “Great job playing gently with the toys”). Labeled praise communicates to the child specifically what it is that they did well, which increases the likelihood that this behavior will happen again, bolsters the child’s self-esteem and also promotes positive feelings between the parent and child. Praise feels good to give and to receive! Another skill practiced in CDI is reflection, or repeating what the child says during the play (e.g., Child says “The kangaroo is jumping”; Parent says “He is jumping very high!”) Reflections show that the parent is listening to the child, that the parent approves of what the child is doing and has also been shown to improve speech. Labeled praise and reflections are just two of the many skills taught to parents in CDI.

While positive behaviors are reinforced in CDI, inappropriate behaviors (e.g., whining, crying, talking back) are intentionally ignored to reduce their occurrence. While ignoring disruptive behaviors, parents are coached to use distraction and redirection skills. CDI then sets the foundation for the next phase of PCIT, called Parent-Directed Interaction (PDI), which continues to encourage appropriate play while also focusing on a structured and consistent approach to discipline.

There have been numerous studies documenting the effectiveness of PCIT (http://www.pcit.org/literature.html). Results have shown improvements in child behavior as well as reduced stress and increased confidence amongst caregivers. In addition to these outcomes, we see a stronger, happier parent-child bond!

NESCA is thrilled to announce that we are now offering PCIT! If you or someone you know might be interested in this treatment, please contact Dr. Ryan Ruth Conway at rconway@nesca-newton.com or (617) 658-9831.

To learn more about PCIT, visit http://www.pcit.org/

 

About the Author: 
Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

Reach out if you would like to work with Ryan: Email rconway@nesca-newton.com

 

 

 

 

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

Intensive Cognitive-Behavioral Therapy (CBT) for Anxiety

By | NESCA Notes 2018

 

By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

Deciding to enroll your child in mental health treatment is a big step in and of itself. Before initiating the process, there is often a trial and error period of interventions to improve the situation, whether at home or in school, and then coming to terms with the fact that they might not be enough to sufficiently address your child’s needs. Finding the right therapy and therapist match for your child can also prove challenging. Not only are there numerous therapeutic approaches available, but there are also varying levels of care depending on the severity of your child’s symptoms and amount of support he or she requires. This ranges from once weekly outpatient therapy to day treatment programs to inpatient hospitalizations for more acute psychiatric issues that may require crisis stabilization (i.e., suicidality, self-harm, etc.)

One type of treatment that has garnered considerable empirical support for treating youth anxiety and depression (conditions we regularly treat at NESCA) is Cognitive-Behavioral Therapy (CBT). CBT focuses on the intersection between our thoughts, emotions, bodily sensations and behaviors. The goal of CBT is to better manage overall emotional distress and reduce physiological symptoms by changing negative thoughts or unhelpful thinking patterns, ineffective coping strategies, and maladaptive behaviors that might be reinforcing uncomfortable feelings. CBT aims to teach children and their parents new, adaptive coping skills while providing opportunities both in and between sessions to practice these skills. CBT is a short-term, targeted treatment that promotes “approach” behaviors (as opposed to “avoidance”) through “exposures,” or exercises designed to practice facing fears gradually, in a safe environment. CBT might also include learning mindfulness, emotion regulation, and distress tolerance; techniques that have been shown to enhance treatment outcomes.

While some youth make progress in meeting with a therapist once per week, others benefit from a condensed, “intensive” format where they receive CBT treatment daily and over a shorter period of time. The accelerated nature of these types of programs, offered in both outpatient and hospital-based settings, allows for quicker acquisition of strategies, substantial exposure practice, and generalization of newly learned skills to other settings in a child’s life. Think of it as a crash-course in CBT.

You may want to consider an intensive therapy program for your child if: 

  • Your child’s symptoms are greatly interfering with his or her life, such as attending school or school performance, family life, and friendships.
  • Your child has tried different therapies in the past but there has been minimal carryover from session to session and/or you haven’t noticed much progress overall.
  • Your child is experiencing distress but other commitments during the school year have hindered attending therapy on a consistent basis, making school breaks or the summer an ideal time to work on it.

At NESCA, we are pleased to offer a highly specialized and immersive therapy experience through our 2-Week Summer Intensive CBT Program for anxiety. We work with children and adolescents who present with all types of anxiety, including generalized anxiety, separation anxiety, social anxiety, specific fears (e.g., dog phobia, vomit phobia, etc.) and obsessive-compulsive disorder (OCD).

What does NESCA’s 2-Week Summer Intensive Program consist of? 

  • Intake evaluation – A meeting is held with the child and parents to gain a comprehensive understanding of the child, provide an assessment of symptoms and discuss goals for treatment, all of which will inform the treatment plan.
  • 1:1 therapy sessions – Individual CBT therapy sessions with the child or teen are conducted 5 days/week for 90 minutes. Homework will also be assigned between therapy sessions to reinforce skills learned.
  • Parent involvement – Parent participation is vital in treating childhood anxiety. Parent sessions are held 5 days/week for 30 minutes. During these meetings, parents will be educated about their child’s anxiety, receive progress updates and also acquire tools to better support their child. Parents might also be asked to help children practice the new skills they are learning.
  • Discharge planning – Families will be assisted in determining follow up support that will be helpful in order to maintain treatment gains.
  • Treatment summary – Following the conclusion of the program, families will receive a written summary that reviews the course of treatment, progress made and discharge recommendations.

There are circumstances in which the frequency, duration and/or structure of the program can be modified to best fit your child’s needs.

For more information about NESCA’s Summer Intensive CBT Program or to find out if the program is appropriate for your child, please contact Dr. Ryan Ruth Conway at (617) 658-9831 or rconway@nesca-newton.com.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please 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.

 

Director’s Update

By | NESCA Notes 2017

 

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

NESCA was founded on the idea that a thorough evaluation reflecting careful analysis of information gathered from history, observations, and testing data is crucial in formulating a comprehensive, individualized plan for supporting a child to realize their potential. Increasingly, NESCA is expanding its intervention services, which allows for a higher level of integration between the evaluator and treater. Clearly recognizing the benefit of psychopharmacological intervention for many children and adolescents, at NESCA, we focus on the powerful benefits of many non-medication approaches.

Our experience, supported by research, is that significant improvements in functioning result from psychoeducation, direct teaching of strategies to parents and students, and intervention at the physical level. Psychoeducation refers to the process of educating clients and their parents about the nature of challenges such as anxiety or ADHD.  Beyond gaining a thorough understanding of the challenges faced by a client, parents, teachers, and students need strategies for managing problematic symptoms and behaviors. Teaching and helping parents and students practice these strategies often yields huge changes in functioning.  Finally, the mind and body are interconnected and intervening at the physical level is often more straight-forward for many of our clients, leading to impressive changes in cognitive and emotional functioning.

NESCA offers the following therapeutic interventions:

Cognitive Behavioral Therapy (CBT):

CBT is an evidence-based therapy that focuses on identifying and changing thoughts patterns and behaviors that are interfering with functioning.  Of note, we have a therapist who is highly experienced in psychotherapeutic intervention with children and adolescents who are on the autism spectrum, including the use of the Sidekicks app developed by the Affinity Project.

Acceptance and Commitment Therapy (ACT):

ACT uses approaches such as mindfulness and behavioral change strategies to help clients increase flexibility and reach goals.

Intensive Outpatient Therapy:

Many children require more frequent meetings in order to master the strategies that are being taught for behavioral/emotional regulation or social functioning. NESCA’s intensive out-patient therapy programs generally involve three weekly sessions of direct service for the child followed by brief parent guidance meetings.

Therapy Groups:

NESCA offers a group for school-age children with ADHD and their parents. Children meet in one group while their parents meet concurrently in another group, both led by experienced psychologists.  Starting in 2018, NESCA will be offering drama-based therapy groups based on the Spotlight model developed at the Northeast Arc and researched by the Social Competence and Treatment Lab at Stony Brook University.

Back to School Program:

This intensive program was developed to address school refusal through both home-based and center-based psychotherapy, parent guidance and school consultation.

Community Based Skills Coaching:

Many clients struggle to generalize strategies that they have learned in therapy to daily living. NESCA has highly skilled coaches that work with adolescents and young adults in the community to practice skills and strategies.

Postsecondary Transition Planning:

Adolescents with developmental challenges, learning disabilities, and psychiatric issues often need support in planning for “life after high school”. Our veteran transition specialists work with adolescents and their parents to identify strengths, formulate realistic goals and a plan for reaching goals over their high school years.

Yoga-Based Therapy:

Individual or small group interventions in our yoga studio to build self-awareness and the ability to use breath and movement to address symptoms of anxiety and enhance attention.

Acupuncture/Acupressure:

These ancient treatments can be highly effective for treating anxiety,  ADHD, and other childhood conditions.

 

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 a consultation with Dr. Helmus 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.

 

A Tale of Two Social Styles: Classical and Jazz Socializers

By | NESCA Notes 2017

 

By:  Jason McCormick, Psy.D.
NESCA Pediatric Neuropsychologist

I work with a number of parents concerned about the quality of their child’s social life.  Lamenting that their child has no true friends, many parents I see note that that their child doesn’t “hang out” with peers.  However, when asked about how their child does spend time with peers, many parents report that their child is involved in several different structured after-school activities, such as a church youth group, scouting, or a gaming club.  In other words, while not getting together with peers in less structured settings, these students often do, despite parent misgivings, have satisfying social lives.

I find it useful to think about socializers as lying in one of two camps: Jazz and Classical.  Jazz socializers are all about improv.  They’ll head downtown with a friend and see where the afternoon takes them, invite a friend over with no particular plan or agenda, or wander the mall in a herd.  They care little about predictability and in fact relish spontaneity and surprise.  Classical socializers, by contrast, are most comfortable with structure.  They crave predictability, wanting to know the specific parameters of a social activity, including the start and end times, the purpose, and the rules of engagement.  Classical socializers, then, tend to do best with organized social activities.

It’s important to note that one type of socializing is not better than the other; it’s about match.  I say that as many parents of Classical socializing children worry that their children will grow up to be friendless and alone.  To those concerns, I observe that there are plenty of socially-satisfied Classical socializing adults: they have their book club the first Monday of every month, poker night every other Thursday, weekly chorus practice, and bar trivia on Wednesdays.

Thus, rather than trying cram to their Classical socializing child into a Jazz paradigm – which in fact runs the risk of leading to more social isolation due to anxiety stemming from the mismatch – I encourage parents to embrace the kind of socializer that their child is.  For parents of Classical socializers, that means supporting their child’s social satisfaction and growth through encouragement of their participation in a variety of structured after school activities (of course without over-scheduling).  In addition to giving their children a chance for a rich and rewarding social life now, participation in such activities serves as important practice and preparation for adult life, as in college and as adults in the working world, that is how Classical socializers will be most socially satisfied.

 

About the Author:

McCormick

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick 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.

 

Catch Them When They’re Good!

By | NESCA Notes 2017

 

By:  Ryan Conway, Psy.D.
NESCA Clinical Psychologist

If your child’s go-to response to your requests is typically “no,” then keep reading…

Children who tend to disobey rules, become easily agitated, experience temper outbursts and argue with authority figures are known to display a pattern of behaviors called disruptive behaviors. These behaviors can cause significant family turmoil and become quite challenging for schools to manage. Children who have trouble regulating their emotions and behaviors may be pinned as “the bad kids.” This is unhelpful because it does not explain what exactly is underlying the acting out. This type of reputation can also impact a child’s self-esteem, resulting in feelings of inadequacy and self-doubt. Disruptive behaviors could be masking other issues that are not obvious to teachers and parents. Consider the possibility that the kindergarten student who shuts down and refuses to engage in class is not oppositional, but instead experiencing anxiety about being away from his mother or father. Maybe the second grader obtains his parents’ attention most often at home when she lashes out. In trying to control disruptive behaviors, children get a lot of attention from adults for what they are doing wrong, often times unintentionally.

One of the hallmarks in teaching caregivers how to effectively manage these kinds of behaviors is positive parenting, which comes from a behavior therapy approach. Among positive parenting techniques is “catching them when they’re good,” which shifts the focus away from what is problematic and towards the appropriate behaviors parents want to see continue. With this technique, parents become more mindful about the behaviors they attend to and seek out opportunities to let their child know when he or she is on the mark. It feels good for both the giver and the receiver, and can bring you closer to your child!

Positive feedback is a powerful tool at any age. For children, it comes in many forms – a sticker for helping to set the dinner table, a praise statement (“I’m so pleased that you are using gentle hands with your brother”), even a hug! As your child starts to recognize that you are giving more attention to appropriate behaviors, they will similarly shift from negative actions (e.g., sassing off, whining, crying, etc.) to positive ones.

Behavioral parent training empowers caregivers by teaching them specific skills to not only manage their children’s behavior at home, but also to improve communication, build warmth within the parent-child relationship and create a calmer household. The Society of Clinical Child and Adolescent Psychology (SCCAP), a group dedicated to disseminating information about evidence-based therapies for youth mental health problems, sites behavior therapy (individual parent and groups of parents with or without child participation) as the most efficacious treatment for disruptive behaviors in children. The SCCAP website, www.effectivechildtherapy.org, was recently updated and is a helpful resource for parents seeking information and guidance about treatment for children and teens.

NESCA is excited to be offering a new group for parents and children ages 7-10 who exhibit disruptive behaviors and/or ADHD symptoms. This group will have separate parent and child sections – with opportunities for combined parent-child sessions – and utilize both behavioral and cognitive-behavioral techniques. For additional information, visit http://www.nesca-newton.com/events.html.

Or visit our previous article about behavioral parent training and the research backing this approach: http://www.nesca-news.com/2017/04/parent-training-programs-101.html.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please 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.