Tag

anxiety disorder

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.

Dec 09
2

Acupuncture for the Treatment of Specific Conditions

By | NESCA Notes 2019

By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

A Primer on Acupuncture

While the insertion of needles into the skin to provoke a healing response is a hallmark characteristic of acupuncture, the practice actually involves the potential use of a number of other tools and techniques, including cupping, magnets and other non-insertive tools, and moxibustion, the topical application of a heated herbal substance designed to improve circulation and reduce inflammation.

Chinese medicine approaches healing by seeking to restore balance in the body; in so doing, it evaluates the patient as a complex and ever-changing ecosystem, a composite of multiple interrelated and mutually interdependent systems. Though a patient may be seeking relief from anxiety, for example, acupuncture addresses the issue within the context of a wider landscape, as there are often other symptoms and imbalances accompanying a primary imbalance. To that end, treatments will, of course, take into account a patient’s reported symptoms, but they are rarely the main driver of an acupuncturist’s treatment decisions. Acupuncturists additionally rely on observation of patients’ mannerisms, the sound and qualities of their voices, how they carry themselves and perhaps most importantly – the use of palpation techniques to elicit feedback from the body that guide treatment decisions. What an acupuncturist feels in a patient’s pulse or palpates on a patient’s abdomen or acupuncture channels is immensely influential to the diagnostic and treatment processes.

Implicit in this process is the notion that despite the fact that a patient may be seeking relief from a particular condition, that patient is not the same person he is today as he was yesterday, nor the same as he will be tomorrow. The treatment aims to address the nuances of a patient’s presentation within the present moment, guided by the knowledge of the patient’s health history and health objectives for the future.

Put into a biological context, we humans are continually and necessarily affected by our innate biochemistry as well as by our surroundings – both our mental-emotional and physical environments. Chinese medicine does not reduce a condition down to its primary symptoms, but rather considers all symptoms that are overtly or seemingly less-directly related. If the immune system is affected by a virus, for example, because of its cross-talk with the nervous and endocrine systems, all systems will be influenced in some way, shape or form. Though the rest of this article will discuss the ways in which acupuncture can impact specific conditions that commonly affect the pediatric population, it is predicated on this concept of mutual inter-relatedness and interdependence of the body’s systems.

Acupuncture’s Impact on Mental and Emotional Conditions

The incidence of anxiety, depression and behavior disorders has increased markedly in recent years, with data from the CDC indicating that anxiety and depression incidence among children aged 6-17 has grown from 5.4% in 2003 to 8.4% in 2011-2012. Currently, incidence rates among children aged 3-17 are 7.4% for behavior problems; 7.1% for anxiety; and 3.2% for depression. These afflictions do not occur in isolation and often accompany each other, as 73.8% of children aged 3-17 with diagnosed depression also have anxiety and 47.2% also have behavior problems.

Though we should keep in mind that enhanced awareness of these conditions among children as well as improved assessment and detection in recent years may paint a more dire picture of afflictions that have never in actuality been absent from the pediatric population, the data do represent a critical need to help children in their formative and impressionable years feel more at ease in their bodies as they navigate growth and development.

A dysregulation of the stress response is characteristic of chronic depression, anxiety and behavior disorders. The HPA (hypothalamic-pituitary-adrenal) axis is responsible in part for regulating the body’s response to stress, whether that stress be mental, emotional or physical. When stress becomes chronic, the ability of the HPA axis to allow for functional communication between the brain and body to keep a person feeling safe and calm becomes impaired, resulting in altered activity of stress hormones, such as cortisol, and neurotransmitters such as serotonin and dopamine. Cortisol is of particular interest in this context, as it not only plays a significant role in the stress response but also modulates immune system activity. When cortisol is elevated due to chronic stress, the body ultimately becomes resistant to it, and the immune system is not kept in check, resulting in a proliferation of inflammation. Acupuncture has demonstrated the capacity to modulate HPA axis function to alleviate stress-related symptoms by restoring the body’s responsiveness to cortisol so that its roles in nervous and immune system function can be maintained appropriately. Dysregulated HPA axis function has been implicated in a number of allergic conditions, such as asthma and dermatitis; somatic conditions, such as Fibromyalgia and Chronic Fatigue Syndrome; psychiatric conditions such as PTSD and depression; and numerous immune and autoimmune diseases, underscoring the importance of maintaining proper function of the HPA axis.

Another component of the body’s response to stress involves the autonomic nervous system, comprised of two branches – the sympathetic nervous system and the parasympathetic nervous system. Where the sympathetic branch of the nervous system is responsible for the ‘fight, flight or freeze’ response that alerts us to and helps us remove ourselves from danger, the parasympathetic branch of the nervous system represents the ‘rest and digest’ state, which we’re biologically designed to occupy the majority of the time. Dysfunction of the autonomic nervous system is thought to underlie a number of prevalent mental, developmental and behavioral disorders, such as depression and anxiety, ADHD, and autism. Acupuncture has been shown to activate and modulate the function of brain regions involved with the autonomic nervous system through a number of mechanisms, including increasing concentrations of endogenous opioids, regulating the function of amino acids, such as GABA and glutamate, and enhancing the activity of neurotrophins, such as nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF).

While depression and anxiety are highly heterogeneous in their presentations, and are driven by numerous mechanisms in the central and peripheral nervous systems, increases in inflammation are thought to play a correlational – if not at least partly causative – role in their development. Depression and anxiety have been associated with elevated levels of inflammatory markers, such as C-reactive protein (CRP), Interleukin 6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-alpha), all of which have been shown to be reduced through acupuncture.

Acupuncture and ADHD

ADHD, as defined by the DSM-IV, has a prevalence of 5.9% – 7.1% among children. Characterized by inattention, hyperactivity and impulsivity, ADHD is commonly treated pharmacologically with stimulant medications, such as methylphenidate. While little is known about the long term effects of stimulant medication in this population, and short-to intermediate-term effects include anxiety, depression, weight loss and insomnia, 12% – 64% of parents of children with ADHD have sought out complementary and alternative (CAM) therapies, including acupuncture. In a study of children aged 7-18 diagnosed with ADHD, twice weekly acupuncture treatments for six weeks demonstrated improved attention and memory function among children not taking medication. Another study explored the potential for acupuncture to improve school performance among children aged 7-16; following a series of 10 acupuncture sessions over the course of eight weeks, study subjects showed significant improvements across all three school subjects: math, social studies and Turkish language. Aside from the capacity of acupuncture to improve the stress response through modulation of the HPA axis and autonomic nervous system, acupuncture’s effects on attention and memory and on learning and perception are thought to be mediated in part by its regulation of the neurotransmitters dopamine and serotonin, respectively.

Acupuncture and Autism

With prevalence reports ranging from as low as 1 in 500 to as high as 1 in 50, Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects social communication and interaction, language and behavior. Standard treatment of ASD includes pharmacological therapy and behavioral/educational therapy, though reports from a wide sampling of children with ASD indicate that approximately 88% had utilized CAM therapies to address symptoms such as hyperactivity, inattention, poor sleep and digestive issues. In a study of boys with autism, a treatment regimen of five daily acupuncture sessions over the course of eight weeks demonstrated improvements in speech, self-care and cognition. Significant increases in glucose uptake were shown within the intervention group (vs. control), with improved glucose metabolism in areas of the brain involved in visual, auditory and attentional functioning being thought to underlie the improvements seen in language, attention and cognition. An analysis of 13 studies on acupuncture for autism indicated that the most effective treatment regimen entailed 12 sessions within four weeks, each using a minimum of four acupuncture points, and went on to associate individual acupuncture points with specific effects, from improved language comprehension to enhanced self-care abilities. A meta-analysis of 27 randomized controlled trials found that acupuncture in combination with behavioral and educational interventions (BEI) was more effective than BEI in improving symptoms as determined by a number of evaluation scales (CARS, ABC1, ATEC), suggesting the potential for acupuncture to yield an additive positive effect when utilized with standard of care therapy.

Ultimately, though research supports the use of acupuncture for specific conditions among children and adolescents, it is important to remember that the approach of an acupuncturist is generally not solely protocol-driven as it would be in a research setting. While research findings can and certainly do inform treatment decisions, acupuncturists also rely to a great extent on what is observed and felt during the treatment – they listen to patients’ reported symptoms and experiences, observe how patients speak and carry themselves, palpate acupuncture channels and reflex areas, and feel the pulse to determine imbalances in the body. In this way, Western and Eastern science and medicine are invited to work together to treat imbalances in an informed, patient-centric, holistic way.

References

Almaali, H. M. M. A., Gelewkhan, A., & Mahdi, Z. A. A. (2017, November 11). Analysis of Evidence-Based Autism Symptoms Enhancement by Acupuncture. Retrieved from https://www.sciencedirect.com/science/article/pii/S2005290117301395.

Data and Statistics on Children’s Mental Health. (2019, April 19). Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html.

Duivis, H. E., Vogelzangs, N., Kupper, N., Jonge, P. de, & Penninx, B. W. J. H. (2013, February 8). Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: Findings from the Netherlands Study of Depression and Anxiety (NESDA). Retrieved from https://www.sciencedirect.com/science/article/pii/S0306453013000073.

Hong, S.-S., & Cho, S.-H. (2015, November 22). Treating attention deficit hyperactivity disorder with acupuncture: A randomized controlled trial. Retrieved from https://www.sciencedirect.com/science/article/pii/S1876382015300585.

Lee, B., Kim, S.-N., Park, H.-J., & Lee, H. (2014, April 1). Research advances in treatment of neurological and psychological diseases by acupuncture at the Acupuncture Meridian Science Research Center. Retrieved from https://www.sciencedirect.com/science/article/pii/S2213422014000237.

Lee, B., Lee, J., Cheon, J.-H., Sung, H.-K., Cho, S.-H., & Chang, G. T. (2018, January 11). The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29552077.

Li, Q.-Q., Shi, G.-X., Xu, Q., Wang, J., Liu, C.-Z., & Wang, L.-P. (2013). Acupuncture effect and central autonomic regulation. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677642/.

Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011, August). Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3112468/.

Wong, V. C.-N., Sun, J.-G., & Yeung, D. W.-C. (2014, December 19). Randomized control trial of using tongue acupuncture in autism spectrum disorder. Retrieved from https://www.sciencedirect.com/science/article/pii/S2095754814000064.

 

About the Author

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.

 

To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: https://meghanmeadeacu.com/. Meghan is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at meghan@meghanmeadeacu.com.

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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.

Sep 02
2

Parenting Orchids and Dandelions

By | NESCA Notes 2019

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

I recently evaluated a 15-year-old boy, who we’ll call Sam, whose parents brought him in due to some concerning new behaviors, including failing classes, disobeying his parents’ rules – particularly around curfew and technology use – and smoking marijuana on a daily basis. When meeting Sam, I was amazed at how engaging, polite and good-natured he was. It was hard to imagine this young man disobeying his parents and staying out all night, which he was also doing frequently.

Sam had grown up in an affluent and supportive family, the third of four children. The other three were, like their parents, easy-going, adaptable and successful – academically, socially and athletically. They were on the path to becoming independent and successful adults. Sam had always been a bit different. He was the child who had colic as an infant, sleep disturbances throughout childhood, separation anxiety at preschool, and extreme sensitivity to sensory stimuli. His parents cut tags out of his clothes, bought him loose-fitting pants, and avoided birthday parties at Chuck E. Cheese’s – or almost anywhere there would be crowds of loud children, as these situations could reduce Sam to tears.

When evaluating Sam, I was impressed by his intelligence, quick reasoning and solid academic skills.  There was nothing obvious that standard neuropsychology tests uncovered. But Sam was also open and articulate about his difficulties. He explained that he was easily overwhelmed – “jangled,” he called it – in social situations, in a fast-paced classroom or on an athletic field. When he started ninth grade in a challenging parochial school, he was faced with more stressful situations, academically and socially. He became extremely anxious about tests and lengthy homework assignments, so he fell behind academically and developed pretty serious school anxiety. Given his sensitive nature, he was particularly likely to struggle in a class where the teacher was, in his words, “too strict,” or even “mean.” He wasn’t successful enough socially or athletically to sustain his self-esteem in these areas, particularly compared to his talented siblings. He found himself becoming angry and anxious, and he started using marijuana to calm himself. As he described it, getting high was the only time he felt happy and relaxed.

Sam was clearly struggling, easily meeting criteria for an anxiety disorder and a substance use disorder.  But I wanted to explain some of the “why” behind his struggles, so, in talking to his parents, I relied on the explanation put forth by Dr. W. Thomas Boyce, in his book, Orchids and Dandelions: Why Some Children Struggle and How All Can Thrive. He explains that most children are like dandelions, born with sturdy, resilient temperaments so that they, like dandelions, grow and thrive wherever they land –  assuming there’s some minimal level of appropriate conditions. But about 20% of children are more like orchids. They are born with a very sensitive nervous system, which is highly attuned to all the stimulation in the world around them. Dr. Boyce found that for these children, lower levels of stress precipitated a full-fledged anxiety response, involving the release of stress hormones that create a Fight, Flight or Freeze response – an appropriate response for a life-threatening situation, but not much help when facing, say, a strict teacher or a hard test. These children are therefore much more likely to develop full-blown anxiety disorders. On the positive side, their high level of sensitivity to the world around them means they are typically very empathic and emotionally attuned. Like an orchid with careful nurturing, they will develop into exceptional adults.

Fortunately, many orchids do naturally gain resilience as they grow, according to Elaine Arons, Ph.D. In her book The Sensitive Child, she cites studies that find most children who are shy as preschoolers – suffering social and separation anxiety – will develop coping strategies and not appear shy by the time they reach school age. These orchids gain resilience without losing their sensitivity.

But this positive evolution requires good parenting. While dandelions do fine with the average “good-enough” mother, as famously defined by psychologist Donald Winnicott, orchids need parents to be just a bit better.

How does one do this? How can a well-meaning, good-enough parent help these orchids become better able to manage the squalls, large and small, that occur in any one’s life?

Fortunately, there is a wealth of research – contained in books and articles – on building resilience in children. Most emphasize that we need to allow children to struggle with challenges, even to the point of sometimes failing, so they learn that they can cope and succeed in the face of adversity. This message is clear from the title of several such books: e.g. The Blessing of the Skinned Knee: Using Timeless Teachings to Raise Self-Reliant Children, by Wendy Mogel and The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed by Jessica Lahey.

We also have a neurobiological explanation for this process. We know that continued exposure to a stressful situation allows the body to habituate and the terrible feelings – such as fear and panic – that accompany a stress response gradually recede. As this happens, the previously scary situation becomes routine, and the child’s self-confidence and willingness to tackle new risks grows. Every preschool teacher knows this. The crying child who is being left by his parents in an unfamiliar preschool will eventually calm down and start to enjoy himself. The process goes more quickly if parents calmly and confidently reassure the child, then leave. The parent who is also anxious, who hovers over the child, attempting to sooth his fears, only increases the child’s anxiety by sending the message that this IS a scary situation. This phenomenon was dramatically illustrated in a study by Susan Crockenberg and Esther Leerkes (Development and Psychopathology, 2006). They found that 6-month-old children had different levels of reactivity – or startle – in response to unfamiliar stimuli. These infants also showed differences in how much they tried to avoid the situation, versus distracting themselves while staying in the presence of the stimuli. Children with high reactivity and a tendency to withdraw from novel stimuli, along with parents who were less sensitive, were more likely to show high anxiety at 2.5 years of age. Exposure to challenge causes the body to habituate and builds resilience. Trying to avoid stressful situations only exacerbates fears.

However, this can be counterintuitive for parents of very sensitive children. In fact, the more attuned a parent is to his/her child’s sensitivity, the harder it becomes. Sam’s parents had always coddled him a bit more than their other children. Knowing that he didn’t like loud birthday parties, his mother tended to decline these invitations. When he became upset and started to cry at a soccer game, his father felt so sorry for him that he didn’t insist that Sam return the next week. This avoidance did not allow Sam to grow and master new situations, but instead narrowed his world.

This is not to say that Sam’s parents should have been less emotionally attuned. Rather, it’s important for parents of children like Sam to walk a fine line between exposing the child to moderate challenges that he can manage but do not overwhelm him. It’s also important that they stay calm themselves, empathizing with the child’s fears but reassuring him at the same time. Not an easy task.

Fortunately, Sam has many strengths, not the least of which are his sensitivity and his intelligence, as well as great artistic gifts. He also has a solid relationship with his parents, even though it has been quite strained of late. After our evaluation, Sam and his parents decided to place him in a therapeutic wilderness program so he could withdraw from daily pot use in a safe place and learn skills from therapists there, as well as learn from peers who were going through similar struggles. This coming year, he will not return to the challenging parochial school he attended for ninth grade and will instead start at an independent school that offers some academic supports and a flourishing arts program. Sam’s roots are well-established, and with a bit more awareness of the gifts and challenges inherent in his sensitive nature, he is expected to grow into a self-confident and resilient young man.

 

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

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.

Aug 19
1

Introduction to Acupuncture with Licensed Acupuncturist Meghan Meade

By | NESCA Notes 2019

 

By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

Acupuncture is one of eight branches of Chinese Medicine that dates back over 3,000 years and involves the insertion of hair-thin needles into the body to provoke a healing response.

The body registers needling as a microinjury to which it responds by summoning the immune, nervous and endocrine systems to increase circulation, produce endorphins and other pain-relieving substances and flips the switch on the stress response.1,2,3 The treatment itself effectively assesses the internal imbalance and sends a signal to the body to address it; for this reason, acupuncture’s effects are often described as regulating – reducing elevations in inflammatory markers, enhancing the production and function of essential neurotransmitters, and so on. 1,2,3

Because acupuncture is so regulating to the body’s internal environment, the effects experienced by the patient can be both targeted and systemic2 – while pain relief could be achieved for a specific injury such as a sprained ankle, a patient might also noticed improved sleep or reduced anxiety, for example.

As a practitioner of Japanese style acupuncture, a style that is particularly reliant on using the body’s feedback to guide treatment decisions (though not to the exclusion of a patient’s verbal feedback about their health concerns and experiences), I incorporate pulse diagnosis and palpation into my overall diagnosis and treatments. Because an individual is considered to be the ever-changing reflection of their environment and experiences – physical, mental and emotional – my treatments for a given patient and a given condition will never look the same; each day the body is slightly different than the day prior, and treatments are designed with this principle in mind.

Another important theme within Chinese Medicine is that of duality; acupuncturists consider mutually opposing and complementary elements, such as heat and cold, internal and external, male and female, and yin and yang to be crucial in both assessment and treatment. Whereas yang represents heat, energy, masculinity, day time and light, yin, by contrast, represents coolness, substance, femininity, night time and darkness. When we are born, we are at our peak state of yang, which progressively gives way to yin throughout the lifetime. Because children are by nature more yang, their energy is ample and at the surface; accordingly, treating children and adolescents with acupuncture requires less stimulation to yield a desired response. Often needling is not involved, and non-insertive tools and techniques are preferred for their gentle, effective and often expedient results. Pediatric treatments may involve the use of magnets placed on acupuncture points, as well as brushing and tapping techniques using stainless steel, copper and/or silver tools. Because acupuncture points exist along 14 channels that run up and down the body, an acupuncturist can effect change both in a given channel/organ system and systemically by stimulating a channel through brushing and tapping techniques. While the above statement is true that inserting needles into the skin triggers an extensive sequence of immune, nervous and endocrine system events, so, too, does the more superficial work that acupuncturists perform for their pediatric patients.

The goal of acupuncture is always to harmonize, reducing what is in excess and restoring what is deficient. On a biomedical level, this typically entails a shift in the autonomic nervous system from a sympathetic dominant state – fight or flight mode – to a parasympathetic state – the calmer and more productive – though elusive – ‘rest and digest’ mode.2,3 Similarly, acupuncture regulates the function of hormones, neurotransmitters and immune mediators to achieve this balance. While many feel a positive response from a single treatment, acupuncture is generally not a ‘one and done’ therapy; instead, the response to acupuncture becomes stronger and more lasting over the course of several treatments, as a cumulative signal is often required for the body to carry out the work of regulating imbalances. Often after an initial series of treatments, a patient can enter a maintenance mode of treatment, spacing treatments out in increasingly longer windows and eventually receiving treatment on a maintenance or as-needed basis.

I hope this introductory conversation provides some insight as to how acupuncture works. I will be back with a follow-up post to shed some light on the effect of acupuncture on specific conditions commonly seen among NESCA’s client base.

  1. Cheng, Kwokming James. “Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician’s Perspective.” Journal of Acupuncture and Meridian Studies 7.3 (2014): 105-14. Web.
  2. Carlsson, C. “Acupuncture Mechanisms for Clinically Relevant Long-term Effects – Reconsideration and a Hypothesis.” Acupuncture in Medicine 20.2-3 (2002): 82-99. Web.
  3. Cheng, K. J. “Neuroanatomical Characteristics of Acupuncture Points: Relationship between Their Anatomical Locations and Traditional Clinical Indications.” Acupuncture in Medicine 29.4 (2011): 289-94. Web.

 

About the Author: 

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.

 

To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: https://meghanmeadeacu.com/. Meghan is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at meghan@meghanmeadeacu.com.

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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.

Aug 12
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What Does Autism Look Like? Exploring the Differences among Girls and Boys

By | NESCA Notes 2019

 

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

In 2018, the Centers for Disease Control and Prevention (CDC) determined that approximately 1 in 59 children is diagnosed with Autism Spectrum Disorder (ASD). Boys are still four times more likely be diagnosed with ASD; however, research indicates that the diagnosis is often missed in girls, especially those who have average intelligence and “milder” forms of ASD. To understand why ASD is more often missed in girls, let’s explore the differences between boys and girls with ASD. This discussion will focus on children with average to above average intelligence (about 50% of all children diagnosed with ASD).

 

Boys Girls
Poor impulse control, more acting out Likely to be quiet and withdrawn
Disruptive behaviors in the classroom setting Tend to be reserved and cooperative at school
Frequent repetitive motor behaviors that are directly observable Lower frequency of these motor behaviors
Lack of interest in imaginary play Very much engaged in imaginary play
Restricted interests may seem unusual – e.g., train schedules, maps, windmills Restricted interests may seem “age appropriate” – e.g., horses, unicorns, ballet
Trouble making friends Might have a few friends
Likely to exhibit angry outbursts when frustrated/anxious Likely to engage in self-harm or other behaviors that are not observed by others when frustrated/anxious
Lack of awareness of being different or not fitting in More motivated to fit in and “hide” social difficulties – might try to imitate the behavior of a peer that is perceived as popular

 

Due to these differences, the diagnosis of ASD is often missed in young girls. Adults might agree that a girl is “odd” or “quirky,” but dismiss these concerns because she has good eye contact, has some friends, and does not engage in hand flapping or other unusual behaviors. Unfortunately, other girls might be misdiagnosed, which could lead to ineffective or inappropriate treatment interventions. Most commonly, they might be misdiagnosed with ADHD or Anxiety Disorder.

In many cases, girls with ASD have increasing difficulties with social interactions as they get older and demands get higher. A young girl with ASD might be able to “get by” in social interactions but by the time she reaches adolescence, she is not able to navigate the intricacies of the social milieu. This can lead to social isolation and high risk of being bullied or rejected by peers.

Unfortunately, a missed diagnosis of ASD for a young girl can have long-reaching ramifications. She might experience depression, anxiety and/or low self-esteem, wondering why she doesn’t “fit in” and “feels different” from other girls. She might start to struggle in school or disconnect from activities that she used to enjoy. Moreover, missing the diagnosis in childhood means that she did not receive services to support her social and peer interaction skills during her formative years.

As always, when parents or other caregivers have concerns about a child’s development, it is important to seek an evaluation from a professional. And if the findings do not feel quite right, parents should never feel uncomfortable about seeking a second opinion.

 

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 Dr. Gibbons or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

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