NESCA has unexpected availability for Neuropsychological Evaluations and ASD Diagnostic Clinic assessments in the Plainville, MA office in the next several weeks! Our expert pediatric neuropsychologists in Plainville specialize in children ages 18 months to 26 years, with attentional, communication, learning, or developmental differences, including those with a history or signs of ADHD, ASD, Intellectual Disability, and complex medical histories. To book an evaluation or inquire about our services in Plainville (approx.45 minutes from NESCA Newton), complete our Intake Form.

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ANXIETY

How the Pandemic Changed In-Person Learning

By | NESCA Notes 2024

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

Among the parts of my job that I find most meaningful are the conversations I get to have with parents during intake and feedback sessions. During an intake, much of the emphasis is on history taking. Some of it isn’t very exciting; trust me, I get that it can be tedious to review information like how much your child weighed at birth, how many ear infections they had, and when they learned to walk. Yet so often the information parents are able to share about a child’s history is crucial. There’s a quote attributed to Michael Ventura that says, “Without context, a piece of information is just a dot. It floats in your brain with a lot of other dots and doesn’t mean a damn thing. Knowledge is information-in-context… connecting the dots.” The history parents share provides essential context that helps us piece together and make sense of the data we get from doing an assessment in the office.

In recent years, we’ve added questions about COVID-19 to help us understand how that experience has impacted the children and teens we work with. I regularly ask parents, “How old was your child when COVID-19 hit? What grade were they in and how long did remote learning go on? When did they return to in-person instruction?” During a recent intake with a parent, I got an answer I wasn’t expecting. A very thoughtful and perceptive mom gave me some dates and ages then paused for a moment and added, “But even though they’re back in school, I don’t think learning has ever been the same since COVID.” I asked her to tell me more, and we had a wonderfully thought-provoking conversation. As so often happens, I learned a great deal from a parent. Since that time, I’ve extended the discussion to include some of my very insightful colleagues, who have also shared their thoughts. The consensus is that “in-person learning” in 2024 doesn’t mean the same thing it did in 2019. So, what’s changed?

Yes, students are, for the most part, sitting at desks inside classrooms rather than connecting remotely from their desks (or kitchen tables or couches) at home, but what happens in the classroom and beyond is different in some important ways.

  • Technology: In speaking with parents and colleagues in different fields, I’ve repeatedly heard that pandemic-related school closures “accelerated the use of technology” and “online learning platforms” in education. There was certainly a need to use online learning platforms during the pandemic, and the extent to which schools incorporated technology speaks to ingenuity and flexibility in the face of an unexpected and incredibly challenging situation. Moreover, technology is a wonderful tool that can be used to enhance learning in many ways. That being said, many parents and colleagues have observed that schools never went back to “how information and tasks were managed pre-COVID.” That is, technology and online platforms have remained a part of the learning experience. The challenge for some students is that even within the same school system, there can be a great deal of variability between the specific platforms individual teachers use and how they make use of them. Especially for students who struggle with anxiety or executive functioning weaknesses, keeping track of and switching between different platforms and applications for different classes can be overwhelming.
  • Different Teaching Methods: One of the trends I’ve observed directly and have gotten feedback on from others has to do with how teachers provide instruction in the classroom. Compared to “the before times,” the post-pandemic years have seen a rise in independent learning, even within the context of the classroom. More often, teachers have students work independently, whether that means reading through Google slides at their desks or completing worksheets and tasks on their own. There seems to be less direct teacher-led instruction and an increased reliance on independent learning, which often incorporates use of technology, such as Chromebooks, in the classroom. While some students thrive when given the freedom and flexibility to learn on their own, many students learn best when provided with instruction using more direct, structured, and an interactive approach.
  • The Boundaries are Blurred: Working adults will relate to this phenomenon. Back before COVID-19, many of us had pretty clear boundaries separating our work lives from our personal lives. We commuted to an office or other workplace, worked for a set time period, then went home. That all changed when many non-essential employees pivoted to working from home at the start of the COVID-19 lockdown. Suddenly our kitchens or bedrooms were transformed from private living areas to undefined spaces that housed both our personal lives and our work lives. And our work and home lives bled into each other as we tried to fit in work when we could, especially if we were also home-schooling or caring for children all day. Though many employees are back to the office at least to some extent, the boundaries remain somewhat blurred. The same phenomenon has happened for students. There is a “24-7 connectedness” that technology enables, which has both pros and cons. Because a lot of schools still use online platforms for assigning, submitting, and grading homework, teachers can post assignments at any time. One parent described a sense of assignments popping up online “like Jenga blocks, one layered in after another.” Similarly, students can turn in assignments at any hour of the day or night. One of my colleagues has observed that this has negatively impacted sleep habits for some students. Another colleague astutely pointed out that, not only can this be overwhelming for students, but it may also be contributing to some of the burn-out many teachers are experiencing.

Education has been perhaps permanently altered by the pandemic, just as many of us have been. The changes that have occurred bring benefits and challenges that our students and teachers are still adjusting to. I don’t have answers or solutions, but I know that I’m going to be adding to the questions I ask parents about COVID-19, education, and the impact on their student. It’s still important for me to learn when a student resumed “in-person learning,” but I’m no longer going to assume that phrase means the same thing it’s always meant. Instead, I’ll be asking parents to tell me what in-person learning looks like now, because the reality is that none of us has gone back to life circa 2019. Just like all of us, our students are living in the “new normal,” and we need to understand it so that we can support them in benefiting from the opportunities it brings and in navigating the challenges it poses.

 

About the Author

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

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

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

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

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

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

The Intersection of Mental Health and Executive Function

By | NESCA Notes 2024

By: Carly Edelstein, MSW, LCSW
Licensed Clinical Social Worker and Executive Function Coach

Mental Health challenges and executive function (EF) deficits are often intertwined, as one can easily impact the severity of the other. As a psychotherapist and executive function coach, I find myself regularly assessing my clients with comorbid EF and mental health challenges in order to identify which presented first.

Why does this matter?
Emotional regulation and executive control both live in the frontal lobe of the brain. They operate close together and impact one another. Because of this, mental health challenges, such as depression and anxiety, can be overlooked and mislabeled as an executive function deficit. Identifying the root cause of a student’s EF struggles is critical for properly planning appropriate next steps and necessary supports. For example, if a student’s depression is causing them not to initiate and/or complete work, the depression usually needs to be addressed before they receive EF coaching. If the student is already working with a mental health professional, such as a therapist, it is important for them to be cleared by the therapist to add in an EF coach. Working on too many new skills at once can be overwhelming, so it is important that enough foundational coping skills are learned first.

An example of anxiety causing an EF deficit:
Clara gets extremely anxious in social situations due to a lack of self-esteem. She had a negative experience in middle school where other students made fun of her lisp whenever she read out loud in class. Now, in high school, Clara is afraid to ask questions, even when she is confused. She is left not fully understanding the material, class assignment expectations, or how to approach studying for quizzes and tests. Rather than asking for help, Clara keeps to herself. Even when teachers offer to help her, she responds with, “Thank you, but I’m all set.”

Clara’s parents can see that she struggles to initiate homework assignments, rarely studies for upcoming tests, and that her grades are declining. They don’t fully understand why, because when they ask her, she is quick to deflect and change the subject.

By checking in with Clara’s teachers, her parents may receive feedback that she often shies away from their support. With a lack of understanding why, her teachers aren’t sure how else to approach the situation other than continuing to check in. Jumping into EF coaching to address her task initiation and study skills may help, but it doesn’t address the root of the problem. A more appropriate action plan would be for Clara to first receive psychotherapy, addressing the bullying that led to her social anxiety and self-esteem issues and then shifting to EF skill building.

An example of an EF deficit causing anxiety/depression:
Gabriel is a seventh grade student diagnosed with ADHD. He has a difficult time advocating for himself and asking for help due to some additional communication challenges. His ADHD also makes it challenging to stay on task and pay attention to details. This results in Gabriel constantly forgetting what his homework assignments are and when they are due, creating a lot of missing work. Gabriel’s teachers are often redirecting him and reminding him of incomplete work. They have tried to help him develop plans to make it up, but he struggles to follow through with these plans. At home, Gabriel’s parents often share their frustrations with him and try to help him get back on track. With adults constantly reminding him he’s behind, Gabriel has developed internalized anxiety, often wondering why he can’t be like everyone else. He tries so hard to remember what his homework is and when it is due, but can never seem to get it right. Over time, he begins to experience symptoms of depression as his self-esteem declines.

In this situation, Gabriel’s lack of EF skills is the root cause of his negative thinking patterns. By receiving EF coaching, he can learn ways to regularly track his assignments. He can be taught how to break them down into smaller, more manageable tasks in a way that helps him overcome procrastination. Additionally, he is able to become proactive and communicate with his teachers so that they are kept on the same page. As these skills get stronger, Gabriel becomes more responsible, and gets praise from his teachers and parents in return. Given the impact of this situation, he may also benefit from short-term counseling to better understand the connection between his EF and anxiety. Increased self-awareness helps students learn how to advocate for themselves the next time they encounter a similar situation.

Does this sound familiar?
These scenarios are common and can be difficult to navigate without proper assessment and guidance from professionals. If you or your child struggles with mental health and EF-related challenges and you are not sure where to start, book a free introductory call with me or one of our other wonderful and experienced EF coaches. NESCA also offers comprehensive neuropsychological evaluation services and neuropsychological consultation for families who are wondering about possible missed learning, attention, mental health, or other diagnoses. We look forward to working with you!

 

About the Author

Carly Edelstein is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Ms. Edelstein provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form

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

 

How to Make the Holidays Less Stressful

By | Nesca Notes 2023

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

Are the holidays the “most magical time of the year?” Maybe, but they can also be the most stressful. In fact, a recent survey by the American Psychological Association found that 41% of U.S. adults experience increased stress levels around the holidays, while 52% find their stress levels remain the same, and only 7% feel less stressed this time of year. A whopping 43% of American adults acknowledge that the stress that accompanies the holidays compromises their ability to enjoy them (and that number includes only the people willing to admit it!).

As an adult reading this, you may be thinking this information comes as no surprise and you’re all too aware of the stress that comes with the holidays. What you may not realize as fully is that this time of year can be stressful for children as well. While the holidays can bring excitement and fun, they can also present challenges, particularly for our kids and teens who struggle with underlying mental health issues (such as anxiety or depression) or neurodevelopmental conditions (such as Autism, Attention-Deficit/Hyperactivity Disorder, or Sensory Processing Disorder). For the next few weeks, many of us will be attempting to navigate our own holiday-related stress and manage the stress our children may feel and express in a variety of ways. So, if you’re feeling less overwhelmed with excitement and joy and instead simply overwhelmed, you’re not alone. Here are some strategies for making the holidays work for you:

Notice and recognize the impact of expectations. It all starts here. From Hallmark movies to the pictures posted by mom-fluencers on Instagram, we are bombarded with unrealistic images of what the holidays “should” look like. Social media is particularly insidious, as it tends to contribute to a sense that the everyday, real people around us (not just those celebrities in magazines) are living what we see reflected in their carefully edited and curated photos. It’s important to remind ourselves that these images don’t reflect the reality of life and that we don’t see 99% of what happens in the daily lives of those we follow on social media. We may see the images of perfectly decorated Christmas cookies but not the kitchen counters covered in flour, eggs, and frosting (or the parent yelling) in the background. We click on the beautiful photo of three kids all smiling at the camera from Santa’s lap but don’t see the 25 outtakes featuring those same children in tears, sticking out their tongues, or bolting out of the frame. Realizing this and taking a step back is key for ourselves and our children, who may also need explicit information about what they can expect (for instance, regarding the number of and type of gifts they will get based on your family’s budget versus what they envision).

Realize we also all harbor implicit ideas about what the holidays “should” look like based on our experiences growing up and the way our families did things, which we take for granted. If you’re in a relationship, you may have encountered your own hidden expectations if they ever come into conflict with those of your significant other. Even if you celebrate the same holiday(s), you may do so in very different ways. Some of you may be familiar with conversations, such as, “What do you mean your family decorates the tree Christmas Eve? Christmas trees go up as soon as we put our jack-o-lanterns in the compost on November 1st!” If you and your partner celebrate different holidays or your kids split their time between your home and that of another parent, all of this becomes much more complicated. So, talk about it openly and together. As a family, re-evaluate your expectations and traditions, and start with a blank slate. Sit down together, make your expectations explicit, then assess them together.

Ask some questions, such as:

  • What does each family member, kids included, envision the holidays will look like? This might be general and abstract (maybe Mom wants to ensure there’s downtime for rest and relaxation) or concrete (maybe the kids want to go ice skating over winter break, and Dad wants to make sure the family goes to midnight mass on Christmas Eve). How will you make this work both logistically and in terms of balancing different needs?
  • What traditions do you automatically take part in, and do they work for your family at this particular moment in time? Although traditions are important and meaningful, blind and rigid adherence to rituals and routines that don’t work for us don’t benefit anyone. We often take part in traditions without questioning whether they add to our lives or why we started doing them in the first place.

Once you’ve had these discussions, consider that you don’t have to “do” the holidays the same way ever single year. There’s no rule that says every holiday season has to look the same. Do you always go take photos with Santa at the mall even though your kids inevitably resist the idea, become anxious and overwhelmed, and you end up frustrated? Open up to the possibility of forgoing that tradition even if it’s just for the time being. Do you make an elaborate holiday dinner each year but aren’t up to it this year? Consider finding an alternative for now that takes the stress off of you and still aligns with your priorities. If what’s important to you is enjoying a meal with your family, maybe you can still do that while letting go of the need to do it all yourself.

Modify your expectations and make accommodations for your children given their unique personalities and potential challenges. This might mean forgoing busy and crowded events, such as parties, for children and teens who struggle with anxiety in social settings or become easily overwhelmed by sensory input. Or maybe you still attend, but you have a pre-established plan for leaving by a certain time and/or managing distress that may arise. These days, many public spaces that host events (e.g., museums, theaters) hold modified sensory-friendly versions of events at specified times. For many children, building in predictable routines, and previewing special plans or changes to their usual schedules can be very helpful. For kids or adolescents with significant “picky” eating or Avoidant-Restrictive Food Intake Disorder (ARFID), you might consider hosting a holiday dinner at your house so you have control over the menu or bringing food you know your child will eat if you’re visiting others. Many kids with ADHD will need movement breaks, so think ahead about how you’ll work those in depending on your plans. It helps to think ahead and have a flexible plan for meeting your kids’ needs in different scenarios.

Now for the twist. Remember that APA study I quoted at the start of this blog? Well, even though so many people reported significant stress, it also found that 69% of adults feel the stress of the holidays is “worth it,” and many endorse positive outcomes related to the holidays, including an increased sense of togetherness. No matter what or how you celebrate, the holidays can be a wonderful and meaningful time of the year, and the odds of finding joy, connection, and calm will be higher if you take a step back and figure out how to make the holidays fit into your life and work for your family.

References:
https://www.apa.org/news/press/releases/2023/11/holiday-season-stress

 

About the Author

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

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

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

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

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

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

NESCA Goes to Brain Camp – Exploring the Connections among Brain Anatomy, Emotional Health, and Neuropsychology

By | Nesca Notes 2023

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; NH Director, NESCA

For three days every July, students, clinicians, and researchers from around the country descend upon Milwaukee for Marquette University’s Neuroanatomical Dissection Course. This Marquette course is the only one in the world that provides a continuing education opportunity to learn about advances in neuroscience research while also engaging in hands-on brain dissection within the university’s gross anatomy lab. This past July, my NESCA colleague, Dr. Erin Gibbons, and I had the pleasure of being two of the participants.

Perhaps not unexpectedly, the lab components of the course were insightful and impactful. This included watching 3-D computer-aided brain maps within the visualization lab at the engineering school, as well as hands-on brain dissection of donor specimens, some of which presented with unique pathologies that had never been seen first-hand within the lab. Across the three days of the seminar, lectures covered a range of topics, such as neuroanatomy, how emotions function in the brain, and functional and neurological presentation of brain pathology. We also had the opportunity to select from a range of presentations that provided a “deep dive” into more specific topics. There was a host of information that directly speaks to our practice as pediatric neuropsychologists. That said, as someone who often works with clients who face depression, anxiety, and trauma, certain information stood out as most relevant to my daily practice.

First, there is an increasing amount of research indicating that early-onset (onset in childhood or adolescence), prolonged depression can significantly reduce the growth and volume of particular brain areas related to learning and memory; however, this negative impact can be ameliorated with antidepressant medication.1,2 Often times, when working with clients, families are understandably reticent about giving medication to their developing child. While individual response to treatment cannot be predicted, this research shows that, when appropriate to the client’s needs, medication can actually protect brain development, and thereby better support learning and memory over the lifespan.

Another topic that was covered was the impact of trauma on brain development and later self-regulation challenges and treatment response. As a clinician who often sees children with developmental, complex trauma, I am often in the position of explaining to families how trauma affects brain development. There is research to suggest that ongoing adversity early in childhood inhibits development in areas of the brain that manage inhibition, emotions, and processing, and this may contribute to later difficulties understanding emotion and modulating stress.3 While trauma may affect brain development in any child, there are also some children who appear to persist through adversity with lesser effect. There is research to suggest that this “resiliency” may not just be a personality characteristic, but may be a result of a larger, better-developed area of the brain that is thought to integrate emotional and cognitive information, allowing them to better manage emotional responses.4 Stronger development in this area can also predict better response to cognitive behavior therapy in older individuals with PTSD. 5 While it is not always clear what allowed those individuals to have stronger brain development, research shows that early treatment and access to social supports results in improved emotion processing and brain function in children with trauma, emphasizing neuroplasticity within the brain.6,7

The message that can be extracted from the above research is that the brain is highly vulnerable, but it can also be very resilient and adaptable. While our experiences and genetic vulnerabilities may present their challenges to neurological development, proper therapies, social supports, and medications can change a person’s developmental course and support long-term gains. Actually measuring brain volume and conducting imaging is not necessary for understanding how these factors present within an individual person. Instead, comprehensive assessment of their neurocognitive functioning, processing, learning, and social/emotional functioning can elucidate their resiliency factors, as well as targets for intervention. This is what we have always strived to do at NESCA, and now with the advantage of the Marquette Neuroanatomical Dissection Course, we can demonstrate how our clinical process, values, and goals are supported by current brain research.

 

References

  1. Schmaal, L., Veltman, D., van Erp, T. et al.(2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular Psychiatry, 21: 806–812. https://doi.org/10.1038/mp.2015.69
  2. Sheline YI, Gado MH, Kraemer HC. (2003). Untreated depression and hippocampal volume loss. American Journal of Psychiatry,160(8):1516-1518. doi: 10.1176/appi.ajp.160.8.1516.
  3. Zhai ZW, Yip SW, Lacadie CM, Sinha R, Mayes LC, Potenza MN. (2019). Childhood trauma moderates inhibitory control and anterior cingulate cortex activation during stress. Neuroimage, 185:111-118. doi: 10.1016/j.neuroimage.2018.10.049.
  4. Stevens, JS, Ely, E.D., Sawamura, T., et al. (2013). Childhood maltreatment predicts inhibition-related activity in the rostral anterior cingulate in PTSD, but not trauma-exposed control. Depression and Anxiety, 33(7): 614-622. https://doi.org/10.1002/da.22506
  5. Bryant RA, Felmingham K, Whitford TJ, et al. (2008). Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder. Journal of Psychiatry and Neuroscience, 2008, 33(2):142-6. PMID: 18330460.
  6. Wymbs, NF, Orr, C, Albaugh, MD, et al. (2020). Social supports moderate the effects of child adversity on neural correlates of threat processing. Child Abuse & Neglect, 102: 104413. https://doi.org/10.1016/j.chiabu.2020.104413.
  7. Garrett A, Cohen JA, Zack S, C, et al. (2019). Longitudinal changes in brain function associated with symptom improvement in youth with PTSD. Journal of Psychiatric Research,114:161-169. doi: 10.1016/j.jpsychires.2019.04.021.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

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

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

By | Nesca Notes 2023

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

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

Get Treatment

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

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

Get Exercise

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

Get a Job

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

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

Consider Taking Classes

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

Get a Coach

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

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

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

 

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

 

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

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

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach

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

How did you became interested in neuropsychology?

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

Tell us about your career journey.

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

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

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

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

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

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

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

What interested you about NESCA?

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

 

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

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

 

To book a neuropsychological evaluation with Dr. Abrams in Londonderry, NH, or to book with another expert NESCA neuropsychologist, complete NESCA’s online intake form

 

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

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 review20(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.

Meet Jasmine Badamo, MA, NESCA Executive Function Coach

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach

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

What brought you to the education field?

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

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

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

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

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

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

What about NESCA did you find attractive?

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

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

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

How do you do tutor students in EF?  

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

What is the favorite part of your job?

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

What do you find most challenging?

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

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

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

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

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

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

 

About Educational Counselor & Executive Function Tutor Jasmine Badamo, MA

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

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

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

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

 

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form

 

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

What Could It Be: ADHD or Anxiety?

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

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

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

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

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

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

 

References:

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

 

About the Author

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

 

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

 

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

 

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

By | NESCA Notes 2022

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

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

Get Treatment

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

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

Get Exercise

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

Get a Job

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

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

Consider Taking Classes

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

Get a Coach

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

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

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

 

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

 

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