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ASD Diagnostic Clinic

5

Neurodevelopmental Evaluations for Children under Age 5

By | Nesca Notes 2023

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Many families are curious about neurodevelopmental testing. Neuropsychologists who specialize in working with young children are often asked about when it is appropriate to pursue an evaluation, what the evaluation process entails, and where to go.

Why Would a Young Child Need an Evaluation?

There are developmental milestones across several domains that children are expected to achieve within certain timeframes. When children are showing delays in achieving those milestones within expected age ranges, seeking an evaluation may be warranted. From birth to 5 years of age, the areas of development that are especially important to monitor include:

  • Speech and Language (e.g., use of single words/phrases, following directions)
  • Social Skills (e.g., eye contact, social smile, interest in others, imaginative play skills)
  • Motor Skills (e.g., crawling, walking, using a pincer grasp)
  • Cognition/Early Problem Solving Skills (e.g., matching shapes and objects, completing simple puzzles)

If delays in any of the areas listed above are observed, pursing an evaluation sooner rather than later is recommended, as research has shown that early diagnosis and intensive treatment are the most important factors in determining rapid progress and long-term prognosis.

What Does a Neurodevelopmental Evaluation Entail?

Within a comprehensive neurodevelopmental evaluation, the child is administered tests that look at the developmental areas listed above. Information should also be collected from parents, teachers, and other caregivers who know the child well. These evaluations help to provide a better understanding of the child’s developmental profile, including areas of relative strength and weakness. In other words, the evaluation can provide more information about where the child’s skills currently fall when compared to their same age peers. Such information can provide diagnostic clarification, as well as help to inform recommendations for services if needed.

Where to Go

There are several options for where families can pursue evaluations, each with their benefits and drawbacks:

  • Early Intervention (EI): EI is meant to support families of children birth to three years of age who have developmental delays or are at risk of developmental delays. The goal of the Massachusetts EI program is to collaboratively promote skill acquisition based on the family’s priorities and child’s individual needs. Evaluations are typically conducted within the home setting to determine the child’s eligibility for EI services. While these evaluations can provide valuable information about the child’s strengths and weaknesses, a diagnosis will not be provided.
  • Hospital-based Setting: These evaluations are structured differently depending on the hospital system. In most cases, these evaluations are interdisciplinary, meaning that they involve a team of providers from different disciplines (i.e., psychologist, medical provider (pediatrician, nurse practitioner) speech and language pathologist, occupational therapist, etc.). While outcomes of these evaluations can include diagnosis and recommendations for services when appropriate, waitlists are often long, and reports tend to be brief.
  • Independent Setting/Private Practice: Independent evaluations usually involve several visits with a pediatric psychologist or neuropsychologist, rather than with a team of providers. Similar to the hospital-based evaluations, independent evaluations can result in diagnosis when appropriate. Specific recommendations based on the child’s individual profile are offered. These evaluations tend to be more detailed and comprehensive than those conducted by EI and within hospital-based settings. Clinicians also have the option to observe the child in other settings (e.g., daycare, preschool, elementary school), as well as attend school-based meetings.

Relatedly, NESCA is currently providing evaluations for children 12 months to 3 years of age who are showing early signs of an autism spectrum disorder (ASD). The wait time is 1 month or less – by design –  so children who meet criteria for an ASD diagnosis can access the appropriate interventions for them. If you are interested in learning more about ASD Diagnostic Testing through NESCA’s ASD Diagnostic Clinic, please visit our website at https://nesca-newton.com/asd-diagnostic-clinic-2/ and/or complete our online Intake Form.

Related resources and links to help track developmental milestones:

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit 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 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.

23

ASD Diagnosis Disclosure with Children

By | NESCA Notes 2022

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

All brains are different. Thus, there is no “one way” to disclose a diagnosis of an Autism Spectrum Disorder (ASD) to a child. The when, where, and how of diagnosis disclosure depends on the child and family’s preferences, values, and experiences. In addition, families do not have to feel alone in this process. Many families find it helpful to consult with parent support groups and professionals (e.g., therapist, neuropsychologist, speech and language pathologist, in-home ABA provider) to collaborate and discuss how to best approach diagnosis disclosure based on an individual child’s needs.

In my experience, I have found that disclosing a diagnosis of ASD to a young child is helpful when a child’s support network is integrated and involved in the process. As a family therapist, I see diagnosis disclosure as a family process and a potential to create and develop a conversation for the child and family that does not focus on identification and labeling of deficits but rather a conversation that is focused on understanding how each individual in the family thinks, feels, regulates, and relates to the world. The narratives we tell ourselves influence our well-being, and it is thus very important that children and families have a narrative or story to help guide their personal understanding and meaning of an ASD diagnosis.

Following a neuropsychological evaluation, I often provide child and family feedbacks to children and their caregivers to discuss the diagnosis. These meetings are designed to be “therapeutic feedbacks.” Here are key components of my “therapeutic feedback” sessions for “making meaning” of the diagnosis of ASD which may be helpful for some parents and providers:

  1. Normalize that all family members have unique learning styles and brains. Encourage parents and siblings to share what they know about their own learning styles of strengths and challenges. For example, a caregiver might say, “All brains are different, and I can’t wait to learn about how your brain works, how your sister’s brain works, and how my brain works.”
  2. Create a story about how the child thinks, feels, regulates, and relates to the world. Assist your child in developing a strength-based individualized narrative or story of their diagnosis, a narrative which also validates and acknowledges challenges. This can help the child and family see and understand how strengths can be used to meet challenges. The diagnosis of ASD becomes secondary to the process of describing the child’s perspective and experience – or describing their learning style. This idea stems from narrative therapy – a therapeutic treatment which helps individuals and families “edit and re-author” the stories we tell about ourselves, others, and our environment to increase well-being. It is important to remember that all stories are unique to the child and depend on the child’s experience and learning style. Examples that children and families have developed include, understanding ASD as “superpower,” “awesome awe-sism,” “data brain,” “legomaster,” “detective,” and “Ms. Feel Big.”
  3. Recognize the child as the “expert” of their experience. Many children with ASD experience heightened feelings of “being misunderstood” which can produce stress and significant emotional difficulties. It is thus very important to connect with the child’s own point of view, language, play themes, and description of their experience. Therefore, think developmentally – use play, videos/movies, books, art, or a written/visual outline (e.g., one column of “superpower” strengths and one column of “superpower” challenges). Here is an example of a book, which has been used in therapeutic feedbacks for diagnosis disclosure for some children depending on the child’s learning profile and special interests.
  4. Externalize the challenges that children experience and identify themselves. Do this by separating “problems” from the child. For example, a child I was working with identified that their “superpower” (ASD) makes them “just do it,” which in diagnostic terms reflects “impulsivity.” The family and I talked about “just do it” to create a story in which the child had a “jumpy monkey” (this child loved monkeys). This “jumpy monkey” needed “help” from the child’s “superpower” to “stop and think,” which in clinical terms means developing the child’s “impulse control.” This is a good example of how a child and family identified an ASD strength that could be used to meet a challenge.
  5. Review and revisit the conversation. Keep the conversation open and accessible to the child in every-day life. Practice normalizing and discussing every family member’s story of strengths and challenges at dinnertime, in the car, and during therapies (speech therapy, occupational therapy, psychotherapy, etc.).

These therapeutic feedback tips are just some of many. For an additional list of tips, please visit the University of Washington Autism Center’s Dr. Sarah Woods’ “Tips for Talking to Your Child About Their Autism Diagnosis.”

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

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

 

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

 

22

Myth Busters: Bilingualism and Language Delays in Young Children

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Bilingual and multilingual children are often diagnosed with both language disorders and autism spectrum disorders later in development than monolingual children. There are a variety of reasons for later diagnosis, such as disparities in service access or structural inequities in society which limit diagnostic or treatment services for bilingual and multilingual families as well as disparities in the availability of providers and experts capable of diagnosing communication disabilities and language delays in bilingual and multilingual children. Another main factor I often see in practice as a neuropsychologist is a “myth” related to language development in bilingual/multilingual children. The myth is that “bilingualism or multilingualism causes language delay.” This is not accurate and not concordant with the scientific research. If a parent, educator, pediatrician, or therapist raises concern about a bilingual or multilingual child’s language development, do not delay an evaluation to consider the presence of a language delay, communication disability, autism spectrum disorder, or a neurological or cognitive disability. It is likewise critical to not delay access to helpful interventions for language development (e.g., speech/language therapy, early literacy/phonics interventions, social skills/play interventions). Early detection of language delays improves outcomes for monolingual and bilingual/multilingual children.

Here are important key facts about language delay and bilingual/multilingual children which can be helpful for parents, educators, therapists, and other professionals:

  • While there are some differences in bilingual and multilingual language development from monolingual development in the brain, those differences do not produce speech delays.
  • Bilingual/multilingual children and monolingual children develop expressive language skills and reach early speech and language milestones at similar times in early development. For example, single-word vocabulary size of bilingual/multilingual children is equitable to vocabulary size of monolingual children.
  • Language regression (a “red flag” for autism spectrum disorders) occurs regardless of language status and is not dependent on a child’s monolingual or multilingual abilities.
  • There is much scientific research indicating that bilingualism/multilingualism enhances social communication skills (including children with autism spectrum disorders). Likewise, bilingualism/multilingualism does not in itself produce or explain social communication challenges for children.

Additional Resources

If you want to learn more about bilingualism and language delay, Dr. Brenda Gorman, Associate Professor in Communication Sciences and Disorders at Elmhurst College, and Dr. Alejandro Brice, Professor in the Department of Education at the University of Florida at St. Petersburg offer an informative YouTube video for parents and clinicians regarding bilingualism, “late talkers,” and language delay: https://www.youtube.com/watch?v=zT0x-EqanGg

This scientific article is also a helpful resource for parents and professionals: “Bilingualism in the Early Years: What the Science Says” (Byers-Heinlein and Lew-Williams, 2013): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168212/

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

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

 

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

 

2

Early Detection of Autism: NESCA’s New ASD Diagnostic Clinic

By | NESCA Notes 2020

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

Children with autism spectrum disorder (ASD) vary widely in terms of the intensity of their symptoms as well as the age at which symptoms emerge. In some cases, signs of autism are apparent during infancy. For other children, concerns about autism might not arise until toddlerhood or even early childhood.

As neuropsychologists, we have become increasingly adept at detecting and diagnosing ASD using a combination of developmental history, clinical observation and standardized assessments. We are constantly learning more about ASD and fine-tuning the tools we have available to us to make a diagnosis.

One of the most important things we have learned through longitudinal research over the past 10 years is that early detection of ASD is a crucial part of a child’s prognosis. Young children who receive intensive services are much more likely to develop language, play and social skills. Because their brains are still in a state of rapid development, they are much quicker to acquire new skills and make progress in the areas where they are struggling. Children who receive early intervention for ASD are typically better able to participate in inclusion settings with same-age peers once they enter elementary school.

Unfortunately, many parents are told to “wait and see” when they express concerns about their child’s development – especially with children who are not yet in preschool. This is a risky and sometimes harmful approach as it leads to children with developmental disabilities not receiving the services they need.

In light of our understanding about the importance of early detection of ASD, NESCA is proud to introduce its ASD Diagnostic Clinic. The clinic offers testing that is targeted specifically at identifying ASD in children between the ages of 2 and 5. For children who do receive a diagnosis of ASD, the report will allow parents to start accessing services immediately. As with all of our families, we hope to establish a lifelong relationship and will be available for follow-up consults and additional evaluations at any time.

 

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 appointment for the ASD Diagnostic Clinic or an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

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

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