Wrap up the school year on a high note with NESCA’s Executive Function Coaching and Functional Occupational Therapy! We offer support in EF, Real-life Skills, Parent/Caregiver Coaching, and OT.

Time is running out to schedule a Transition Assessment before the school year ends—gain valuable insights to guide the IEP process.

Ready to learn more or book a service? Fill out our Intake Form today!

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ASD

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Therapy session image

Finding the Right Therapist for Individuals with ASD

By | NESCA Notes 2024

Therapy session imageBy: Carly Loureiro, MSW, LICSW
Therapist, Executive Function Coach, Parent Coach

Finding the right therapist for individuals diagnosed with Autism Spectrum Disorder (ASD) can be challenging to come by. Finding an appropriate fit has more to do with the therapist’s background, style, and experience than it does with their license type (LICSW, PhD, LMHC, or LPC). As a therapist who specializes in ASD with a background in special education, I have developed a list of general guidelines when searching for an appropriate mental health provider.

  • Their ASD specialty should be visible on their website or profile: Websites or profiles on databases like Psychology Today and Zencare should highlight whether or not a clinician specializes in working with individuals with ASD. Not all, but some of these providers may have the letters CAS (Certified Autism Specialist) next to their name as well. A CAS is a professional who has obtained a certification that demonstrates specialized knowledge and training in working with individuals with ASD. Though this certification isn’t necessary, now you’ll know what it represents if you see it.
  • Schedule a free consultation if offered: If you see an ASD specialty or focus, schedule that introduction call or consultation! Ask the provider about their experience and approach with the population, and see if what is explained resonates with your needs.
  • They emphasize the importance of rapport building: Individuals diagnosed with ASD may struggle to communicate things like their preferences, needs, feelings, emotions, opinions, interests, and humor. An ideal therapist for this population will take the time to learn these unique attributes through a variety of different approaches and integrate them into treatment. This won’t be achieved in the intake or even within a specific number of sessions, but when the client is ready and able to share and open up.
  • They offer a strengths-based approach rooted in self-determination and self-empowerment: Often working with specialists all their lives, folks with ASD are more likely to have low self-esteem due to the amount of professionals who have been working to help them. Therapy should feel completely different from any other service. It should be a safe space where the individual feels in control, practicing self-advocacy as they learn new skills and strategies.
  • There is a family/caregiver component: If the client lives with a caregiver, partner, or other family members, it will be important for the provider to offer family work, if deemed necessary. Oftentimes, communication challenges exist in families and households where one or more members are diagnosed with ASD. By identifying and working through these challenges with a trained professional, life at home can get a whole lot easier.
  • They display flexibility and patience: Timelines and therapeutic frameworks should be approached gently and with curiosity, with an understanding that no two people with ASD are alike. Given this, a provider with a “one size fits all” approach or therapy framework will not be successful with this population. When you book an introduction call, make sure to explore this with the provider to check for flexibility regarding what a treatment plan may look like.

  

About the Author

Carly Loureiro is a Licensed Independent 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. Mrs. Loureiro provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood, as well as to parents/caregivers. 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.

 

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Rebecca Dautoff headshot and quote

Pediatric Neuropsychologist Rebecca Dautoff, Psy.D., Joins NESCA

By | NESCA Notes 2024

Rebecca Dautoff headshot and quoteBy: Jane Hauser
Director of Marketing & Outreach, NESCA

You adapt your approach with neuropsychological evaluations for each individual based on their developmental stage. Tell us about that.

With younger kids, it’s a much more interactive experience. Their attention spans are shorter, so they often need a warmer environment that feels less intimidating. Sometimes it’s getting on the ground and playing with them, other times it is starting testing under a table until the individual feels confident enough to sit at a table. I try to make it feel like a collaborative process.

It ultimately comes down to how you connect with someone. I connect very differently with a four-year-old than I do with a 14-year-old or a 20-year-old.

How do you get older adolescents, who may not be eager to be evaluated, to buy-in on engaging in evaluations?

This can be tricky. Usually, we can find a reason that they are comfortable sharing about why they are being evaluated, and I use that to explain what an evaluation can do to help them with that reason or issue. I try to understand what they want to get out of an evaluation and what it will help clear up for them.

Sometimes parents and adolescents are not aligned. Maybe a parent wants their child evaluated because they think that they have ADHD. The individual being evaluated may agree that they are neurodivergent, but may feel like their symptoms align better with Autism than ADHD. We can work with whatever that individual is feeling, even if it’s different from their parents’ concerns. We take the information and feelings from both the parents and adolescents – as well as input from educators and professional providers – and combine that history with the testing data, our observations during the evaluation, and synthesize it all to identify a diagnosis (when applicable). Then we develop highly personalized recommendations for interventions and hope to partner with the family along the way to support both parents and the adolescent.

You conduct neuropsychological evaluations and also projective testing here at NESCA. What is your approach to projective, or psychological testing?

If you’re questioning major psychiatric diagnoses that often feel very scary and are hard to talk about, projective testing can be very useful. It gives us a way to look at someone’s inner world or emotions, especially when they’re unwilling or unable to talk about it directly.

Describe the most challenging but rewarding individuals you’ve evaluated.

I enjoy working with the kids who think differently from their parents. It can be really rewarding to validate their feelings, explain their concerns to their parents and do some psychoeducation for their parents to get the adolescent or young adult and the parents back on the same page. Getting members of a family to understand each other’s perspectives is a really rewarding experience.

I also enjoy working with families who have gone through some kind of really hard experience, perhaps for a long time – whether that’s a traumatic experience or an adoption. And again, the part that I like so much is the feeling of bringing people back together and giving them some hope for the future.

Finally, I like incredibly complicated cases where there isn’t a clear answer – the ones where it’s a bit of a struggle to figure out or, in some instances, you work with a family as part of a longer-term partnership to gradually see a path forward. It’s not always clear-cut. When you can’t immediately clarify all of the pieces, you need to find a path forward for the family to start out on, revisit that path and potentially change or enhance that path. I like knowing that I can be part of someone’s team for the long term, like I’m joining the family and other providers, who are all working for that child. I’m talking about the ones that aren’t one-offs, rather the ones where we can build lasting relationships on behalf of a child.

You’ve worked in private and public schools and at a clinical treatment center. What brought you to NESCA, and how do you feel your past experiences impact your work with NESCA families?

Having lots of different experiences at different places and settings makes it easier for me to connect with a huge variety of people. I’m very rarely uncomfortable or fazed by the families or individuals I work with, their comments, or experiences, because I feel like I’ve heard so much from so many different people throughout my career.

I enjoy working with adolescents and young adults. Since they spend so much time in school, it has been beneficial for me as a clinician to have spent years working in the school setting. You have that perspective on schools – where they spend more waking hours than even at home. I have a good understanding of how schools work and the social dynamics for adolescents in schools. That has been especially useful in my work as a neuropsychologist.

What brought you to NESCA and why?

In my last position, I was in a mostly administrative role, doing a lot of supervision and teaching, which I really liked, but I missed the clinical work.

I was also looking for more exposure to different ways of doing things.

Since NESCA’s Founder and Director Dr. Ann Helmus is such a phenomenal clinician and is so well-known and respected, it felt like a great opportunity to learn from her. I had also trained as an intern with Dr. Miranda Milana, who is in NESCA’s Plainville office, and she talked a lot about the culture, the people, and how great everyone was. She was right! It’s a very supportive environment.

What I’ve found in the several months that I’ve been with NESCA is that the people are very smart here. I remember coming to one of NESCA’s weekly Case Conferences before I had agreed to join and thinking, “Wow, these people certainly know what they’re doing!” I learned something new in that Case Conference that I hadn’t thought about before, even though I had been practicing for years. I thought that was really powerful. NESCA is a group of professionals who truly love what they do and are so passionate about it. It is impressive to see so many people who have different perspectives and experiences come together to be so skilled at what we do. To be quite frank, I have learned a ton since being here and it hasn’t even been that long!

 

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents,Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

 

If you are interested in booking an appointment for an evaluation with Dr. Dautoff 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; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Leah Weinberg headshot and quote

NESCA Adds Pediatric Neuropsychologist Leah Weinberg, Ph.D. to its Team

By | NESCA Notes 2024

Leah Weinberg headshot and quoteBy: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is pleased to welcome Dr. Leah Weinberg to its team of expert neuropsychologists. Learn more about her professional experiences and what she hopes to bring to NESCA and the families it serves. 

Tell us about your career path and what made you get into neuropsychology.

My path to neuropsychology was not a direct one. My initial field of interest was in school psychology, a discipline that focuses on the mental health, behavioral, and academic needs of students within the school setting. The program I went to at Fordham University had a focus on testing, but also offered very strong consultation and counseling components. That’s how I got into psychology, broadly speaking. I did my internship at and worked as a school psychologist in a large private school for different age groups. During that time, I worked in early childhood, elementary, and in high school grades. As a school psychologist, I engaged in psychoeducational assessment, provided direct therapeutic support to students, and collaborated closely with educators, parents, and administrators to promote positive student outcomes.

And as a side job during and after graduate school, I dipped my toes into some teaching – assistant teaching, regular classroom instruction, some special education settings, and school counseling, primarily with middle to high schoolers. From there, I got into neuropsychology, which brought together my love of testing and helping children/students – and by extension, their families – by helping to figure out what is going on and how to direct them to the appropriate intervention(s).

I was a post-doctoral fellow at a group practice in the greater Boston area and stayed with them as a pediatric neuropsychologist for a total of 10 years.

What are your areas of expertise in evaluating students?

As far as ages go, I like to work with individuals from age six through the college years or into young adulthood. Regarding the profiles of students I evaluate, I have experience in a little bit of everything, but largely focus on children with executive function and attention deficits. I also evaluate for learning disabilities, including reading, math, and writing challenges, nonverbal learning disability, as well as children with concerns of various types of anxiety, depression, or mood issues. I also see a lot of children with emotional regulation issues, presenting as emotional outbursts, behavioral outbursts, meltdowns, or ADHD-type symptoms.

It’s really interesting to me to determine the cause of the various forms of regulation challenges. It may stem from being born prematurely or could also be related to a disorder or disability. The behaviors that children with regulation challenges exhibit may look similar from one child to another, but no two children are the same. The root cause is unique within each child or individual.

I really enjoy working with these kids and helping their parents or caregivers understand what’s going on with them. It’s often mind-blowing to see their parents or caregivers finally understand that there is a reason behind the difficult behaviors and that they have a chance to support them. You can watch them start to connect the dots or see things start to make more sense to them. It’s like pulling the veil off of something that looks and feels very complex, but through evaluation, we are giving them a path to go down to support the child and mitigate the challenges. This is why I love my job. I can provide clarity to parents and other providers. And with that clarity, we can empower them to seek appropriate and tailored care and support for their child.

What were you looking for in choosing to join the NESCA team?

I was hoping for a more supportive and collaborative environment and with a strong peer group. I wanted to be in a setting surrounded by colleagues who love their jobs as much as I do and who can work well together and independently.

I am hoping to nurture the relationships I have with the families I work with and also with my colleagues. From what I’ve experienced, NESCA is a supportive environment that will assist me in doing my job through its collaborative, enriching peer group, and that benefits the families we serve and strengthens our skills as neuropsychologists. I love learning from the different perspectives, experiences, and insights into schools, providers, and interventions we recommend.

What do you tell parents or caregivers who are hesitant to have their child evaluated?

Often, parents are setting out trying to find answers for their child’s struggles, maybe for the first time. Very frequently, they are unsure of the process and what it all means. They are worried about their child getting a label, what the implications of having a label will be  and for how long their child will carry this. They are scared of what they don’t know. Those who have been seeking answers for quite some time may be skeptical that a neuropsychological evaluation won’t deliver the answers they are desperate for.

Parents and caregivers exploring whether to get a neuropsychological evaluation carry a lot of fear, and rightfully so. In my role, I try to put myself in their shoes. They feel as if they are putting their child under a microscope and are unsure and afraid of what we will find. I keep their journey or experiences, which are often frustrating and tumultuous, in mind and educate them about the different ways in which a neuropsychological evaluation can be beneficial. For example, beyond assisting the family in understanding their child’s strengths and weaknesses in a thorough fashion, a diagnostic label may just be the key to giving their child (and them) some relief from their struggles. With a diagnostic label, they may finally access the services needed to help their child realize their full potential as a student, friend, or community member. Our goal is always to make things better for the child.

What have you been seeing in children, teens, and young adults since Covid hit?

I am seeing more emotionally driven scenarios, stemming from the increase in anxiety. I am also seeing kids with more of a mood component to their profiles. In addition, we are seeing an increase in learning disabilities alongside that mood piece. In many cases, it is more difficult to distinguish what exactly is the root cause of the challenges, whether each issue they have exists independently of or is part of another disorder, or which of the issues they are experiencing is at the forefront of the challenges. We also are seeing younger students taking much more time to learn to develop their academic skills, such as reading. Since Covid, there have been more cases involving questions about gender identity

We are also seeing a large population of students who are struggling with those important developmental and educational transitions, such as with the jump from elementary school to middle school and middle school to high school. The time that should have been dedicated to preparing students for these types of milestones was wildly disrupted. These students were left struggling to navigate so much on their own – things like how to work with multiple teachers, how to get around in a new environment and with a different schedule than they were used to. Their transitional preparation was essentially bypassed and children were required to carry out their education in developmentally unsuitable ways that they were not prepared for.

Finally, schools scaled down the level of work so much during Covid, which made it more challenging for the students when they came back to school. Since being back in the school setting, their demands were raised back up. It’s been difficult  for students and families to rebound, especially if there is some kind of identified need or challenge with the student. We’re still very much dealing with the ramifications of these shifts.

 

About the Author

Dr. Leah Weinberg specializes in the assessment of school-aged children and adolescents with a wide range of concerns including development disorders, such as Autism spectrum disorder, learning disabilities (e.g. dyslexia, dysgraphia), language-based learning difficulties, Attention Deficit Hyperactivity Disorder (ADHD), Nonverbal Learning Disability (NVLD), and executive functioning disorders (e.g. slow processing speed). She also has experience in working with individuals with psychiatric difficulties, such as anxiety, mood disorders (e.g. depression), and behavioral disorders. Dr. Weinberg has expertise in working with children with complex profiles or multiple areas of strength and weakness that cannot be encapsulated by a single diagnosis. Dr. Weinberg is passionate about helping families better understand their child’s neuropsychological profile and the impact it may be having on their behavior or functioning in order to best support them in all areas of their life.

 

If you are interested in booking an appointment for an evaluation with Dr. Weinberg 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; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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Map of Massachusetts with Plainville identified on the map and a quote from Dr. Erin Gibbons

Why Choose Plainville?

By | NESCA Notes 2024

Map of Massachusetts with Plainville identified on the map and a quote from Dr. Erin GibbonsBy: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

NESCA opened in 2007 in beautiful Newton, Massachusetts, which is a central location for many residents of the state, who are coming from different directions. Over the last 17 years, we have expanded both in Massachusetts and beyond to Londonderry, NH, Plainville, MA, and Hingham, MA (our newest location).

Our amazing intake coordinators frequently tell me that when they are talking with new clients on the phone and explain that their evaluation will take place in NESCA’s Plainville location, they commonly hear, “Where is that?!”

So, I am here to extol the many benefits of coming to NESCA in Plainville!

  • We are conveniently located off I-495 and Route 95. Since Plainville is in the suburban metropolitan areas of both Boston and Providence, there is very little traffic getting to the office. We also have ample free parking.
  • Miranda Milana, Psy.D. and I both work in Plainville. Between us, we evaluate clients ranging from 12 months to 30+ years of age. We both have extensive experience testing clients who have historically struggled to participate in traditional testing; for example, clients who are nonverbal, behaviorally dysregulated, or medically complex.
  • We receive frequent referrals for challenging diagnostic questions related to autism spectrum disorders (ASD), mood disorders, or intellectual disabilities and are comfortable taking on these often-complicated cases.
  • Both Dr. Milana and I evaluate toddlers for autism spectrum disorders in our ASD Diagnostic Clinic in Plainville. Our goal in the clinic is to help provide early detection of autism in children under three-years-old, when interventions are most effective.
  • Our fantastic occupational therapist, Jessica Hanna, MS, OTR/L works in the Plainville office. She is available for both OT evaluations and treatment. She also allows our testing clients to use the sensory gym during their breaks in their evaluation.
  • While your child is engaging in testing sessions during their evaluation, there are several stores, such as Target, that are only a 5-minute drive from our office. If you are looking to get some self-care in during their testing, you can even catch a 60-minute yoga or barre class in the plaza next door.
  • Finally, Patriot Place is a 10-minute drive from NESCA’s office in Plainville. If your child is a football or soccer fan, a visit to Gillette Stadium/Patriot Place is a great way to reward them for their hard work during the evaluation!

We invite you to learn more about the services we offer at NESCA in Plainville, MA, who we serve, and the many benefits of our convenient location. If you have any questions about our Plainville location, please let us know. We are happy to discuss the options for evaluations in Plainville.

 

About the Author

Since 2011, Dr. Gibbons has been a trusted expert at NESCA where she evaluates children presenting with a range of attentional, learning,Erin Gibbons headshot and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories. In addition, she evaluates adults who have concerns about whether they meet criteria for an ASD or ADHD diagnosis.

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

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Hingham, and Plainville, Massachusetts; Londonderry, New Hampshire; and staff in Burlington, Vermont and Brooklyn, NY, 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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Filled backpack ready for the first day of school

How to Prepare Students with Autism for the New School Year

By | NESCA Notes 2024

Filled backpack ready for the first day of schoolBy: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

I know that summer is about to end here in New England when I see posts on Facebook from my West Coast friends about their children’s first day of school and when every other commercial on TV is heralding back-to-school sales. A little sense of panic sets in, because of all the preparations needed for children going back to school. In my work with children with special needs, one group that often struggles with transitions such as these is children with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. One of the symptoms of ASD is difficulty with transitions. Some children with ASD get really upset with even slight changes in routines or plans. This is the reason why the start and end of the school year is often difficult for them. Here are some strategies for helping children with ASD transition back to school. They can also be used for any child to prepare for any transition, major or minor.

Visit the new school/classroom – A lot of schools are already doing this, but a visit to a new school or classroom a few days before the official start of school could help your child get acclimated to their new environment or teacher. Teachers usually report for work the week before the first day of school to prepare their rooms. Set a time to meet with the new teacher and let them provide your child with a tour of the room and other areas, such as the library or cafeteria. Show the child their desk and cubby. Tell them about the schedule posted on the board. This will ease some of your child’s fears and anxieties about the first day of school.

Use social stories – Social stories are written or illustrated stories that present information about social situations. Developed by educational consultant, Carol Gray, they instruct students about what to do or say in social situations, for example, the first day of school, together with information about other people’s motives or expectations. Using pictures from the school visit above, you can create a social story about the first day of school that talks about what to expect, directives about what your child can do or say, and the reason behind these actions. Here is an example of part of a social story for the first day of school:

  • This is Ms. Smith, my new teacher. She is very nice.
  • My mom and I walk to my classroom.
  • Smith is there to greet me. I look at her and smile.
  • I say goodbye to my mom and give her a big hug. She will come back at the end of the day to pick me up.
  • I enter the room and place my bag in my cubby. I find my desk and take my seat.
  • I look at the kid next to me and say, “Hi.” I want other kids to like me.

For help with creating social stories, you can go to https://carolgraysocialstories.com/social-stories/what-is-it/ or https://www.autismspeaks.org/templates-personalized-teaching-stories.

Use video modeling – In my work with children with autism, I often find that they are visual learners; they have better developed abilities in thinking and reasoning with pictures. And with the popularity of technology, such as iPads and smartphones, they are usually attracted to videos. Speech and language pathologist Linda Hodgdon, M.Ed., CCC-SLP (www.usevisualstrategies.com) has developed a strategy of using videos to teach skills/competencies for children and adolescents with ASD. In video modeling, you can bring your child to the new school/classroom a few days early with a video camera. You can record walking the hallways from class to class, opening the locker, going to the cafeteria or the gym, and other things they would need to do when school is in session. While you are filming, you can add dialogue explaining each item or place of interest. Then, your child/teenager can watch the video at home to prepare for the first real day of school when students will be there. Video modeling can also be used to prepare for other transitions/novel situations, such as preparing for a holiday or a new experience (e.g., riding a train, watching a movie, visiting a new restaurant).

Transitions are difficult because they require us to leave a place or state that we have been accustomed to and enter something that is unknown or unpredictable. Preparing ourselves for transitions by demystifying some of the unknowns can help us cope better with the anxiety that is inherent in these situations. I hope the suggestions above can help you and your child transition back to school.

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

To schedule an appointment with one of NESCA’s pediatric neuropsychologists, 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; 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.

 

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Busting a Common Autism Myth

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

I often hear from parents and caregivers that their child has several friends and likes going to social events, leading them to wonder how they could have autism.

First, let’s take a look at what autism is:

Autism spectrum disorder is a neurodevelopmental disorder classified by persistent deficits in social communication and social interaction skills.

To meet criteria for an autism spectrum disorder, one must exhibit the following social communication deficits across multiple contexts:

  1. Deficits in social-emotional reciprocity—this may include feeling unsure or uncomfortable when approaching others, having difficulty initiating social interactions, or having difficulty responding appropriately when approached by others. When engaged in conversation with others, it may be difficult to engage in back-and-forth conversation and share interests/emotions.
  2. Deficits in nonverbal communication skills—examples include poor eye contact, poorly integrated gestures in conversation, reduced facial expressions, difficulty reading the facial expressions and gestures of others, and not picking up on subtle body language cues.
  3. Deficits initiating, maintaining, and understanding relationships—characterized by difficulties making new friends, not wanting to engage with peers in any capacity, or difficulties maintaining long lasting friendships.

One must also demonstrate evidence of at least two of the following: repetitive behaviors, inflexibility/rigidity, restricted and intense interests, and sensory sensitivities.

Next, let’s look at what autism isn’t:

While individuals with autism experience social challenges, it is a common misconception that having autism means not having any friends or social skills at all. Contrary to this popular misconception, I evaluate many children, adolescents, and adults who are on the autism spectrum, are socially motivated, and have numerous friendships.

It is important to remember that while a diagnosis of autism requires social communication deficits, that does not mean a complete lack of skills must be evident. For example, I see many individuals on the autism spectrum who have several longstanding friendships but have difficulty making new friends. Conversely, some individuals find that they initiate friendships well, but have difficulty maintaining friendships over time. It is also possible for an autistic individual to demonstrate appropriate eye contact and facial expressions but have difficulty reading subtle nonverbal cues of others. With high social motivation, it still may be challenging to know how to participate in social conversation, how to build on the interests of others, and how to respond to emotional reactions.

Individuals with high-functioning autism often get overlooked as they have learned to “mask” or “camouflage” really well. That is to say that they work hard to “fit in” or hide areas of vulnerability. It might not feel comfortable for them to participate in group conversations or to interpret nonliteral language. They may feel as though there are written social rules that everyone else has access to except for them. When observing them, it may appear as though they are social and well-integrated into social environments; however, they may report a vastly different internal experience.

Taken together, having an autism diagnosis does NOT mean there is a complete inability to form friendships or participate in social settings. Rather, aspects of social communication can be challenging and warrant supports and services designed to enhance these skills.

If you have any questions or concerns regarding your child’s social development, speak with your pediatrician and/or schedule an evaluation with one of our neuropsychologists at NESCA.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

14

You’ve Got a Friend – The Importance of a Mentoring Relationship in ASD

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

It is graduation time again. Graduation speeches usually include a portion where the graduates thank their parents, siblings, friends, and teachers for their success. Most of the time they also thank coaches, mentors, and counselors for their accomplishments. Listening to them takes me back to my own graduation experience where I credited part of my success to people who came alongside me to mentor and support me through the various stages of my development. The encouragement and feedback provided by these mentors shaped me in ways that I would not have gotten simply by sitting in the classroom or reading books. The role of mentors is also important, and I should say more so, for children and adolescents who are on the autism spectrum.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in problems with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. Children and young people with ASD usually have problems with what are called social pragmatic skills – those skills that are necessary for knowing how to act in social situations, reading social cues, and conducting back-and-forth conversation with others. Some persons with ASD have a hard time appreciating the unwritten “rules” of social engagement, for example, that you should look at a person you are talking to, smile, and nod occasionally to signify that you are paying attention and interested in what other people are saying. It is difficult for persons with ASD to read subtle cues and “feel” the room to know how to react to certain dynamics. Appreciating sarcasm or humor could be difficult for them. These skills are often the hardest to “teach” a child or adolescent with ASD because of the complex and dynamic nature of social interactions. Also, these are skills that come naturally or instinctively for many of us, so it is hard to break down interactions and make subtle behaviors (e.g., eye contact, nonverbal cues, gestures) more salient. This is where an older sibling or a mentor – a camp counselor, a coach, or a tutor – could be a wonderful resource for teaching these skills to a young person with ASD. Have you ever had a camp counselor model for you how to react when you are introduced to a new person? Maybe you had a coach hang out with you after a game to model how to engage in back-and-forth conversation and listen to other people’s interests. These mentoring relationships are a good venue for practicing skills that may have been taught to the person with ASD in the context of a formal speech/language therapy session or in the classroom. Indeed, I have found over the years that children and adolescents with autism and have older siblings or mentors do better in these social pragmatic skills than those without this kind of guidance.

Beyond teaching social pragmatic skills, mentors also provide guidance about practical everyday decisions. Has an older sibling ever given you feedback about how your top does not match your pants? Or that you should slow down eating that burger because you are such a messy eater? You may have had an older friend who has shared with you how they navigated dating. Teenagers, not only those with autism, are usually more open to receiving such feedback or information from those who are a little older than they are as opposed to older adults or parents because of wanting to develop their own personalities apart from parents. Therefore, for these young people I usually recommend having a mentor who is a little older than they are who can serve as a friend/mentor/model.

Many skills that are crucial in navigating social situations – how to behave appropriately, how to make friends, how to be a good team member – are usually learned in the context of organic relationships, such as a mentoring relationship, as opposed to a classroom lesson because the interaction itself is the “content” of the instruction. The mentor must be reminded, though, to be more intentional in modeling/teaching these social pragmatic skills to the client.

There is no better way of learning how to be a good and caring friend than to experience having a friend come alongside you to show you how it is done. As my favorite singer, James Taylor, sings, “Ain’t it good to know you’ve got a friend?”

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

To schedule an appointment with one of NESCA’s pediatric neuropsychologists, 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; 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.

 

11

Is My Child Neurodivergent, and What Does That Mean?

By | NESCA Notes 2024

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

One of society’s leading sources of information is social media, which can be an excellent source of information and support. Parents may turn to social media when they notice their child struggling, trying to find others with similar concerns or answers about why their child seems “different.” Additionally, many children, adolescents, and young adults who feel different or out of place seek and find people or ideas that resonate with them online. While it may put them at ease, it often leads parents and their children to question if there is a diagnosis that will help them understand their child or themselves. Increasingly, people are asking if it is autism or another neurodivergent condition.

Neurodivergence is a term used to describe individuals whose brains function differently from what is considered typical. Neurodivergence is a broad term describing neurodevelopmental disorders present at birth and lasting throughout one’s life. Identifying if your child is neurodivergent can be the first step in understanding their unique strengths and challenges. There are numerous neurodivergent conditions, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), dyslexia, and others, each with their own characteristics and support needs.

Recognizing signs of neurodivergence in children can vary depending on the specific condition, but some common indicators include:

  • Difficulty with social interactions and communication
  • Repetitive behaviors or intense interests
  • Sensory sensitivities or aversions
  • Challenges with attention and focus
  • Delayed speech or language development
  • Difficulties with organization and planning
  • Impulsivity or hyperactivity
  • Unusual reactions to sensory stimuli
  • Emotional regulation difficulties
  • Learning and academic challenges

Observing patterns of behavior, communication, and sensory processing in your child can help indicate if they may be neurodivergent. Seeking a professional evaluation from a psychologist or developmental specialist can provide a more accurate diagnosis and guidance on supporting your child effectively. It is essential to remember that neurodivergence is not a label or limitation but a spectrum of diverse traits and abilities that contribute to the richness of human experience. By recognizing and embracing neurodiversity, society can benefit from the unique perspectives, talents, and contributions of individuals with diverse neurological profiles. Proper diagnosis, support, understanding, and accommodation are essential in helping neurodivergent individuals thrive and succeed in their lives.

About the Author

Dr. Cynthia (Cindy) Hess conducts neuropsychological evaluations as a pediatric neuropsychologist at NESCA. Dr. Hess enjoys working with children and young adults with complex emotional and behavioral profiles. She is skilled at evaluating social and emotional challenges as well as a range of learning profiles. Her experience allows her to guide families in understanding the supports and services their child requires to be successful in school.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, 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.

 

10

Understanding the Neuropsychological Evaluation Process When an Autism Spectrum Disorder is Suspected

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In January, Dr. Folsom published a blog post detailing the reasons why so many females on the autism spectrum are misdiagnosed in childhood. Here at NESCA, we are continuously working to improve our testing practices and administration protocols to ensure that we accurately capture one’s diagnostic picture when they come in for a comprehensive neuropsychological evaluation regardless of gender identity, age, or diagnostic presentation. As clinicians, tailoring an appropriate testing protocol is only one piece of the puzzle when working with our clients. From the moment we review your intake paperwork and questions/concerns, we work diligently to make sure we are teasing apart each component of a child’s neuropsychological profile to ensure clarity and accuracy for diagnoses and tailored recommendations. Here is a look into some of what that process looks like:

Initial Paperwork: Before your first intake appointment, your clinician will thoroughly review all of the intake paperwork and supporting documents you have submitted to us. We make sure to read all of your questions and concerns, while also making our own notes of questions that we will have for you during the intake appointment. All neuropsychologists here at NESCA are trained to identify “red flags” or areas of potential concern that we want to know more about through our interviews with you, your child, teachers, and our testing protocols.

Intake Appointment: During this appointment, we will ask you more in-depth questions about your responses and questions from the intake paperwork you provided. This is an opportunity for us to explore any concerns we may have. For many diagnoses, there are overlapping diagnostic features that are important to tease apart. For example, inflexibility and rigidity (not handling transitions well, struggling with changes in routine) may be related to an anxiety diagnosis, a mood disorder, an autism spectrum diagnosis, and/or executive functioning weaknesses.

Speaking with Collaterals: Oftentimes, clinicians will ask for permission to speak to other caregivers who have knowledge of your child, such as teachers, therapists, and pediatricians. Because we only see your child for a “snapshot” in time, it is important for us to also consider the perspectives of those who have longstanding relationships with them in a variety of contexts and environments.

Developing a Testing Battery: After the intake appointment, clinicians put together a tentative list of assessment measures that we may want to utilize. Tentative is the key word because oftentimes testing batteries change throughout the course of the assessment as a diagnostic picture becomes clearer or when specific areas of deficit become more apparent.

At NESCA, we have access to multiple testing tools that allow us to tailor our testing battery to capture any nuanced constellation of symptoms or diagnostic profile. For example, when thinking about how to accurately diagnose someone who is “high functioning” or “masking” areas of vulnerability related to an autism spectrum diagnosis, clinicians have access to the following batteries:

  • Autism Diagnostic Observation Schedule—2nd (ADOS-2): The ADOS-2 is one of the most well-known assessments for autism as it utilizes a semi-structured format to assess social communication skills as well as restricted interests, repetitive behaviors, sensory sensitivities, and rigidity. The ADOS-2 relies on standardized observations to capture any difficulties in the aforementioned categories.
  • Childhood Autism Rating Scale—2nd (CARS-2): The CARS-2 is another measure that involves a standardized rating scale based on direct observations of the child. While playing and interacting with your child, the clinician is able to fill out this rating scale to assess symptoms associated with an Autism Spectrum Disorder. The CARS-2 also includes a parent questionnaire to allow for qualitative parent observations.
  • Monteiro Interview Guidelines for Diagnosing the Autism Spectrum—2nd (MIGDAS-2): The MIGDAS-2 assesses qualitative observations of language and communication skills, social relationships, emotional responses, as well as sensory interests and/or sensitivities. The MIGDAS-2 can be particularly helpful for children and adolescents who are “high-functioning,” or do not fit the presentation of the “male prototype” described in Dr. Folsom’s blog.
  • Social Language Development Test (SLDT): The SLDT measures social communication skills such as the ability to make inferences, interpret social situations, and navigate peer conflicts.

In addition to the above measures, clinicians may also choose to administer subtests related to social thinking, perspective taking, and/or emotion identification. Examples of these subtests include:

  • Affect Recognition and Theory of Mind from the NEPSY-II
  • Inferences, Meaning from Context, Idiomatic Language and Pragmatic Language on the CASL-2

For older children and adolescents, clinicians may ask them to fill out/answer questions about their own perceptions of their lived experiences. This can be done through an unstructured interview or by one of the following:

  • Camouflaging Autistic Traits Questionnaire (CAT-Q)
  • Ritvo Autism Asperger Diagnostic Scale—Revised (RAADS-R)
  • Autism Spectrum Quotient (ASQ)

Parent Questionnaires: Whenever there are any questions or concerns related to social communication and interpersonal relatedness, your clinician may ask you to fill out rating scales assessing your perception of your child’s ability to interact with others, engage in age-appropriate play, be flexible in their responses to change or new environments, and have a variety of interests. These questionnaires include:

  • Social Responsiveness Scale—2nd (SRS-2)
  • Social Communication Questionnaire (SCQ)
  • Autism Diagnostic Interview—Revised (ADI-R)
  • Gilliam Autism Rating Scale—3rd (GARS-3)
  • Gilliam Asperger’s Disorder Scale (GADS)
  • Autism Spectrum Rating Scales (ASRS)

As you can see, we have a wide variety of measures available at NESCA to look at symptoms of an Autism Spectrum Disorder. Based on the discretion of your clinician, one or more of these may be used to further assess social communication concerns. While you may have heard of some of these being referred to as “the gold standard,” your clinician will use their knowledge, experience, and training to tailor a testing battery for the individual needs of your child. There is never a one size fits all approach to neuropsychological testing!

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

14

Why Do So Many Girls Get Diagnosed with ASD Later in Life?

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

In the 15 years that I have been doing neuropsychological evaluations, I have made countless diagnoses of Autism Spectrum Disorder (ASD) in females who are already in high school or even in college. Many times, the diagnosis comes as a surprise to the girls and the families alike, because no one has ever suggested it previously and/or their perceptions are colored by the stereotypes created in the media about autistic individuals. However, a discussion about what ASD is and how it manifests in females as opposed to males usually helps my clients and their families understand the nuanced and comprehensive nature of the ASD diagnosis. They often pivot to feelings of relief and gratitude for having a label for what they have been struggling with for a long time. Many of my clients learn to embrace this new diagnosis and use it as a framework for celebrating their strengths and looking for supports to address their vulnerabilities. They often say, “It totally makes sense!”

Autism Spectrum Disorder is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. When autism was first introduced by Dr. Leo Kanner in 1943, he described children (boys) who showed little interest in other people, insisted on routines, and displayed unusual body movements, like rocking back-and-forth and flapping their hands. Many of the children could talk but they rarely used their speech to communicate with others, and they had a variety of pervasive learning difficulties. For the most part, this continues to be the image that is conjured when people mention autism. However, with advances in research, especially within the last few decades, we have come to recognize the various manifestations of autism in children and adolescents who are higher functioning, have better communication skills, and have fewer learning issues. Thus, the newer conceptualization of autism as a spectrum with a wide range of capabilities and communication skills. More recently, researchers have also discovered that the presentation of autism varies in boys versus girls. This has made the diagnosis of ASD in girls difficult.

In their book Girls Growing Up on the Autism Spectrum, ASD researchers Shana Nichols, Ph.D., Gina Moravcik, MA, CCC-SLP, and Samara Pulver Tetenbaum, MA, outlined some preliminary findings of differences between males and females on the spectrum. They reported that:

  • The play of boys with ASDs is more restricted in range and more repetitive when compared to girls with ASDs who have stronger pretend-play skills.
  • Girls have stronger communication skills.
  • Sex-related social difficulties emerge over time – boys have more impairments early on (thus leading to earlier diagnoses), whereas for girls, the difficulties appear more in early adolescence.
  • Boys are more easily distracted when compared to girls.
  • Girls with mild difficulties may not be included in research samples.

They added that these differences could impact the assessment and diagnosis of ASD. They wondered if girls with ASD are being missed or overlooked during an evaluation because their presentation does not fit how professionals currently characterize ASD based on a male prototype. Other researchers have suggested that girls with ASD may be better able to compensate for symptoms despite having persistent core deficits associated with ASD, which might contribute to greater social “camouflage” or what is called “masking” (an individual hides or suppresses symptoms, behaviors, or difficulties). Indeed, as I have been learning more and working with girls diagnosed with ASD, I have been keeping in mind these potential sex differences. For example, I often compare my client’s social and communicative abilities to what is considered normative for girls their age and cognitive ability. I have been avoiding comparing my female clients with what has been the prototypical profile of autism in males. I also think about other manifestations of repetitive behaviors and interests in girls with ASD that are more socially acceptable, for example, an obsession on reading or running as opposed to preferred topics of males on the spectrum (e.g., trains, schedules, calendars, etc.).

Researchers have speculated that these differences in the manifestation of ASD in girls versus boys stem from how girls are socialized at an early age to pay attention to social cues/actions as opposed to boys. There is also research that suggests that girls are more able to follow social actions by delayed imitation. They observe and copy other children more effectively than do boys. This could lead to the phenomenon of masking and to milder presentations when compared to boys.

Sources:

Evans, S., et. al. (2019). Sex/gender differences in screening for autism spectrum disorder: Implications for evidence-based assessment. Journal of Clinical Child Adolescent Psychology, 48 (6), 840-854.

Nichols, S., Moravcik, G. & Tetenbaum, S. P. (2009). Girls growing up on the autism spectrum. London: Jessica Kingsley Publishers.

Ozonoff, S., Dawson, G. & McPartland, J. (2002). A parent’s guide to asperger syndrome and high functioning autism. New York: Guilford Press.

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

To schedule an appointment with one of NESCA’s pediatric neuropsychologists, 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 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.

 

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