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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AUTISM

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child saying no to food.

Beyond Picky Eating: Understanding ARFID in Children

By | NESCA Notes 2024

child saying no to food.By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Feeding children is one of the many aspects of parenting that seems pretty straightforward before you have kids of your own. But most parents will tell you that it can actually be mind-bogglingly difficult. That’s because “picky eating” is very common, so much so that it’s considered a normal developmental phase in early childhood. In fact, almost half of typically developing children go through a phase of “picky eating,” and the prevalence is even higher in children with neurodivergences, such as Autism Spectrum Disorder. The good news is that, as frustrating as picky eating can be, most children naturally outgrow this phase and eventually expand their diets to include more than chicken nuggets and buttered pasta. However, there is a subset of picky eaters for whom their selective food choices are part of a more serious problem that requires intervention.

In some case, highly selective eating may signal the presence of a condition called Avoidant Restrictive Food Intake Disorder or ARFID. A diagnosis of ARFID is made when an individual’s picky or selective eating is severe enough to cause secondary problems, such as nutritional deficiencies, reduced growth or weight loss, and/or social-emotional difficulties.

Unfortunately, little is understood about the underlying causes of ARFID. However, most people with ARFID fall into one or more of these three “subtypes,” each of which derives from different underlying factors.

  • In some cases, anxiety about choking, vomiting, or allergies drives avoidance of certain foods. This appears to be a factor for up to half of all children with ARFID and may develop after a traumatic experience, such as an illness.
  • Sensory sensitivities are another underlying factor for some individuals. These people may respond more intensely and/or have aversions to particular textures or flavors. Roughly one out of five of those with ARFID endorse sensitivities to flavors, textures, or smells. Interestingly, “supertasters”—people who have a higher concentration of taste buds—experience flavors much more intensely than is typical. These individuals may be more likely to develop ARFID as they avoid bitter foods.
  • Additionally, some people simply experience fewer hunger cues and may forget to eat or simply have a low level of interest in and motivation for eating. In these cases, individuals may be willing to eat a broader range of foods but struggle to eat enough.

Importantly, unlike most other eating disorders, ARFID is NOT related to concerns about body image or a desire to lose weight. It’s also important to recognize that ARFID is NOT just extremely picky eating, and individuals with ARFID won’t simply “outgrow” it.

Regardless of the initial triggering factors, limited or restricted intake is maintained by avoidance. That’s why early identification and treatment is important. It is also critical in order to prevent the development of potentially serious health problems related to nutritional issues, which can, in turn, cause difficulties ranging from fatigue and poor concentration to anemia, reduced immune system functioning, stunted growth, and even delayed puberty. Individuals with ARFID are also at risk of experiencing diminished self-esteem, may struggle to take part in social situations that center around food (e.g., meals with others), and develop emotional distress.

Though ARFID can be challenging to address, there are effective treatments. The goals of treatment depend upon individual factors but typically involve restoring weight if necessary, reducing anxiety, and gradually introducing new foods. Specific treatment modalities include family-based treatment, cognitive behavioral therapy, and exposure and response prevention. Treatment may also involve working with a physician and/or dietician.

If you’re concerned that your child’s “picky eating” may be more than a phase, please reach out to a professional who can further assess the situation and provide direction. There are screening tools that may be helpful in providing direction. One such resource can be found here: https://equip.health/arfid-screener. You can also contact the National Eating Disorders Association (NEDA) Helpline at 1-800-931-2237 or by texting NEDA to 741-741.

References/Resources

https://www.chop.edu/news/dos-and-donts-feeding-picky-eaters#:~:text=Do%20remember%20that%20picky%20eating,2%20to%20about%20age%204.

https://equip.health/conditions/arfid

https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/

 

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.

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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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Sean O'Brien headshot and quote

Introducing Pediatric Neuropsychologist Sean Hyde O’Brien, Psy.D., ABPdN

By | NESCA Notes 2024

Sean O'Brien headshot and quoteBy: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to welcome Sean Hyde O’Brien, Psy.D., ABPdN, to our team, conducting evaluations in the Newton, Massachusetts office! My interview with Dr. O’Brien offers an opportunity for readers to get to know him, his professional background, experiences and expertise, and his approach to working with children, adolescents, and young adults as a pediatric neuropsychologist.

You covered a broad swath of academic, emotional, and developmental challenges in your career as a pediatric neuropsychologist. Tell us more about that.

I think I’m a good generalist as far as pediatric neuropsychology goes, covering a lot of the high-incidence disorders, like ADHD, autism spectrum disorder, and learning disorders, but there are a couple groups that I really like working with.

What are the groups of children or students you find the most interesting?

I really like kids that are on the high functioning end of the autism spectrum, so I did one of my post-doctoral years at McLean at the Center for Neurointegrative Services, which is a DOE-approved special education school for kids who used to have what was called Asperger’s Disorder, which is now part of the ASD diagnosis. I got to spend a lot of time honing my assessment skills, but also spending quality time getting to know this group of students. They have a special place in my heart.

Another area I enjoy is working with children who came from other countries and may have moved because of war, famine, or simply for better opportunities for their families. They often come to this new country, perhaps not with the best English skills, and a lot of complex developmental and psychiatric challenges. Teasing all of those components apart and helping them acclimate to a new school, culture, and world has been interesting to me.

It takes a lot of thinking on your feet from an assessment standpoint to work with this population. For example, when you evaluate a child who speaks Russian and has only been learning English for six months, you’re not going to be able to do your standard battery of tests to figure out what their cognitive functioning is like. You have to think creatively and find ways to work slightly outside the domain of standard evaluation procedures. I’ve learned so much being with them, watching, and observing them in different settings, and, of course, getting the information from multiple sources, like teachers and parents. Those kids along with those who come from other countries through adoption are the most challenging, but also probably the most rewarding to me.

My wife and I were both adopted, so I come from a family of people who know and are part of the adoption community. I did a lot of research and clinical work involving international adoption. I love working with children who are coming from China, India, Korea, or domestically and their adoptive parents who are trying to figure out how to best support them with the range of strengths and weaknesses that they might have. These are also some of the kids who stick out to me.

Why did you come to NESCA?

I was looking for a change. I’ve been a partner in a private practice that we built from scratch for about 15 years, handling all of the many aspects of running a small business and evaluating students. I felt that the operational and clinical duties became too time-consuming to have a healthy work-life balance. I decided that it was time for a recalibration that would allow me to continue to evaluate children, but not have to stress over all of the other time-consuming operational details.

Throughout my career, I’ve had many NESCA reports come across my desk. They were very well done, and the practice has an incredible reputation. I met with NESCA’s founder and I knew it was the right place. She values the same things that I value – collegiality, warmth, and child-centric care. I was looking for a place where I could do good work and do it in a way that feels good at the end of the day. I found that in NESCA.

What do you feel you can contribute to NESCA families and staff?

The feedback I received over the years is that my ability to connect with children makes me an ally to them, especially those who may be a little resistant to the process. Some kids come in and are scared or angry that they have to be there for an evaluation. I always find a way to let them know this is in their best interest. I will explain what an evaluation will do for them in the end and that I want to work with them to figure out their “operating system” to make life work better for them. Families feel that I’m warm, approachable, and just a nice guy. I make sure that the individuals I evaluate don’t see me as Dr. O’Brien – I’m just Sean, and I’m a “learning detective,” of sorts, who helps figure out what’s going on with them.

I’ve had a number of students who I’ve seen three or so times over the course of the past 15 years. They may have come to me as a struggling six- or seven-year-old and are now in college. It’s the long-term relationships and knowing that the work I did, or that we did together, changed their developmental trajectory and helped them start to feel better about themselves as a learner and/or a person. That’s the piece that keeps me loving the work that I do and feeling young, fresh, and energized. I couldn’t ask for a better job.

What are your thoughts on the field of neuropsychology overall?

We’re a field that is a mixture of art and science. We are students of the brain; not experts, and we are all still learning about how the brain works. That is continuously being questioned, refuted, and remodeled. Since I first started studying neuroanatomy, we have come so far and yet we still know so little.

We can’t become rigid or complacent in the evaluation of children, adolescents, or adults, because that will be the biggest disservice we can give to our clients. We have to always be learning and evolving. Using antiquated models, not being open to new tests or new ways of thinking about things will not help anyone. I have the feeling I will learn a lot of new, creative, proven approaches while I am at NESCA, and that is very exciting to me.

I don’t think you get that kind of ongoing learning and exposure to innovative ways of doing things in many places. Often, neuropsychologists have to go outside of their practices to get that kind of knowledge from colleagues. Having that built in here at NESCA is something I am excited about.

 

About the AuthorHeadshot of Sean Hyde O'Brien

Dr. Sean Hyde O’Brien has been providing comprehensive neuropsychological evaluations in the Greater Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as  Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To book a consultation with Dr. O’Brien or one of our many other expert neuropsychologists or other clinicians, 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, 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.

3
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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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.

 

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If My Child Attends a Residential School, Will the State Pay for Housing When They Graduate?

By | NESCA Notes 2024

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

The goal of transition services is to help students who are on IEPs to progress toward their measurable postsecondary goals. This includes planning for future learning and work situations, and also planning for future living—as independently as possible. An enormous challenge that comes up in this planning process is that families (and sometimes the professionals supporting them) do not fully understand the realities of housing for adults who have exited public education.

There is a common misconception that if your child has qualified for residential special education programming, that will mean that your child will qualify for residential support as an adult. However, adult human service supports are not an entitlement like special education—these services are voted on by state legislature. The truth is that adult services and benefits are built to fill in the gaps of what you cannot physically or financially do to support your child. If you are alive and you can reasonably take care of your child, even with support, that is what you will be expected to do. If, instead, you want your child to be able to live in their own home or a shared home, then you and your child will be responsible for figuring out how to find and fund that living situation.

Hopefully, this data, shared by Cathy Boyle of Autism Housing Pathways in a January presentation, titled “Thinking About Housing,” will help to hammer home this point. Cathy shared numbers from fiscal year 2021 which quantified some of the residential supports awarded to young adults in Massachusetts who turned 22 during that fiscal year. Specifically, there were 1,233 students turning 22 who were served by the Department of Developmental Services (DDS) in Massachusetts. Of that number, only 263 received “residential supports.” However, the majority of those “residential supports” were provided in shared living situations where the housing was not being funded by DDS. It was only about 100 individuals statewide who turned 22 and entered into brick-and-mortar homes funded by DDS.

Regarding who is able to secure DDS housing in Massachusetts, it is typically only available to individuals who have an intellectual disability that was diagnosed before age 18 and (1) are a danger to themselves, and/or (2) are a danger to others, and/or (3) have pica (a condition in which a person eats items not usually considered food). There are some other criteria considered, including whether the caregiver can keep the individual healthy and safe (based on caregiver criteria, such as age, health, employment) and the judgment of the evaluator from the state. But, as previously described, housing is reserved for individuals with the most significant needs. Also, while there is funding through DDS for day services for adults with autism in Massachusetts, this budget explicitly does not cover residential services or housing. Only individuals with autism who also meet the intellectual disability criteria are eligible for housing under standard criteria.

If your child has a mental health condition, you may wonder about housing through Department of Mental Health (DMH). While it’s difficult to find current statistics on the number of young adults turning 22 and receiving group home services, there is a limited number of beds, and eligibility criteria for DMH services specifies that you can only be eligible for services if they are actually available. Also, the criterion for housing is quite similar to DDS in that an individual has to be entirely unable to live at home even with intensive in-home support. This often equates to the same variable of whether your child is actively at risk of harming themselves or another person.

While I’m providing data from Massachusetts in order to exemplify these housing challenges, the struggles are similar, if not more difficult, across the United States. The reality is that if you have a child with a disability, you and your child are more than likely going to have to plan for and figure out how to pay for their housing in adulthood. This is one of the ways that our children are treated 100% similarly to nondisabled adults. Although having a disability may help your child to qualify for accommodations in adulthood, living accommodations are most often not part of that right.

Resources:

NESCA offers many services designed to help students bridge the transition from high school to college including executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our transition planning services, visit https://nesca-newton.com/transition/. To learn about other coaching services, visit: https://nesca-newton.com/coaching-services/. To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/.

 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker who has been engaged in evaluation, development, and direction of transition-focused programming for teenagers and young adults with a wide array of developmental and learning abilities since 2004. While Ms. Challen has special expertise in working with youth with autism, she enjoys working with students with a range of cognitive, learning, communication, social, emotional and/or behavioral needs.

Ms. Challen joined NESCA as Director of Transition Services in 2013. She believes that the transition to postsecondary adulthood activities such as learning, living, and working is an ongoing process–and that there is no age too early or too late to begin planning. Moreover, any transition plan should be person-centered, individualized and include steps beyond the completion of secondary school.

Through her role at NESCA, Ms. Challen provides a wide array of services including individualized transition assessment, planning, consultation, training, and program development services, as well as pre-college coaching. She is particularly skilled in providing transition assessment and consultation aimed at determining optimal timing for a student’s transition to college, technical training, adult learning, and/or employment as well as identifying and developing appropriate programs and services necessary for minimizing critical skill gaps.

Ms. Challen is one of the only professionals in New England who specializes in assisting families in selecting or developing programming as a steppingstone between special education and college participation and has a unique understanding of local postgraduate, pre-college, college support, college transition, postsecondary transition, and 18-22 programs. She is additionally familiar with a great number of approved high school and postsecondary special education placements for students from Massachusetts including public, collaborative, and private programs.

Ms. Challen enjoys the creative and collaborative problem-solving process necessary for successfully transitioning students with complex profiles toward independent adulthood. As such, she is regularly engaged in IEP Team Meetings, program consultations, and case management or student coaching as part of individualized post-12th grade programming. Moreover, she continually works to enhance and expand NESCA’s service offerings in order to meet the growing needs of the families, schools and communities we serve.

When appropriate, Ms. Challen has additionally provided expert witness testimony for families and school districts engaged in due process hearings or engaged in legal proceedings centering on transition assessment, services and/or programming—locally and nationally.

Nearly two decades ago, Ms. Challen began her work with youth with special needs working as a counselor for children and adolescents at Camp Good Times, a former program of Milestones Day School. She then spent several years at the Aspire Program (a Mass General for Children program; formerly YouthCare) 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. Also, she 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 skill and transition programs.

Ms. Challen received her Master’s Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. While training and obtaining certification as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling.

Ms. Challen has worked on multiple committees involved in the Massachusetts DESE IEP Improvement Project, served as a Mentor for the Transition Leadership Program at UMass Boston, participated as a member of B-SET Boston Workforce Development Task Force, been an ongoing member of the Program Committee for the Association for Autism and Neurodiversity (AANE), and is a member of the New Hampshire Transition State Community of Practice (COP).

She is also 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: Innovations that Enhance Independence and Learning.

To schedule an appointment with one of NESCA’s transition specialists, 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 (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.

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.

 

11

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.

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.

10

Falling through the Cracks

By | Nesca Notes 2023

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

“You’re going to have a tough conversation on your hands,” I said. The parent sighed and nodded in response. “That’s what her ABA provider said, too,” she responded.

This conversation would not be difficult because her child was acting out, engaging in challenging behaviors, or taking up a great deal of adult time. In fact, she was exactly the opposite. Quiet, calm, gentle, and well-regulated were some of the words I used during our feedback session. And this, we discussed, is a huge part of the problem.

Despite their best efforts, teachers simply cannot be with every child that needs help, each time they need help. School providers do not have infinite caseloads, time, or capacity. There are real-world limitations to providing support and services for children at school. And yet, the children who suffer from these very real constraints are so often the quietest and least disruptive. This is extremely unfortunate when the child has real, diagnosed, observable deficits that absolutely require special attention and intervention at school.

Our brains often develop schema in order to reduce the brain’s workload (these occur entirely outside of our conscious awareness). Many social psychology studies have characterized the harm that schema can do. One such harm often comes to children for whom teachers have either strong positive or strong negative schema about. The effects of negative schema are likely obvious, but the positive schema can be just as challenging to manage. When teachers view a child very positively, they may be more likely to “write off” concerns (e.g., “she was just tired today,” “he really does know, he’s just having a bad day”), over-emphasize the child’s effort and diligence (rather than their actual skill level or mastery), and focus on positive attributes of the child in place of focusing on their weaknesses.

It can be challenging for parents to hear such positive feedback, particularly when it does not correlate with their perception of the child’s difficulties. Although neuropsychology attempts to be a strength-based field as much as possible, fully exploring and adequately characterizing deficits is often an invaluable part of what we do. This can help us to bring objective, data-driven recommendations to school teams for all students, hopefully preventing those quiet, hard-working youngsters from “falling through the cracks.”

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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.

 

To book an appointment with Dr. Yvonne Asher or another NESCA clinician, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

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