Tag

behavior

Meltdowns Happen

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

When we think of the word meltdown, we may think of the economy or stock market, glaciers, nuclear meltdowns or even volcanoes erupting. These are all examples of things collapsing from being over-stressed, overheating, a major disruption to a system or an internal collapse. Using the word meltdown to describe people is similar. In homes across America, even as we settle into quarantine, slow down our lives and find ways to enjoy our time together, there may be more meltdowns happening that are filled with tears, screams and lots of “No, I don’t want to!” Adults and children are becoming overheated, over-stressed, and our systems are over-burdened. And when a system can no longer take it, it melts down, boils over, erupts, or crashes and burns. In these moments, it is the only way of coping – to let loose, let off of steam, erupt – or just plain melt down. Sometimes it’s hard to believe, but each of us is doing the best we can to cope with a difficult environment. We’re trying to do the best we can, because our biological system is in a meltdown. We are not responding; instead we are reacting from our “downstairs” brain and not our “upstairs” brain.

A meltdown may be an explosion and look like crying, throwing things, yelling, aggressing, breaking things, etc. Or it may be more like an implosion – a withdrawal from the family, hiding, sleeping more, lethargy, etc. Both are the same in many ways biologically; the system is in fight, fright or freeze. A meltdown should be viewed as a “neurological storm.” This fight, flight or freeze response is not a child being “bad” or disrespectful, but rather is “bad behavior” that needs to be changed. Remember, it is their best attempt to cope, not a deliberate, willful, defiant act towards you. It is your child saying, “Help me – I can’t help myself! I’ve lost it!” This is not a time to teach, reason with, or win a battle. It is a fire to be put out, and you as the parent or caretaker is the firefighter. It’s a crisis to be managed, and you become your child’s “upstairs brain” or frontal lobe (even though you may want to react from your “downstairs brain,” because you may also be losing it.

Everyone wants to have a good day. Remember, when it’s going in a different direction, you are the adult. You can take a breath and even walk away (if you can) for a few seconds to compose yourself. This allows you to respond versus react. It is your job to manage the situation and take the emotional high road (often easier said than done). In these moments, it is really only about a few things.

  1. Safety and dignity
  2. Keep calm and reduce/simplify your language
  3. Keep calm and know this too shall pass
  4. Don’t get pulled off topic by all the things your child is saying or doing – this is a rabbit hole that you won’t emerge from
  5. Mention what you want to have happen, rather than what you want to stop (“Bang your pillow” instead of “Stop banging the wall”)
  6. Establish connection – right brain to right brain. Remember the mantra, “Name it to tame it.” (i.e. I know this is hard; I know you don’t want to do it; I wouldn’t want to either; or I know you don’t like it, etc.)

Resources:

https://www.drdansiegel.com/books/the_whole_brain_child/

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

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

 

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

 

Good Ideas for Dogs are Good for People, Too

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

  • Play Every Day! — Play can promote calmness and reduce anxiety. This is true for adults and kids.
  • Play Is Learning — Reflect after play by creating and asking questions. Did you learn anything new? What surprised you? How did you feel before you played? How you feel now?
  • Walk, Walk, Walk! — Walking helps dogs stay engaged with the world and brains stimulated. Yup, works for humans, too.
  • Be Present While Walking — Go for walks with or without a dog. Feel the air blowing, smell the flowers, hear the birds singing, feel the rain on your face. Learn the bird calls, bring binoculars and look closely at the birds. Be present as you walk, laugh, sing, splash in puddles….
  • Game Play — Playing games can help satisfy natural instincts. Play old games, teach your children games you played as a child, learn new games. Any games will do – board, card, dice, movement, etc. Play skill games, games of chance or luck games, silly games, etc.
  • Feed Relationships Through Play and Exercise — Bond with each other (a child, a dog or both!) through playing or getting some exercise together. Be active together…teach new tricks, kick a ball around, play catch, take a yoga or Zumba class, watch GoNoodle as long as it’s together.
  • Be in gratitude that you are experiencing this time together to slow down and reconnect with each other. Laugh, play, sing and dance together. Love and care for each other. Enjoy each other.

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

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

 

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

 

Acupuncture for the Treatment of Specific Conditions

By | NESCA Notes 2019

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

Licensed Acupuncturist, NESCA

A Primer on Acupuncture

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

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

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

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

Acupuncture’s Impact on Mental and Emotional Conditions

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

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

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

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

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

Acupuncture and ADHD

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

Acupuncture and Autism

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

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

References

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

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

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

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

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

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

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

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

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

 

About the Author

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

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

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

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

 

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

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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

Teenage Stress and Executive Functioning

By | NESCA Notes 2019

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

It is increasingly clear to educators, parents, clinicians and the like that teens are experiencing high levels of stress. Why? There are, of course, many reasons stemming from family, social, historical, and systemic “forces” that impact a teen’s personal day-to-day experience.

As an evaluator, I am very aware of one “force” affecting our teens: the “mis-match” between what teens are expected to do and what their executive function skills can handle. I recently participated in a panel discussion along with professionals from Summit Education Group, Engaging Minds and Beyond BookSmart to discuss this “mis-match,” a large contributing factor to student stress. Here are a few important “take-aways” from the discussion:

First, what is executive functioning?  Executive functioning skills are a “family” of skills that operate in a “top-down” process, controlling and regulating brain regions associated with attention, impulse control, emotion regulation and meta-cognition or “thinking about thinking.” A helpful analogy is that executive function skills are the CEO or the “boss” in the brain that monitors, plans, organizes and makes decisions. Here is a useful diagram from ADD Vantages describing executive function skills.

This depicted “family” of executive function skills develops throughout our development. A six year-old is not expected to plan multi-step assignments and check for errors when they write. A six year-old is expected to begin controlling impulses (e.g. waiting their turn in a game) and respond to adult prompts to organize belongings. As a child grows, their brain develops, and executive function skills expand.

However, higher-level metacognition and executive function skills do not simply “magically appear in the brain” or develop “in a vacuum.” Akin to learning a subject, such as math or science, children and teens need to learn executive function skills through teaching, modeling, observing and doing.

We know that teens face a number of responsibilities, particularly in high school – whether that be studying for exams, working on projects, participating in extra-curricular activities, participating in community-run volunteer opportunities, considering academic options post-high school, following their family’s weekly schedule, manage their social media page – and all while getting enough sleep, eating three meals a day and having self-care or “me time.” That adds up to a lot of expectations and demands. Some may posit that these are higher expectations for teens than in decades prior. Yet, what we know is that all teens are unique and develop executive function skills at different speeds. It is therefore logical to expect that many teens will become stressed…stressed because there is a “mis-match” between their daily expectations and the executive function skills that are required to carry out and manage those activities.

As an evaluator, I have worked with a number of teens who experience this “mis-match.” They haven’t yet learned the tools and strategies needed to manage their academic, social and personal responsibilities, and this contributes to low self-confidence, academic underperformance, limited independence, depression and worries about the future. They not only need support and teaching to grow executive function skills to study, work and live more efficiently now and in the future, they also need this “mis-match” and the stress it produces identified and acknowledged by the adults around them.

This “mis-match” can be identified by parents, teachers and/or through a comprehensive neuropsychological evaluation, which is oftentimes critical for determining a teen’s unique learning strengths and challenges. This “mis-match” is also sometimes identified by teens themselves – who are often highly aware of their own needs and simultaneously aware of difficulties that are impacting their vision and goals. As educators, clinicians and professionals who work with stressed teens, we have a responsibility to recognize when executive function “mis-matches” may be a source of stress and support our teens in developing an individualized, collaborative action plan.

 

About the Author:

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

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

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

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

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

 

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

 

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

 

Mindfulness: It’s Not Just for Grown-ups

By | NESCA Notes 2019

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow

There has been increasing interest in intervention strategies that target self-regulation in childhood. Self-regulation is the process through which the systems of emotion, attention and behavior are controlled in response to a situation, stimulus or demand. It develops rapidly in the early years of life. Self-regulation is necessary for social development because it supports and enhances peer acceptance and social success. Furthermore, it increases academic performance, particularly in elementary school. Problems with self-regulation and the accompanying executive functioning have been shown to correlate with a number of behavioral and emotional problems, particularly depression and anxiety. Mindfulness is emerging as an effective intervention for children struggling with self-regulation, especially when implemented at a time when children are acquiring these foundational skills.

Mindfulness is a way of paying attention, on purpose and non-judgmentally, to the experience of the present moment. Being mindful involves reflecting on the current internal experiences such as thoughts or emotions and the current external environment, such as sights and sounds, both clearly and objectively. This act of purposeful reflection enhances and facilitates self-regulation by promoting control, such as sustained attention and cognitive flexibility. Furthermore, it helps to reduce the incidences of such things as snap judgments, emotional reactivity or distressing thoughts.

Mindfulness-based social-emotional training has been shown to be effective in reducing stress, improving coping skills and building resilience when used with children. Mindfulness teaches children the skills needed to improve focus, calm themselves, plan and organize, and behave in a thoughtful manner. Research on adult populations shows that practicing mindfulness may reduce symptoms of anxiety and depression, and limited number of studies show some of the same benefits in children. Mindfulness is well tolerated by children and has been proven to improve psychological well-being. Introducing mindfulness practices to children has the potential to make a positive impact on a child’s ability to self-regulate, and thus facilitate their social, emotional and educational growth.

There are a number of ways to introduce children to mindfulness. One activity that children have responded positively to is being challenged to sit still and silent for as long as they possibly can. I have used this strategy in classrooms of children from pre-k to high school, as well as individually with children of all ages. Sometimes they are able to sit for 15 seconds, but they embraced the challenge of trying to beat their record by trying it again. Another mindful technique that works well with children is called “grounding.” Grounding techniques use the five senses to bring ourselves into the present moment. One grounding technique is finding five things in the room – they can be 5 things of the same color or any five things; four things the child can feel; three things the child can hear; two things the child can smell; and one thing the child can taste. Mindfulness can be playful and fun for children and families while effectively reducing stress, improving coping skills, improving ability to self-regulate and building resilience in children.

 

Helpful resources for families:

Mindful Games Activity Cards: 55 Fun Ways to Share Mindfulness with Kids and Teens. Susan Kaiser Greenland and Annaka Harris

A Still Quiet Place: A Mindfulness Program for Teaching Children and Adolescents to Ease Stress and Difficult Emotions By Amy Salzman, MD

I am Peace: A Book of Mindfulness By Susan Verde and Peter H. Reynolds

Breathe Like a Bear: 30 Mindful Moments for Kids to Feel Calm and Focused Anytime, Anywhere By Kira Willey

 

References:

Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.

Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and psychopathology, 2(4), 425-444.

Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social–emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental psychology, 51(1), 52.

Schonert-Reichl, K. A., & Lawlor, M. S. (2010). The effects of a mindfulness-based education program on pre-and early adolescents’ well-being and social and emotional competence. Mindfulness, 1(3), 137-151.

Sibinga, E. M., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: an RCT. Pediatrics, 137(1), e20152532.

 

About the Author

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

 

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

 

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

 

Introduction to Acupuncture with Licensed Acupuncturist Meghan Meade

By | NESCA Notes 2019

 

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

Licensed Acupuncturist, NESCA

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

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

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

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

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

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

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

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

 

About the Author: 

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

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

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

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

 

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

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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

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

By | NESCA Notes 2019

 

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

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

 

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

 

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

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

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

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

 

About the Author: 

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

If you are interested in booking an evaluation with Dr. Gibbons or another NESCA neuropsychologist, please fill out and submit our online intake form

 

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