Tag

child anxiety

Growing in a Fog: The Impact of Sleep Loss on Children’s Development

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

A recent study conducted at the University of Warwick, in the United Kingdom, supported the long-held belief that reduced sleep in children has a significant negative effect on their cognitive and emotional functioning. Findings were recently published in the journal Molecular Psychiatry, in an article, titled “Sleep duration, brain structure, and psychiatric and cognitive problems in children.”

When examining children ages nine to 11, reduced sleep was associated with higher levels of depression, anxiety and impulsive behavior, as well as poorer cognitive performance. Findings showed that, on average, behavior problems were 53% higher in children who got less than seven hours of sleep, compared to those who got nine to 11 hours. Additionally, on average, total cognitive scores were 7.8% lower in the children with reduced sleep.

Negative effects of sleep loss were not only observed through children’s behavior and task performance, but there were table differences within brain structure as well. Shorter sleep duration was related to lower volume in brain structures that are responsible for decision making, learning, emotion regulation, memory, executive function, sensory regulation, language function and spatial perception, among other skills. Because sleep is a highly active process, during which children’s brain circuitry reorganizes, it is thought that sleep loss can interfere with actual physical brain maturation, not just emotional, behavioral and cognitive functioning.

This study conducted by the University of Warwick is not the first to demonstrate how a lack of sleep negatively impacts children’s and adolescent’s functioning. In addition to better emotional and cognitive health, adequate sleep is also related to better physical health, including reduced injuries, heart disease and obesity (www.aap.org).

The American Academy of Pediatrics recommends that preschoolers get 10 to 13 hours of sleep per day; grade school children get 9 to 12 hours of sleep; and teenagers get eight to 10 hours of sleep. While this is so, children are often chronically sleep deprived due to excessive school, social and extracurricular demands. Increasing screen time and access to social media is also problematic, not only because these distract children and teens from sleeping, but technology use interferes with the release of melatonin, reduces REM sleep and activates the wake center of the brain. It is thus not surprising that a 2015 analysis of data from the Youth Risk Behavior Surveys found that approximately 57.8% of middle schoolers and 72.7% percent of high schoolers are not getting enough sleep. In spite of this, school start times remain early, expectations for extracurricular involvement remain high, and blue-light-filled technology is increasingly necessary for the completion of late-night homework assignments. This occurs alongside a steady rise of stress and anxiety within pediatric populations, pointing to the importance of re-evaluating the demands and conditions under which our children are expected to grow and learn.

Sleep is a foundational necessity on which cognition, emotion regulation, attention and learning build. The negative effects of sleep loss can be felt at any age, but they are particularly concerning in childhood, a time when the brain is rapidly developing. The American Academy of Pediatrics has provided some tips on how to support healthy sleep in a child of any age. These can be accessed at www.healthychildren.org, at the below link.

References

University of Warwick. (2020, February 4). Children’s mental health is affected by sleep duration. Retrieved on February 24, 2020 from www.sciencedaily.com/releases/2020/02/200204094726.htm

Wheaton AG, Jones SE, Cooper AC, Croft JB 2018, ‘Short Sleep Duration Among Middle School and High School Students — United States, 2015’, MMWR Morb Mortal Wkly Rep., vol. 67, pp. 85–90.

American Academy of Pediatrics (2016). American Academy of Pediatrics Supports Childhood Sleep Guidelines, June 13, 2016. Retrieved on February 24, 2020 from https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Supports-Childhood-Sleep-Guidelines.aspx

American Academy of Pediatrics (2018). Healthy Sleep Habits: How Many Hours Does Your Child Need? Retrieved on February 24, 2020 from https://www.healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

How to Help Children Grieve

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

and

Cynthia Hess, Psy.D.
Pediatric Neuropsychologist Fellow, NESCA

Oftentimes, the loss of a celebrity may be a child or adolescent’s first experience with loss or grief. Many this week who grew up admiring the talents of Kobe Bryant are unfortunately finding themselves in this group. Even when a child has never met the celebrity who perishes, they may feel as though they just lost a good friend.

If you are looking for guidance on how to help manage your child’s grief as it relates to the loss of a “hero,” we have some pointers to share with you. Most of these tips are also appropriate for the loss of a family member or close friend.

  • Talk about your child’s feelings openly, but try to let them approach you first. Normalize their feelings and validate them.
  • They will have questions about what took place, so be prepared to answer them and provide information to a developmentally appropriate degree.
  • Answer questions directly and truthfully, trying not to overly soften the information, as this can be confusing for children (e.g. “gone to heaven” is abstract, “died” is clear and concrete).
  • When it comes to celebrities or public figures who die, set limits around how much information your child is accessing within the media (i.e. keep access to television news limited, monitor internet use, etc.). An important aim is to not only control the influx of information, but also control the visuals that they are exposed to – preventing exposure to video clips and images that may be scary and difficult to let go of. With today’s 24-hour news cycle and on-demand access, there is just too much available to watch, so stay on top of what they see.
  • Be sure to pay tribute to the person who has died. It is important to share memories of that person. Let your child know that it is okay to talk about them.
  • While a death or tragedy is thankfully not a common occurrence, try to maintain the typical schedule that your child is accustomed to. Adhering to a “normal” routine will help them feel a sense of stability while learning to cope with loss.

Resources:

Talking With Children About Loss; Words, Strategies, and Wisdom to help Children Cope with Death Divorce and Other Difficult Times by Maria Trozzi

For loss of pets: All Dogs Go To Heaven by Lu Pierro and The Tenth Good Thing About Barney by Judith Viorst

https://www.nypl.org/blog/2017/07/21/childrens-books-about-loss-and-grieving

https://www.scholastic.com/parents/books-and-reading/raise-a-reader-blog/7-touching-books-to-help-kids-understand-death-and-grief.html

https://childmind.org/article/helping-children-deal-grief/

https://childmind.org/guide/helping-children-cope-grief/

 

About the Authors:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

 

 

Dr. Cynthia Hess recently graduated from Rivier University with a Psy.D. 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 book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

What is a Nonverbal Learning Disability?

By | NESCA Notes 2019

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

There is often lack of awareness or confusion about what a Nonverbal Learning Disability (NLD or NVLD) is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management.  As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning. On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception. In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration. Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills. Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive Functioning. Executive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning. With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges. Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD? The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. Some available options include Pamela Tanguay’s Nonverbal Learning Disabilities at Home: A Parent’s Guide and Nonverbal Learning Disabilities at School: Educating Students with NLD, Asperger Syndrome and Related Conditions, and Kathryn Stewart’s Helping a Child with Nonverbal Learning Disorder or Asperger’s Disorder: A Parent’s Guide.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at www.nesca-newton.com.

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Taking parents to SPACE! A groundbreaking treatment for parents of children with anxiety

By | NESCA Notes 2019

By: Ryan Ruth Conway, PsyD
Clinical Psychologist

As a child and adolescent psychologist who specializes in treating anxiety, it is very rare that I work solely with the individual. More commonly, in working with anxious youth, I engage the caregivers in treatment as well, as they serve a unique role in helping children better manage their symptoms. Sometimes I even meet with parents without ever seeing their anxious child, usually in situations where children are either very young or having difficulty participating in treatment.

Anxiety is a universal emotion that we all experience, and it can be quite helpful in alerting us to danger. However, some people experience heightened anxiety related to things or situations that do not actually pose a real threat, even though it truly feels that way. There are three parts of anxiety that impact each other – 1) cognitions (worrisome thoughts), 2) feelings (emotions and physiological sensations e.g., racing heart, stomachaches), and 3) behaviors (fight/flight/freeze response e.g., having tantrums, avoidance of anxiety-provoking stimuli).

Children will go to great lengths to find relief from anxiety. One of the typical ways they do so is by avoiding things they find scary. For instance, a child with separation anxiety may decline invitations for sleepovers and/or refuse to go to school. As their “go to” for support, children oftentimes manage anxiety by eliciting their parents to make them feel better. For a child with social anxiety, parents might step in and speak for the child when confronting strangers. When a teenager is facing persistent and obsessive thoughts about germs and cleanliness, parents might wash and re-wash the child’s clothing. For the individual who worries about a bunch of different things, parents might find themselves providing reassurance by answering a lot of their child’s questions or responding to repeated text messages ensuring the parents’ safety.

Anxiety has an interesting way of entangling family members into its “worry web,” and families fall victim to its demands to maintain peace in the household, largely without even realizing they are doing so! We call this parent accommodation, or any actions caregivers take or deliberately do not take because of their child’s anxiety. Accommodation is incredibly common and understandable. Parents will do anything and everything to protect their children and make them feel better. While accommodation might alleviate anxiety symptoms quickly and reduce anxiety in the short-term, unfortunately it is unhelpful in the long-term. Anxiety is tricky – the more parents accommodate, the more the worry web continues to grow, and children end up relying on their parents to bring relief as opposed to learning to manage anxiety on their own.

Last month I had the pleasure of attending a training for the SPACE (Supportive Parenting for Anxious Childhood Emotions) program, an innovative, short-term intervention developed at Yale University’s Child Study Center under the leadership of Dr. Eli Lebowitz, a prominent child therapist, researcher and author. As an empirically-supported treatment, SPACE has been well researched and, in a recent study, shown to be just as effective as individual cognitive-behavioral therapy (CBT) in treating child and adolescent anxiety (Click here).

SPACE is unique in that the treatment is delivered only to parents. In considering the interpersonal nature of anxiety and different reactions parents can have to their child’s symptoms, it brings caregivers together to send consistent, supportive messages. The aim of SPACE is two-fold. One goal is to help parents respond effectively to their child, in a way that both validates the child’s experience of anxiety and also shows confidence in the child’s ability to tolerate discomfort. Parents also work collaboratively with the therapist to develop a clear plan to take small, gradual steps in reducing accommodations. In addition, parents receive guidance on how to respond to their child’s reactions to these changes. Parents are not viewed as the problem, but rather as part of the solution. The result is a child or teen who can better self-regulate and cope with anxiety independently.

The interested reader can access additional articles about the SPACE program here:

https://www.jaacap.org/article/S0890-8567(19)30173-X/pdf

https://www.sciencedirect.com/science/article/pii/S1077722913000977?via%3Dihub

Dr. Conway offers SPACE to parents at NESCA’s Newton location. For caregivers who would like to participate in this treatment or have any questions, feel free to contact Dr. Conway at rconway@nesca-newton.com or 617-658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT) and Exposure with Response Prevention (ERP). Dr. Conway conducts therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

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.

State Dyslexia Laws – What do they aim to do and how can we aid their success?

By | NESCA Notes 2019

 

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

While in 2013 there were only 22 states that had laws regarding dyslexia, as of March 2018, 42 states have dyslexia-specific laws, and as discussed in the article Dyslexia Laws in the USA: A 2018 Update by Martha Youman and Nancy Mather, 33 legislative bills related to dyslexia were introduced between January and March 2018 alone. These dyslexia laws address such things as dyslexia awareness, teacher training, early screening of risk factors, interventions and accommodations, and rights of individuals with dyslexia. In addition to identifying the need to address these matters, at least 10 states have developed dyslexia handbooks, and New Hampshire (where I practice as an evaluator and consultant) has developed a dyslexia resource guide. With Governor Charlie Baker’s signing of S2607 on October 19, 2018, Massachusetts now joins the list of states with dyslexia training, screening, and intervention mandates.

To see such progress in the identification and intervention of dyslexia is exciting for everyone who is connected to this community. As a pediatric neuropsychologist, I have worked with individuals with dyslexia and related disorders for many years, and in 2017 I had the pleasure of being one of the many professionals involved in the development of the NH dyslexia resource guide. Since that time, it has been encouraging to see a number of school districts embrace training opportunities and develop early screening efforts. While that is so, across the nation several states still do not have dyslexia-specific laws, and most states that do have them continue to experience uncertainty about how to implement said laws. Based on my personal experience and observations, there appear to be some basic steps or efforts that may improve the effectiveness of these efforts:

  • Use the term “Dyslexia.” Historically, the term “dyslexia” has been rejected or discouraged by most schools, instead preferring to label the associated learning profile as a Specific Learning Disability in reading; however, dyslexia specialists and advocates have long argued that this latter term is problematic because it fails to acknowledge the neurobiology of dyslexia and it does not inform interventions, accommodations, and related services with the level of specificity that is dictated by the defined diagnosed label. To address this concern, in 2015 the U.S. Department of Education issued a formal letter clarifying that “there is nothing in the IDEA or [the] implementing regulations that would prohibit IEP Teams from referencing or using dyslexia, dyscalculia, or dysgraphia in a child’s IEP.” Until schools are willing to routinely use the term “dyslexia,” the potential success of dyslexia laws is significantly challenged.
  • Educate families about universal screening and differentiated instruction. The screening and intervention requirements outlined in most dyslexia laws fall within the purview of general education, aiming to identify children with risk factors for learning disabilities and support their needs through multi-tiered systems of support, such as Response to Intervention (RTI). As such, there are not as many defined requirements regarding progress monitoring and reporting, or the coordination of the child’s “team” (i.e. parents, teachers, and other pertinent school personnel), as there would be within special education procedures. Families need to be educated about these universal screening procedures and methods of differentiating instruction within the general education curriculum so that they can understand their child’s challenges and monitor progress in a more informed manner.
  • Coordinate general education and special education screening and evaluation procedures. While the screening and intervention procedures discussed in dyslexia laws are generally within general education, a child should be referred for special education consideration if he or she is not making progress with the increased levels of RTI support. To optimize the utility and impact of the early screenings and to ease the referral process, the criterion that is measured within the general education setting should map onto the criterion for special education eligibility as much as possible; however, should a child require referral for special education consideration, it will also be critical to conduct a comprehensive evaluation of why the child is not progressing, allowing for more individualized and appropriate interventions.
  • Ensure the dissemination of dyslexia handbooks or resource guides. While the dyslexia community is enthused by state dyslexia laws, many teachers and school personnel are not aware of these mandates or the associated resources. These resources are a treasure trove of information about how to delivery differentiated instruction and integrate instructional methods and accommodations that are likely to be helpful for all students.
  • Continue raising awareness. Parents, teachers, and school personnel should all be educated about learning profiles, early warning signs, screening procedures, and interventions. School districts should take advantage of the resources provided by their state, which often includes the availability of a state-appointed reading specialist who can provide training or aid the dissemination of information or development of screening and intervention procedures.

There has been great progress in the recognition, identification, and remediation of dyslexia within American schools; however, this work is only just beginning. At the core of this issue is the need to recognize dyslexia as a defined, neurologically-based learning disability that can be identified at an early age and can be effectively remediated through targeted, evidence-based interventions.

Through our evaluations with students in New Hampshire and Massachusetts, clinicians at NESCA aim to identify and define learning profiles such as these and provide recommendations for targeted instruction as well as systemic support and training. Please visit our website at www.nesca-newton.com for more information.

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Lessons from My Children: Always Ask “Why?”

By | NESCA Notes 2018

 

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

There is a lot that we can learn from our children. They are not as burdened as we, and they approach life with more vigor, wonder, and confidence. With this, they do a lot of important things that we adults have forgotten to do.

Right now, both of my boys are at ages when they are constantly asking, “Why?” For my two year old, it may sound something like this:

Me: “It’s time to put on our shoes.”
Him: “Why?”
Me: “Because we have to go to school.”
Him: “Why?”
Me: “Because we leave at 7:45.”
Him: “Why?”
Me: “Because I have to be at work at 8:15.”
Him: “Why?”

I think you can see where that one is going…

For my five year old, the questioning is a little more sophisticated:

“Why can’t we feel the earth moving?”
“Why do the teens always start with number one?”
“Why is ‘W’ an upside down ‘M’?”

While sometimes the incessant questioning can make a parent’s head spin, asking “why” is how children learn about the world. Questioning is one of the primary tools aiding children’s cognitive development. But in spite of the importance of questioning early on, as we get older, we increasingly forget to make such inquiries. While this may be for understandable reasons – life is busy, we are set in our routines, we have learned to trust the expertise and opinions of others, etc. – such lack of questioning can often interfere with our ability to effectively solve life’s dilemmas, and effectively help our children.

At NESCA, families and caregivers seek out our evaluations for a range of concerns: reading interventions were tried, but they did not work; a child’s behavior is out of control, but they are not responding to the behavioral plan; a teenager is not motivated to do their schoolwork, and they are failing; or conversely, in spite of spending five hours per night on homework, the teen is still failing.

What is most often happening in these situations is that there is not a sufficient understanding of why the child is struggling, and so well-intentioned attempts at helping are rendered fruitless.

Things are not always as they seem. Behavior, be it academic difficulties or noncompliance, is a symptom of an underlying issue. So while some children struggle to read because they are delayed in the acquisition of phonological skills and other foundations of reading, other children may struggle to read because of deficits in things like visual scanning and processing, attention, and/or auditory processing. For the out of control child, if their noncompliance is based in underlying anxiety and their need to avoid anxiety triggers and feared situations, then behavioral plans that are not paired with anxiety-focused therapeutic interventions will be ineffective.

It is because of the need to know “why” that NESCA’s neuropsychologists always conduct the most comprehensive neuropsychological evaluations. Unless we know the underlying reasons for a client’s challenges, we cannot create the well-informed recommendations and roadmap for how to help them make progress. Through in-depth inquiry and investigation, we get a detailed understanding of a client’s strengths and challenges. We find the reason “why.”

So, while I may sometimes get tired of answering my children’s near-constant questioning, they may have this one right. It is only with ongoing contemplation and inquiry that we can be confident in our understanding of the world, and of our children.

 

About the Author:

Dr. Angela Currie conducts neuropsychological and psychological (projective) assessments out of NESCA’s Londonderry, NH and Newton, MA offices, seeing individuals with a wide range of concerns. She enjoys working with stressed-out children and teens, working to tease apart the various factors that may be lending to their stress, including assessment of possible underlying learning challenges (such as dyslexia or nonverbal learning disability), attentional deficit, or executive function weakness. She also often conducts evaluations with children confronting more primary emotional and anxiety-related challenges, such as generalized anxiety, obsessive compulsive disorder, or depression. Dr. Currie particularly enjoys working with the seemingly “unmotivated” child as well as children who have “flown under the radar” for years due to their desire to succeed.

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

Blog Update: Intensive Therapy

By | NESCA Notes 2018

By: Ryan Ruth Conway, PsyD
Clinical Psychologist, NESCA

Earlier this month, the New York Times published an article about intensive therapy, a type of treatment that is more accelerated and condensed than traditional once weekly therapy. The author described a “new wave” of therapy programs popping up around the country designed to help clients with all types of anxiety experience relief more quickly. The article cited new research to explain the growing popularity of concentrated treatment, which shows that the approach is generally just as effective, and in some ways more effective, than longer-term care for both children and adults. Also noteworthy is that fewer clients dropped out of the intensive treatment, which suggests that clients are more likely to “stick with” therapy when it is delivered in a shortened, consistent format.

In short-term therapies, clients have the opportunity to practice using newly learned skills to face their fears in all different situations and environments that elicit anxiety. For instance, a client with social fears might be instructed to order for himself at a restaurant, ask a stranger for directions or purposely do something embarrassing in public. By practicing daily in session and also for homework, you see a lot of carryover from day to day and faster acquisition of skills, which is a huge confidence booster! Exposure and Response Prevention (ERP), a technique often used in Cognitive Behavioral Therapy (CBT), helps clients approach anxiety-provoking situations and learn that anxiety eventually habituates, or dissipates, on its own over time, and those other behaviors they have been using to manage their fears (e.g., excessive washing, checking, seeking reassurance from parents or avoidance) are neither helpful nor necessary.

NESCA offers intensive CBT “boot camps” for children and adolescents with anxiety, including (but not limited to) social anxiety, phobias, OCD and generalized anxiety. NESCA clinicians thoroughly enjoyed helping clients build coping skills and feel better through intensive treatments this past summer, and received a positive response from children and their families! Our treatment programs are individually tailored for each client and also include parent sessions in order to teach caregivers the tools they need to best support their child. Summer or school breaks can be the perfect time to focus on mental health without the distractions of the academic year or other extracurricular activities.

To learn more about intensive therapy and NESCA’s program visit: http://www.nesca-news.com/2018/03/intensive-cognitive-behavioral-therapy.html

For any questions about NESCA’s intensive treatment program or to sign up please contact Ryan Ruth Conway, PsyD at rconway@nesca-newton.com or (617) 658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, 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.