concussion Archives - NESCA

I had the chance to interview Dr. Alison Burns, a pediatric neuropsychologist who joined NESCA earlier this year. I learned a lot about Dr. Burns, both personally and professionally in my interview. I invite you to learn more about her, her approach to pediatric neuropsychological evaluation, and her expertise in ADHD and concussion, among other domains.  

You returned to the workforce this year after having children. How was your experience returning to work, and how was NESCA instrumental in doing so?

When I had my second and final child, I wanted to take a more extended parental leave to really soak up that precious early childhood time before returning to the workforce. Throughout my time out of the workforce, I completed continuing education classes and remained involved with a research project from my time at Children’s National in Washington DC. Because of the excellent supports at NESCA, it was a smooth transition back to work! I had the support of Dr. Moira Creedon, who served as a mentor for the first six months. In addition to the larger collaborative group of colleagues, I had someone I could go to with any specific questions I had.

Why did NESCA feel like the best fit for you?

I knew that I wanted to join a group practice because I wanted the ability to consult and collaborate with colleagues, particularly when working with more complex patients. It was important to me to join a team that is multidisciplinary as the unique perspectives that other disciplines at NESCA offer allow me to think more holistically about a patient’s profile and needs. NESCA has a culture of professional development and encourages clinicians to continue to learn through continuing education which fit with my core belief in the importance of staying up to speed with new evidence-based research.

I was also looking for a practice that understood family balance, because even though I am working, I am still the primary caregiver for our children, particularly during those morning and afterschool shifts. I knew I would need some flexibility, and everyone I met at NESCA really understood what it’s like to be a working mom and the load that comes with that role. At NESCA, I can make my work schedule fit my family’s needs.

What types of issues do you enjoy figuring out and unraveling for families?

My favorite population of kids to work with is those who have or are showing signs of ADHD. I trained at Children’s National with Gerard Gioia, Ph.D., who is an expert in the field of executive functioning. It was a big focus of my training, and I had the opportunity to evaluate many kids with ADHD throughout my post-doctoral training. It’s a very important population to assess because often times children are diagnosed with ADHD based on a symptom checklist alone. However, there are many other things that cause symptoms of ADHD such as anxiety/depression, learning disorders, or language difficulties just to name a few. This overlap in symptoms can lead to a misdiagnosis which is problematic as interventions for these disorders are wildly different. It’s important to tease apart these symptoms through a comprehensive evaluation so children receive the correct interventions and supports.

You’ve talked about the importance of behavioral observation during evaluations? What makes that so important?

Test scores, or data, can only tell me so much. Really watching a child and understanding how and why they performed a certain way adds critical information that fine tunes my understanding of a child’s neuropsychological profile. While it is important to consider a person’s history and current symptoms from clinical interviews, questionnaire data from a variety of sources, and direct testing scores, I think behavioral observations allow us to “look under the hood” so to speak. Seeing how a child works and thinks often provides me with excellent insight that helps me develop very targeted and specific recommendations for that individual.

You were previously part of a hospital-based multidisciplinary team. Can you explain how your experience with that team helps you in your work at NESCA?

I completed my internship and postdoctoral fellowship at Children’s National and had the opportunity to be a member of two multidisciplinary medical specialties (i.e., epilepsy and hematology/oncology). So far at NESCA, I’ve had the opportunity to work with one child who is post-chemotherapy, and it was rewarding to be able to support that patient with an understanding of the neuropsychological risks that chemotherapy can pose. It’s such a wonderful, unique population to work with. The resilience of child cancer survivors is just remarkable.

In addition, I worked with a range of medical providers across my other training opportunities, including therapists, psychiatrists, speech and language therapists, occupational therapists, physical therapists, behavioral health specialists, and primary care physicians. This experience taught me the importance of working with all providers who may be associated with a given patient in order to provide the most integrated care.

My training in a children’s hospital also taught me how important it is to rule out any medical explanations for the challenges we may see in the individuals we evaluate. For example, while I was a post-doc, I was evaluating a child who came to our ADHD clinic for a general ADHD evaluation. I noticed some things that had me concerned about the possibility of absence seizures. After further testing, it was determined that this child was actually experiencing absence seizures and not ADHD. Thankfully, we were able to refer them to the epilepsy team to get the correct treatment.

How did you gain expertise in evaluating students with concussions and supporting those who have lingering effects from concussion?

That specialty came out of my internship and post-doctoral fellowship at Children’s National. I was fortunate to have been able to work with some of the leading experts in the field of concussion, both clinically and in research pursuits. I am part of a “sports family,” so it was a natural fit for me. It’s also a booming area of research that was so interesting to me. During my fellowship, I saw patients who had suffered a concussion recently (often around a week after injury), following them serially through to the point of recovery. I provided them with guidance about how to safely return to school and physical activities, adapting the plan each week as their recovery progressed. Some children took much longer to recover from their concussion and had ongoing struggles and negative impacts long after the injury. In doing a full neuropsychological evaluation with these kids, we were able to consider the full scope of their needs and whether they needed a 504 plan or IEP in place.

It’s become an increasingly important population to think about because it’s not just kids who play sports that get concussions. It could be anything from a child who falls on ice or runs into playground equipment. It is not uncommon to learn that a patient being seen for an evaluation has a history of concussion at some point in their childhood. Having this training and expertise helps to tease apart what may be related to concussion and what is most likely unrelated to concussion.

About the Author

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, New York (coaching services only) serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.