Tag

cynthia hess

Jun 26
11

Understanding Behavior as Communication

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

School is out for many, and it is no surprise to many that it was a challenging year for teachers, parents, and children. One word that captures the experience of the 2022-2023 school year is stress. Teachers were stressed as their students continued to contend with the academic and social deficits that resulted from the pandemic. Many students have struggled to adapt to post-pandemic learning, and incidents of acting out behavior have increased precipitously. How do we make sense of children’s behavior while helping them develop and effectively manage the academic, social, and behavioral expectations of an ever-changing world?

Ross Greene, Ph.D., states, “Children want to do well and would if they could.” Behavior is not just random or meaningless. It serves as a way for children to express their needs, feelings, and experiences, especially when they have not yet developed strong verbal or communication skills. When the demands of the environment exceed a child’s capacity to manage them, they are apt to become stressed, increasing the likelihood that they will act out. Stress is a complex concept that is a response to perceived or anticipated demands or pressures that exceed an individual’s coping abilities.

When stressed, the adrenal glands release cortisol, a stress hormone that helps mobilize energy reserves for the fight-or-flight response. Fear and anxiety also increase individuals’ vulnerability to responding with fight or flight. So, while fear is focused on a specific threat, physiologically, it feels much the same as stress. Behavior is, therefore, a way of communicating that something is amiss. For instance, a child who acts aggressively may express frustration, which is stressful. And a child who becomes withdrawn might feel overwhelmed or anxious, triggering a stress response. Behavior is a natural way for children to communicate their needs, emotions, or reactions to the environment.

Our job as adults is first to check our own emotional status, because if we are tired or stressed, it will likely influence how we respond when children behave badly. Observing and interpreting behaviors with a curious and open mindset is important. By paying attention to patterns, triggers, and context, adults can gain insights into what a child might be trying to communicate through their behavior. Our job is not to manage the behavior but to understand, per Dr. Greene, what skills are lagging or what problems need to be solved, build relationships, and work collaboratively with children to solve problems and change behavior.

Resources:

The Explosive Child, Ross Greene, Ph.D., 2021

Beyond Behaviors; Mona Delahooke, Ph.D., 2019

Podcast: Two Sides of the Spectrum; episode dated April 5, 2023; “Safety as the Foundation for Everything

 

About the Author

Dr. Cynthia Hess (Cindy), a licensed psychologist, worked as an elementary counselor and school psychologist for 15 years before starting her doctorate. In this role, she developed extensive expertise and aptitude for working with individuals and groups struggling with a wide range of emotional and learning challenges.

She completed her pre-doctoral internship with Rochester Institute of Technology in Rochester, N.Y., where she trained at Hillside Family of Agencies in a therapeutic residential school. At Hillside, she worked with youth ages 5-17 who had experienced complex developmental trauma.

She earned her Psy.D. in Counseling and School Psychology from Rivier University in 2018. Having a strong interest in the impact of social media on children and our culture, her doctoral dissertation studied the impact social media has on social skills development in fourth- and fifth-grade children.

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 and young adults.

Dr. Hess joined NESCA’s Londonderry, N.H. office in 2019, where she completed a second two-year fellowship in pediatric neuropsychological assessment. Dr. Hess now conducts neuropsychological evaluations as a pediatric neuropsychologist and has a particular interest in working with children and young adults with complex emotional and behavioral profiles. Her experience allows her to guide families in navigating the complicated options for school and other support services.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, Londonderry, New Hampshire, and the greater Burlington, Vermont area, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Feb 06
11

What Could It Be: ADHD or Anxiety?

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

Many of my clients find NESCA after experiencing years of difficulty, whether at school, at home, or in the community. They have often been evaluated previously but still do not clearly understand what underlies their challenges. When clients struggle for years, they have often received a variety of diagnoses. The DSM-V provides diagnostic criteria that label a person’s experience due to developmental concerns, learning differences, or psychiatric problems. In essence, diagnoses are a simplified way to describe complex, ever-changing, multi-layered differences and are difficult to pin down with a single term. One of the most challenging diagnoses for a neuropsychologist to make, and a person to live with, is attention-deficit/hyperactivity disorder (ADHD).

ADHD is diagnosed when an individual displays difficulty directing and sustaining their attention to the extent that it negatively affects functioning across multiple domains. They may be distracted by internal processes resulting in daydreaming or struggle to filter incoming sensory information in the environment. For example, sounds, lights, and feeling too hot or cold. Because the regulatory part of their brain is not fully developed, they are more likely to become distracted. ADHD can be tricky, though, because there are many other explanations for why someone struggles with attention that may seem like ADHD but are not. This article focuses on similarities and differences between ADHD and anxiety in children.

When a child is anxious or stressed, whether about getting a good grade, disappointing a teacher or parent, or how he/she is getting home after school, this takes her mind off instruction, work, and social interactions. The result is inattention, but not due to ADHD. Individuals with anxiety may hyperfocus on worry, limiting attention to other information. Furthermore, it is common for children with ADHD to experience anxiety; however, it is most often a consequence of poor attention regulation rather than a cause of inattention. Both conditions can be associated with procrastination, but the basis for delaying work differs. The child with ADHD may struggle with initiating a task, while the child with anxiety may be preoccupied with anticipation about how well she will perform. At times, anxiety and ADHD present so similarly that it can be difficult to distinguish one from the other.

As you can see from the graphic below, there is a tremendous overlap in symptoms between ADHD and anxiety, making a comprehensive evaluation necessary to make an informed diagnosis.

Humans are complex, and a single diagnosis rarely captures their emotional and behavioral challenges.

 

References:

Essentials of ADHD Assessment for Children and Adolescents, First Edition, by Elizabeth P. Sparrow and Drew Erhardt, Wiley, 2014

 

About the Author

Dr. Cynthia Hess 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.

 

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.

 

Jan 16
11

Boredom: The Good, the Bad, and the Ugly

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

According to the APA Dictionary of Psychology, boredom is defined as:

A state of weariness or ennui resulting from a lack of engagement with stimuli in the environment. It is generally considered to be one of the least desirable conditions of daily life and is often identified by individuals as a cause of feeling depressed. It can be seen as the opposite of interest and surprise

In an APA podcast called Speaking of Psychology, Erin Westgate, PhD, a psychologist who studies boredom, suggests that boredom is an unpleasant emotion similar to anger, sadness, fear, and pain. In her efforts to understand and define boredom, Dr. Westgate explored the ways in which attention and meaning affect emotions and explain boredom. She opines that boredom may result from one’s inability to sustain attention, which may occur either when a task is too easy or too hard. It may help to understand why students describe a less preferred subject (e.g., math) as boring. Boredom may also be due to a sense that what we are doing lacks meaning. In both instances, the mind wanders and we are faced with that sense of being alone with our thoughts. Dr. Westgate notes that some thoughts are more engaging than others, and there are certain conditions under which people enjoy or do not enjoy their own thoughts. It has become increasingly difficult for people to sit and think, and consequently they search for ways to escape or avoid the boredom that results. However, boredom is not all bad. Like many things in life, it depends on how we manage it.

Similar to other negative emotions, boredom alerts us that something is wrong in our body, and it is human nature to want to escape or avoid it. When escape and avoidance become the only method to cope with boredom, individuals may begin experiencing chronic boredom, which can be detrimental to emotional and physical wellbeing. When boredom becomes chronic, it no longer works as a useful signal. Boredom can be more impactful than loneliness and is often mistaken for loneliness. When boredom is not well managed, it can lead to depression and self-destructive behaviors, such as self-harm and addiction. As alluded to above, the ability to sit with our thoughts and feelings without trying to avoid or escape them has become increasingly difficult. Perhaps related to the ease with which they can be avoided; for example, when our body sends out the first signal of discomfort, we can distract ourselves by reaching for our phone. An article in TIME magazine stated:

We’re trying to swipe and scroll the boredom away, but in doing that, we’re actually making ourselves more prone to boredom, because every time we get our phone out we’re not allowing our mind to wander and to solve our own boredom problems, Mann says, adding that people can become addicted to the constant dopamine hit of new and novel content that phones provide. Our tolerance for boredom just changes completely, and we need more and more to stop being bored.

Relying on electronics is only one example of a way to avoid and escape the discomfort of boredom. It is highly reinforcing because, in the short-term, it works. However, when it is one’s only tool in the toolbox, it may quickly undermine their ability for learning to manage uncomfortable thoughts and feelings and use them for creating positive change. Therefore, it is necessary to find a positive, opposite behavior to replace the maladaptive behavior. This often leads to an increased sense of purpose and agency, and improved self-esteem and self-concept.

Children and adolescents often complain about being bored, and while boredom is uncomfortable, it can also help to develop skills, creativity, and boost self-esteem. Once boredom sets in, it can be difficult for children to shift their attention to find meaning when confronted with the discomfort of boredom. According to an article published by the Child Mind Institute, boredom can be a great way to teach children how to manage frustration and regulate emotions when things are boring or not going their way. It is not that boredom teaches the skills, but rather it is what they do when faced with boredom. There are many strategies outlined in the article to help parents nurture skills when their children are bored. In general, be aware that behaviors may be attention-seeking, and therefore, should not be reinforced. Otherwise, boredom offers an opportunity for children to do something meaningful that benefits them and those around them. When properly managed, it spurs creativity and innovation. Along the way, it is important to be realistic and recognize that there will be failure, and learning to manage the discomfort of failure is an added bonus.

 

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.

 

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.

 

Aug 15
11

Private Neuropsychological Evaluation vs. School Evaluation

By | NESCA Notes 2022

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

While both a school evaluation and a private neuropsychological evaluation often provide valuable information, there are some considerable differences. The primary purpose of a school evaluation is to determine whether or not a student presents with a disability that impairs their ability to access the curriculum and fully participate in the academic and social life of the school. Once a student has been referred for special education, the special education team convenes to determine if, when, and how the student should be evaluated. They decide which instruments will be used for the assessment and who will be responsible for administering them. For example, if a student is referred for a suspected disability, a school psychologist conducts a cognitive evaluation, and a special education teacher will administer an academic assessment. A speech and language, physical therapy, functional behavior, or occupational therapy evaluation may be requested as well. After testing, each specialist writes their report and presents their results individually.

When a student participates in a private neuropsychological evaluation, the parents and student work closely with the evaluator through the entire process, from the intake to feedback and beyond. While there are certainly very comprehensive school evaluations, the information obtained by the evaluators is rarely integrated and instead presented as separate evaluations. This does not allow for a complete understanding of how deficits (or strengths) impact functioning across domains, especially when the child has complex challenges. A comprehensive neuropsychological evaluation is comprised of many elements. Most evaluations consist of a detailed developmental and family history, cognitive, academic, learning and memory (auditory and visual) assessment, visual-spatial and graphical motor skills, and attention and executive function. Depending on the referral question, the evaluation may include reviews of social skills and adaptive functioning or specific measures to assist with making a differential diagnosis. Generally, the assessment is conducted by a single evaluator. The data, including data from prior testing, is synthesized into a detailed report with specific recommendations for school, home, and community life when appropriate.

There are undeniably circumstances when a thorough school evaluation is beneficial. School evaluators have opportunities to observe students at school and consult with their teachers, which can be advantageous (although observations may be requested or necessary to complete a thorough private evaluation, too). School team members also have many opportunities to collaborate when evaluating and working with students. However, school personnel are limited in their ability to integrate data across disciplines, provide diagnoses, and directly assess medical conditions, such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and complex challenges, such as dyslexia and nonverbal learning disability (NLD). Additionally, while some parents establish a good working relationship with members of the special education team, they do not have the opportunity to develop a long-term, collaborative relationship with the evaluator as they would when a private evaluation is obtained.

 

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.

 

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.

 

Dec 20
10

Boredom: The Good, the Bad, and the Ugly

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

According to the APA Dictionary of Psychology, boredom is defined as:

A state of weariness or ennui resulting from a lack of engagement with stimuli in the environment. It is generally considered to be one of the least desirable conditions of daily life and is often identified by individuals as a cause of feeling depressed. It can be seen as the opposite of interest and surprise

In an APA podcast called Speaking of Psychology, Erin Westgate, PhD, a psychologist who studies boredom, suggests that boredom is an unpleasant emotion similar to anger, sadness, fear, and pain. In her efforts to understand and define boredom, Dr. Westgate explored the ways in which attention and meaning affect emotions and explain boredom. She opines that boredom may result from one’s inability to sustain attention, which may occur either when a task is too easy or too hard. It may help to understand why students describe a less preferred subject (e.g., math) as boring. Boredom may also be due to a sense that what we are doing lacks meaning. In both instances, the mind wanders and we are faced with that sense of being alone with our thoughts. Dr. Westgate notes that some thoughts are more engaging than others, and there are certain conditions under which people enjoy or do not enjoy their own thoughts. It has become increasingly difficult for people to sit and think, and consequently they search for ways to escape or avoid the boredom that results. However, boredom is not all bad. Like many things in life, it depends on how we manage it.

Similar to other negative emotions, boredom alerts us that something is wrong in our body, and it is human nature to want to escape or avoid it. When escape and avoidance become the only method to cope with boredom, individuals may begin experiencing chronic boredom, which can be detrimental to emotional and physical wellbeing. When boredom becomes chronic, it no longer works as a useful signal. Boredom can be more impactful than loneliness and is often mistaken for loneliness. When boredom is not well managed, it can lead to depression and self-destructive behaviors, such as self-harm and addiction. As alluded to above, the ability to sit with our thoughts and feelings without trying to avoid or escape them has become increasingly difficult. Perhaps related to the ease with which they can be avoided; for example, when our body sends out the first signal of discomfort, we can distract ourselves by reaching for our phone. An article in TIME magazine stated:

We’re trying to swipe and scroll the boredom away, but in doing that, we’re actually making ourselves more prone to boredom, because every time we get our phone out we’re not allowing our mind to wander and to solve our own boredom problems, Mann says, adding that people can become addicted to the constant dopamine hit of new and novel content that phones provide. Our tolerance for boredom just changes completely, and we need more and more to stop being bored.

Relying on electronics is only one example of a way to avoid and escape the discomfort of boredom. It is highly reinforcing because, in the short-term, it works. However, when it is one’s only tool in the toolbox, it may quickly undermine their ability for learning to manage uncomfortable thoughts and feelings and use them for creating positive change. Therefore, it is necessary to find a positive, opposite behavior to replace the maladaptive behavior. This often leads to an increased sense of purpose and agency, and improved self-esteem and self-concept.

Children and adolescents often complain about being bored, and while boredom is uncomfortable, it can also help to develop skills, creativity, and boost self-esteem. Once boredom sets in, it can be difficult for children to shift their attention to find meaning when confronted with the discomfort of boredom. According to an article published by the Child Mind Institute, boredom can be a great way to teach children how to manage frustration and regulate emotions when things are boring or not going their way. It is not that boredom teaches the skills, but rather it is what they do when faced with boredom. There are many strategies outlined in the article to help parents nurture skills when their children are bored. In general, be aware that behaviors may be attention-seeking, and therefore, should not be reinforced. Otherwise, boredom offers an opportunity for children to do something meaningful that benefits them and those around them. When properly managed, it spurs creativity and innovation. Along the way, it is important to be realistic and recognize that there will be failure, and learning to manage the discomfort of failure is an added bonus.

 

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.

 

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.

 

Sep 20
11

When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

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.

 

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.

 

Mar 15
10

The Uncertainty, Stress and Anxiety About What School Will Look Like

By | NESCA Notes 2020

*This blog post was originally published prior to the start of in-person school last fall for some. While many students have returned to their school buildings, many others are just now returning or will be in the coming weeks. 

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

Much of adjusting to the world in the midst of a global pandemic has been learning to live with nearly constant uncertainty. Undoubtedly, this pandemic and ensuing uncertainty has caused significant stress for youth and their families. The experience of persistent stress can result in increased vulnerability to anxiety and depression. Symptoms may become magnified in those who already faced mental health challenges. There is little doubt that there will be increases in mental and behavior health problems for children and families both in anticipating the re-opening of schools, and when schools reopen their physical buildings.

We all wonder what school will look like in the fall. The anticipation of returning to school can be especially stressful, and will likely be so for most youth. Given that students will not have been in schools with their peers for several months, it can be anticipated that they might feel a heighted sense of insecurity and uncertainty. Even in “normal times,” returning to the complex social and educational environment of school can be worrisome for many children and adolescents.

Each individual child will have had their own experiences while schools were closed. Some children and/or staff members may have been impacted by COVID-19 and some families and/or staff may be experiencing financial hardship due to parental unemployment or loss of household income. It is important to realize that regardless of their experience, each individual will have a unique response. It is helpful to recognize the signs of stress and help children learn positive ways of coping with it.

Signs of stress in preschool children include, but are not limited to, anger, nervousness, eating and sleeping problems (including nightmares), fear of being alone, irritability and uncontrollable crying.

In elementary age children, stress may manifest as increased complaining of headaches and stomachaches, feeling insecure, reduced appetite and difficulty sleeping, withdrawal and worrying about the future.

Signs of stress in pre-teens and teens may include anger, disillusionment, distrust of the world, low self-esteem, stomachaches and headaches, panic attacks and rebellious behavior.

As each person works through this very challenging situation, it is more important than ever to adopt a position of acceptance, as we never truly know what another person is experiencing or has experienced. The following are offered as suggestions on how to help children and teens cope with stress.

  • Help them identify how they are feeling and acknowledge and validate those feelings.
  • Encourage them to talk about what is bothering them.
  • Share strategies you use to cope with stress.
  • Talk openly and, as appropriate, share stories about stress in your day.
  • Find a physical activity and/or hobby that they enjoy and encourage them to participate.
  • Encourage them to eat healthy foods and emphasize the importance of a healthy lifestyle, especially as it relates to stress.
  • Make sure they get plenty of sleep.
  • Set clear expectations, without being overly rigid, and allow for “down” time.
  • Spend time outdoors, encourage them to do something they love – read a book, ride their bike, bake, etc.
  • Learn and teach your children relaxation skills, such as breathing exercises, muscle relaxation exercises, meditating, yoga, drawing or writing.

Our world will have changed by the time children re-enter their classrooms. No matter what happens in the fall, when it is time for school to start, it will inevitably be stressful. Learning to cope with and manage stress is important for physical and emotional health. However, if you are concerned about your child or are struggling yourself, seek help and support for yourself, your child or anyone in your family who is struggling.

Below are some helpful resources:

https://www.apa.org/topics/children-teens-stress

https://nesca-newton.com/helping-your-anxious-child-through-covid-19/

https://childmind.org/article/how-to-ask-what-kids-are-feeling-during-stressful-times/

https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.stress-in-children-and-teens.ug1832

 

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.

 

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.

 

Jan 18
11

When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

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.

 

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.

 

Oct 26
11

Kids Want to Do Well and Would If They Could

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

Ross Greene, Ph.D., is the author of several books including The Explosive Child, Lost at School, Lost and Found, and his most recent book, Raising Human Beings. He also is the founder of Lives in the Balance, a non-profit dedicated to supporting families with behaviorally challenging children. The foundation of his approach is that all kids want to do well and would if they could. Dr. Greene emphasizes using a collaborative problem-solving approach, which he calls Collaborative and Proactive Solutions (CPS). This model is based on the assertion that challenging behaviors arise when a child is faced with expectations that exceed their capacity to respond adaptively. Thus, adults are encouraged to take a collaborative, proactive approach to managing challenging behavior as opposed to relying on punishment and rewards.

The focus of collaborative problem-solving is not on the child’s challenging behavior, which could range from crying and whining, to hitting and biting, but rather on the expectations the child is having difficulty meeting. Adults work to identify the problematic expectations and the skills the child is lacking to meet the expectations. Dr. Greene refers to unmet expectations as “unsolved problems.” The goal is to solve those problems rather than modify behavior. Dr. Greene describes the CPS model as non-punitive and non-adversarial, and as such, it decreases the likelihood of conflict, enhances relationships and improves communication.

As a result of the pandemic, many parents and children are spending much more time together. For some parents of challenging children, their child’s behavior has been exacerbated by the increase in uncertainty and constantly changing expectations. There are many situations that arise that may lead to power struggles with children. It is important to remember that behavior is communication. Families are encouraged to reconsider their expectations and work collaboratively with their children to solve problems, especially when faced with extraordinary circumstances.

The specifics of collaborative problem-solving are much more detailed than there is space in this blog, and I encourage you to check out the resources listed below. While the consequences of the pandemic are certainly very stressful, they also present a good opportunity for families to enhance communication, uncover unsolved problems, teach skills and foster resilience.

 

Books for families by Dr. Greene:

The Explosive Child

Raising Human Beings

Website – contains educational videos and free resources for families and educators: https://www.livesinthebalance.org/about-cps

There are many YouTube videos available about CPS, but this one is pertinent to our current circumstances

 

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.

 

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.

 

Aug 10
10

“Doomscrolling” and Creating Space for Gratitude

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

A recent article in the New York Times (July 15, 2020) discusses a newly coined term for a coping strategy that has become pervasive amidst all the uncertainty: “Doomscrolling.” In the article, doomscrolling is defined as, “…the experience of sinking into emotional quicksand while bingeing on doom-and-gloom news.” It has become so common, it has a name.

We are collectively experiencing a great deal of anticipatory anxiety, which occurs when we feel anxious or stressed about an event that will happen in the future. We know there will be an event, but we do not know when or what that event will be. For those who participate in doomscrolling, perhaps it is an effort to find a sense of certainty. If we know what is coming next, it helps us feel more in control. However, while doomscrolling may provide a short-term sense of control, like many maladaptive ways of coping, it will eventually take a toll on our mental and physical well-being. Several wonderful suggestions are offered in the article and a follow-up piece to deal with doomscrolling. Another positive strategy for coping with anxiety and stress is practicing gratitude.

According to the National Institutes of Health, early research suggests that a daily habit of practicing gratitude may improve emotional and physical health. Practicing gratitude reduces stress and anxiety by regulating stress hormones in the brain. It also enhances the production of dopamine and serotonin, two neurotransmitters responsible for our emotions and sense of well-being. Practicing gratitude can be as simple as taking a moment to appreciate a good cup of coffee or a refreshing breeze on a hot day. There are many ways to create space for gratitude:

  • Take a few moments each day to write down as many things as you can that you are grateful for
  • Try to notice positive moments as they are happening
  • Compliment yourself each day and say it out loud
  • Keep a gratitude journal that includes: Compliments that you give yourself, current challenges and what you are learning, people you are grateful for, and significant assets of your life right now.
  • Start a gratitude jar with your family where each person writes one thing they are grateful for that day on a slip of paper and adds it to the jar. The notes can be read aloud at the start of each new week.

For further reading check out these articles:

https://www.nytimes.com/2020/07/15/technology/personaltech/youre-doomscrolling-again-heres-how-to-snap-out-of-it.html

https://www.nytimes.com/2020/07/16/technology/coronavirus-doomscrolling.html?searchResultPosition=2

https://positivepsychology.com/neuroscience-of-gratitude.

 

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.

 

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.