NESCA is currently accepting therapy and executive function coaching clients from middle school-age through adulthood with Therapist, Executive Function Coach, and Parent Coach Carly Loureiro, MSW, LICSW. Carly specializes in therapy for individuals with Autism Spectrum Disorders and individuals who are highly anxious, depressed, suffer with low self-esteem, etc. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

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diagnostic label

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Image of flowers coming out of a person's head, symbolizing various mental health disorders/diagnoses

Understanding Diagnostic Labels

By | NESCA Notes 2024

Image of flowers coming out of a person's head, symbolizing various mental health disorders/diagnosesBy: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Throughout the evaluation process, many families express concern about the potential negative impacts of placing diagnostic labels on a child. Unfortunately, parental worries associated with stigmatization, as well as others making incorrect assumptions and placing inappropriate expectations on their child are common and valid. As such, it is reasonable to ask, “where does diagnostic labeling come from?”

In 1952, the first version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed by the American Psychological Association (APA) as the standard classification of mental disorders used by mental health professionals in the United States. Since that time, several iterations of the DSM have been developed. Most recently, the DSM-IV- Text Revision (TR) was published (2022), in which sections of text describing diagnostic categories and associated features were revised based on new research. Hundreds of international experts in all aspects of mental health contributed to the development of the DSM, as well as adjustments to subsequent versions.

There are certainly benefits and drawbacks for making specific diagnoses, a few of which are detailed below:

 

Pros Cons
  • Provides a common language in an effort to help mental health and medical professionals communicate effectively.
  • May provide some relief to clients who come to find their symptoms are associated with a disorder that others also experience.
  • Helps guide providers in recommending appropriate treatment options based on diagnostic presentation.
  • May not fully account for contextual influences, such as ethnicity and culture on the development of psychopathology.
  • Potential for disagreements related to interpreting diagnostic criteria when trying to make diagnostic decisions.
  • Places individuals into “boxes,” which can lead to stigmatization.

Broadly, much of the neuropsychological evaluation process focuses on identifying how a child’s behavioral, emotional, and/or social functioning may be discrepant from that of their peers for the purpose of identifying appropriate treatment and educational services to support the child. Of equal importance is highlighting the child’s strengths, as well as understanding individual family values and cultural factors that may be contributing to a child’s presentation.

As neuropsychologists at NESCA, we take a holistic view of your child and consider multiple sources of information when answering referral questions, including information from parents, teachers, providers with whom the child has developed strong rapport, as well as our observations throughout the evaluation process. While we do refer to the DSM when making diagnoses, we pride ourselves on taking an incredibly individualized approach and high level of care when working with clients. Our goal is not to simply put your child in a “box” and send you on your way. We seek to understand your child’s symptoms and how they impact functioning across environments. We consider initial evaluations as the first step in your journey to fully understanding your child, treating the aspects of their presentation that you’d like to prioritize, and ultimately promoting their overall well-being and success.

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form. 

 

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

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Shouldn’t We All Get Neuropsychological Evaluations, Then?

By | Nesca Notes 2023

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

One frequent question I have been asked by parents following a neuropsychological evaluation is, “Wouldn’t this process be helpful for everyone?” This tends to come up around the issue of disclosing results of an evaluation to children and teenagers and helping them better understand “how their brain works.” Many families with whom I have had the privilege of working come back months or years later with siblings of an initial client, noting that the process was so valuable the first time, they are hoping for a similar experience for their other child or children.

So, should we all get neuropsychological evaluations? Largely, I think this question is motivated by parents who are eager to help their children understand their own strengths and weaknesses. This is a wonderful goal, as self-understanding is one of the most valuable and lifelong gifts we can give our children.

In my experience, many people come to this kind of self-understanding naturally, over time, through experiences in adolescence and young adulthood. In particular, experiences that involve more independence in living and learning promote this kind of understanding. During childhood, we may learn our relative skill among family members (“I’m good at soccer, and my sibling is good at piano”), but these relative differences may not hold once we leave our family of origin. Many people venture out into the world and find that, compared to their peers, they are actually quite skilled at getting groups of friends together, doing everyday math, putting their thoughts down in writing, or staying organized. These real-world strengths often reflect the strengths that could be found through formal evaluation. As we gain self-understanding, we may be prompted to enter certain professions, take on particular hobbies, or pursue friends and partners with specific traits.

A neuropsychological evaluation can “speed up” the process of self-understanding, giving some young people a head start on the identity formation process that naturally occurs during adolescence. For some, this head start is vital – their brains are structured in ways that present clear, observable differences between them and their peers. This may be the case with diagnoses like autism spectrum disorder, a learning disability, or ADHD. For these individuals, the feedback from a neuropsychological evaluation can (under the best of circumstances) stave off feelings of inadequacy, negative self-esteem, and shame, helping a young person to recognize the deeply important strengths that are present alongside their more observable challenges. In these cases, a neuropsychological evaluation is not only for self-understanding, but also for self-compassion. Our goal as neuropsychologists in these cases is not just to help the child or teen understand themselves, but also to be gentle and kind with how they view their difficulties. Our hope is that, when these individuals venture out of their families and into the broader world, they are able to show resiliency in the face of the obstacles that will almost certainly be present.

 

About the Author

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

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

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

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

 

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

 

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

 

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Receiving, Understanding, and Sharing Diagnostic Labels and Profiles

By | NESCA Notes 2022

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

A recent New York Times article described a trend, noticed by many mental health professionals, where adolescents and young adults have been exploring mental health on social media. The article references the explosion of TikTok videos in which individuals disclose their psychiatric diagnoses and symptoms. For young people searching on social media, these videos are shown at an increasing rate, based on algorithms. Young people are finding a great deal of validation and connection by watching these videos. Many begin to seek out mental health support, often entering the therapeutic relationship with a clear idea of what their diagnosis will be.

As a mental health professional, I see a great deal of complexity coming from this trend. Certainly, the dissemination of information about mental health and reduction in stigma seems to be positive. Allowing individuals to more readily learn about psychiatric conditions will hopefully reduce fear, embarrassment, shame, and avoidance of mental health care. In addition, promoting self-understanding is important, particularly for young people who are in a developmental stage of identity exploration.

However, there are also concerning implications. First, self-diagnosis can be problematic in mental health, as it is in the medical field. There is a fine balance between being an informed health care consumer and a patient unwilling to listen to the expert opinion of their physician. Entering a physician’s office, unwavering in certainty of your diagnosis, can lead to friction and frustration. In contrast, entering with relevant personal and family history, a thoughtful list of your current symptoms, and readily accessible notes on recent changes in your lifestyle can be invaluable in partnering with your doctor to determine the origin of the problem. This is paralleled in mental health. Entering a therapeutic or evaluation process with information and an open mind is vital to the partnership between clients and clinicians.

The other implication of this trend involves the necessity of a formal diagnosis. I hear from many individuals, after a comprehensive neuropsychological evaluation is completed, that they feel relief at “finally knowing what is wrong.” This validation is entirely understandable, and is not restricted to times when I have provided a diagnostic label. An in-depth exploration of neurocognitive strengths and weaknesses can provide invaluable information that can help individuals understand themselves, access what they need, and plan for their future. Sometimes, a client’s symptoms are best captured by a diagnostic label. However, other times, a person’s comprehensively evaluated profile does not warrant a formal diagnosis. The latter does not mean that a person’s symptoms are any less valid or impactful. Formal diagnoses generally require multiple symptoms, occurring within specified timeframes, and occurring in the presence or absence of other important factors. There are many instances where a symptom is clearly impactful and interfering for a client, without the client’s profile meeting the full range of criteria necessary for a diagnosis. At other times, a symptom that appears, on the surface, to indicate one diagnosis, may in fact indicate a very different diagnosis after a person’s full neuropsychological profile is explored.

As a wise mentor once told me that, in the evaluation process, we must “hold our hypotheses lightly.” We enter a therapeutic relationship, either as a client or a clinician, with a sense of what we might discover or be told. Our initial sense can be entirely accurate, or shockingly incorrect. Therefore, it is vital for all of us to hold our ideas about what may come from an evaluation lightly.

 

About the Author

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

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

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

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

 

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

 

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

 

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