NESCA’s Newton, MA location has immediate availability for neuropsychological evaluations. Our MA clinicians specialize in the following evaluations: Neuropsychological; Autism; and Emotional and Psychological, as well as Academic Achievement and Learning Disability Testing.

Visit www.nesca-newton.com/intake for more information or to book an evaluation.

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diagnostic label Archives - NESCA

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Image of a feedback session with a parent and neuropsychologist along with a quote from Dr. Rodriguez

Beyond a Label: The Value of Neuropsychological Evaluation Even When There’s No Clear Diagnosis

By | NESCA Notes 2024

Image of a feedback session with a parent and neuropsychologist along with a quote from Dr. RodriguezBy: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Why Diagnosis Matters

Most parents seek out a neuropsychological evaluation because they’re looking for answers. Often, someone in the child’s life—whether a parent, teacher, or caregiver—has noticed something that doesn’t quite add up. Pursuing testing is a wise and proactive step toward understanding the root of a child’s challenges. In many cases, families hope to find a diagnosis that explains what’s going on. To borrow a phrase from psychiatrist and author Dan Siegel, “You have to name it to tame it.” Having a name for a child’s difficulties is often the first step toward effective support and intervention. Many parents describe feeling validated and relieved when a professional can identify and explain what their child is experiencing. Knowing there is an understandable reason behind their child’s struggles can be both reassuring and empowering.

Why A Clear Diagnosis Isn’t Always Possible

Despite everyone’s best efforts, sometimes a child’s challenges don’t fit neatly into a single diagnostic label. There are several reasons for this:

  • Human complexity: Diagnoses can be helpful frameworks, but they don’t always capture the full picture. Children are wonderfully complex, and their unique mix of strengths and challenges often doesn’t align perfectly with one specific category.
  • Overlap between conditions: Diagnoses are often presented as distinct “boxes,” but in real life, there is a lot of overlap between conditions. It’s often more accurate to picture diagnoses as overlapping circles in a Venn diagram, with many children’s experiences falling in the spaces where these circles intersect. It’s not always possible—or even helpful—to fully separate features into distinct diagnoses.
  • Gradual emergence of symptoms: Some conditions develop slowly and may not be fully recognizable until later in life. For example, mild Autism Spectrum Disorder can be subtle and hard to identify, especially in gender-conforming girls and women. Social challenges may not be obvious in early childhood but can become clearer as social demands increase in adolescence, delaying a clear diagnosis.
  • Lack of formal diagnostic labels: There are profiles commonly seen in clinical settings that don’t yet have formal diagnostic labels. For instance, significant executive functioning weaknesses can greatly impact daily life and academics, but there is no official diagnosis for this. Similarly, while we may use the term “Non-Verbal Learning Disorder” to describe certain patterns of difficulty with visual-spatial skills, organization, social cues, or motor abilities, this label isn’t formally recognized in current diagnostic systems.

What To Do Next

Receiving an evaluation without a clear diagnosis can be disappointing and even anxiety-provoking for parents; however, a neuropsychological assessment still offers significant value. The true strength of a thorough evaluation lies in its ability to provide a detailed understanding of your child’s unique strengths and challenges, and to clearly outline the supports and interventions that will be most helpful. Even among children who share a diagnosis, there can be important differences in how their difficulties present. A high-quality assessment goes beyond simply assigning a label; rather, it paints a comprehensive picture of your child as an individual. Ultimately, the most effective recommendations are those tailored specifically to your child’s needs, regardless of whether they meet criteria for a particular diagnosis.

If you find yourself in this situation, allow yourself space for your feelings. It’s natural to crave clear answers, and it can be difficult to live with uncertainty. Yet, there are concrete steps you can take:

  • Recognize challenges independently of diagnosis: Throughout history, people have faced real and significant difficulties long before science could provide official explanations. For example, prior to advanced imaging, vision problems caused by multiple sclerosis were often mislabeled as “hysterical blindness” until CT scans revealed nervous system lesions. Similarly, before HIV was identified as the cause of AIDS, individuals suffered and died from the illness without a clear diagnosis. Sometimes, it takes time for science to catch up. In the same way, your child’s needs are real and valid, regardless of whether a formal diagnosis has been made.
  • Advocate for your unique child: Similarly, focus on addressing their specific areas of need, rather than waiting for a label.
  • Seek appropriate support services: There’s no need to wait for a formal diagnosis to pursue executive function coaching, psychotherapy, occupational or speech therapy, or specialized academic support. In some cases, early intervention may even help prevent a difficulty from becoming a full-blown diagnosis.
  • Try to be patient and stay open to change:  Remember that your child is still developing in very significant ways. Consider re-evaluation in a few years, as more information may become clear over time.

Remember, your child is more than a label. The insights from a neuropsychological evaluation can guide you in supporting their growth and well-being, even when there isn’t a specific diagnostic term to describe their unique profile. If you have questions or want to discuss whether a neuropsychological evaluation might be helpful, our team is here to support you.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

To book a consultation with Dr. Rodriguez or one of our many other expert neuropsychologists, complete NESCA’s 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, NY, 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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Picture depicting the root cause of a person's functioning or challenges

When Neuropsychological Evaluations Fall Short: Finding the Root Cause through Thorough Analysis vs. Giving a Label

By | NESCA Notes 2025

Picture depicting the root cause of a person's functioning or challengesBy Ann Helmus, Ph.D.
Founder & Director, NESCA

In a recent blog, I discussed how not all neuropsychological evaluations yield equally useful outcomes for helping a struggling child and touched on the consequences of misdiagnosis. This week, I’d like to explore another common challenge: evaluations that merely label a symptom without uncovering the underlying cause.

Consider a patient who visits a doctor with concerns of persistent fatigue and weight gain. After routine labwork returns normal results, the doctor offers the diagnoses  “mild obesity” and “idiopathic fatigue”—labels that describe the symptoms but do not provide a meaningful explanation. The patient is advised to get more sleep or possibly prescribed a new medication. After waiting months for the appointment and paying out of pocket, the individual is left feeling frustrated and still without clarity or direction about how to address the root cause of the problem.

Parents sometimes experience this result from their child’s neuropsychological evaluations, particularly when conclusions focus primarily on standardized test results without integrating the broader picture of a child’s daily functioning, course of development, and learning profile.

For example, I recently reviewed a report for a fifth grader whose parent was deeply concerned about the emotional distress their child experienced with writing. Despite the teacher reporting that the child’s writing was “fine,” and the child handling other homework with ease, the parent observed significant distress during writing tasks. The evaluation found a discrepancy between IQ and written expression scores, diagnosing a Disorder of Written Expression (ICD-10 F81.81), and recommending a writing tutor as intervention.

While this diagnosis is valid based on test scores, it simply labels the problem rather than explaining why the writing challenge existed or what type of support might be most effective for this individual. Difficulties with written expression can stem from a variety of root causes—fine motor challenges, language deficits, executive functioning difficulties, or learning differences like dyslexia, among others. Effective interventions vary widely depending on the underlying issue. For example:

  • Children with communication disorders may benefit most from working with a speech-language pathologist on written expression embedded in the context of language development
  • Children with dyslexia often require structured literacy approaches
  • Children with executive functioning challenges may need explicit, scaffolded instruction in planning and organizing written output

In the case I reviewed, the child’s intellectual abilities were in the Very Superior range, with especially strong abstract reasoning and pattern recognition. Standard tests showed that his organizational skills were age-appropriate, yet he struggled to express his ideas in writing. Why? Because the complexity and richness of his ideas exceeded his ability to structure them effectively. In this case, his frustration stemmed from a bottleneck in translating thoughts into written form—a challenge not uncommon in gifted learners.

The solution wasn’t simply more writing practice; it was a targeted program matched to his unique cognitive profile, along with strategies for reducing emotional stress around writing.

After additional observation and analysis, we were able to offer the family not only a clear explanation but also a tailored plan, including specific interventions and home supports. Most importantly, we helped the child understand why writing felt so difficult and reassured him that effective help was available.

When done thoughtfully, a neuropsychological evaluation can be truly transformative. At NESCA, we are deeply committed to providing comprehensive evaluations that go beyond scores to understand the whole child. We aim to provide the kind of service we would want for our own children—thorough, compassionate, and actionable.

NESCA clinicians receive ongoing training and mentorship to ensure a consistently high standard of care. Each clinician participates in multiple weekly case conferences to discuss complex profiles and refine their clinical thinking. We also offer weekly seminars to stay informed about evolving interventions and treatments. New team members—regardless of prior experience—receive six months of mentorship to support their transition into our collaborative model. This structure fosters a culture of continual learning and clinical rigor. We take pride in our work because we know that careful, individualized evaluations can change the trajectory of a child’s life.

 

About the Author

NESCA Founder and Director Ann Helmus, Ph.D., is a licensed clinical neuropsychologist who has beenAnn Helmus headshot practicing neuropsychology for 35 years and has been director of NESCA’s Neuropsychology practice for nearly three decades, continuously training and mentoring neuropsychologists to meet the highest professional standards.

To book a neuropsychological evaluation at NESCA, complete NESCA’s 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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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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