NESCA is currently accepting Therapy and Executive Function Coaching clients from middle school-age through adulthood with Therapist/Executive Function Coach/Parent Coach Carly Loureiro, MSW, LCSW. Carly specializes in the ASD population and also sees individuals who are highly anxious, depressed, or suffer with low self-esteem. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

Tag

emotional challenges

6

When Parents and Kids Have BIG Emotions

By | NESCA Notes 2020

By Miriam Dreyer, Ph.D.

Pediatric Neuropsychologist Fellow

Brianna Sharpe’s recent essay for the New York Times – Parenting section titled, “I’d Like to Melt Down When My Kids Do,” captures an essential challenge of parenting – managing one’s own emotions when your child is having big and difficult feelings. Ms. Sharpe writes about her own extensive training as a mental health professional and how even with lots of experience working with children, she was not prepared for the emotional demands of parenting. She writes, “. . . like all preschoolers, my son needs an anchor when the waters get rough. But just when he needed me most, I found myself being pulled under by my own emotions. Although I never called him names or outright accused him of being at fault, I would yell in anger when hurt. My irrational response was often, ‘Why would you do that?!’ Once the red haze faded, I knew he was doing just what preschoolers are designed to do – but I had a hard time reconnecting with him.”

Ms. Sharpe beautifully depicts the intricate link between a child and a parent’s emotions. As parents, one of our essential roles throughout our children’s lives is to help them regulate. From birth, our job is to love, soothe, feed, attend and help our kids make sense of their feelings. This is a hard job, made even more complicated by the nuances and complexities of our own emotional lives.

Emotion regulation is a multifaceted process. As defined by Gross (1998), emotion regulation involves conscious and unconscious processes that operate both before an emotional response is generated and after it occurs. He writes that emotion regulation consists of “processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions.” Challenges with emotion regulation are a component of many of the presenting problems we see at our center. Children with ADHD can struggle with emotional impulsivity, shifting and modulating emotional responses. Individuals with depression and anxiety face challenges balancing positive and negative feelings, as well as controlling irrational thoughts and worries. Difficulties with emotion regulation for individuals on the Autism spectrum are also common and intersect with social/emotional and behavioral problems that can arise with symptoms related to rigidity, self-direction and repetitive, self-soothing behaviors.  Symptoms associated with traumatic stress, such as dissociation, mood lability and alexithymia, all interfere with one’s ability to regulate emotionally. Even challenges like communication disorders and other learning disabilities are related to emotion regulation since they generate anxiety and can impede expressing oneself using language, which is a key regulatory process. In fact, theorists are now conceptualizing emotion regulation as a possible unifying, underlying component across psychological disorders (Aldao, Nolen-Hoeksema, & Schweizer, 2010).

What are we, as parents, to do then in the face of our children’s and our own stormy emotions?  How do those of us caring for children who are struggling help them while attending to our own complicated emotional processes? A helpful framework for considering these questions comes from researchers who focus on attachment relationships in parenting, mentalization, as well as the mindfulness and self-compassion literature. 

  • Cultivate self-compassion. Parenting is hard, as is childhood. A stance of self-compassion which acknowledges challenges and encourages kindness to oneself helps move out of cycles of self-blame and anger.
  • Encourage curiosity about your own and your child’s emotions. Developing awareness of our own and our children’s emotional lives helps create a buffer in moments of heightened emotional arousal and can shed light on challenging patterns and interactive cycles.
  • Take a pause. Try breathing and mindfulness exercises to regain calm in difficult moments.
  • Consult with a therapist for parent guidance. There are many different types of parenting programs and support that can help tailor strategies and target complicated dynamics within family systems.

 

References

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review, 30(2), 217-237.

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of general psychology, 2(3), 271-299.

Sharpe, B. (2019, June 21). I’d like to melt down when my kids do.  The New York Times.

 

About the Author

Dr. Dreyer enjoys working with children, adolescents and families who come to her office with a wide range of questions about learning, social and emotional functioning. She is passionate about helping children and parents understand the different, often complex, factors that may be contributing to a presenting problem and providing recommendations that will help break impasses – whether they be academic, therapeutic, social or familial.

Dr. Dreyer joins NESCA after completing her Doctorate in Clinical Psychology at the City University of New York.  She most recently provided psychological assessments and comprehensive evaluations at the Cambridge Health Alliance/Harvard Medical School for children and families with a wide range of presenting problems including trauma, anxiety, psychosis, and depression.  During her training in New York, she conducted neuropsychological and psychological testing for children and adolescents presenting with a variety of learning disabilities, as well as attentional and executive functioning challenges.  Her research focused on developmental/complex trauma, as well as the etiology of ADHD.

Dr. Dreyer’s experience providing therapy to children, adolescents and adults in a variety of modalities (individual, group, psychodynamic, CBT) and for a wide range of presenting problems including complex trauma/PTSD, anxiety, depression, ADHD, and eating disorders informs her ability to provide a safe space for individuals to share their concerns, as well as to provide tailored recommendations regarding therapeutic needs.

Before becoming a psychologist, Dr. Dreyer taught elementary and middle school students for nine years in Brooklyn, NY.  She also had an individual tutoring practice and specialized in working with children with executive functioning challenges, as well as providing support in writing, reading and math.  Her experience in education informs both her understanding of learning challenges, as well as her capacity to make specific and well-informed recommendations.

She received her Masters in Early Childhood Education from Bank Street College, and her B.A. in International Studies from the University of Chicago.

 

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 one of our expert neuropsychologists, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

4

What’s Up, Postdocs?

By | NESCA Notes 2019

NESCA currently enjoys having three pediatric neuropsychology fellows on its roster: Caroline Kleeman, Psy.M., Miriam Dreyer, Ph.D., and Zachary Cottrell, Psy.D, LMHC. NESCA’s postdoctoral positions are two-year engagements allowing clinicians who have completed or are finalizing their doctoral degrees to advance their training and acquire/hone their skills in preparation for their long-term careers.

We recently sat down with two of our fellows to learn more about their postdoctoral experiences now that they have almost reached the one-year mark in their time at NESCA.

By Jane Hauser
Director of Marketing & Outreach

Tell us about your postdoctoral experience at NESCA so far.

Both: As postdocs, we sit in on every phase of an evaluation – from the intake session to the administering and scoring of the tests, interpretation of the results, feedback session with parents, and writing of the report.

We are always working with a supervising clinician during evaluations, and we participate in a training seminar led by NESCA’s Director of Training Dr. Angela Currie. We get feedback from our supervising clinicians throughout every stage in the testing process.

Caroline: I was fortunate to have worked at NESCA as a practicum student in 2016-2017. It’s been great to be back here in a different role. I’ve had the chance to work closely with Dr. Alissa Talamo during my fellowship.

Miriam: I’ve been on board here at NESCA since September 2018, so almost a year now. I worked closely with Dr. Amity Kulis, and now I am working with Drs. Nancy Roosa and Stephanie Monaghan-Blout.

Based on your experiences at NESCA, have you identified a specialty you would like to focus on?

Caroline: Autism has been and remains my area of interest. I also really enjoy working with children with learning disabilities and collaborating with schools to get the right plans in place for the kids we work with. I’ve really enjoyed and benefited from attending school observations and sitting in on Team meetings.

Miriam: Before I went to graduate school, I was a teacher. My area of interest is the intersection of emotional and learning challenges, including executive functioning difficulties and attentional disorders.  In graduate school, my research and therapy training focused on trauma. So, my goal is to combine my clinical and educational experiences to support families in understanding how emotional experiences impact learning in children and adolescents.

 Why did you choose to do your postdoctoral work at NESCA?

Caroline: As I mentioned, this is my second time being a part of the NESCA team. I came back to NESCA for my postdoc work because I valued the collegial environment. I also felt I could benefit from the different clinical staff and their various areas of expertise. It’s such a great experience to work in a practice where someone always knows the answer to my most challenging questions. I really appreciate the model of teaching at NESCA. Because of the apprenticeship model, there’s so much in-the-moment teaching with our clinical supervisors that I benefit from.

Miriam: I was really Interested in the apprenticeship model of training at NESCA as well. It’s a unique arrangement in that postdocs are with a supervising clinician every step of the of the evaluation process. We receive a lot of mentoring here, which is very important to me. I also value the integrated nature of the reports NESCA produces, which portray the sometimes complex kids we see in a nuanced way. Again, this is very important to me in my continued learning.

Both: We get to work with different people here who do different things. It’s given us exposure to so many new areas of neuropsychology that we may not have seen elsewhere. There are a lot of experts here to learn from.

What makes NESCA different? What did you find most beneficial?

Miriam: The structure of NESCA’s training program and the emphasis on continued learning throughout the organization are both so valuable. We frequently have seminars where third-party speakers come in to educate our staff on new areas of psychology and treatments so we all stay current with the latest evidence-based approaches. We also have a weekly case conference where all of our clinicians gather to discuss complex cases and to share resources, knowledge, and experiences to benefit the case at hand. There is a heavy emphasis on learning within the practice, so I am constantly getting exposed to new ideas. I think that’s a valuable and unique asset of NESCA.

Caroline: I absolutely agree with the fact that we are really benefiting from the heavy emphasis on learning and the years of experience our clinicians have. Their willingness to share the knowledge they’ve gained with each other and us is a great benefit to our clients and to my own education. I have also learned so much from our clinicians who attend and bring back such good information from conferences as well as the conferences I’ve had the opportunity to attend.

What’s been your favorite and your most challenging experience so far at NESCA?

Miriam: Each case is unique, so I’ve had lots of exposure to new areas of neuropsychology. Every person who walks in the door presents new opportunities for learning. While this is one of my favorite aspects of NESCA, it is also challenging. With the unique caseloads we take on, there is a lot to learn about the different profiles. As fellows, we do not yet specialize in one area, so we are getting a broad education across domains of neuropsychology. For every new case, there are unique recommendations tailored to that individual that require research, which is an important part of our training.

Caroline: Seeing each child who comes to NESCA as a unique individual is probably my most rewarding and challenging part of being in this practice. Getting to work with some of the more complex profiles out there is exciting to me, but is obviously a challenge, too. There’s always a lot to be learned about each child, and that can take some time to do.

What advice can you share with others looking into this field or who are looking for the right place for their postdoc experience?

Miriam: It’s a great opportunity to be here. My advice is to visit NESCA for an interview, see what it’s like here and learn about the different specializations of the practice’s clinicians. In your search, look for a postdoc position where you get varied training and exposure to a lot of different cases, even if they aren’t in your specific area of interest.

Caroline: Neuropsychology is a very fulfilling career. Every day and every child are different, so it never gets boring. Of course, it can also be frustrating in that there are sometimes barriers to kids getting what they need, whether in school or with community resources not being available. In those moments, you have to be creative and problem-solve. That said, the rewards far outweigh the challenges.

 

About Pediatric Neuropsychologist Fellow Miriam Dreyer, Ph.D.:

Dr. Dreyer enjoys working with children, adolescents and families who come to her office with a wide range of questions about learning, social and emotional functioning. She is passionate about helping children and parents understand the different, often complex, factors that may be contributing to a presenting problem and providing recommendations that will help break impasses – whether they be academic, therapeutic, social or familial.

Dr. Dreyer joins NESCA after completing her Doctorate in Clinical Psychology at the City University of New York.  She most recently provided psychological assessments and comprehensive evaluations at the Cambridge Health Alliance/Harvard Medical School for children and families with a wide range of presenting problems including trauma, anxiety, psychosis, and depression.  During her training in New York, she conducted neuropsychological and psychological testing for children and adolescents presenting with a variety of learning disabilities, as well as attentional and executive functioning challenges.  Her research focused on developmental/complex trauma, as well as the etiology of ADHD.

Dr. Dreyer’s experience providing therapy to children, adolescents and adults in a variety of modalities (individual, group, psychodynamic, CBT) and for a wide range of presenting problems including complex trauma/PTSD, anxiety, depression, ADHD, and eating disorders informs her ability to provide a safe space for individuals to share their concerns, as well as to provide tailored recommendations regarding therapeutic needs.

Before becoming a psychologist, Dr. Dreyer taught elementary and middle school students for nine years in Brooklyn, NY.  She also had an individual tutoring practice and specialized in working with children with executive functioning challenges, as well as providing support in writing, reading and math.  Her experience in education informs both her understanding of learning challenges, as well as her capacity to make specific and well-informed recommendations.

She received her Masters in Early Childhood Education from Bank Street College, and her B.A. in International Studies from the University of Chicago.

About Pediatric Neuropsychologist Fellow Caroline Kleeman, Psy.M.:

Caroline Kleeman comes to NESCA with experience providing evaluations for children with a range of neurodevelopmental profiles.  She has focused on assessing children with autism spectrum disorder, including those presentations accompanied by cognitive delays, language impairments, or genetic disorders.  She also enjoys evaluating children with academic difficulties stemming from learning disorders or attention/executive function disorders.

Ms. Kleeman’s approach to testing recognizes that children are so much more than a list of scores.  Combining her own careful observations with input provided by parents and teachers, Ms. Kleeman strives to differentiate between skill deficits or performance deficits, while also identifying unique strengths.  Additionally, drawing on her applied behavior analysis (ABA) background, Ms. Kleeman looks beyond the individual to identify helping and hindering features of the surrounding environment.  The result is meaningful, highly individualized educational and therapeutic recommendations.

Ms. Kleeman received her Sc.B. with honors from Brown University, where she studied cognitive science.  Focusing on early childhood, she conducted research on the role of sleep (especially naps!) in cognitive development.  After college, Ms. Kleeman worked as a therapist at Nashoba Learning Group, using the tenets of ABA to provide instruction across educational, vocational, behavioral, and adaptive domains.

Bridging between psychology and education, Ms. Kleeman is finalizing her doctorate in school psychology at Rutgers University Graduate School of Applied and Professional Psychology.  Her dissertation is investigating the role that Sesame Street’s autistic muppet, Julia, could play in early childhood social and emotional learning (SEL) programs.  She completed her pre-doctoral internship at the Center for Children with Special Needs in Connecticut, where, in addition to psychoeducational evaluations, she provided ABA therapy and ABA-based reading intervention for children across the autism spectrum.

 

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 one of our expert neuropsychologists, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

1

Child Feedback Sessions: How and Why We Explain What Testing Means To Kids

By | NESCA Notes 2019

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

“Who get’s the results of the testing, me or my parents?” As a neuropsychologist, clients of all ages ask why they are being tested and who is going to get the information from the testing. Sometimes these questions come from a place of nervousness, while others are asking because they have a general curiosity.

Neuropsychological evaluation is an intensive process where students are trying out all sorts of skill sets, some activities that are familiar (e.g., math problems), and some activities that they will only ever do in the context of an evaluation process (e.g., putting pegs in a pegboard, drawing weird rocketship shaped patterns from memory). Even children as young as elementary school are often curious about the results of the assessment (e.g., how did I do? what were you testing? what is the report going to say?). These are such important questions and I am always excited when the children I am working with are curious about what this all means.

At NESCA, a neuropsychology and integrative treatment practice founded in Newton, MA, we conclude our testing with a parent feedback session where results and preliminary recommendations are clearly presented to parents. This is a conversational format so that we can ensure that there is good understanding and a shared picture of what we have learned about the child. Even with a lengthy conversation, parents often question about how to share the findings with their children because it often results in changes for the child like working with new people or getting more/less or different services at school.

Importantly, we offer child/adolescent feedback sessions for children of all ages. These mini-feedback sessions are presented in a developmentally appropriate manner to share the findings of the evaluation. Often with older children and adolescents this conversation includes discussing any diagnosis that came out of the evaluation. For all individuals the conversation always includes a strengths-based approach highlighting the things the child/adolescent did wonderfully using examples from the testing to explain these strengths and how they might show these skills in real life. Then we move on to also talking about some of the activities that were more challenging and how we envision teachers, providers, or other supports helping them to make progress. For example, a child might do extremely well on tasks of visual problem solving such as recreating block designs or on verbal tasks that ask them to define words, but have greater challenges on tasks that assess processing speed. These findings suggest a child is able to think and problem solve at a high level, yet processes information more slowly and might need more time to show off their strengths when they are expected to produce output. This important difference is so essential to explain to even younger children. Children often value speed over all else, and explaining to them that working slow but producing amazing ideas is a real asset. The same type of careful explanation can be taken when explaining learning disabilities, attentional issues, social difficulties and emotional vulnerabilities. There is a calculated effort to include the child/adolescent in a conversation about their own ideas on how to improve areas of need and I feel this really empowers them to work for the change and positive growth. Plus, these sessions are a great way to gain closure over the experience of testing and allow them to understand what was accomplished and learned through all of their hours of hard work.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

To book an evaluation with Dr. Kulis or one of our many other expert neuropsychologists and transition specialists, complete NESCA’s online intake form.

 

 

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

 

 

0

School Observations

By | NESCA Notes 2018

By: Amity Kulis, PsyD
Pediatric Neuropsychologist, NESCA

One of my favorite activities as a neuropsychologist is getting to conduct school observations. Many parents ask why would I need a school observation? And the answer is simple, they provide a wealth of information about your child and their everyday experience at school. For so many, understanding the comings and goings of a child’s day at school is something most parents do not have the opportunity to explore. You ask your child, “how was your day?” and for many, all you get is a “fine” or “okay” with no elaboration of what actually happened. Understanding a child’s experience of the school day is important for all families, but especially important if your child is having difficulties at school such as learning, social or emotional stressors.

After conducting a neuropsychological assessment of a child, I am able to get a good understanding of the child’s learning profile and a good grasp of the child’s strengths and needs. With this information, I am able to conduct school observations with a lens towards what the children I am seeing might need and how they interact with their environment. For the majority of the children I observe at school they are already getting specialized services and for one reason or another, their parents are concerned.

During the observation, I am able to gain a better understanding of a child’s social functioning within the context of their peers at school. I often purposefully schedule observations during a combination of structured class time as well as less structured time such as art or gym, and finally during an unstructured time such as lunch or recess. This combination of environments allows me to see the child interact with peers in a variety of settings. I am able to answer questions about where a child does best and what types of environments might be more challenging. Are they a rock star during group lessons or are they leading a group of peers across the playground? For other children they may fade into the background, refusing to participate during large group instruction but become more animated during one-on-one time with their teacher. Or maybe they are a child that cannot handle the unstructured recess time and hide in the corner isolating themselves. Gaining a better understanding of a child’s social successes and then relating that information to their neuropsychological profile can help to explain why a child is struggling and how best to support them.

Beyond looking at a child’s social functioning during the school day, I am also able to observe the delivery of instruction and how the child responds. I am always watching how a teacher deliveries information to the class and then seeing how the child is able to respond. Does the child follow the direction the first time they are heard or do they need them repeated and modeled by watching other students begin the activity first? I also look at how a child interacts during whole group instruction or discussion versus a small group or more individual work. I also love the opportunity to speak with teachers during the observation to understand what curriculums they are using as well as answering questions about how they see the child interacting in the classroom. If a child is on an education plan I am also paying close attention to how accommodations and supports are being integrated into and across the child’s school day.

In addition to being a fun and engaging part of my job, observations also provide such valuable information from which I can create very specific and targeted recommendations for a child based on their own school environment. There is definitely not a one-size-fits-all recipe for helping a child with a particular profile because an environment is so influential on a child’s successes and challenges. An amazing relationship with one teacher can go a long way toward helping a child take chances and make progress, just as the opposite is true. With a school observation, there is the opportunity to gain more clarity into a child’s everyday school life to help foster their strengths and support their vulnerabilities.

About the Author:

Dr. Amity Kulis joined NESCA in 2012 after earning her doctoral degree in clinical psychology from the Massachusetts School of Professional Psychology, with a concentration in Children, Adolescents and Families (CAF). She completed post-doctoral training in pediatric neuropsychology with an emphasis on treating children with developmental, intellectual, learning and executive functioning challenges. She also has extensive training psychological (projective) testing and has conducted individual and group therapies for children of all ages. Before joining NESCA, Dr. Kulis worked in private practices, clinics, and schools, conducting comprehensive assessments on children ranging from toddlers through young adults. In addition, Dr. Kulis has had the opportunity to consult with various school systems, conducting observations of programs, and providing in-service trainings for staff. Dr. Kulis currently conducts neuropsychological and psychological (projective) assessments for school-aged children through young adulthood. She regularly participates in transition assessments (focusing on the needs of adolescents as they emerge into adulthood) and has a special interest in working with complex learners that may also struggle with emotional challenges and psychiatric conditions. In addition to administering comprehensive and data-driven evaluations, Dr. Kulis regularly conducts school-based observations and participates in school meetings to help share her findings and consultation with a student’s TEAM.

 

 

 

 

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