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Image of student walking into middle school with a quote from Dr. Madeline Manning

Navigating the Transition from Elementary to Middle School with ADHD

By | NESCA Notes 2026

Image of student walking into middle school with a quote from Dr. Madeline ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

The transition from elementary to middle school is a significant developmental milestone, bringing new academic demands, shifting social dynamics, and greater expectations for independence. For students with attention-deficit/hyperactivity disorder (ADHD), who often experience executive function (EF) vulnerabilities, this period can be particularly challenging. Understanding and proactively addressing the academic, social-emotional, and behavioral needs of these students is essential to support their adaptation and long-term success.

Academic Demands and Executive Function

Middle school introduces a significantly more dynamic, fast-paced academic environment, characterized by multiple teachers, changing classrooms, and a heavier workload. Students must manage assignments from various instructors, each with different expectations and communication methods. This environment requires cognitive flexibility and other advanced EF skills, including organization, time management, task initiation, and prioritization. For students with ADHD, these demands can quickly overwhelm existing coping strategies, leading to forgotten assignments, missed deadlines, and difficulty transitioning between classes. This, in turn, can contribute to a reduced sense of self-efficacy as a learner.

Notably, many students have not yet been explicitly taught the EF skills needed for this new level of independence. Evidence shows that many students with ADHD require direct instruction, repetition, clear structure, frequent feedback, and opportunities to practice these skills in real contexts. Early identification of EF difficulties and targeted supports, such as executive function coaching, visual organizers, structured routines, and regular teacher check-ins, can ease the transition and build confidence (Giannakopoulos, 2025).

Social Dynamics and Emotional Development

Middle school is also marked by greater complexity in peer interactions. Friendships shift from more convenience-based connections, often formed through proximity and shared activities in elementary school, to deeper emotional bonds, and students face heightened peer pressure and the formation of social cliques. The onset of puberty, elevated emotional sensitivity, emerging interest in romantic relationships, and the influence of social media can further complicate peer dynamics during this developmental stage.

Students with ADHD are already at increased risk of experiencing challenges with impulse control, emotional regulation, and social problem-solving. The reduced adult scaffolding in middle school means students are expected to navigate social situations with more independence, which can be both empowering and challenging. Difficulties in these areas can negatively affect self-esteem and lead to anxiety or withdrawal.

Fostering resilience involves teaching prosocial coping strategies and promoting self-advocacy. This includes encouraging students to seek support from trusted adults when needed and to practice assertive communication skills. Guidance on managing peer pressure, conflict resolution strategies, and building and maintaining healthy friendships is critical for positive social development and emotional well-being in middle school and beyond.

The Adolescent Brain: Developmental Realities

During early adolescence, the brain undergoes significant changes. The prefrontal cortex (responsible for planning, decision-making, and self-control) is still maturing, while the limbic system (a complex set of brain structures governing emotions and reward systems) develops far earlier. This developmental mismatch means that adolescents are more likely to exhibit heightened emotional responses, increased impulsivity, and a greater sensitivity to rewards and peer influence, often before they have fully developed the cognitive skills necessary for effective self-regulation and long-term planning.

These neurodevelopmental factors mean that even typically developing students may struggle with EF tasks and social functioning during middle school. For those with ADHD, whose brains are already wired for greater difficulty with attention and self-regulation, the challenges can be far more pronounced.

Supporting Skill Development

To help students with ADHD navigate this transition, families and educators can collaborate to provide:

  • Explicit instruction in organizational and planning skills
  • Consistent routines and predictable expectations
  • Visual supports (e.g., checklists, planners)
  • Regular feedback and positive reinforcement
  • Opportunities for guided practice and reflection

These supports help students gradually build independence, resilience, and the executive function skills necessary to meet new demands.

A Critical Window for Evaluation and Intervention

The transition from elementary to middle school is a pivotal time to address concerns around academic, social-emotional, and/or behavioral functioning. A comprehensive neuropsychological evaluation can clarify your child’s unique strengths and challenges, guide targeted interventions, and support the development of formal education plans (e.g., IEPs or 504 Plans) to ensure they are receiving the services they require. Early identification and collaboration between home and school are essential for maintaining self-esteem, fostering self-efficacy, and ensuring access to appropriate supports.

If you have questions or concerns regarding your child’s transition to a new school, executive functioning, or any other aspect of their development, please contact NESCA for guidance. Comprehensive evaluation and targeted strategies can make a meaningful difference in your child’s educational journey and overall well-being.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 a reward chart and quote from NESCA

“I’ve tried a sticker/reward chart, and it does not work!” – Strategies to Make Incentive Plans Actually Work

By | NESCA Notes 2026

Image of a reward chart and quote from NESCABy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Behind the simple sticker chart or reward chart is decades of solid science. Psychologists and brain researchers have found that these charts work because they tap into how the human brain naturally learns and stays motivated. When a child gets a sticker or a point towards a reward immediately after doing a good job, their brain releases a tiny splash of dopamine, the “feel-good” chemical that helps us focus and feel successful. Decades of research, especially with kids who have ADHD, shows that rewards make boring or difficult tasks feel achievable. By focusing on positive rewards rather than nagging or punishment, these charts help shape behavior through slowly motivating changes which become habits or routines.

Incentive charts are highly versatile tools. While most commonly associated with young children, they are effective for anyone, including elementary-aged students and teenagers, who need help changing behaviors, building new habits, or staying motivated.

Despite these benefits, many parents I work with share the same frustration: “I’ve tried a sticker/reward chart, and it just didn’t work.”

When I dig a little deeper, I usually find that the incentive system wasn’t set up in a way that allowed the child, and the family, to succeed. I provide the following guidance to make their incentive plans more effective:

  1. Pick Your Battles: Focus on just 2 to 3 goals at a time (or even just one for very young kids). Ask yourself: What is the most pressing behavior change we need right now? Is it brushing teeth without an argument? Getting out the door on time for school? Stopping hitting or food-throwing? Trying to change too many things at once is a major reason why these charts fail. Think of it like New Year’s resolutions: when we try to overhaul our diet, go to sleep early, start a daily workout routine, complete a gratitude journal, and read a book a week all at the same time, we quickly burn out. It is simply too hard to maintain that much change long enough for new habits to stick. The same is true for your child. Keep it simple. Once your child masters one specific goal, you can “graduate” them from that goal and introduce a new one.
  2. State Goals Clearly and Positively: Tell your child exactly what you want them to do, rather than what you want them to stop doing. Instead of “Don’t be late for school,” phrase the goal as “Be ready with your shoes on and backpack packed by 7:20 AM.”
  3. Start with “Easy Wins”: Incentive plans often fail when parents set the bar too high right away; if a child goes several days without earning a reward, they will lose motivation and give up. Instead, start with an easy, highly achievable version of your goal and slowly raise the bar. For example, if your ultimate goal is for your child to have their shoes on and backpack packed by 7:20 AM, start by rewarding them just for having their shoes on by 7:20. Once that becomes a habit, you can raise the bar to include the backpack. Slowly shaping the behavior in these small, manageable steps keeps your child winning, building the momentum they need to succeed rather than setting the bar out of reach and causing them to throw in the towel.
  4. Reward the Behavior Immediately: Timing is everything. To help your child’s brain connect the good behavior with the reward, hand over the incentive right away. For timed tasks (like being ready by 7:20 AM), give the sticker, token, or point the second they finish. For all-day goals (like keeping hands to themselves), have a set time every day (like right after dinner) to hand out the reward. Connect the dots for them by saying: “Because you kept your hands to yourself today, you earned your sticker!” The more immediate or consistent the reward process is, the more likely the incentive system will be a success.
  5. Let Your Child Choose the Rewards: Children are far more motivated by rewards they actually care about. Sit down together and make a list of prizes. Remember, rewards do not have to be toys or cost money. Kids are highly motivated by quality time and special privileges, such as an extra bedtime story, 10 minutes of one-on-one time with a parent, choosing what’s for dinner, or picking the movie for family night.
  6. Make the “Exchange Rate” Clear: Make sure your child knows exactly what their stickers/points can buy. For young kids: Keep it simple. Placing the sticker on the chart might be enough, or they can “cash in” 3 stickers for a reward (like 10 minutes of screen time). For older kids, let them save up. They can earn points daily, but saving up 5 points might earn them a larger weekend reward (like a trip to get ice cream).
  7. Never Take Stickers Away: This is the golden rule of incentive charts. Once a sticker or point is earned, it is locked in. If your child has a great morning and earns a sticker/point, but has a meltdown in the afternoon, do not peel the morning sticker off or take away a point. Taking away earned rewards feels unfair to kids and ruins their motivation to keep trying. If they have a tough afternoon, simply say: “You didn’t earn your sticker/point for this afternoon, but you can try again tomorrow.”

Why Summer is the Perfect Time to Start

Summer is a fantastic time to introduce an incentive plan because it provides a light, predictable structure to those otherwise unstructured summer days. Furthermore, behavior change can be easier to accomplish when kids are relaxed and free from the daily stress of the school year. Making small, positive changes over the summer months can pay large dividends and set your family up for a smooth transition back to school in the fall. Not only will your child be accustomed to using a reward system by then, but they will also have already established several positive habits that will make the start of the school year much easier for everyone!

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

To book a consultation with Dr. Burns or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

NESCA is a pediatric neuropsychology practice and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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images showing what In-person or Teletherapy Speech Services look like and a quote from Olivia Rogers, CCC-SLP

Teletherapy vs. In-Person Therapy: What Families Should Know

By | NESCA Notes 2026

images showing what In-person or Teletherapy Speech Services look like and a quote from Olivia Rogers, CCC-SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Speech-language therapy has evolved significantly over the past several years, giving families more options than ever before. While in-person therapy has long been the traditional model, teletherapy has emerged as an effective, flexible, and research-supported way to deliver high-quality services.

Both approaches can support meaningful progress, but they offer different advantages depending on a student’s needs, learning style, and family schedule.

What is In-Person Therapy?
In-person therapy takes place face-to-face in a clinic, school, or home setting. Sessions often include hands-on materials, physical movement, and direct interaction with the clinician in the same space.

Benefits of In-Person Therapy

  • Natural opportunities for play-based learning
  • Physical prompts and hands-on support
  • Easier for very young children who need frequent redirection
  • Helpful when targeting feeding, articulation placement, or sensory-motor skills

For some students – particularly younger children or those needing physical cueing – in-person therapy can be an important option.

What is Teletherapy?
Teletherapy delivers speech, language, and coaching services through a secure video platform. Sessions remain interactive, individualized, and structured and use digital materials, shared screens, real-time coaching, and collaborative activities. Teletherapy is not “less than” in-person therapy. In many cases, it offers unique advantages that directly support academic and functional skill development.

The Benefits of Teletherapy

  1. Therapy Happens in the Student’s Real Learning Environment

Students often join sessions from home or school, allowing strategies to be applied immediately to real assignments, writing tasks, and classroom demands. This is especially powerful for:

  • Academic language
  • Writing
  • Executive functioning
  • Organization and study skills

Skills transfer more naturally because therapy is embedded in everyday routines.

  1. Increased Engagement for Older Students

Many school-age students and adolescents are highly responsive to digital learning. Interactive slides, collaborative documents, and visual supports can increase participation and independence. Teletherapy often feels:

  • Less intimidating
  • More conversational
  • Provides more room for independence
  • More aligned with how students already learn

This can lead to stronger buy-in and carryover.

  1. Greater Family Involvement

Caregivers can easily observe sessions, ask questions, and learn strategies without travel. Due to the ease of meeting, consultation time can easily be built into teletherapy sessions or added on as a monthly service. This improves consistency between therapy and daily life – one of the biggest predictors of progress.

  1. Flexible Scheduling and Reduced Barriers

Teletherapy eliminates commuting, waiting rooms, and geographic limitations. Families can access specialized services that may not exist locally. This flexibility is particularly helpful for:

  • Busy families
  • Students with extracurricular schedules
  • Students who fatigue easily
  • Families planning transitions or moves
  1. Strong Fit for Language, Literacy, and Executive Functioning

Many higher-level communication skills naturally occur on screens, such as reading passages, writing responses, organizing ideas, and managing tasks. Middle and High School students now type essays, rather than handwriting. Teletherapy allows clinicians to:

  • Model writing in real time
  • Scaffold comprehension strategies
  • Practice planning and organization
  • Teach digital learning skills students already need

For these goals, the teletherapy environment can actually mirror classroom expectations more closely than a clinic setting.

When One Approach May Be Better Than the Other
In-person therapy may be preferred when:

  • Physical cueing is essential
  • Attention regulation is extremely challenging
  • Sensory-motor or feeding work is a primary goal

Teletherapy may be ideal when:

  • Goals are academic or language-based
  • Students benefit from visual/digital supports
  • Families need scheduling flexibility
  • Collaboration with caregivers or teachers is important

Often, the best approach is individualized, and some students benefit from a combination over time.

Final Thoughts
Teletherapy has expanded what is possible in speech-language support. For many students, particularly those working on language, literacy, and executive functioning, it provides a flexible, effective, and highly relevant model of care.

Rather than replacing in-person therapy, teletherapy offers another pathway for families to access specialized support and help students build skills that extend beyond the therapy session.

At NESCA, we know that the research shows that outcomes depend less on location and more on the clinician’s expertise, individualized goals, consistency of sessions, and strategy carryover into daily life. Whether sessions occur in-person or online, meaningful progress happens when therapy is functional, engaging, and connected to a student’s real-world demands. For more information on Speech and Language Therapy and services at NESCA, please complete our online Inquiry/Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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Graphic showing the transition from elementary to middle to high schools and a quote from Olivia Rogers, CCC-SLP

What Is a School Transition Intensive – And Who Is It For?

By | NESCA Notes 2026

Graphic showing the transition from elementary to middle to high schools and a quote from Olivia Rogers, CCC-SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Transitions between school levels are exciting – but they are also academically demanding. Whether a student is moving from elementary to middle school, middle to high school, or into a new independent school environment, expectations around writing, organization, and independence increase dramatically. A School Transition Intensive is a short-term, highly focused summer program designed to strengthen the language and executive functioning systems students need before those expectations rise. It’s not tutoring. It’s proactive skill-building.

Why School Transitions Are So Challenging
Each new school level brings longer writing assignments, multi-paragraph essays, increased note-taking demands, greater independence, fewer teacher prompts, and more complex academic language. Many capable students struggle not because they lack intelligence, but because organizational and language demands exceed their internal systems.

What Skills Are Targeted?
Depending on grade level, a transition intensive may include:

  • Paragraph structure foundations
  • Expanding sentences with detail
  • Multi-paragraph writing
  • Analytical paragraph writing
  • Text-based evidence integration
  • Academic vocabulary development
  • Written summaries of complex texts
  • Comprehension of texts of varying length and complexity
  • Note-taking systems
  • Planning and project organization routines
  • Independent study and homework systems

The focus is always on integrating language and executive functioning together.

Who Would Benefit Most?
A School Transition Intensive is particularly helpful for students who are:

  • Bright but disorganized
  • Struggle to get ideas onto paper
  • Avoid writing or academic tasks
  • Require extra support to get homework or assignments done
  • Have ADHD or executive functioning weaknesses
  • Receive feedback such as “needs more organization” or “struggles with written expression.”
  • It is also ideal for students entering competitive independent schools where writing expectations are high from day one.

Why Summer Is the Ideal Time
During the school year, students juggle multiple subjects, deadlines, and social demands. Summer allows for focused, structured practice without grade pressure, helping students build independence and confidence before the school year begins.

The Real Goal
The goal is not simply better essays. It is stronger internal organization, reduced academic anxiety, clearer thinking on paper, increased independence, and confidence walking into a new academic environment.

At NESCA, we offer intensive summer therapy that targets communication (such as listening comprehension, and expressive language), written language, and academic executive functioning.  For more information on summer intensives at NESCA, please complete our online Inquiry/Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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Student trying to write despite hidden language demands

The Hidden Language Demands of Upper Elementary and Middle School

By | NESCA Notes 2026

Student trying to write despite hidden language demandsBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

By upper elementary school, learning shifts dramatically. Students are no longer learning foundational skills; they are expected to apply them flexibly, independently, and across subjects. The academic language load increases quietly but significantly.

What Changes in Grades 4 to 7?

  • Students are reading to learn
  • Texts become denser and more abstract
  • Vocabulary shifts from concrete to conceptual
  • Sentence structures become longer and more syntactically complex
  • Students are expected to compare, analyze, justify, and synthesize
  • Writing moves from short responses to multi-paragraph compositions

The Cognitive Load Increases
Students must now hold multiple ideas in working memory, track shifting perspectives in texts, interpret figurative language, and integrate background knowledge – often simultaneously. These demands require strong executive functioning and well-developed language networks.

The Invisible Language Skills Required

  • Understanding complex sentences with embedded clauses
  • Interpreting nuanced vocabulary and morphology
  • Making inferences beyond literal meaning
  • Organizing ideas cohesively in speech and writing
  • Explaining reasoning using precise academic language

Common Signs of Strain

  • Strong verbal knowledge but weak written output
  • Short, underdeveloped written responses
  • Difficulty summarizing or explaining key ideas
  • Avoidance of reading-heavy assignments
  • Homework taking significantly longer than expected
  • Increased anxiety or shutdown around school tasks

Why This Stage Matters
Upper elementary and early middle school are pivotal years for our students. If language organization, executive functioning, and literacy systems are strengthened during this window, students often transition into higher grades with greater confidence and independence. When gaps remain unaddressed, demands compound year after year.

If This Sounds Familiar…
If your child is bright but suddenly struggling with writing, comprehension, or workload, it may not be motivation. It may be due to the increased language load. Strong academic performance is not just about effort. It’s about systems of learning. When language, executive functioning, and literacy are strengthened together, students gain not only skill, but confidence.

 

At NESCA, we view communication holistically. Our therapists use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom! If you’re curious whether this integrative approach would benefit your child, I welcome the opportunity to connect to identify what targeted support may make the greatest difference. For more information on Speech and Language Therapy, Literacy, and Executive Functioning Support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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SLP working with a student on a summer intensive program focused on speech

Seven Signs Your Child Would Benefit from a Summer Writing Intensive

By | NESCA Notes 2026

SLP working with a student on a summer intensive program focused on speechBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Summer is often seen as a break from academics, but for many students, it’s also the most powerful window for growth. If writing has been a source of stress, avoidance, or frustration during the school year, a structured summer writing intensive program can make a meaningful difference before fall. Here are the most common signs that a student may benefit from targeted, language-based writing support.

  1. They Have Strong Ideas. . . But Difficulty Getting Them Onto Paper
    Your child may speak clearly and express complex ideas verbally, yet struggle to translate those thoughts into written form. Pages remain blank, sentences feel short or incomplete, and written work does not reflect their true ability.
  2. Writing Takes a Long Time
    Assignments that should take 20 minutes stretch into an hour or more. Slow writing can signal challenges with planning, organization, working memory, or executive functioning fatigue.
  3. Paragraphs Lack Structure
    You may notice missing topic sentences, disconnected details, weak transitions, or repetitive ideas. These patterns often reflect underlying language organization challenges rather than simple grammar issues.
  4. Writing Causes Emotional Stress
    Avoidance, frustration, or shutdown at the mention of writing or during the writing process are common signs. When writing feels overwhelming, students often lack internal planning systems to guide them.
  5. Teacher Feedback Highlights Organization or Elaboration Concerns
    Comments such as, “needs more detail,” “ideas are unclear,” or “work lacks organization” often indicate that both language development and executive functioning need targeted support.
  6. ADHD or Executive Functioning Challenges
    Writing requires planning, working memory, inhibition, flexibility, and self-monitoring. Students with executive functioning weaknesses often benefit from explicit writing routines that reduce cognitive load.
  7. Transitioning to a New School Level
    Rising 3rd, 6th, or 9th graders face increased writing demands. Strengthening foundational systems before expectations rise can dramatically improve confidence and performance.

Why Summer Is So Effective
Without academic pressure and competing demands, students can build writing fluency, strengthen organization systems, and increase independence in a focused and supportive environment. Application can be embedded in students’ areas of interest, for added motivation. The goal of a writing intensive is not simply to be able to create “better essays.” It is reduced anxiety, stronger thinking on paper, increased independence, and systems students can carry into the fall.

 

At NESCA, we offer intensive summer therapy that targets both verbal communication (such as listening comprehension, expressive language, and social communication) and written expression, an area where many students struggle. For more information on summer intensives and written language support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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student writing in a notebook and quote by Olivia Rogers, SLP

Why Speech-Language Pathologists Are Uniquely Equipped to Support Written Language

By | NESCA Notes 2026

student writing in a notebook and quote by Olivia Rogers, SLPBy Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

Written language refers to the system of communication that involves the use of written symbols to represent language, and it encompasses skills such as fluent word recognition, reading comprehension, written spelling, and written expression. It is one of the most complex academic skills students are asked to master. It requires vocabulary, grammar, organization, working memory, attention, reading skills, and the ability to translate ideas into structured sentences and paragraphs.

Because written expression sits at the intersection of language, literacy, and executive functioning, Speech-Language Pathologists (SLPs) are uniquely positioned to support it. At NESCA, speech language pathologists bring specialized training – including EmPOWER, Brain Frames, and The Orton-Gillingham Approach – that allows them to address writing and reading comprehension in a comprehensive, structured, and functional way.

Written Language Is… Language
Writing is not just handwriting or spelling. At its core, writing is language expressed on paper. Students must generate ideas and vocabulary, use grammar and sentence structure, organize thoughts into narratives or explanations, maintain cohesion across sentences, and consider audience and purpose.

Reading is not just decoding words on a page. True, reading happens when a child understands, connects, and makes meaning from what they read. Comprehension – linking new information to background knowledge, vocabulary, and language skills – is what transforms word calling into real literacy.

These are core areas of SLP expertise. SLPs are trained to analyze how language breaks down,  whether at the word, sentence, or discourse level, and to teach skills explicitly and systematically.

The Executive Function Connection
As discussed in last week’s blog, writing and reading are executive functioning tasks. When writing, students must plan what to say, hold ideas in working memory, organize information, initiate writing, and revise and edit. When reading, students exercise their working memory, inhibition, and metacognitive skills.

NESCA SLPs use the EmPOWER and Brain Frames approaches to make these invisible thinking processes visible. EmPOWER supports students in navigating “how” to bring the writing process from start to finish. Brain Frames provide visual scaffolds that help students map ideas before writing, organize paragraphs, and understand the structure of different text types.

Structured Literacy Strengthens Writing
Strong writing depends on strong reading and spelling skills. NESCA SLPs, trained in Orton-Gillingham, also bring a structured literacy lens to written language intervention through explicit teaching of phonology, morphology, and spelling patterns – all while integrating reading and writing instruction systematically.

SLPs Bridge Ideas and Expression
Many students know what they want to say but cannot translate it into written form. SLPs help students expand sentences, develop narrative and expository structure, use academic vocabulary, improve cohesion and clarity, verbalize ideas before writing, and revise language for precision.  Because SLPs focus on communication, written language therapy is functional and meaningful. Intervention often targets classroom assignments, essays and projects, note-taking, digital communication, and self-advocacy writing so that strategies learned transfer directly to school demands. SLPs brings a functional, real-world approach to written language.

Speech-Language Pathologists are not an alternative option for written language support; they are a natural fit. With explicit strategy instruction, visual scaffolding, and structured literacy methods, SLPs help students move from uncertainty to confident, organized expression. When writing is approached through language, thinking, and literacy together, students gain tools that extend far beyond the page.

The NESCA Difference
NESCA SLPs combine deep knowledge of language development with specialized training in executive functioning and structured literacy. Our intervention addresses how students think, understand language, read and spell, and express ideas in writing.

 

At NESCA, we use evidence-based strategy to target written language. Our clinicians use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom!  For more information on written language support at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 yarns intertwined representing EF and language skills being intertwined and a quote from Olivia Rogers, SLP at NESCA

Executive Functioning & Language: Intertwined and Recursive Systems of Learning

By | NESCA Notes 2026

image of yarns intertwined representing EF and language skills being intertwined and a quote from Olivia Rogers, SLP at NESCA

By Olivia Rogers, MA, CCC-SLP
Speech-Language Pathologist, NESCA

When we think about learning, we often separate skills into categories – language, executive functioning, literacy, academics, just to name some. But in real life, these systems don’t operate independently. They are deeply intertwined and recursive, meaning they continuously influence, shape, and strengthen one another over time.

What Is Executive Functioning?
Executive functioning refers to the brain’s management system. These skills help students plan and organize ideas, initiate tasks, hold information in working memory, monitor understanding, shift between strategies, and manage time and attention.

What Is Language?
Language includes understanding directions, expressing ideas clearly orally and in writing, narrative organization, comprehension of complex oral and written information, academic language use, and internal self-talk.

How Executive Functioning Depends on Language
Students rely on language to talk themselves through steps, plan written responses, explain reasoning, organize narratives, monitor comprehension, and use strategies independently.

How Language Depends on Executive Functioning
Producing and understanding language requires holding ideas in working memory, sequencing information, shifting between topics, inhibiting irrelevant details, revising messages, and planning written expression.

The Recursive Relationship image showing the recursive nature of EF and language skills
Growth in one area supports growth in the other. Stronger language supports clearer thinking, and better executive skills support more organized language.

The Big Picture
Integrated support helps students explain their thinking, plan before speaking or writing, use language as a strategy, monitor understanding, and become more independent learners. Executive functioning and language are overlapping systems that continuously shape each other. Supporting both together makes learning more accessible, meaningful, and transferable.

At NESCA, we view communication holistically. Our speech language pathologists use a comprehensive approach to treat the systems of learning as integrative, helping students develop valuable skills they can use in and out of the classroom! For more information on Speech and Language Therapy at NESCA, please complete our online Intake Form or email me directly at orogers@nesca-newton.com.

 

About the AuthorOlivia Rogers

Olivia Rogers is a licensed speech-language pathologist with experience in pediatric clinics and public schools, working with children from age 2 through young adulthood across a range of communication challenges. With a special interest in the connection between oral language and literacy, Ms. Rogers is trained in the Orton-Gillingham method and the Brain Frames program, supporting students in language comprehension, expression, and written organization. She is dedicated to making therapy engaging and personalized for each child.

 

To learn more about NESCA’s Speech and Language Services or schedule appointments, complete our online Intake Form or email orogers@nesca-newton.com.

 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 student walking into middle school with a quote from Dr. Madeline Manning

Navigating the Transition from Elementary to Middle School with ADHD

By | NESCA Notes 2026

Image of student walking into middle school with a quote from Dr. Madeline ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

The transition from elementary to middle school is a significant developmental milestone, bringing new academic demands, shifting social dynamics, and greater expectations for independence. For students with attention-deficit/hyperactivity disorder (ADHD), who often experience executive function (EF) vulnerabilities, this period can be particularly challenging. Understanding and proactively addressing the academic, social-emotional, and behavioral needs of these students is essential to support their adaptation and long-term success.

Academic Demands and Executive Function

Middle school introduces a significantly more dynamic, fast-paced academic environment, characterized by multiple teachers, changing classrooms, and a heavier workload. Students must manage assignments from various instructors, each with different expectations and communication methods. This environment requires cognitive flexibility and other advanced EF skills, including organization, time management, task initiation, and prioritization. For students with ADHD, these demands can quickly overwhelm existing coping strategies, leading to forgotten assignments, missed deadlines, and difficulty transitioning between classes. This, in turn, can contribute to a reduced sense of self-efficacy as a learner.

Notably, many students have not yet been explicitly taught the EF skills needed for this new level of independence. Evidence shows that many students with ADHD require direct instruction, repetition, clear structure, frequent feedback, and opportunities to practice these skills in real contexts. Early identification of EF difficulties and targeted supports, such as executive function coaching, visual organizers, structured routines, and regular teacher check-ins, can ease the transition and build confidence (Giannakopoulos, 2025).

Social Dynamics and Emotional Development

Middle school is also marked by greater complexity in peer interactions. Friendships shift from more convenience-based connections, often formed through proximity and shared activities in elementary school, to deeper emotional bonds, and students face heightened peer pressure and the formation of social cliques. The onset of puberty, elevated emotional sensitivity, emerging interest in romantic relationships, and the influence of social media can further complicate peer dynamics during this developmental stage.

Students with ADHD are already at increased risk of experiencing challenges with impulse control, emotional regulation, and social problem-solving. The reduced adult scaffolding in middle school means students are expected to navigate social situations with more independence, which can be both empowering and challenging. Difficulties in these areas can negatively affect self-esteem and lead to anxiety or withdrawal.

Fostering resilience involves teaching prosocial coping strategies and promoting self-advocacy. This includes encouraging students to seek support from trusted adults when needed and to practice assertive communication skills. Guidance on managing peer pressure, conflict resolution strategies, and building and maintaining healthy friendships is critical for positive social development and emotional well-being in middle school and beyond.

The Adolescent Brain: Developmental Realities

During early adolescence, the brain undergoes significant changes. The prefrontal cortex (responsible for planning, decision-making, and self-control) is still maturing, while the limbic system (a complex set of brain structures governing emotions and reward systems) develops far earlier. This developmental mismatch means that adolescents are more likely to exhibit heightened emotional responses, increased impulsivity, and a greater sensitivity to rewards and peer influence, often before they have fully developed the cognitive skills necessary for effective self-regulation and long-term planning.

These neurodevelopmental factors mean that even typically developing students may struggle with EF tasks and social functioning during middle school. For those with ADHD, whose brains are already wired for greater difficulty with attention and self-regulation, the challenges can be far more pronounced.

Supporting Skill Development

To help students with ADHD navigate this transition, families and educators can collaborate to provide:

  • Explicit instruction in organizational and planning skills
  • Consistent routines and predictable expectations
  • Visual supports (e.g., checklists, planners)
  • Regular feedback and positive reinforcement
  • Opportunities for guided practice and reflection

These supports help students gradually build independence, resilience, and the executive function skills necessary to meet new demands.

A Critical Window for Evaluation and Intervention

The transition from elementary to middle school is a pivotal time to address concerns around academic, social-emotional, and/or behavioral functioning. A comprehensive neuropsychological evaluation can clarify your child’s unique strengths and challenges, guide targeted interventions, and support the development of formal education plans (e.g., IEPs or 504 Plans) to ensure they are receiving the services they require. Early identification and collaboration between home and school are essential for maintaining self-esteem, fostering self-efficacy, and ensuring access to appropriate supports.

If you have questions or concerns regarding your child’s transition to a new school, executive functioning, or any other aspect of their development, please contact NESCA for guidance. Comprehensive evaluation and targeted strategies can make a meaningful difference in your child’s educational journey and overall well-being.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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 a person's brain with gears working in sync, representing Executive functioning

Executive Functioning: What is it and how do we address weaknesses?

By | NESCA Notes 2026

Image of a person's brain with gears working in sync, representing Executive functioningBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Although the concept of executive functioning has existed since the 19th century, it began to gain significant attention in the fields of psychology, education, and neuroscience in the late 1990s and early 2000s. Executive functioning can be thought of as the brain’s “management system.” It enables us to plan ahead, stay organized, remember important information, initiate tasks, control impulses, adapt to changes, and manage our emotions. These skills help us get started on homework or chores, remember what we need to buy at the store, keep track of our schedules, stay calm when upset, switch gears when plans change, and finish tasks without getting distracted. When executive functioning skills are strong, individuals are able to juggle responsibilities, solve problems, and cope effectively with everyday challenges.

Executive functioning difficulties can arise from a variety of causes. Neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder, and learning disabilities frequently involve challenges with executive skills. Neurological conditions – including brain injury or stroke, particularly those affecting the frontal lobes – can impair executive functioning. Mental health disorders such as depression, anxiety, bipolar disorder, and schizophrenia may also impact these skills, making it harder to plan, organize, or regulate emotions. Environmental factors, including chronic stress, lack of sleep, poor nutrition, or substance use (alcohol or drugs), can temporarily or permanently weaken executive functioning. Additionally, some individuals may have a genetic predisposition to weaker executive functioning, and developmental delays due to prematurity, or early childhood adversity can further contribute to difficulties in these areas.

Fortunately, executive functioning weaknesses can be improved through targeted interventions. Direct interventions may include cognitive-behavioral therapy to enhance skills such as self-regulation, cognitive flexibility, and self-monitoring. Executive function coaching can also be beneficial, focusing on skills like planning, organization, and time management by identifying barriers and providing practical strategies for implementation.

In addition to direct intervention, accommodations can be provided to help individuals compensate for areas of challenge. Accommodations should be matched to an individual’s specific executive functioning weaknesses. Below are examples of accommodations for specific areas of challenge. This is not meant to be an exhaustive list, but rather to provide examples of the types of accommodations that may be recommended depending on an individual’s specific profile.

Planning & Organization

  • Use a paper planner, wall calendar, or smartphone app to record assignments, appointments, and deadlines. Review these tools daily to clearly see what needs to be done and when.
  • Divide complex assignments or larger projects into smaller, more manageable tasks, and set individual deadlines for each one. This approach will make the overall project less overwhelming and easier to tackle.
  • Use visual tools such as graphic organizers, outlines, or flow charts to organize ideas and information before beginning an assignment or task.
  • Use folders, color-coding, and binders to organize physical belongings. Use trial and error to identify what works best and take time every day to maintain organizational systems (i.e., put it away before it piles up and feels overwhelming).

Working Memory (the brain’s “scratch pad” where we hold and manipulate information)

  • Use detailed checklists for tasks that require memory of several steps to reduce the burden on working memory. Check off each step when completed. Apply this strategy to recurring tasks, such as morning or bedtime routines, but also schoolwork or chores that have multiple steps or components.
  • Give the individual verbal instructions more than once and ask them to repeat the instructions back to ensure they understand what needs to be done. Instructions should be provided in in small chunks, rather than all at once, so the individual can focus on one step before moving to the next.
  • Permit individuals to use audio recorders or AI technology to capture information during lectures or meetings, so they can replay and review content as needed.

Task Initiation

  • Define the first action required for a task, such as “open your book to page 10,” so it is clear exactly how to begin.
  • Sentence starters or example problems can be helpful in clarifying task expectations, and, in turn, improving task initiation.
  • Establish regular routines and schedules, such as starting homework at the same time each day, to make it easier to get started on tasks.

Inhibition (Impulse Control)

  • Have a teacher, supervisor, or caregiver nearby to provide quick feedback or reminders when impulsive behaviors occur.
  • Provide items like fidget spinners, putty, or doodling pads to give individuals a safe way to channel their energy and reduce impulsive actions. Allow individuals to take short movement breaks to help manage restlessness or impulsivity.
  • Provide praise or rewards when individuals demonstrate restraint or appropriate behavior, encouraging them to continue using impulse control strategies.

Cognitive Flexibility

  • Inform individuals ahead of time about changes in plans or schedules so they can mentally prepare and reduce stress. Give warnings ahead of transitions (e.g., “You have five minutes to finish up that essay) to assist in the transition from one activity to the next, particularly when shifting from a preferred to non-preferred task.
  • Using written or visual stories that describe upcoming events and expected behaviors will help individuals anticipate and cope with new experiences.
  • Teachers or supervisors should preview any partner and group work ahead of time, including carefully outlining roles and expectations.

Emotional Regulation

  • Offer designated quiet areas or allow breaks for individuals to calm down when feeling overwhelmed or upset.
  • Use charts, cards, or other visual tools to help individuals recognize and communicate their emotions.
  • Allow individuals a few minutes to reflect or calm down after an emotional incident before discussing their behavior or asking them to resume work or activities.

Self-Monitoring

  • Provide tools that allow individuals to evaluate their own work against specific criteria and track their progress over time. For example, an editing checklist for a writing assignment should include specifics such as a review of content, spelling, punctuation/capitalization, and grammar/run-ons. This would help shift the vague task of “check your work” into a more actionable task with greater success of being beneficial.
  • Schedule frequent reviews and provide constructive feedback to help individuals stay on track and make adjustments as needed.
  • Allow individuals extra time to double-check their work for errors or improvements before turning it in or finishing a task.

This vast network of skills, collectively referred to as executive functioning, plays a critical role in an individual’s ability to function in daily life. Comprehensive neuropsychological evaluations can provide valuable insight into specific areas of weakness and how they impact an individual’s functioning. This understanding allows for tailored, targeted recommendations that are more likely to be effective than implementing broad, non-specific executive functioning supports.

If your child or student can benefit from executive function coaching, complete NESCA’s online inquiry/intake form to receive additional information or book sessions.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

To book a consultation with Dr. Burns or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

NESCA is a pediatric neuropsychology practice and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, 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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