Exciting announcement! NESCA is accepting clients for home- and/or community-based Real-life Skills and Executive Function Coaching with Leah Bridge, MSOT, OTR. Leah is available for in-person occupational therapy (OT) and coaching services in the Newton, MA and Central MA areas. NESCA’s team of coaches offer Real-life Skills, Executive Function, Functional OT and Parent/Caregiver Coaching remotely for those outside of the Newton area. To learn more or book coaching services, complete our Intake Form.

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Social Skill Concerns in a Time of Reduced Social Opportunities

By | NESCA Notes 2021

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

Even in pre-pandemic times, we saw many children and adolescents where social difficulties were the primary concern. Now, almost two years into the life-altering changes brought on by COVID-19, it is rare that I see a young person whose parents do not raise social concerns. Some common concerns include:

My child does not know how to play with peers.

My child is anxious/fearful around peers.

My child avoids peers and/or would rather play alone.

My child does well with 1-2 peers but cannot handle a group.

My child does not have friends and/or does not seem to know how to make friends.

These are all important, valid concerns. Social development is critical to evaluate and understand when we look at a child’s overall functioning, and early social skills lay an important foundation for later independent functioning, fulfilling interpersonal relationships, and vocational/academic success. Concerns about social presentation (i.e., how your child “looks” or behaves socially) can have many varied causes. Sometimes the cause is clear and relatively straightforward to determine with a neuropsychological evaluation. For example, an evaluation may lead to an autism diagnosis, explaining why a child is struggling socially. Other times, the exact cause is unclear, and probably related to many different factors all coming together. For example, children with ADHD very often present with social challenges, though the path from ADHD to social problems is not always “cut and dry.”

For children coming in to testing now (and over the past 18 months), some of the biggest complicating factors are the social isolation, online learning, and reduced social opportunities related to the pandemic. This is not to say that there are no longer clear cases where a child has autism at the root of their social difficulties – there certainly are. However, for each child now, we must consider the impact that COVID has had on their specific social development. This will depend on the child’s age (and age at the onset of the pandemic), school placement and educational environment, family structure (e.g., siblings and/or other children in the home), and community policies. For example, young children who are attending daycare/private preschool may actually not have missed as much socialization time, as many daycares re-opened after only a few months of closure. This is not to minimize the disruption or extreme challenge of such closures to families; for young children, however, it is likely that their social development is not radically impacted by a few months of reduced social opportunities. In contrast, an elementary-age child may have experienced well over a year of reduced socialization, with remote learning in place for many communities until the fall of 2021.

In all cases, pre-existing and/or co-occurring areas of difficulty are extremely important in our conceptualization of why a child is struggling socially. If your child will have an evaluation soon and you have social concerns, you can prepare by thinking about:

  • What was my child like socially before COVID?
    • Did they have strong friendships? Did they have conflict or “drama” with peers often? Were they invited to playdates and/or birthday parties?
  • What was my child like emotionally before COVID?
    • Happy? Easy-going? Quiet and shy? Sensitive? Irritable?
  • What were the practical, observable things that changed from March 2020 through the present?
    • How much time did they spend doing online learning? Did someone in their family become very ill? Lose a job? How isolated were they?
  • What was my child’s response to the things that happened above?
    • Did they enjoy online learning? Were they fearful about becoming sick? Did they miss spending time with friends or family?
  • What other areas seem to be challenging for them?
    • Communicating? Reading? Managing feelings? Paying attention?

All of these are helpful pieces of information that you can communicate to an evaluator. This will build context for the concerns that you see now, and help us move through the web of complex possibilities that may be contributing to your child’s social challenges. Remember that it is always good to be watchful and thoughtful when your child is struggling. At the same time, keep in mind that many individuals (children, adolescents, and adults alike) will require long periods of time to rebuild their skills, stamina, strength, and sense of safety. It is still OK not to be OK quite yet.

 

About the Author

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

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

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

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

 

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

 

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

 

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

By | NESCA Notes 2020

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

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

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

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

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

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

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

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

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

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

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

Below are some helpful resources:

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

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

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

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

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

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

 

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

 

“Doomscrolling” and Creating Space for Gratitude

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

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

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

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

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

For further reading check out these articles:

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

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

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

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

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

 

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

 

How to Talk to Your Kids about Racial Inequality and Current Events

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

It is old news that parents and children have been experiencing an increased sense of uncertainty and vulnerability due to COVID-19. That vulnerability may be exacerbated by the news of violent protests that were sparked by anger over police brutality against black men and women. News of widespread violence around the country spread rapidly in a country already stressed to its capacity in dealing with a global pandemic and the resulting economic hardship. In the aftermath of these recent tragedies, parents should be aware that children may be experiencing collateral consequences, such as fear, anxiety and confusion. Rhea Boyd, MD, MPH, stated, “Whether from social media accounts, conversations with peers or caregivers, overheard conversations, or the distress they witness in the faces of those they love, children know what is going on. And without the guidance and validation of their caregivers, they may be navigating their feelings alone.” So, what do we do?

First, take care of yourself. Now is a good time to practice self-compassion and selfcare. The stress of watching traumatic events on television and smartphones “lingers within our bodies and minds,” states developmental pediatrician Dr. Jenny Radesky. Recognize that vicarious trauma is real, and even if you have not been directly affected, you may be experiencing heightened anxiety, difficulty sleeping, fatigue or increased irritability. Practice accepting your own feelings, instead of controlling them. Go for a walk, talk with a friend, practice relaxation techniques or do something you enjoy.

It is important to consider how we talk with children. While children from birth to age three do not understand what is happening, they can feel it through the reactions of the adults around them. You may notice that your young child has become more irritable, or perhaps crying more than usual. In addition to calming your child, limit the amount of time you spend accessing unsettling news reports in the presence of young children.

With elementary children, it is wise to begin your discussion with, “tell me what you know.” By elementary age, children have a good idea about what is happening. Asking children what they know and following up with any questions they might have will help you to provide age appropriate information. It is important to keep channels of communication open, because as time passes it is likely more questions will arise. Children may want to know that they are safe and, if they ask, provide reassurance. With that being said, limit their exposure to media, be it on television, tablet or smartphone. If they are accessing media, be aware of what they are watching and learning. Answer questions as appropriate and, as with all ages, validate their feelings and assure them that whatever they are feeling, it is okay.

It is probable that teenage youth have seen the images and been involved in learning about the events that precipitated the violence that unfolded. They may even be getting involved in activism by posting and re-posting social media messages. Teenagers often process events by talking with their peers, and it can, at times, be difficult to engage them in conversation. Approach the topic with your teen from a position of curiosity. What do they know? How do they know it? How do they feel about it? It is also a good time for you and your teen to become more educated about the history of racism in our country and how it has been perpetuated through generations of people. A broader societal context of racism will help youth have a better understanding of the anger seen in the demonstrations. A documentary called “13th,” about the 13th amendment, takes an in-depth look at the prison system in the United States and how it mirrors the nation’s history of racial inequality. It is both educational and provides a starting point for having conversations about race with your teen. Additionally, as much as possible, be aware of your teen’s online activity. There is a lot of misinformation and inflammatory rhetoric on social media, and teens need guidance on how to be thoughtful and responsible consumers of all types of media.

Given that the recent unrest was sparked by anger over police brutality against black people, it is important take this opportunity to have these conversations with children about race and racism. By age four, children have begun to internalize cultural attitudes and values, thus, it is not too early to introduce your child to the concepts of race and inequality. Books that include multi-racial characters are a good way to introduce children to people of color in a positive light. Common Sense Media has a list of books appropriate for kids of all ages beginning in infancy, and the link is provided below.

Experts stress that parents also need to give their children the broader societal context of racism to try to explain the rage of protestors filling the streets of cities across the nation. Doing so helps build empathy and teach perspective-taking, shifting the focus from the child’s specific fears. Helping children to view events from different perspectives provides understanding and promotes empathy. When your child sees something on television, YouTube or social media, employ a sense of curiosity. Ask them what they saw, how they felt about what they saw, and have them think about and share how they think different people involved in the situation felt. Dr. Radesky suggests, “Instead of focusing on questions the child may have about concrete things, ask them questions like ‘How do you think those people were feeling? Do you know why they were angry? What do you do when you feel like something is unfair?’” We all have our different perspectives regarding racism and the complex history of race in our country. Providing space for children to ask questions, discuss their feelings and process the world around them will help them cope with the myriad emotions that may arise due to current events and the sense of helplessness and fear they may be experiencing.

 

Some helpful resources:

https://www.pbs.org/parents/authors/jenny-radesky-md

https://www.commonsensemedia.org/lists/books-with-characters-of-color

https://www.commonsensemedia.org/blog/black-history-movies-that-tackle-racism

https://www.commonsensemedia.org/lists/movies-that-inspire-kids-to-change-the-world

https://pediatrics.aappublications.org/content/144/2/e20191765

https://raisingequity.org/

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

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

 

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

 

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

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

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

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

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

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

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

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

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

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

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

Below are some helpful resources:

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

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

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

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

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

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

 

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

 

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