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

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

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Leah Weinberg Archives - NESCA

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Student struggling in school

When Capable Children Struggle

By | NESCA Notes 2026

Student struggling in schoolBy NESCA Neuropsychology Clinical Staff

Understanding the Gap Between Intelligence and Performance

“I know my child is smart.” This is something parents sometimes say to me with both confidence and confusion.

During intake meetings, parents describe their children to me as being able to grasp complex ideas, ask thoughtful questions, and often seem to understand more than their schoolwork shows. Yet school feels harder than it should. Assignments take too long, work is inconsistent, focus slips under pressure, and emotions rise quickly when tasks become demanding.

Over time, a gap becomes visible where intelligence is clear, but performance does not consistently reflect it. Understanding that gap requires looking beyond intelligence alone.

Intelligence Is Only Part of the Picture

Intelligence reflects the ability to reason, understand concepts, and make connections. It is an important foundation.

Performance reflects how intelligence interacts with other essential skills, such as attention, language, memory, organization, emotional control, and follow-through. When one or more of these areas is strained, a child may know the material yet struggle to show it consistently.

Sometimes attention drifts. Sometimes reading or writing requires more effort than it appears. Sometimes instructions are harder to hold in mind. Sometimes frustration rises quickly when work feels open-ended. Often, it is not one issue. It is the interaction among several of these areas.

Intelligence and performance are not the same thing.

Why It Often Becomes More Noticeable Over Time

In the early years, structure is built in, tasks are shorter, and teachers provide frequent guidance. As children grow older, expectations shift, and assignments become longer and less structured. Organization is assumed, and independence is expected. As demands increase, underlying vulnerabilities become harder to compensate for. The child’s intelligence has not changed, but the demands have.

What Happens When Demands Rise

Academic tasks require coordination. A child must sustain attention, organize ideas, remember instructions, manage frustration, and monitor accuracy – often at the same time. When any part of that system is stretched, patterns shift, work slows down, mistakes increase, focus drops, frustration intensifies, and often voidance or shutdown follows.

These reactions are not signs of limited ability; they are often signs that demands are exceeding capacity in one or more areas. That distinction matters. It shifts the question from “Why aren’t they trying?” to “What is making this harder right now?”

When Structure Helps…and When It Doesn’t

Some children appear steady in structured settings but struggle during independent work. External support can temporarily reduce strain. But when that support is reduced, inconsistencies become more visible. Without context, this can feel confusing; however, with a broader understanding, it often makes sense.

A Broader View

Looking only at intelligence can leave the picture incomplete. Considering how intelligence interacts with attention, learning processes, language, emotional patterns, and self-management brings greater clarity. Children and students are not simply performing or underperforming. Instead, they are navigating a complex interaction of strengths and vulnerabilities within changing demands. Understanding that interaction allows parents and educators to respond with greater clarity and thoughtfulness.

My Approach

In my work with children, teens, and families, I focus on integration. I consider how different aspects of a child’s profile – from cognitive strengths to patterns of attention and emotional response – all come together within the real demands of school and daily life.

My goal is not to simplify difficulty to a single cause, but to clarify patterns. When these interactions are understood, conversations shift. Blame decreases, and direction becomes clearer.

Clarity does not eliminate challenges. It does, however, replace confusion with understanding, which helps adults respond in ways that are steadier, more precise, and better aligned with their child or student.

To book a neuropsychological evaluation, 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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child with FASD and parent

Often Overlooked: Recognizing and Supporting Children with Fetal Alcohol Spectrum Disorder

By | NESCA Notes 2025

child with FASD and parentBy NESCA Pediatric Neuropsychologist

One of the reasons I joined the NESCA team was for the opportunity to continually learn and grow professionally. NESCA has a well-earned reputation for fostering an environment where clinicians can expand their knowledge and refine their skills in meaningful ways, and a session I was able to attend for our staff earlier this year was a perfect example of that.

I attended an insightful seminar on Fetal Alcohol Spectrum Disorder (FASD), a topic that is often overlooked yet critically important in neuropsychological practice. The presentation provided clinically relevant information and tools to better recognize and address this condition.

One key takeaway was a reminder of how challenging FASD can be to diagnose. While many people associate the condition with characteristic facial abnormalities, these features are present in only a minority of affected children. Additionally, the social stigma around alcohol use during pregnancy means parents may be reluctant to disclose this history. This can make it easy to miss the diagnosis, particularly in children who present with behavioral or learning challenges that could be attributed to other conditions.

Hallmark symptoms of FASD include executive functioning deficits (e.g., working memory), poor impulse control, difficulties with generalization (people, situations, consequences), difficulties with abstraction, perseverations, and diminished adaptive skills within the context of healthy levels of intellect.

The seminar emphasized why making an accurate diagnosis is so critical: It directly informs how we approach treatment, including how we assist families in accessing services, setting realistic expectations for the child, diminishing the risk of the child receiving inappropriate diagnoses (e.g., Oppositional Defiant Disorder), and assisting the child in developing stronger self-awareness and self-advocacy skills. Moreover, it is important for the adults in the child’s life, including parents and educators, to understand that behaviors that are part of the disability are not willful. Behavioral challenges in children with FASD, for example, often do not respond well to traditional behavioral programs. Instead, a trauma-informed approach is typically more effective, as it accounts for the neurodevelopmental impact of prenatal alcohol exposure and addresses the underlying emotional and regulatory difficulties these children face.

Being part of a team that prioritizes professional development, like the one at NESCA, means continually sharpening my skills and expanding my understanding to better serve the children and families we work with. The FASD seminar was not only a great learning experience but also a reminder of the importance of staying open to complex diagnoses and tailoring treatment plans to meet the unique needs of each child.

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

NESCA is a pediatric neuropsychology practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, 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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Approaching Cultural Knowledge and Sensitivity as More Than Just Buzzwords: A Neuropsychologist’s Perspective

By | NESCA Notes 2024

By Pediatric Neuropsychologist, NESCA

In recent years, the conversation around cultural knowledge and sensitivity has gained significant traction across many fields, including education, healthcare, and psychology. Yet, despite the increasing prevalence of these terms, we must ask ourselves: Are we truly embodying cultural sensitivity, or are we merely paying lip service to it?

As a neuropsychologist, originally from the former Soviet Union (what is now Ukraine), I believe that cultural competence is not just a set of buzzwords we throw around to make ourselves sound aware; it’s a crucial, ongoing practice that demands attention, empathy, and, above all, genuine understanding. Now more than ever, as we witness global conflicts and societal shifts, it’s essential to engage deeply with the cultural and psychological needs of children who are affected by these events. The horrific events of October 7, 2023, in Israel, the subsequent rise in incidents involving anti-Jewish sentiments, and other crises around the world have had a profound impact on vulnerable children. How can we, as mental health professionals, approach these children in a way that truly honors their cultural identities while understanding the potential toll of trauma?

Children who experience trauma often find themselves at the intersection of multiple identities—cultural, familial, national, and personal. In the Jewish community, for example, the devastating events of October 7, 2023, marked a profound moment of collective grief and fear. For some Jewish children, the emotional impact of these events may be compounded by historical trauma, including awareness of past experiences of antisemitism and persecution. These children may be processing not only the immediacy of their own situation but also an ancestral history of violence and oppression. Similarly, Ukrainian children displaced by the ongoing conflict face a complex mix of trauma. These children might not only be mourning the loss of their homes, but also grappling with the disintegration of their sense of safety and national identity. The trauma of war is not just physical; it disrupts the very fabric of who these children are and how they see the world. Their cultural identity, bound up in language, traditions, and the shared history of their people, may suddenly feel threatened or fragmented.

It’s essential to recognize that cultural knowledge is not simply about understanding “facts” about a group’s history or customs. It’s about recognizing the psychological and emotional realities of that culture in the present moment, particularly when faced with trauma. When working with children from these communities, it’s important to begin by listening. Listen not only to their words, but also to the silence in between, to their body language, and to the nuances of how they express their grief and fear. Children from these communities may not always have the language to articulate their feelings, particularly when these feelings are wrapped up in both current trauma and long-standing cultural narratives. For instance, a Jewish child might not immediately say, “I’m scared because of antisemitism.” Instead, they may exhibit anxiety in social settings, avoidance of certain situations, or a sense of hypervigilance. It’s essential to recognize these subtler expressions of distress. Furthermore, cultural sensitivity means appreciating how culture influences coping mechanisms. For Jewish children, faith, community rituals, and family structures often play a significant role in both day-to-day life and in how they process adversity. These rituals, whether it’s a prayer or a specific practice for remembering the dead, can provide crucial emotional support, and understanding their importance can help guide effective interventions. Similarly, Ukrainian children may draw strength from their deep cultural connection to the land and their national identity. Understanding these cultural touchstones allows us to better support their emotional recovery.

To effectively support children affected by trauma, it is important to approach care from a framework that integrates both cultural sensitivity and trauma-informed practice. Children need to feel understood, and this means recognizing their cultural identity as an integral part of their experience. Safe spaces where children can express themselves without fear of judgment are paramount. It is important for clinicians not only to appreciate the current crisis but also the cumulative effect of historical events that have shaped the children’s cultures. As a clinician, this means being aware of the historical context and acknowledging the weight of collective memory. This helps to build trust and validates the child’s emotional experience. Working with families and community leaders helps ensure that interventions are not only culturally relevant but also supported by the broader social structure. This collaborative approach fosters resilience and provides ongoing emotional support.

Cultural competence is not a static goal, but rather a lifelong learning process. As clinicians, we must constantly engage with the evolving cultural, social, and political landscapes to ensure our approach remains relevant and respectful. This includes continuing education and being open to adjusting our practices based on new insights. Ultimately, cultural sensitivity is not about checking off a list of “do’s and don’ts.” It’s about recognizing and understanding that culture shapes how children experience and process the world. This empathetic approach allows us to meet children where they are—emotionally, psychologically, and culturally—and to support them as needed. As we move forward, let us take cultural sensitivity beyond a buzzword and make it a true cornerstone of our practice. In times of crisis, the need for empathy, understanding, and culturally informed care has never been greater.

NESCA has a long-standing commitment to working with internationally based clients, families, and schools through neuropsychological evaluation, consultation, coaching, and transition services. For more information on NESCA’s international work, visit: https://nesca-newton.com/international/.

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

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

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