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

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LEARNING DISABILITY

an image of a child thinking about how different each side of his brain is, used to describe the difference in functioning between both sides when nonverbal learning disability is present

What is a Nonverbal Learning Disability?

By | NESCA Notes 2024

an image of a child thinking about how different each side of his brain is, used to describe the difference in functioning between both sides when nonverbal learning disability is presentBy Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

At August’s Democratic National Convention, Gus Walz, the teenage son of Democratic Vice Presidential nominee Tim Walz and his wife Gwen, melted hearts throughout the country with his outward show of emotions upon his father’s nomination. He exhibited deep love and pride for his dad in that moment. His tearful cheers evoked a sense of tenderness among many, confusion for others, and, sadly, public mockery, as well. At that time, many people were unaware that Gus carries the diagnosis of Nonverbal Learning Disability (NLD or NVLD) – a cognitive processing profile that often impacts emotion regulation and social cognition; however, his family’s openness about his condition has brought new attention to this profile.

There is often lack of awareness or confusion about what a NLD is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management.  As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning – On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception – In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration – Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills – Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive FunctioningExecutive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning – With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges – Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD?

The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. One comprehensive resource is the NVLD Project (https://nvld.org/), a nonprofit organization that conducts research, offers educational workshops and community outreach, and has an extensive list of NLD-related resources for parents, clients, and schools.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at www.nesca-newton.com.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

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

When Average Doesn’t Feel Like Average

By | NESCA Notes 2024

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

When we conduct a neuropsychological evaluation with a child, adolescent, or adult, one important component involves administering a battery of assessments. This is certainly not the only, or many times the most important, component, but it is part of the unique skill set of a neuropsychologist. A large percentage of these assessments are interpreted by comparing an individual’s performance to the performance of others who are similar in age. For example, we may compare an 8-year-old’s reading skills to the reading skills of a nationally-representative sample of 8-year-olds. This comparison helps us to understand if the child’s reading skills are generally below their peers, about at the same level as their peers, or above the level of their peers.

A nationally-representative sample of children may not be the most salient comparison for some families. In fact, the concerns that bring parents to a neuropsychologist in the first place can often include comparing their child to friends’ children, classmates, or other children in their community. This is an almost inescapable process. As parents, it is nearly impossible not to compare children – meeting milestones, academic skills, temperament, behavior, sociability, etc. Although it can have significant negative impact when done in front of a child or in a detrimental manner (e.g., “Why can’t you be more like Johnny?” “Susie has already figured that out and she’s younger than you!”), comparing your child to others can be valuable in specific circumstances. Many parents have little experience with child development before having children, and the children in their community and friend group can serve as helpful “guideposts” for what to expect at different ages. Many times, a parent has brought concerns to a neuropsychological evaluation along the lines of “my child seems different than my friends’ children/nieces and nephews/other kids at daycare,” and I have confirmed a significant disability or disorder was present. Parental instincts are valuable and can be an important first step.

However, there are times where comparing a child to a very specific set of other children can be a fraught process, particularly when seeking neuropsychological evaluation. Parents may live in an area or socialize with a group of families who are far from the nationally-representative samples that we utilize in our evaluations. Cousins and the children of close friends may have unusually well-developed skills, unusually calm or easy-going temperaments, or unusually easy progress through school. Children may be learning in a school environment that is extremely competitive, the result of a highly selective admissions process, or inaccessible to most of the general population. Any or all of these can make a child seem more impaired than neuropsychological assessments may indicate.

This is certainly not to discount valid, important parent concerns. A child who is far behind their classmates, even when those classmates are part of a highly selective school environment with academic expectations far beyond most schools, is still struggling and may be suffering. What is vital for parents to understand is the profile of their own child, and from where the challenges that they see are coming. A mismatch between a child and their environment, be it a social environment or an academic environment, can still result in real, impactful struggles – even if the child appears “average” on neuropsychological assessment measures.

 

About the Author

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

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

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

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

 

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

 

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

 

Educational Assessment – Measuring What We See and Understanding What Underlies

By | Nesca Notes 2023

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

At NESCA, all neuropsychological evaluations from ages pre-k through young adult include assessment of academic skills, in addition to assessment of other domains, including intellectual, language, memory, attention, executive function, social, and emotional skills. Because learning is a primary “job” for any individual in this age range, it is important to understand how their unique profile of skills impacts their learning process as well as consider whether underlying learning issues may be impacting observed challenges with stress, inattention, etc.

Just because all evaluations include educational assessment, it does not mean that the battery of tests always looks the same. If that is so, what tests might you expect your child’s neuropsychologist to include?

First and foremost, when an evaluator is selecting tests, it is important to first consider whether learning is a specific area of concern. When caregivers and/or teachers are specifically concerned about reading, writing, and/or math, it is important to assess both the child’s achievement level as well as assess underlying reasons for any observed challenges. This can be thought of as assessing both functional (i.e., actual academic performance) and foundational (i.e., the underlying problems) skills. While understanding a student’s functional academic skills is critically important, giving insight into their day-to-day performance in school, if the foundational skills are not examined, then interventions are likely to be misinformed and ultimately less effective.

For example, a child may be referred for evaluation due to difficulties with reading, and perhaps there is a family history of dyslexia. For this child, the educational portion of the evaluation would consider four functional skill domains, including:

  • Decoding – ability to sound and blend together unfamiliar words
  • Sight word reading – ability to recognize whole words
  • Fluency – reading efficiency, or speed
  • Comprehension – understanding of written material

While information about the above functional reading skills may tell us a lot about how the child’s reading skills are presenting, the scores alone do not elucidate the underlying neurocognitive pattern that contributes to these scores. So, in addition to assessment of cognition, processing, and memory, the evaluation will also examine the following foundational skills for each domain:

This graph demonstrates that these skills build directionally – without having the underlying ability to hear sounds in words, appreciate what words look like “in your head,” quickly access information from memory, or understand meaning within language, then individual, functional reading skills will not develop as expected, and overall reading will be behind. Similar analysis can be done for writing, such as examining skills for language expression and retrieval, mechanics, grammar, and word forms. For those with math concerns, examination of applied problem solving, calculations, and fluency as functional skills is important, but so is examination of the foundational skills of orthography, retrieval, visual-motor integration, visual processing and imagery, and quantitative reasoning.

Even for those who are referred for neuropsychological evaluation for concerns that are not directly academic, it is still critical to assess reading, writing, and math achievement and efficiency (i.e., fluency) as key skills on which they rely for their “full time job” of learning. This is also important because many individuals with ADHD, anxiety, mood challenges, or other neurodivergence often experience challenges with executive function. Executive function is a set of cognitive and regulator skills that allow for efficient, goal-oriented problem solving and task completion. This includes skills such as planning, organizing, managing time, self-monitoring work process, and controlling impulses. With this, it is very common for individuals with such challenges to experience slow academic fluency or efficiency, despite strong achievement. Academic achievement scores are thus critical for informing the appropriateness of various academic accommodations, such as extended time for tests or accessing teacher notes.

Children, teens, and young adults spend much of their time learning – both in and out of the classroom. It is for this reason that, at NESCA, full consideration of their educational profile is considered to be a critical component of any neuropsychological assessment. We aim to understand what we see – the functional skills, or achievement ­– but we also aim to see the foundational needs so that interventions and accommodations can truly meet the student’s needs. More information about NESCA’s approach to neuropsychological assessment can be found on our website at https://nesca-newton.com/neuro_eval/.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

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

Neurodevelopmental Evaluations for Children under Age 5

By | Nesca Notes 2023

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Many families are curious about neurodevelopmental testing. Neuropsychologists who specialize in working with young children are often asked about when it is appropriate to pursue an evaluation, what the evaluation process entails, and where to go.

Why Would a Young Child Need an Evaluation?

There are developmental milestones across several domains that children are expected to achieve within certain timeframes. When children are showing delays in achieving those milestones within expected age ranges, seeking an evaluation may be warranted. From birth to 5 years of age, the areas of development that are especially important to monitor include:

  • Speech and Language (e.g., use of single words/phrases, following directions)
  • Social Skills (e.g., eye contact, social smile, interest in others, imaginative play skills)
  • Motor Skills (e.g., crawling, walking, using a pincer grasp)
  • Cognition/Early Problem Solving Skills (e.g., matching shapes and objects, completing simple puzzles)

If delays in any of the areas listed above are observed, pursing an evaluation sooner rather than later is recommended, as research has shown that early diagnosis and intensive treatment are the most important factors in determining rapid progress and long-term prognosis.

What Does a Neurodevelopmental Evaluation Entail?

Within a comprehensive neurodevelopmental evaluation, the child is administered tests that look at the developmental areas listed above. Information should also be collected from parents, teachers, and other caregivers who know the child well. These evaluations help to provide a better understanding of the child’s developmental profile, including areas of relative strength and weakness. In other words, the evaluation can provide more information about where the child’s skills currently fall when compared to their same age peers. Such information can provide diagnostic clarification, as well as help to inform recommendations for services if needed.

Where to Go

There are several options for where families can pursue evaluations, each with their benefits and drawbacks:

  • Early Intervention (EI): EI is meant to support families of children birth to three years of age who have developmental delays or are at risk of developmental delays. The goal of the Massachusetts EI program is to collaboratively promote skill acquisition based on the family’s priorities and child’s individual needs. Evaluations are typically conducted within the home setting to determine the child’s eligibility for EI services. While these evaluations can provide valuable information about the child’s strengths and weaknesses, a diagnosis will not be provided.
  • Hospital-based Setting: These evaluations are structured differently depending on the hospital system. In most cases, these evaluations are interdisciplinary, meaning that they involve a team of providers from different disciplines (i.e., psychologist, medical provider (pediatrician, nurse practitioner) speech and language pathologist, occupational therapist, etc.). While outcomes of these evaluations can include diagnosis and recommendations for services when appropriate, waitlists are often long, and reports tend to be brief.
  • Independent Setting/Private Practice: Independent evaluations usually involve several visits with a pediatric psychologist or neuropsychologist, rather than with a team of providers. Similar to the hospital-based evaluations, independent evaluations can result in diagnosis when appropriate. Specific recommendations based on the child’s individual profile are offered. These evaluations tend to be more detailed and comprehensive than those conducted by EI and within hospital-based settings. Clinicians also have the option to observe the child in other settings (e.g., daycare, preschool, elementary school), as well as attend school-based meetings.

Relatedly, NESCA is currently providing evaluations for children 12 months to 3 years of age who are showing early signs of an autism spectrum disorder (ASD). The wait time is 1 month or less – by design –  so children who meet criteria for an ASD diagnosis can access the appropriate interventions for them. If you are interested in learning more about ASD Diagnostic Testing through NESCA’s ASD Diagnostic Clinic, please visit our website at https://nesca-newton.com/asd-diagnostic-clinic-2/ and/or complete our online Intake Form.

Related resources and links to help track developmental milestones:

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; 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.

Falling through the Cracks

By | Nesca Notes 2023

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

“You’re going to have a tough conversation on your hands,” I said. The parent sighed and nodded in response. “That’s what her ABA provider said, too,” she responded.

This conversation would not be difficult because her child was acting out, engaging in challenging behaviors, or taking up a great deal of adult time. In fact, she was exactly the opposite. Quiet, calm, gentle, and well-regulated were some of the words I used during our feedback session. And this, we discussed, is a huge part of the problem.

Despite their best efforts, teachers simply cannot be with every child that needs help, each time they need help. School providers do not have infinite caseloads, time, or capacity. There are real-world limitations to providing support and services for children at school. And yet, the children who suffer from these very real constraints are so often the quietest and least disruptive. This is extremely unfortunate when the child has real, diagnosed, observable deficits that absolutely require special attention and intervention at school.

Our brains often develop schema in order to reduce the brain’s workload (these occur entirely outside of our conscious awareness). Many social psychology studies have characterized the harm that schema can do. One such harm often comes to children for whom teachers have either strong positive or strong negative schema about. The effects of negative schema are likely obvious, but the positive schema can be just as challenging to manage. When teachers view a child very positively, they may be more likely to “write off” concerns (e.g., “she was just tired today,” “he really does know, he’s just having a bad day”), over-emphasize the child’s effort and diligence (rather than their actual skill level or mastery), and focus on positive attributes of the child in place of focusing on their weaknesses.

It can be challenging for parents to hear such positive feedback, particularly when it does not correlate with their perception of the child’s difficulties. Although neuropsychology attempts to be a strength-based field as much as possible, fully exploring and adequately characterizing deficits is often an invaluable part of what we do. This can help us to bring objective, data-driven recommendations to school teams for all students, hopefully preventing those quiet, hard-working youngsters from “falling through the cracks.”

 

About the Author

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

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

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

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham (coming soon), 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.

 

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

 

Shouldn’t We All Get Neuropsychological Evaluations, Then?

By | Nesca Notes 2023

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

One frequent question I have been asked by parents following a neuropsychological evaluation is, “Wouldn’t this process be helpful for everyone?” This tends to come up around the issue of disclosing results of an evaluation to children and teenagers and helping them better understand “how their brain works.” Many families with whom I have had the privilege of working come back months or years later with siblings of an initial client, noting that the process was so valuable the first time, they are hoping for a similar experience for their other child or children.

So, should we all get neuropsychological evaluations? Largely, I think this question is motivated by parents who are eager to help their children understand their own strengths and weaknesses. This is a wonderful goal, as self-understanding is one of the most valuable and lifelong gifts we can give our children.

In my experience, many people come to this kind of self-understanding naturally, over time, through experiences in adolescence and young adulthood. In particular, experiences that involve more independence in living and learning promote this kind of understanding. During childhood, we may learn our relative skill among family members (“I’m good at soccer, and my sibling is good at piano”), but these relative differences may not hold once we leave our family of origin. Many people venture out into the world and find that, compared to their peers, they are actually quite skilled at getting groups of friends together, doing everyday math, putting their thoughts down in writing, or staying organized. These real-world strengths often reflect the strengths that could be found through formal evaluation. As we gain self-understanding, we may be prompted to enter certain professions, take on particular hobbies, or pursue friends and partners with specific traits.

A neuropsychological evaluation can “speed up” the process of self-understanding, giving some young people a head start on the identity formation process that naturally occurs during adolescence. For some, this head start is vital – their brains are structured in ways that present clear, observable differences between them and their peers. This may be the case with diagnoses like autism spectrum disorder, a learning disability, or ADHD. For these individuals, the feedback from a neuropsychological evaluation can (under the best of circumstances) stave off feelings of inadequacy, negative self-esteem, and shame, helping a young person to recognize the deeply important strengths that are present alongside their more observable challenges. In these cases, a neuropsychological evaluation is not only for self-understanding, but also for self-compassion. Our goal as neuropsychologists in these cases is not just to help the child or teen understand themselves, but also to be gentle and kind with how they view their difficulties. Our hope is that, when these individuals venture out of their families and into the broader world, they are able to show resiliency in the face of the obstacles that will almost certainly be present.

 

About the Author

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

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

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

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

 

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

 

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

 

Explaining Neuropsychological Testing to Your Child

By | Nesca Notes 2023

By: Lauren Halladay, Ph.D.
Pediatric Neuropsychologist, NESCA

Neuropsychological testing can be confusing for adults to understand and explain, let alone children. Some of the most common questions that parents ask our neuropsychologists prior to their in-person appointments include:

  • “How do I explain the evaluation to my child?”
  • “How can I best prepare my child for what to expect when they are in the office?”

The answers vary depending on several factors. To name a few, your child’s age, level of awareness of areas they are struggling, and your child’s language abilities guide decision-making about the best way to discuss their upcoming evaluation experience. It is important to talk with your neuropsychologist to plan the most appropriate approach for your child. However, below is some standard guidance.

When describing the evaluation itself, I advise parents to use language that reduces pressure on the situation. In other words, it is best to frame the evaluation as a low stakes experience. For example, using words like “testing” or “evaluation” can create unnecessary worry. I often recommend describing the evaluation experience as a variety of “activities,” some of which may include looking at pictures, playing with toys, drawing, and answering questions. Other activities may seem similar to what your child is asked to do in school, such as reading stories, completing math problems, and writing.

Oftentimes, when children hear they are going to the “doctor” they may worry about medical exams. For this reason, it can be helpful to reassure your child that they are not going to be getting poked and prodded; and definitely will not be getting any shots!

To explain the reasons for doing the evaluation, some key phrases to use with your child include:

  • We want to understand how you learn, because everyone learns differently. It’s great that everyone learns differently because it keeps life interesting!
  • Everyone has things they are really good at and other things that are more challenging for them. This will help us understand what comes easy to you and what might be a little trickier, so that we can help you with things like schoolwork, completing activities around the house, and play.
  • We can also share this information with your teacher so they can better understand your learning style and support you at school.
  • Some activities might seem easy and others might be hard, but your job is just to try your best!

For more helpful tips, please see Dr. Gibbons’ previous blog posts, “How Do I Prepare My Child for a Neuropsychological Evaluation?” and “Preparing our Kids to Reenter the Community.”

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a Dr. Halladay or another NESCA neuropsychologist/clinician, please fill out and submit our online intake form

 

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

Neuropsychological Evaluations at Different Stages of Childhood & Adolescence

By | Nesca Notes 2023

By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

Having been at NESCA for more than 11 years, I have been fortunate enough to follow many clients throughout their childhood. In some cases, I have conducted two or three neuropsychological evaluations on the same student at different points in their life. After their first experience with an evaluation, parents will often ask, “Will we need to do this again?” or “How often should we get evaluations?”. As is the case for most things, the answer is different for every child depending on their needs. When determining how often to seek an evaluation, it might be helpful to think about what information you are trying to gather depending on the child’s age.

Preschool (2-5)

  • Concerns about developmental delays (not meeting milestones)
  • Concerns about autism spectrum disorder (ASD)
  • Transition from Early Intervention into preschool
  • Transition from preschool to kindergarten

Elementary School (5-10)

  • Concerns about academic skills – assess for dyslexia, dysgraphia, dyscalculia, or other specific learning disability
  • Why is the student not making expected progress in school?
  • Concerns about attention and executive functioning (possible attention-deficit/hyperactivity disorder (ADHD)
  • Concerns about ASD (if not already diagnosed)
  • For children who already have an identified disability – need to monitor progress
  • Plan for transition to middle school

Middle School (10-14)

  • If this is the first neuropsychological evaluation – it is usually because the child did okay in elementary school but is now struggling with increased demands in the areas of academics, executive functioning, and social
  • For students with a previously identified disability – need to monitor progress
  • Plan for transition to high school

Early High School (14-16)

  • Monitor progress – how is the student managing increased demands of high school?
  • Mental health – emerging concerns about anxiety and/or depression
  • Start planning for postsecondary transition
    • Is the student on track to graduate in 4 years?
    • Does the student need programming beyond 12th grade?

Late High School (16-18)

  • Heavy emphasis on postsecondary transition planning
  • Do we need to work on vocational skills?
  • If the student is college-bound – determine whether any accommodations will be needed
  • If the student is not going to college – what is next?
    • Remain at high school with ongoing special education services
    • Gap year
    • Young adult transition program for students with disabilities
  • Consult with transition specialist to help with planning

Early Adulthood (18+)

  • If the student is in college – do they need additional supports?
  • If the student is still accessing special education services – where should we be putting the emphasis?
    • Academics
    • Vocational
    • Life Skills
  • For students with developmental disabilities, need to plan for adult services
    • Should the parents seek guardianship?
    • Is the student eligible for DDS or other adult service agencies?
    • What resources are available to the family?
  • Combine with transition specialists to help navigate adult services

 

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit 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, Londonderry, New Hampshire, and Burlington, Vermont, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Meet Pediatric Neuropsychologist Lauren Halladay, Ph.D.

By | NESCA Notes 2022

By: Jane  Hauser

Director of Marketing & Outreach, NESCA

I recently had the opportunity to learn more about Pediatric Neuropsychologist Lauren Halladay, Ph.D., who joins NESCA in September. Learn more about her background and specialties in today’s blog interview.

How did you choose pediatric neuropsychology as a profession?

My interest was originally piqued when I was younger, as early as my high school years. I volunteered at a therapeutic riding program for kids with disabilities. That’s what initially sparked my desire to work with kids, and those with disabilities, in particular. My mother was a third grade teacher, which also imparted the desire to work with kids and help them overcome their challenges at school.

I went on to major in psychology and had a strong interest in pediatrics for the reasons I mentioned previously. Based on some of the work I did in graduate school, I learned that I really enjoyed the assessment piece, especially with the younger kids, helping them in life by identifying the right diagnosis (when applicable) and helping to put the right interventions in place for them to build skills that will equip them for the future.

How have your previous work experiences prepared you to be a neuropsychologist?

I’ve had a wide breadth of work experiences where I was supervised by neuropsychologists, whether it be in satellite health systems, the hospital setting, etc. While in those clinics, I had the opportunity to work with a variety of populations and presentations, including those who have experienced trauma, or have developmental or learning disabilities.

Having worked in several states throughout the country, including Oregon, Ohio, New York and Massachusetts, I’ve had the pleasure of working closely with a variety of families who present with unique backgrounds, experiences, and cultural values, which I always consider when making diagnostic decisions and developing recommendations.

What areas of neuropsychology have you most enjoyed to date? What would you consider your specialty area?

There are several areas that I am very passionate about. I really enjoy working with young kids, those under the ages of five or six. I also have a great interest in working with families who have concerns about their child potentially having an autism spectrum disorder or an intellectual or developmental disability. In addition, I find it incredibly rewarding to work with and help families whose children are medically complex or have moderate to severe cognitive impairments.

Regardless of how the child or student presents or what challenges they may have, I always individualize my approach so that I can meet the needs of each child. This is especially true in cases where families have had a hard time getting assessments done in the school setting or even privately in the past.

What is the most rewarding experience in neuropsychology that you’ve had to date?

I find it rewarding to hear from families when the strategies I’ve recommended are or are not working for them. For example, hearing that parents achieve success in implementing behavior management strategies, accessing support in the community, and/or learning about their child’s diagnosis and how to create an environment that suits their needs is a wonderful feeling. On the other hand, when the initial recommendations are not as helpful as intended, I enjoy approaching the problem-solving process together and discussing alternate approaches.

I also find it incredibly rewarding to offer parents and caregivers a deeper perspective on a child who has a moderate to severe cognitive impairment or is medically complex. Being able to give them a sense of where their child is developmentally in relation to their peers can be enlightening. Additionally, having more information about a child’s developmental level can help families and school staff establish appropriate, and individualized, expectations that set the child up for success. I strive to make a difference in these cases by developing strong partnerships with families, as well as serving as a trusted resource and advocate as they navigate how to best access supports in the community and in school.

What benefits, having been trained in a school psychology department, do you bring to families at NESCA?

My school psychology background allows me to bring a deep awareness and perspective on how the IEP process works. My experience and knowledge of special education rights allows me to be a true partner to families who are trying to navigate and understand the IEP process. I am able to share that knowledge and better advocate for my clients in Team meetings.

Why did you decide to join the team at NESCA?

I knew that in my next career move, I wanted to be part of a collaborative community that puts an emphasis on work/life balance—I feel that both allow clinicians to produce the highest quality work. At NESCA, I will also have the opportunity to use my school psychology skills and be an active participant in the IEP process on behalf of our clients.

NESCA is known for creating and building long-lasting relationships with the families they work with. I look forward to working with families and their schools/districts for the long-term, helping students to build skills along the way that will help them throughout their lives.

Finally, not being a native Bostonian, I am excited to learn more about and partner with the different school systems on behalf of the families and students we work with at NESCA.

 

About Lauren Halladay, Ph.D.

Dr. Halladay conducts comprehensive evaluations of toddlers, preschoolers, and school-aged children with a wide range of developmental, behavioral, and emotional concerns. She particularly enjoys working with individuals with Autism Spectrum Disorder, Intellectual and Developmental Disabilities, and complex medical conditions. She has experience working in schools, as well as outpatient and inpatient hospital settings. She is passionate about optimizing outcomes for children with neurodevelopmental disabilities by providing evidence-based, family-oriented care.

 

If you are interested in booking an appointment for an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit 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.

What Do We Mean by Individualized Neuropsychological Evaluations?

By | NESCA Notes 2022

By: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

Previous blogs in our recent series addressing frequently asked questions during the intake process, have covered the important differences between school-based testing and an independent neuropsychological evaluation. A neuropsychological evaluation should always be comprehensive, meaning that it covers various aspects of the student’s learning profile: cognition, language, memory, attention, and social-emotional functioning. However, the evaluation should also be individualized. Essentially, a good evaluation should aim to answer the questions that are specific to that student, not just a cookie-cutter list of tests.

Prior to starting testing, the clinician reviews any previous records and holds an intake appointment with the student’s parents or caregivers. Through this process, the clinician gathers information about the student’s early developmental history, medical background, and current challenges. If the student is already receiving services – either privately or through the school district – that is also important information. All of this helps to shape the “Referral Questions” for the evaluation. In some cases, the questions are very specific; for example, “Does my child have dyslexia?” or “Does my child have ADHD?” In other cases, the question is less defined, such as when we are asked “What is going on with my child and how do I help them?”

We often get asked by parents or caregivers if their child can have all of the tests available performed during their child’s neuropsychological evaluation. As clinicians, we understand that temptation. An evaluation is both an investment of time and money for the parents or caregivers. But neuropsychological evaluations are a lot of work for children, so we want to be sure to tailor the tests to what is actually going to yield beneficial findings for them or will help answer the referral question.

Some families request the list of tests that will be included in the evaluation. Unfortunately, this is not always possible until after testing is underway. Following the intake process, the clinician starts to develop the “battery” – the specific tests that will be administered to the student. Most clinicians have a skeleton battery of tests that they include for every client – an intelligence test, some academic tests (reading, writing, and math), and tasks that assess skills, such as language, memory, and attention – as described above. The clinician then fills in the testing battery based on the specific questions for that student. For example:

  • An evaluation designed to test for dyslexia should include several tests of reading as well as tests that look at very specific skills related to reading (e.g., phonological processing). When there are no concerns about reading, this aspect of the evaluation would be briefer.
  • An evaluation designed to assess for autism spectrum disorder should include a variety of tasks that examine social communication and reciprocal social skills. These types of tasks would likely not be included for a student who has never had any challenges in the social domain.

If a school district or another provider is asking for the list of tests that will comprise the neuropsychological evaluation, please talk to your clinician about this during the intake process. The final list might not be available until testing is complete, but this is definitely something that your clinician can provide as soon as possible.

 

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

If you are interested in booking an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit 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.