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

Tag

learning disorder

10

How Can a Neuropsychological Evaluation Help?

By | Nesca Notes 2023

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Recently I met with a family seeking a neuropsychological evaluation for their daughter. After talking about their reasons for pursuing testing, the parents asked me, “So…do you think this will help? Is this type of testing what our child needs?” It’s an important question and one I’m sure many families wonder about but don’t always ask. A comprehensive neuropsychological evaluation can be of tremendous value, but the process requires time and energy as well as a financial investment, so it makes sense to consider this question carefully.

Though it may be surprising to hear this coming from a neuropsychologist, the answer to the question of whether to have a child evaluated is not always clear-cut. For instance, parents sometimes wonder if there is practical benefit to seeking testing when a child or adolescent already has a diagnosis but there are questions about its accuracy. Consider the following scenario as an example. A child with issues regulating attention and with weaknesses in social skills has a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Her therapist has raised the question of whether a diagnosis of Autism Spectrum Disorder (ASD) might better explain the issues the child is facing. Inattention can be present in both ADHD and ASD, and both conditions can result in social difficulties. Especially if a child is already receiving appropriate services, does the diagnostic label matter, and is it worth pursuing formal assessment?

There are valid arguments to be made in favor of seeking an evaluation in this type of situation and valid arguments to support choosing not to invest in an assessment.  In such a scenario, I would encourage a family to consider the following questions:

  • Will diagnostic clarification address unanswered questions that previous diagnoses have not fully addressed?

Sometimes an established diagnosis partially explains a child’s issues but there are lingering questions about other aspects of a child’s presentation. If a different or additional diagnosis could fill in the gaps, it may be worth assessing.

  • Could testing help identify your child’s unique pattern of strengths and weaknesses?

Especially when an existing diagnosis has been made without testing (for instance by a therapist or physician), there may be important aspects of a child’s neuropsychological profile that have not yet been identified. For instance, individuals with Autism Spectrum Disorder share certain key features, but they also differ in significant ways. A diagnosis alone cannot capture the nuances of an individual child’s strengths and weaknesses, while a full neuropsychological evaluation can more fully describe a child on an individual level.

  • Will understanding the root of the problem help guide recommendations?

NESCA’s clinic director compares a child’s observable difficulties to the “tip of an iceberg.” There are inevitably hidden underlying factors, and discerning these can be important in determining how to address the issues that are visible on the surface. For example, problems with social interactions can arise from deficits in social communication (e.g., difficulty interpreting facial expressions), as seen in Autism. Alternatively, a child with ADHD may encounter social challenges because they have trouble paying attention to relevant social cues or because impulsivity leads them to behave inappropriately. Someone with social phobia may have few relationships because their anxiety drives them to avoid social interactions. Effective intervention in each of these cases requires a nuanced approach that targets not just the surface issue but the factors underlying it.

  • Will establishing a particular diagnosis open up opportunities for additional support and resources that may be important?

In some cases, there are specific resources that are available to individuals with particular diagnoses. For instance, in Massachusetts, individuals with a diagnosis of Autism Spectrum Disorder or Intellectual Disability may be eligible to receive services through the Department of Developmental Services. If qualifying for such services could be beneficial, diagnostic clarification may be important.

More broadly, the internet and social media have allowed people with shared diagnoses to connect in new ways. The opportunity to connect with others experiencing similar difficulties can be invaluable, and online communities can provide a sense of support, educational information, and practical resources for children and parents alike.

The answers to these questions and to the bigger question of whether to seek neuropsychological evaluation will be different for different families. There are many factors to weigh in making the decision to seek testing. If you are considering an assessment for your child and need additional information to make an informed decision, answers to frequently asked questions about neuropsychological evaluation can be found on NESCA’s website.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

 

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

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, Londonderry, New Hampshire, and staff in greater 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.

10

Paying Proper Attention to Inattention

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

One of the most common referral questions I see in my work as a neuropsychologist is, “Does my child have ADHD?” When a child has trouble focusing, Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the first things that comes to mind, and for good reason. However, ADHD is only one potential underlying cause of inattention. In fact, there are many cases in which attentional difficulties are present as part of another underlying issue. Some of these include:

  1. Anxiety—On a physiological level, anxiety involves activation of the “fight or flight” response. This adaptive process is designed to alter attention in order to prioritize survival. When the brain senses a threat, it tunes out everything else so it can focus on dealing with the danger at hand. This is extremely useful when the threat is something like a wild animal chasing you. In that case, you need to momentarily shift all of your attention to survival. It’s the worst possible time to be distracted by anything that could divert your attention from escaping a dangerous situation. But when students are anxious, especially for extended periods of time, the same process can make it difficult to focus on day-to-day tasks, including learning.
  2. Learning Disorder—Students who lack the academic skills to engage with the curriculum can appear to be simply not paying attention. If a student’s reading skills, for instance, are several grade levels below expectations, they won’t be able to actively engage with written assignments or materials in class.
  3. Communication Disorder—Deficits in receptive and/or expressive language often manifest in ways that mimic inattention. If a child cannot grasp what is being communicated, they will have significant difficulty following verbal instructions, answering questions, and retaining important information. This can easily be misinterpreted as a sign of an attentional issue when, in reality, the underlying problem has to do with communication.
  4. Autism Spectrum Disorders (ASD)—Many individuals on the Autism spectrum tend to be more attuned and focused on internal experiences (e.g., their own thoughts and specific interests) than to the external environment. As a result, they can miss important information, ranging from social cues to expectations communicated at home or within the classroom.
  5. Other neurocognitive disorders—Weaknesses in other cognitive functions, particularly those we refer to as “cognitive proficiency” skills (e.g., processing speed) and executive functions (e.g., working memory, organization) can also result in apparent inattention. Students who cannot process information quickly are sometimes unable to keep up with the pace of instruction, which causes a diminished ability to comprehend and retain information. Similarly, students who cannot hold information in working memory or organize ideas and concepts can demonstrate reduced comprehension.

There is a range of other issues that can contribute to children or adolescents appearing inattentive. Some of these include trauma, absence seizures, hearing impairments, thought disorders and/or hallucinations, and Tourette’s Syndrome. It is important to thoroughly evaluate the potential causes of inattention and to consider an individual’s full history and presentation.  Because different underlying issues will necessitate different treatment approaches, getting to the root of the issue can be tremendously important.

 

About the Author

Maggie Rodriguez, Psy.D., provides comprehensive evaluation services for children, adolescents, and young adults with often complex presentations. She particularly enjoys working with individuals who have concerns about attention and executive functioning, language-based learning disorders, and those with overlapping cognitive and social/emotional difficulties.

Prior to joining NESCA, Dr. Rodriguez worked in private practice, where she completed assessments with high-functioning students presenting with complex cognitive profiles whose areas of weakness may have gone previously undiagnosed. Dr. Rodriguez’s experience also includes pre- and post-doctoral training in the Learning Disability Clinic at Boston Children’s Hospital and the Neurodevelopmental Center at MassGeneral for Children/North Shore Medical Center. Dr. Rodriguez has spent significant time working with students in academic settings, including k-12 public and charter school systems and private academic programs, such as the Threshold Program at Lesley University.

Dr. Rodriguez earned her Psy.D. from William James College in 2012, where her coursework and practicum training focused on clinical work with children and adolescents and on assessment. Her doctoral thesis centered on cultural issues related to evaluation.

Dr. Rodriguez lives north of Boston with her husband and three young children.  She enjoys spending time outdoors hiking and bike riding with her family, practicing yoga, and reading.

 

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

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, 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.

5

Nearly 1/3 of College Students Drop out or Transfer by the End of Freshman Year: What Can We Do Differently?

By | NESCA Notes 2018

 

 

By: Kelley Challen, Ed.M., CAS 
Director of Transition Services  & Assistant Director of NESCA

 

As a transition specialist with a guidance counseling background, I work with many students during the college application process and the transition to managing life on a college campus. I help students and their families determine whether the student is ready to make the transition, whether an “in between” step such as a postgraduate or transitional year is needed, and how to shore up necessary skills for managing the enormous step between structured life at home and high school where adults constantly tell you what is expected and independently managing the freedoms, responsibilities, and unspoken expectations of being an adult on a college campus. Furthermore, I support young adults after a transition home from college participation, whether successful or unsuccessful, as they figure out the next steps in their life journey.

Two weeks ago, the New York Times (see link below) featured an article by Dr. William Stixrud and Ned Johnson emphasizing the hard reality that initial college transitions are unsuccessful for nearly one-third of young people.  The article further added that college is not actually a four-year endeavor for the majority of students who enroll (only 20% of the students who enroll in four-year college finish a bachelor’s degree in four years, and only 57% of students graduate within six years). The cited statistics are numbers that I have often mentioned in my own work with families and schools. I believe we need to be talking about, and normalizing these experiences. But, while many high schools track and publicize college admissions statistics, long-term graduate outcomes are less often known or shared. For students, parents, and teachers, being accepted into a college is frequently thought of as a final achievement for a successful high school student, rather than a small step in the context of a larger life plan.

Cue the transition specialist! Postsecondary transition planning is a process by which a young person is supported in the setting of goals and expectations for themselves and in building the skills and resources that will enable them to reach those goals. This should be a completely individualized process. However, in working with a large number of clients in Massachusetts and New Hampshire, I have observed that most middle and high school students have the same postsecondary vision: College. There is a strong consensus that college is the only goal to reach after high school, rather than an important step that leads to gainful employment in an area of strength, interest, or aptitude. Students with and without disabilities often know that they want to go to college (or that they are expected to go to college) but they have no career goals or sense about whether a college degree will actually benefit them in finding employment related to their aptitudes. Despite the data, most young people (and their parents) simply take as fact that college is what you do after high school.

But, as Stixrud and Johnson point out, thirty percent of students leave college by the end of their freshman year, and “the wheels can start to fall off as early as Thanksgiving.” Students find themselves back at home, no longer a student, but with no other sense of plan or identity. The authors cite two primary issues faced during this transition to college: the highly dysregulated environment that college provides (e.g., inconsistent sleep and diet patterns, lack of structure, and substance abuse including stimulant overuse, binge-drinking, and pot-smoking), and the late transition of managing daily life from parents to students. While I see students transfer or leave colleges for many reasons (e.g., difficulty managing social relationships without support, burnout, technology overuse, underusing needed/available support services, disciplinary issues, etc.), I certainly agree that the identified issues are often at the heart of college difficulties.

So how do we help students to better manage the transition process? First and foremost, we need to start discussing career development earlier and help our youth to understand the wide range of postsecondary options available to them. A bachelor’s degree is one academic pursuit that has a place for many students, but for a great number of students, it is not the best immediate option available after high school. There are many other options worth exploring such as two-year college programs, vocational or certificate programs, apprenticeships, military, employment, and gap year programs (see https://www.gapyearassociation.org/gap-year-programs.php). Without understanding the concept of career development, and the alternative paths available, students often do not know that they can make another choice besides (or on the way to) college. We also need to acknowledge that four-year college degrees are not a reality for the majority of people. To be truly informed decision-makers, students need to know that enrolling in college is likely to be a 5 or 6-year process.

In addition to helping students make informed decisions, we must begin planning for a transition of power and responsibility much earlier. Transition planning starts at a young age with things like sleep training, taking the school bus, learning to brush one’s own teeth, or packing one’s own school lunches. But as parents, we often establish patterns of doing things for our kids in order to save time and to cram in more activities. However, the net result of this process can end up being a high school student who has a long resume of extracurricular activities but no idea how to get out of bed in the morning or independently manage a schedule of schoolwork, athletics, and clubs. For students who actually need more time to plan and organize independently, they can also end up feeling like failures for not being able to manage this type of busy (and unrealistic) schedule on their own. As pointed out by Stixrud and Johnson, many college students have been used to their parents managing their daily lives and making decisions for them. When faced with a lack of structure and the opportunity to make an unlimited number of poor choices on a daily basis, new college students are frequently unable to navigate the landscape and manage their responsibilities.

“It takes time, practice and some failure to learn how to run a life.” This is probably my favorite quote from the article as it is very similar to a phrase I learned from my colleague Kathleen Pignone; for every transition-aged client at NESCA, we talk with parents about the importance of allowing the young person to have “the dignity to fail.” This is easiest to do when kids are young and consequences are less (e.g., letting them wear pajamas to third grade when they dawdle with their morning routine). However, the reality is that allowing a high school student to oversleep and be late, or to not turn in an assignment, is a much lower risk activity than waiting for them to fail an expensive class in college or binge drink themselves into a hospital bed. Picking and choosing opportunities to allow our children to be “in charge” and to experience the natural consequences of their actions is critical for helping them to develop planning, organization, and coping skills. Also, letting students advocate for themselves with classmates, teachers, and authority figures is vital since they will be expected to do this for themselves after high school. (You may need to plan a script together initially.)

Work experience is briefly mentioned as an alternative to college, but I see employment as much more than an alternative. Early work experience is something that we should be striving to help all youth attain as part of the process of transferring power and responsibility. There are many recent articles (e.g., J. Selingo., 2015; Gowans, H., 2018) highlighting that the number of teenagers who have a paid job while in high school has dropped from nearly 40% in 1990 to somewhere between 16-17%, an all-time low. While the causes for a decline in teen employment are not clear, I have anecdotally observed that summer academic participation, travel, and extracurricular activities (e.g., athletics) are often prioritized above work experience. Sometimes this is in the name of bolstering a college admissions packet which is unfortunate because colleges are often more eager to accept applications from high school students with work experience. Work experience is exactly the way that a young person can learn to manage a schedule, be on time, complete a task list, budget personal money, and generally be accountable for one’s actions. Having employment during high school has long been a predictor of success in college as well as success in attaining employment later in life. Work experience also helps students to start thinking about work they might like to have, or not have, in their adult lives and to begin to think about the concept of a career path.

But, what if you are reading this blog and your child is already at the end of their high school experience? Certainly, some of the alternatives mentioned by Stixrud and Johnson (e.g., employment, gap year) are important options to consider for building maturity. Another transition plan not mentioned, but often essential for students who struggle with executive dysfunction, social, or emotional difficulties, is to continue living at home and start with community college. This type of slower transition reduces the number of skills that the student has to independently learn to manage at the outset. If your child and you really want to give four-year college a try, the authors note that it is important to strike a balance between supporting student autonomy and extending some parental oversight to college. For example, parents who are contributing to college tuition might require that students give them access to on-line grades and/or that students sign a grade release. I often suggest that parents require that students are engaged in at least one or two student organizations or activities on campus to enable social and emotional success. Also, parents can schedule regular phone times, lunches, or dinners in order to more closely monitor the transition. While you don’t want to hover, it is likely that your child would jump at the chance for a free off-campus dinner once a month, especially if they can bring a few friends.

Finally, there is enormous value in talking about the reality that students who finish high school can “try” college and that it may not be completely successful the first time around or they may not like it at all. Students may figure out that they have picked the wrong school, don’t actually like lecture learning, would rather live at home, or don’t want to participate in a general studies program because they don’t want to take another math class, ever.  We need to be clear that the requisites for getting into college are not the same as those for getting out. College failure is a reality for a high percentage of students and good transition planning requires that teens and young adults make informed decisions, understand the risks, and have the skills for coping with the realities. As part of transition planning, we need to be emotionally and financially planning for much more than a four-year college experience and we need to be thoughtful about the timing of college participation and how the experience fits or doesn’t fit, into a longer and larger plan for our children. Thank you to Dr. Stixrud, Mr. Johnson, and the editors at The New York Times for shining a light on something we need to talk more about!

Articles:

Stixrud, W., and Johnson, N. (November 19, 2018). When a College Student Comes Home to Stay. The New York Times. Retrieved from https://www.nytimes.com/2018/11/19/well/family/when-a-college-student-comes-home-to-stay.html?nytapp=true.

Selingo, J. (November 25, 2015). Why more teenagers and college students need to work while in school. The Washington Post. Retrieved from https://www.washingtonpost.com/news/grade-point/wp/2015/11/25/why-more-teenagers-and-college-students-need-to-work-while-in-school/?noredirect=on&utm_term=.db2aeb63c5bd.

Gowins, H. (May 25, 2018). Fewer high schoolers are working. This is not good. Crain’s Chicago Business. Retrieved from https://www.chicagobusiness.com/article/20180525/ISSUE07/180529922/fewer-teens-working-in-high-school-a-worrisome-trend.

 

About the Author:

Challen

Kelley Challen, EdM, CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training, and program development services. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles.  She also worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities including students with complex medical needs. She is also co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism.

 

To book a consultation or evaluation with one of NESCA’s expert transition specialists, please complete NESCA’s online intake form today.

 

 

 

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.