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Intensive Cognitive-Behavioral Therapy (CBT) for Anxiety

By | NESCA Notes 2018

 

By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

Deciding to enroll your child in mental health treatment is a big step in and of itself. Before initiating the process, there is often a trial and error period of interventions to improve the situation, whether at home or in school, and then coming to terms with the fact that they might not be enough to sufficiently address your child’s needs. Finding the right therapy and therapist match for your child can also prove challenging. Not only are there numerous therapeutic approaches available, but there are also varying levels of care depending on the severity of your child’s symptoms and amount of support he or she requires. This ranges from once weekly outpatient therapy to day treatment programs to inpatient hospitalizations for more acute psychiatric issues that may require crisis stabilization (i.e., suicidality, self-harm, etc.)

One type of treatment that has garnered considerable empirical support for treating youth anxiety and depression (conditions we regularly treat at NESCA) is Cognitive-Behavioral Therapy (CBT). CBT focuses on the intersection between our thoughts, emotions, bodily sensations and behaviors. The goal of CBT is to better manage overall emotional distress and reduce physiological symptoms by changing negative thoughts or unhelpful thinking patterns, ineffective coping strategies, and maladaptive behaviors that might be reinforcing uncomfortable feelings. CBT aims to teach children and their parents new, adaptive coping skills while providing opportunities both in and between sessions to practice these skills. CBT is a short-term, targeted treatment that promotes “approach” behaviors (as opposed to “avoidance”) through “exposures,” or exercises designed to practice facing fears gradually, in a safe environment. CBT might also include learning mindfulness, emotion regulation, and distress tolerance; techniques that have been shown to enhance treatment outcomes.

While some youth make progress in meeting with a therapist once per week, others benefit from a condensed, “intensive” format where they receive CBT treatment daily and over a shorter period of time. The accelerated nature of these types of programs, offered in both outpatient and hospital-based settings, allows for quicker acquisition of strategies, substantial exposure practice, and generalization of newly learned skills to other settings in a child’s life. Think of it as a crash-course in CBT.

You may want to consider an intensive therapy program for your child if: 

  • Your child’s symptoms are greatly interfering with his or her life, such as attending school or school performance, family life, and friendships.
  • Your child has tried different therapies in the past but there has been minimal carryover from session to session and/or you haven’t noticed much progress overall.
  • Your child is experiencing distress but other commitments during the school year have hindered attending therapy on a consistent basis, making school breaks or the summer an ideal time to work on it.

At NESCA, we are pleased to offer a highly specialized and immersive therapy experience through our 2-Week Summer Intensive CBT Program for anxiety. We work with children and adolescents who present with all types of anxiety, including generalized anxiety, separation anxiety, social anxiety, specific fears (e.g., dog phobia, vomit phobia, etc.) and obsessive-compulsive disorder (OCD).

What does NESCA’s 2-Week Summer Intensive Program consist of? 

  • Intake evaluation – A meeting is held with the child and parents to gain a comprehensive understanding of the child, provide an assessment of symptoms and discuss goals for treatment, all of which will inform the treatment plan.
  • 1:1 therapy sessions – Individual CBT therapy sessions with the child or teen are conducted 5 days/week for 90 minutes. Homework will also be assigned between therapy sessions to reinforce skills learned.
  • Parent involvement – Parent participation is vital in treating childhood anxiety. Parent sessions are held 5 days/week for 30 minutes. During these meetings, parents will be educated about their child’s anxiety, receive progress updates and also acquire tools to better support their child. Parents might also be asked to help children practice the new skills they are learning.
  • Discharge planning – Families will be assisted in determining follow up support that will be helpful in order to maintain treatment gains.
  • Treatment summary – Following the conclusion of the program, families will receive a written summary that reviews the course of treatment, progress made and discharge recommendations.

There are circumstances in which the frequency, duration and/or structure of the program can be modified to best fit your child’s needs.

For more information about NESCA’s Summer Intensive CBT Program or to find out if the program is appropriate for your child, please contact Dr. Ryan Ruth Conway at (617) 658-9831 or rconway@nesca-newton.com.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please 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.

 

Special Holiday Edition: ‘Tis the Season for Self-Care

By | NESCA Notes 2017

 

By:  Jackie Reinert, Psy.D. LMHC
Pediatric Neuropsychologist

As a child, the idea of Christmas meant cookies, presents, time with family, and of course, giving up TGIF’s Full House in favor of holiday movies. Everything from Scrooged to A Miracle on 34th Street to Home Alone, and every clay animated favorite served as the framework for my formulation of what the holidays truly meant; “It’s Christmas Eve. It’s the one night of the year when we all act a little nicer, we smile a little easier, we cheer a little more. For a couple of hours out of the whole year we are the people that we always hoped we would be.” Frank Cross’s commentary on Christmas set expectations high, and year after year, we hoped to top the magic and splendor of the previous year’s festivities.

As a parent, the holiday season conjures up warm memories of childhood, ignites aspirations to establish new traditions, and creates opportunities to share experiences with our loved ones, particularly our children. The magic of the holidays can also cultivate high expectations; to act nicer, smile easier, and to cheer more. These expectations more often than not exceed our capacity to truly encapsulate the hopes and aspirations we drum up in our heads. High expectations can pave the way for increased levels of perceived stress.

The American Psychological Association recently released its annual review, Stress in America (November, 2017), which indicates the United States has reached its highest stress level yet. Acute arousal stress in isolation can activate and enhance mobilization, sharpening our concentration and preparing our bodies to engage in challenging tasks, such as wrapping those last two presents and baking another round of cookies. This basic human reaction known as the “flight-or-fight” response has served us well, priming our bodies to flee or combat unsafe situations; however, our bodies can also overreact to simple, non-threatening situations, such as holiday pressure, financial difficulties, and increasing family demands.

Chronic stress has far more lasting and serious complications, particularly when it exceeds our ability to cope and leads to emotional and physical dysregulation. Stress is negatively related to our coping potential and our perception of control, which decreases use of problem-solving coping strategies and increases negative coping strategies, such as alcohol consumption and avoidance tactics (Rui Gomes, Faria, & Gonçalves, 2013). Individuals who experience elevations in stress and engage in maladaptive coping strategies such as drinking more alcohol, complaining, sleeping less, and consuming unhealthy foods which increase chances of becoming physically and mentally run down.

For parents, the added stress of the holidays and high expectations can have a significant impact on not only themselves, but those around them. Research suggests that adults are more likely to find family responsibilities stressful than they have in the past (APA, November, 2017). High expectations can make capturing the perfect holiday, particularly when parenting a child with special needs, a stressful time, leading to feelings of resentment (“I’m doing all of this and no one is helping me”), frustration (“I have no time to fit this all in”), and disappointment (“It seems like they didn’t have a good time”).

This year, I encourage you to lower your holiday expectations, increase self-care and self-compassion. While practicing self-care may be the furthest thing from your mind, the following may offer some reprieve from the hustle and bustle of the holiday season.

  1. Expect that things will go wrong, and that’s okay. Someone will get sick, you might burn a dish, and yes, that’s okay. Avoid catastrophic thinking, a common cognitive distortion where we imagine and worry about the worst possible situation, either consciously or subconsciously. For example, your ability to prepare the perfect holiday dinner for twelve people is an act, not a representation of how good of a person you are. You are not the sum of how well-executed things are, how perfectly the house looks, how your children act.
  1. Practice self-regulation and utilize coping skills. The easiest way to understand the subtle difference between these two concepts is to imagine yourself in a car, driving down I-90 into Boston and someone cuts you off. To access a coping skil to manage your anger, you would first need to pull off the highway, put the car in park, and throw on your hazard lights. Conversely, if you were utilizing a self-regulation skill, you could continue driving and manage your thoughts and feelings in the moment. Self-regulation is the ability to modulate our emotions and impulses, to keep ourselves in check, whereas coping is a process or actions that help you manage difficult emotions. Examples of self-regulation skills include diaphragmatic breathing (learn more here: https://www.youtube.com/watch?v=hFcQpNr_KA4&t=140s) and box breathing (https://www.youtube.com/watch?v=dP4Jxxhhzl0). Coping skills can include meditation (https://www.youtube.com/watch?v=4Bs0qUB3BHQ), and progressive muscle relaxation (https://www.youtube.com/watch?v=1nZEdqcGVzo).
  1. Practice micro-moments of positivity. Research suggests that rather than pursue the perfect gift to demonstrate your love for a family member, seeking out opportunities to be present and make a meaningful connection have a more lasting effect (Heshmati, Oravecz, Pressman, Bathcelder, Muth, & Vandekerckhove, 2017). Crawling into bed and reading a holiday book with your children, or complete a small craft together can have a more lasting impact that securing a sloth Fingerling for them. You can read more about micro-moments here: https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence
  1. Opt outside! Research suggests that spending time in nature can have a significant effect on mood (https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence) and can increase sun exposure and the benefits of Vitamin D. Locate a winter wonderland hike here: http://www.bostonmagazine.com/health/2016/01/11/winter-hiking-massachusetts/
  1. Finally, don’t forget about self-care. Self-care is a deliberate act to support and nurture your physical and mental health. Taking care of yourself not only helps you but those around you. There are several TED talks highlighting the benefit of self-care: https://www.ted.com/playlists/299/the_importance_of_self_care

 

About the Author:

Dr. Reinert is a Pediatric Neuropsychology Postdoctoral Fellow who joined NESCA in September 2017. Dr. Reinert assists with neuropsychological and psychological (projective) assessments in the Newton office and in the Londonderry office. In addition to assisting with neuropsychological evaluations, Dr. Reinert co-facilitates parent-child groups and provides clinical consultation. Before joining NESCA Dr. Reinert worked in a variety of clinical settings, including therapeutic schools, residential treatment programs and in community mental health. She has comprehensive training in psychological assessment, conducting testing with children, adolescents, and transitional-aged adults with complex trauma. Dr. Reinert is particularly interested in researching the intersectionality of ASD and gender exploration.

 

To book a consultation with one of our many 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.

 

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2017

 

By:  Alissa Talamo, Ph.D.
Pediatric Neuropsychologist

I recently attended the International Dyslexia Association Conference in Atlanta, GA (dyslexiaida.org). Among the conference attendees were researchers, teachers, speech-language pathologists, psychologists, and parents of children with dyslexia. One recurring key point was the importance of early identification of reading difficulties, as early provision of appropriate interventions and services leads to better outcomes.

It is important to remember that unlike seeing, hearing, and eating, reading is not something humans do naturally. Reading must be learned and it is not easy (Maryanne Wolf, Proust and the Squid).

As a parent, your early observations are important as there are many developmental indicators that may signal a risk for reading difficulties such as:

  • Experiencing repeated early ear infections
  • History of speech delay and/or pronunciation problems
  • Slow vocabulary growth, frequent difficulty finding the right word, use of less specific words such as “the thing,” “the stuff,” or “that place.”
  • Your child struggles to recognize words that start with the same sound (e.g., cat and car) or end with the same sound (rhyming).
  • Difficulty learning letter and number symbols when in preschool
  • Family history of reading problems

During first grade, you can watch for these warning signs as you listen to your child read aloud:

  • Does not know the sounds associated with all of the letters
  • Skips words in a sentence and does not stop to self-correct
  • Cannot remember words; sounds out the same word every time it occurs on the page
  • Frequently guesses at unknown words rather than sounding them out
  • If you ask your first grader to read aloud to you and he/she is reluctant and avoidant

Remember: 

Early identification of reading issues is extremely important for outcome. If children who have dyslexia receive effective phonological awareness and phonics training in Kindergarten and 1st grade, they will have significantly fewer problems learning to read at grade level than children who are not identified or helped until 3rd grade.

What should I do if I suspect my child has challenges with reading?
If you suspect your child is struggling to learn to read, have your child receive an independent comprehensive evaluation so that you understand your child’s areas of cognitive and learning strengths and weaknesses. This evaluation should also include specific, tailored recommendations to address your child’s learning difficulties.

To learn more about evaluations and testing services with Dr. Talamo and other clinicians at NESCA, you may find the following links helpful:

What if I am not sure whether my child needs a neuropsychological evaluation?

When determining whether an initial neuropsychological evaluation or updated neuropsychological evaluation is needed, parents often choose to start with a consultation. A neuropsychological consultation begins with a review of the child’s academic records (e.g., report card, progress reports, prior evaluation reports), followed by a parent meeting, during which concerns and questions are discussed about the child’s profile and potential needs. Based on that consultation, the neuropsychologist can offer diagnostic hypotheses and suggestions for next steps, which might include a comprehensive neuropsychological evaluation, work with a transition specialist, or initiation of therapy or tutoring. While a more comprehensive understanding of the child would be gleaned through a full assessment, a consultation is a good place to start when parents need additional help with decision making about first steps.

Sources used for this blog:

 

About the Author:

With NESCA since its inception in 2007, Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

She has given a number of presentations, most recently on “How to Recognize a Struggling Reader,” “Supporting Students with Working Memory Limitations,” (with Bonnie Singer, Ph.D., CCC-SLP of Architects for Learning ), and “Executive Function in Elementary and Middle School Students.”

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders, and emotional issues. She is also interested in working with highly gifted children.

Her professional memberships include MAGE (Massachusetts Association for Gifted Education), IDA (International Dyslexia Association), MABIDA (the Massachusetts division of IDA) and MNS (the Massachusetts Neuropsychological Society).

She is the mother of one teenage girl.

 

 

To book a consultation with Dr. Talamo 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.

 

Emerging Psychosis: When to worry about your teen’s thinking

By | NESCA Notes 2017

 

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Emerging Psychosis: When to Worry about Your Teen’s Thinking

Teenagers are famous for incidents of bad judgment and poorly considered decisions; it is one of the rites of passage for parents and children to have had at least one “What were you thinking?” discussion before the teen leaves the family nest for college or employment. These events are often memorable, however, because they tend to be outliers, occurring simultaneously with instances of relatively accurate appraisals of situations and relatively adequate problem-solving as they navigate the expectations of school, family, friends, and community.

Some parents must confront a separate set of ongoing concerns about their child’s thinking that effect their assessment of the world and themselves. In this article, I will talk about the nature of psychosis, describe the changes leading up to an episode of psychosis and outline emerging models of treatment which aim to prevent the first acute episode or at least delay onset of the episode as much as possible. These findings emphasize the critical importance of early identification and treatment of symptoms to prevent or reduce future impairment.

The Nature of Psychosis
Psychosis refers to a condition in which a person has lost contact with reality and is unable to distinguish what is real and what is not. Psychotic symptoms include what are called “positive” (what is present) and “negative” (what is absent) symptoms.

  • Positive symptoms include: abnormalities of thinking in both content as well as form; the former refers to distortions of reality such as hallucinations or delusions, and the latter refers to disorganization of thinking and bizarre behavior.
  • Negative symptoms refer to the reduction of emotional response (“blunted” or incongruous affect), apathy and loss of motivation, social withdrawal, impaired attention, reduced speech and movement, loss of enjoyment in life (“anhedonia”).

Researchers have also identified subtle cognitive impairments that include:

  • Deficits in processing speed
  • Executive function
  • Sustained attention/vigilance
  • Working memory
  • Verbal learning and memory
  • Reasoning and problem solving
  • Verbal comprehension
  • Social cognition

The impact of these issues can result in severe functional deficits across a range of domains such as work, school, and relationships.

Psychosis is now thought to be a neurodevelopmental disorder, meaning that it is thought to be related to abnormalities in brain development that become apparent as the brain matures in adolescence. Psychosis is thus a condition that emerges gradually as the underlying dysfunction comes to the fore. It is also thought to be a neurodegenerative disorder, meaning that the disease causes physical changes to the brain that results in impaired functioning. These changes include, on average, slightly larger lateral ventricle and slightly less cerebral gray matter for people at the first psychotic break compared to controls. From a behavioral perspective, researchers have found that the longer people live with an untreated psychosis, the more likely they are to experience functional impairments, have a poor response to psychiatric medications, and experience a poor quality of life. These alarming findings have prompted researchers and clinicians to research the period of time before the first psychotic break, referred to as the prodromal period, where symptoms start to emerge, in an effort to discover a way to divert or slow this process.

The Prodromal Period

The prodromal period is a time when “subclinical”, or milder symptoms of psychosis begin to appear. This period can vary in length from a few weeks to a few years. During this period, the adolescent or young adult may experience mild disturbances in perception, cognition, language, motor function, willpower, initiative, level of energy, and stress tolerance. These are differentiated from frank psychosis by lower levels of intensity, frequency or duration. The teen may complain of nonspecific clinical symptoms such as depression, anxiety, social isolation, and/or difficulties with school. They then may start to occasionally experience positive symptoms that are brief in duration and moderate in intensity. These events may become more serious over time, although they don’t happen often, last for only a few minutes to hours, and the person still retains some insight as to the unusual nature of the phenomena. However, this situation changes as the person comes closer to the initial psychotic break, signaled by the emergence of unusual thoughts, perceptual abnormalities, and disordered speech.

Risk and Resource

Who is most likely to move from the prodromal period to frank psychosis? Factors most predictive of this transition include people with a family history of psychosis and a recent deterioration of functioning, a history of substance abuse, and higher levels of unusual thoughts and social impairments. Other mediating factors include poor functioning, lengthy time period of symptoms, elevated levels of depression or other comorbid conditions, and reduced attention.

What factors appear to ameliorate risk of descending into psychosis? Risk/protective factors include higher premorbid cognitive skills and social skills and lack of a history of substance abuse.

How and When to Intervene

The information provided here about emerging psychosis underlines the critical importance of early intervention to address the serious and pervasive impact on functioning. Professionals who treat people at risk of psychosis are now beginning to use a clinical staging of treatment, meaning treatments should be tailored to the client’s needs, starting with safer and simpler interventions for the prodromal stages and increasingly intensive and aggressive treatment for people who are already contending with psychosis. This requires starting with what appears to be most problematic at the time for the person. For some people, this means treating the comorbid psychiatric conditions. For those who are experiencing difficulties with attention/executive function or reporting elevated levels of unusual symptoms, it may mean starting the person on an atypical antipsychotic. The use of targeted psychosocial interventions such as cognitive behavioral therapy, social skills training, and family therapy have all been found to be associated with reduced or delayed transition to first episode psychosis.

Where to Go for Help

Living in the Boston area, we are fortunate to have a wealth of resources in our hospitals and training sites that are engaged in cutting edge research and intervention to address the needs of young people who are contending with emerging psychosis. These include Beth Israel-Deaconess Hospital’s Center for Early Detection and Response to Risk (CEDAR) and the Prevention and Recovery in Early Psychosis (PREP) jointly run by the Beth Israel-Deaconess and Massachusetts Mental Health Center. Also, Cambridge Health Alliance offers the Recovery in Shared Experiences (RISE) program for the treatment of first episodes of psychosis.

Neuropsychological testing, augmented by psychological testing can be a useful tool to learn more about cognitive and emotional functioning. However, this is best undertaken as part of a comprehensive program of intervention.

 

Articles used for this blog:

  • Larson, M, Walker, E, and Compton, M (2010) Early Signs, diagnosis, and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders, Expert Review of Neurotherapy. Aug. 10 (8), 1347-1359. https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml
  • NPR Your Health Podcast (2014) Halting Schizophrenia Before It Starts
  • Miller, Brian Negative Symptoms in Schizophrenia; The Importance of Identification and Treatment, Psychiatric Times, March 2017

 

 

About the Author:

Monaghan-BloutFormerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences.

 

 

To book a consultation with Dr. Monaghan-Blout 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.

 

Director’s Update

By | NESCA Notes 2017

 

By:  Ann Helmus, Ph.D.
NESCA Founder/Director

NESCA was founded on the idea that a thorough evaluation reflecting careful analysis of information gathered from history, observations, and testing data is crucial in formulating a comprehensive, individualized plan for supporting a child to realize their potential. Increasingly, NESCA is expanding its intervention services, which allows for a higher level of integration between the evaluator and treater. Clearly recognizing the benefit of psychopharmacological intervention for many children and adolescents, at NESCA, we focus on the powerful benefits of many non-medication approaches.

Our experience, supported by research, is that significant improvements in functioning result from psychoeducation, direct teaching of strategies to parents and students, and intervention at the physical level. Psychoeducation refers to the process of educating clients and their parents about the nature of challenges such as anxiety or ADHD.  Beyond gaining a thorough understanding of the challenges faced by a client, parents, teachers, and students need strategies for managing problematic symptoms and behaviors. Teaching and helping parents and students practice these strategies often yields huge changes in functioning.  Finally, the mind and body are interconnected and intervening at the physical level is often more straight-forward for many of our clients, leading to impressive changes in cognitive and emotional functioning.

NESCA offers the following therapeutic interventions:

Cognitive Behavioral Therapy (CBT):

CBT is an evidence-based therapy that focuses on identifying and changing thoughts patterns and behaviors that are interfering with functioning.  Of note, we have a therapist who is highly experienced in psychotherapeutic intervention with children and adolescents who are on the autism spectrum, including the use of the Sidekicks app developed by the Affinity Project.

Acceptance and Commitment Therapy (ACT):

ACT uses approaches such as mindfulness and behavioral change strategies to help clients increase flexibility and reach goals.

Intensive Outpatient Therapy:

Many children require more frequent meetings in order to master the strategies that are being taught for behavioral/emotional regulation or social functioning. NESCA’s intensive out-patient therapy programs generally involve three weekly sessions of direct service for the child followed by brief parent guidance meetings.

Therapy Groups:

NESCA offers a group for school-age children with ADHD and their parents. Children meet in one group while their parents meet concurrently in another group, both led by experienced psychologists.  Starting in 2018, NESCA will be offering drama-based therapy groups based on the Spotlight model developed at the Northeast Arc and researched by the Social Competence and Treatment Lab at Stony Brook University.

Back to School Program:

This intensive program was developed to address school refusal through both home-based and center-based psychotherapy, parent guidance and school consultation.

Community Based Skills Coaching:

Many clients struggle to generalize strategies that they have learned in therapy to daily living. NESCA has highly skilled coaches that work with adolescents and young adults in the community to practice skills and strategies.

Postsecondary Transition Planning:

Adolescents with developmental challenges, learning disabilities, and psychiatric issues often need support in planning for “life after high school”. Our veteran transition specialists work with adolescents and their parents to identify strengths, formulate realistic goals and a plan for reaching goals over their high school years.

Yoga-Based Therapy:

Individual or small group interventions in our yoga studio to build self-awareness and the ability to use breath and movement to address symptoms of anxiety and enhance attention.

Acupuncture/Acupressure:

These ancient treatments can be highly effective for treating anxiety,  ADHD, and other childhood conditions.

 

About the Author:

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

 

To book a consultation with Dr. Helmus 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.

 

Is Acupuncture Right for You?

By | NESCA Notes 2017

 

By:  Holly Pelletier, La.C.
Licensed Acupuncturist

One of the most common questions I receive as an acupuncturist is “Can it help with (insert any condition or ailment here)?”   And the answer is most emphatically “Yes”.  This is because the majority of us suffer from something we wish we didn’t have to. The reason is that we have been taught only to receive medicine and health care as a means of fixing something which is already broken. We do not think about creating and maintaining a healthy body before these malfunctions begin to occur. But what if we could change our way of thinking?

As a society in general, we tend to be hyper-focused on fixing problems. When we shift our focus back a bit, we can usually see that problems come from preventable causes. It is these precipitants or causes that need to be addressed. When it comes to the human body, we all ought to be able to recognize ourselves in the following scenario:

Imagine a time where you had an injury or felt pain somewhere in the body. You may have noticed that you quickly developed a very intuitive way to relieve the pain; perhaps you shifted your bodyweight to avoid an achy foot, or used your non-dominant hand to pick up something heavy, or placed a pillow below a sore hip in the car. Whatever the situation, I’m sure you instinctively and creatively found a way to lessen your pain.

At first, these adjustments may have been just what you needed to allow some part of your body to rest and heal. Sometimes, however, circumventing pain can cause prolonged unnatural use of your body in other areas; and when you strain one part of your body in order to avoid strain on another part of your body every day for a week or a month, or in many cases even years, you will without a doubt begin to feel pain somewhere else. The body has a way it is supposed to move, and when you move in a way that is contradictory to it, you incite a domino effect.

The entire body is interconnected. Every system, every organ, and every cell that is out of balance has to pull from reserves somewhere else. Simply put, the sick robs from the healthy. This is how imbalance forms in the body, and it is the reason unpleasant symptoms begin to manifest.

Symptoms of imbalance can be subtle–they may show up in the form of dry mouth, a slightly aching head, or difficulty sleeping. Every person has a different chemical makeup, and therefore these imbalances will show up differently in everyone. It takes an in-tune and aware individual to begin noticing these changes in their body, and an even more proactive and intelligent person to decide to do something about them when the first signs arise.

At last, we come to acupuncture and its role. Acupuncture is part of a holistic medicine system that originated in China and dates back thousands of years. Its entire motivation is to restore balance anywhere in the body. That means that, in a roundabout way, acupuncture can work with any ailment, although its strength is with preventative and early-onset illness.

This is why acupuncture is a phenomenal modality for children and adolescents. Their imbalances are fresh and new, still close to their root cause, and relatively easy to reverse. It becomes more difficult as we age.

When explaining this to those who are new to acupuncture, I often get follow-up questions about whether or not acupuncture can cure things such as cancer, diabetes, Alzheimer’s, and other extreme ailments. Without a doubt, there are some very debilitating diseases that are best managed with a combination of pharmacological treatments and acupuncture.

Until you begin getting treated with acupuncture and seeing how your body responds, it is nearly impossible to determine the level of imbalance in the body. What I can say with clarity and assertion is that acupuncture will most definitely help in some areas of a person’s life. When dealing with chronic illness, there is such a deep imbalance in the body that the person’s main concern may not be transformed in the way that they hope. In these individuals, although their illness may not be cured, their quality of life will almost certainly improve and many symptoms will be managed with acupuncture included in their care.

Because acupuncture works with such a variety of individuals with drastically differently manifesting symptoms, it is challenging to specifically say what changes you will see after beginning your course of treatments. Following are a list of benefits I have found to show up in almost everyone I treat, regardless of primary concern:

  • Improved and more stable mood
  • Stress reduction and the body’s ability to handle difficult situations
  • Better and more sustainable energy throughout the day
  • Deeper and more quality sleep
  • Appetite regulation – more or less depending on what the individual needs
  • Overall increased feeling of well being
  • Decrease in pain and inflammation in the body

There are many lists out that there have been approved by the FDA detailing specific ailments that “acupuncture treats” and they can be helpful, but looking at the benefits of acupuncture in that way minimizes the vast comprehensive approach that it actually has on the body.

It is a much more holistic medicine that can positively affect many individuals.

For any questions involving acupuncture, or to set up a free consult or appointment please contact Holly at hpelletier@nesca-newton.com.

 

 

About the Author:

Holly Pelletier, L.Ac. is a licensed acupuncturist who practices part-time at NESCA. Holly Pelletier has been working with children of varying ages, in many different capacities since 2004. Prior to treating kids with acupuncture, she worked as a teacher, coach, and mentor. She exceptionally enjoys working with children and acupuncture because of their speedy response time and genuine excitement about this form of medicine. Holly has a very gentle technique and has specific training in non-insertive acupuncture styles, which does not require needling directly into the skin. In additions to working with children, Holly is also very passionate about working with issues involving women’s health, nutrition/herbs, neurological disease, and psychological challenges such as anxiety and depression. For more information on our acupuncturist, Holly visit: http://www.hpelletieracu.com/

 

 

 

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.

 

Mindfulness in Schools

By | NESCA Notes 2017

 

By:  Ann-Noelle McCowan, M.S., RYT
Guidance Counselor; Yoga Specialist

Open Google and type in Mindfulness in Schools and you are presented with a buffet of resources. What was once seen as an alternative idea has become mainstream. But what is Mindfulness and why is it something that deserves a place in schools?

Mindfulness was originally developed as part of the 8 Fold Path of Buddhism. With mindfulness, your attention would be turned inward and also impact your relationship with the world through mindful actions and behaviors.  Now it is scientifically studied and found in locations like professional locker rooms, jails and hospitals to fortune 500 companies like Nike, Google and Apple. Advancements in brain imaging show that a regular mindfulness practice creates increased activity in the areas of the brain associated with working memory, executive function, emotional regulation, perspective taking and empathy, with decreases in the areas of the brain associated with depression, PTSD and stress (correlated with a decrease in amygdala size).

Mindfulness’ increased popularity may be due to the fact that it is an adaptable, take with you anywhere antidote to a society that is increasingly fast-paced and technology focused. In a global world, it helps us feel both connected to ourselves and grounded where we are. More adults and kids are feeling stressed, anxious and depressed, and mindfulness can help soothe our worries without negative side effects.

Schools are responsible for teaching children skills and information across many content areas, yet how often are children taught the best way to pay attention, or how to use attention?  Attention is the lens through which all of our experiences are filtered through, yet it is rarely directly and specifically taught! Mindfulness is at its core simply focusing on a single thing at a time, in a particular way, without evaluation. It is an invaluable life skill for helping children be successful students as well as happy well adjusted and connected children. An informal survey of my colleagues and friends found that yoga and mindfulness are being adapted to various school settings.  From class transitions that begin with listening bells, rounds of belly breathing before assessments, calming scented oils on cotton balls in the nurse’s’ office,  books clubs with teachers, introductions to mindfulness apps in health class and mindfulness or yoga activities and clubs.  mindfulness is staking its place in schools.

When introducing mindfulness in classrooms and schools the following steps help outline ways to weave mindfulness into classrooms and schools.

1. Learn More. 

Starting with this blog post the internet is full of articles and videos to explore.
How Meditation Can Reshape Our Brains: Sara Lazar at TEDxCambridge 2011
https://www.nytimes.com/guides/well/mindfulness-for-children
Kids getting lessons in mindfulness in school – Today’s Parent

2. Model Mindfulness and Practice Yourself. 

You can’t teach what you don’t know. Practicing mindfulness will help you be aware of your own reactions if at first your students are squirmy or resistant. Keep in mind that students may not use the words you expect to describe their experience, listen for what is behind their words.

3. In an age-appropriate way, explain how mindfulness is beneficial for them. 

My teens love learning about how their brain works and that mindfulness is a form of training for their brain.

Some videos for younger  kids:

4. Teach about the monkey or animal mind. 

Children of all ages enjoy the practice of noticing how many places their thoughts go and how quickly thoughts connect to others. There are fantastic books for younger kids such as Moody Cow Meditates and  Mindful Monkey, Happy Panda.  Teens understand how if walk into class and see their friend laugh with a peer after a glance towards them their thoughts immediately race…. “ “what did I do” …“ they are mad”…“I’m not going to have a partner for this project”… “ there goes my secrets, begin the rumors”… “I’ll be left out of the weekend plans” … “I’ll be alone forever”.  Teach them to acknowledge the chatter but not get caught in it.

5. Start small. 

Begin with 1-3 minutes at the start of class directing kids to feel their seat in their seat, their feet on the floor, their hands on their lap and intentionally take 5-10 long inhales and exhales. Other ideas:

  • Practice silent snack one day a week, take a mindful walk as a class and have them focus on their senses and record it in their own journal ( words or visuals) when back in the classroom. Create a mindful space in a corner of your room with coloring books, pencils, cushions as a safe break place.
  • For kids it may be hard to focus on a single item at a time, so use manipulatives. A Hoberman Sphere, Pinwheels or feathers to demonstrate breath.  Build Worry Jars, adapt Chutes and Ladders or other familiar games with mindful exercises. Use one of the many Yoga Card Decks.

6. There’s an App for this!

Ironic perhaps to use technology but most kids love technology and it offers choice and control. Try  “Calm.com”, “Stop, Breathe and Think”, “Smiling Mind” or the “Insight Meditation Timer” (after medications my kids love to check out the world map and see all the locations where people are meditating!).  Try a classroom program such as http://www.innerexplorer.org/.

7. Be consistent.

Greater benefits and habits are created when mindfulness is done repeatedly. Colleagues who practice mindfulness daily, even for a few minutes notice the impact is greater than if  done sporadically.

Mindfulness is good for us and our children and has a natural place in our schools. Benefits abound like enhanced attention, self-regulation, social competence, as well as greater kindness and compassion. After I have practiced mindfulness with my students or clients they look different, calmer and relaxed and ask for it again. I too notice the rest of my day feels more manageable and my smile is broader. Enjoy adding mindfulness to your classroom or express your hope to your child’s teacher or school leaders that mindfulness be a part of your child’s school experience.

About the Author:

McCowan

Ann-Noelle provides therapeutic yoga-counseling sessions individually designed for each child. NESCA therapeutic yoga establishes a safe space for a child to face their challenges while nourishing their innate strengths using the threefold combination of yoga movement, yoga breath, and yoga thinking.

Ann-Noelle has worked with children and adolescents since 2001 and practiced yoga and meditation since 2005. Since 2003 she has been employed full time as a school counselor in a local high performing school district, and prior to that was employed in the San Francisco Public Schools. Ann-Noelle received her dual Masters Degree (MS) in Marriage, Family and Child Therapy (MFCC), and School Counseling from San Francisco State University in 2002, her BA from Union College in New York, and her 200 hour-Registered Yoga Credential (RYT) from Shri Yoga. Ann-Noelle completed additional Yoga training including the Kid Asana Program in 2014, Trauma in Children in 2016 and Adaptive yoga for Parkinson’s in 2014.

For more information on the therapeutic yoga at NESCA, please visit  https://nesca-newton.com/yoga/

 

 

 

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.