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

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

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4

Mindfulness: It’s Not Just for Grown-ups

By | NESCA Notes 2019

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow

There has been increasing interest in intervention strategies that target self-regulation in childhood. Self-regulation is the process through which the systems of emotion, attention and behavior are controlled in response to a situation, stimulus or demand. It develops rapidly in the early years of life. Self-regulation is necessary for social development because it supports and enhances peer acceptance and social success. Furthermore, it increases academic performance, particularly in elementary school. Problems with self-regulation and the accompanying executive functioning have been shown to correlate with a number of behavioral and emotional problems, particularly depression and anxiety. Mindfulness is emerging as an effective intervention for children struggling with self-regulation, especially when implemented at a time when children are acquiring these foundational skills.

Mindfulness is a way of paying attention, on purpose and non-judgmentally, to the experience of the present moment. Being mindful involves reflecting on the current internal experiences such as thoughts or emotions and the current external environment, such as sights and sounds, both clearly and objectively. This act of purposeful reflection enhances and facilitates self-regulation by promoting control, such as sustained attention and cognitive flexibility. Furthermore, it helps to reduce the incidences of such things as snap judgments, emotional reactivity or distressing thoughts.

Mindfulness-based social-emotional training has been shown to be effective in reducing stress, improving coping skills and building resilience when used with children. Mindfulness teaches children the skills needed to improve focus, calm themselves, plan and organize, and behave in a thoughtful manner. Research on adult populations shows that practicing mindfulness may reduce symptoms of anxiety and depression, and limited number of studies show some of the same benefits in children. Mindfulness is well tolerated by children and has been proven to improve psychological well-being. Introducing mindfulness practices to children has the potential to make a positive impact on a child’s ability to self-regulate, and thus facilitate their social, emotional and educational growth.

There are a number of ways to introduce children to mindfulness. One activity that children have responded positively to is being challenged to sit still and silent for as long as they possibly can. I have used this strategy in classrooms of children from pre-k to high school, as well as individually with children of all ages. Sometimes they are able to sit for 15 seconds, but they embraced the challenge of trying to beat their record by trying it again. Another mindful technique that works well with children is called “grounding.” Grounding techniques use the five senses to bring ourselves into the present moment. One grounding technique is finding five things in the room – they can be 5 things of the same color or any five things; four things the child can feel; three things the child can hear; two things the child can smell; and one thing the child can taste. Mindfulness can be playful and fun for children and families while effectively reducing stress, improving coping skills, improving ability to self-regulate and building resilience in children.

 

Helpful resources for families:

Mindful Games Activity Cards: 55 Fun Ways to Share Mindfulness with Kids and Teens. Susan Kaiser Greenland and Annaka Harris

A Still Quiet Place: A Mindfulness Program for Teaching Children and Adolescents to Ease Stress and Difficult Emotions By Amy Salzman, MD

I am Peace: A Book of Mindfulness By Susan Verde and Peter H. Reynolds

Breathe Like a Bear: 30 Mindful Moments for Kids to Feel Calm and Focused Anytime, Anywhere By Kira Willey

 

References:

Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.

Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and psychopathology, 2(4), 425-444.

Schonert-Reichl, K. A., Oberle, E., Lawlor, M. S., Abbott, D., Thomson, K., Oberlander, T. F., & Diamond, A. (2015). Enhancing cognitive and social–emotional development through a simple-to-administer mindfulness-based school program for elementary school children: A randomized controlled trial. Developmental psychology, 51(1), 52.

Schonert-Reichl, K. A., & Lawlor, M. S. (2010). The effects of a mindfulness-based education program on pre-and early adolescents’ well-being and social and emotional competence. Mindfulness, 1(3), 137-151.

Sibinga, E. M., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: an RCT. Pediatrics, 137(1), e20152532.

 

About the Author

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

 

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

 

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

 

9

What is a Nonverbal Learning Disability?

By | NESCA Notes 2019

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

There is often lack of awareness or confusion about what a Nonverbal Learning Disability (NLD or NVLD) 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 Functioning. Executive 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. Some available options include Pamela Tanguay’s Nonverbal Learning Disabilities at Home: A Parent’s Guide and Nonverbal Learning Disabilities at School: Educating Students with NLD, Asperger Syndrome and Related Conditions, and Kathryn Stewart’s Helping a Child with Nonverbal Learning Disorder or Asperger’s Disorder: A Parent’s Guide.

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. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. 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.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

4

Increasing Reading Success: Early Identification of Reading Challenges

By | NESCA Notes 2019

 

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.

 

This blog was originally published in 2017.

1

Introduction to Acupuncture with Licensed Acupuncturist Meghan Meade

By | NESCA Notes 2019

 

By: Meghan Meade, L.Ac, MAOM, MS PREP, CYT

Licensed Acupuncturist, NESCA

Acupuncture is one of eight branches of Chinese Medicine that dates back over 3,000 years and involves the insertion of hair-thin needles into the body to provoke a healing response.

The body registers needling as a microinjury to which it responds by summoning the immune, nervous and endocrine systems to increase circulation, produce endorphins and other pain-relieving substances and flips the switch on the stress response.1,2,3 The treatment itself effectively assesses the internal imbalance and sends a signal to the body to address it; for this reason, acupuncture’s effects are often described as regulating – reducing elevations in inflammatory markers, enhancing the production and function of essential neurotransmitters, and so on. 1,2,3

Because acupuncture is so regulating to the body’s internal environment, the effects experienced by the patient can be both targeted and systemic2 – while pain relief could be achieved for a specific injury such as a sprained ankle, a patient might also noticed improved sleep or reduced anxiety, for example.

As a practitioner of Japanese style acupuncture, a style that is particularly reliant on using the body’s feedback to guide treatment decisions (though not to the exclusion of a patient’s verbal feedback about their health concerns and experiences), I incorporate pulse diagnosis and palpation into my overall diagnosis and treatments. Because an individual is considered to be the ever-changing reflection of their environment and experiences – physical, mental and emotional – my treatments for a given patient and a given condition will never look the same; each day the body is slightly different than the day prior, and treatments are designed with this principle in mind.

Another important theme within Chinese Medicine is that of duality; acupuncturists consider mutually opposing and complementary elements, such as heat and cold, internal and external, male and female, and yin and yang to be crucial in both assessment and treatment. Whereas yang represents heat, energy, masculinity, day time and light, yin, by contrast, represents coolness, substance, femininity, night time and darkness. When we are born, we are at our peak state of yang, which progressively gives way to yin throughout the lifetime. Because children are by nature more yang, their energy is ample and at the surface; accordingly, treating children and adolescents with acupuncture requires less stimulation to yield a desired response. Often needling is not involved, and non-insertive tools and techniques are preferred for their gentle, effective and often expedient results. Pediatric treatments may involve the use of magnets placed on acupuncture points, as well as brushing and tapping techniques using stainless steel, copper and/or silver tools. Because acupuncture points exist along 14 channels that run up and down the body, an acupuncturist can effect change both in a given channel/organ system and systemically by stimulating a channel through brushing and tapping techniques. While the above statement is true that inserting needles into the skin triggers an extensive sequence of immune, nervous and endocrine system events, so, too, does the more superficial work that acupuncturists perform for their pediatric patients.

The goal of acupuncture is always to harmonize, reducing what is in excess and restoring what is deficient. On a biomedical level, this typically entails a shift in the autonomic nervous system from a sympathetic dominant state – fight or flight mode – to a parasympathetic state – the calmer and more productive – though elusive – ‘rest and digest’ mode.2,3 Similarly, acupuncture regulates the function of hormones, neurotransmitters and immune mediators to achieve this balance. While many feel a positive response from a single treatment, acupuncture is generally not a ‘one and done’ therapy; instead, the response to acupuncture becomes stronger and more lasting over the course of several treatments, as a cumulative signal is often required for the body to carry out the work of regulating imbalances. Often after an initial series of treatments, a patient can enter a maintenance mode of treatment, spacing treatments out in increasingly longer windows and eventually receiving treatment on a maintenance or as-needed basis.

I hope this introductory conversation provides some insight as to how acupuncture works. I will be back with a follow-up post to shed some light on the effect of acupuncture on specific conditions commonly seen among NESCA’s client base.

  1. Cheng, Kwokming James. “Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinician’s Perspective.” Journal of Acupuncture and Meridian Studies 7.3 (2014): 105-14. Web.
  2. Carlsson, C. “Acupuncture Mechanisms for Clinically Relevant Long-term Effects – Reconsideration and a Hypothesis.” Acupuncture in Medicine 20.2-3 (2002): 82-99. Web.
  3. Cheng, K. J. “Neuroanatomical Characteristics of Acupuncture Points: Relationship between Their Anatomical Locations and Traditional Clinical Indications.” Acupuncture in Medicine 29.4 (2011): 289-94. Web.

 

About the Author: 

Meghan Meade is a licensed acupuncturist practicing part-time at NESCA.

Having suffered from anxiety, digestive issues, hormonal imbalances and exercise-induced repetitive stress injuries throughout her adolescence and twenties, Meghan first sought out acupuncture as a last ditch effort to salvage some semblance of health and sanity during a particularly stressful period in her life. It worked. Remarkably well. So palpable was the influence of acupuncture on her well being that she was compelled to leave a career in advertising to study Chinese medicine so that she could help others benefit from its effects.

Meghan earned her masters degree in Acupuncture and Oriental Medicine from the New England School of Acupuncture at Massachusetts College of Pharmacy and Health Sciences (MCPHS) and a masters degree in Pain Research, Education and Policy from Tufts University Medical School. She is licensed by the Massachusetts Board of Medicine and is a Diplomate of Oriental Medicine, certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

In her clinical practice, Meghan integrates both Eastern and Western perspectives to provide treatments unique to each patient’s needs and endeavors to empower patients to move forward on their paths to not just feeling good, but feeling like their true selves. In addition to her work as a licensed acupuncturist and herbalist, Meghan serves as adjunct faculty at MCPHS and is a certified yoga teacher.

 

To learn even more about Meghan and acupuncture, visit her alternate web site or read her blog: https://meghanmeadeacu.com/. Meghan is practicing at NESCA during the following hours. Appointments at NESCA can be booked by reaching out to me directly at meghan@meghanmeadeacu.com.

Monday: 10am – 6pm

Thursday: 9am – 7pm

 

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.

1

What Does Autism Look Like? Exploring the Differences among Girls and Boys

By | NESCA Notes 2019

 

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

In 2018, the Centers for Disease Control and Prevention (CDC) determined that approximately 1 in 59 children is diagnosed with Autism Spectrum Disorder (ASD). Boys are still four times more likely be diagnosed with ASD; however, research indicates that the diagnosis is often missed in girls, especially those who have average intelligence and “milder” forms of ASD. To understand why ASD is more often missed in girls, let’s explore the differences between boys and girls with ASD. This discussion will focus on children with average to above average intelligence (about 50% of all children diagnosed with ASD).

 

Boys Girls
Poor impulse control, more acting out Likely to be quiet and withdrawn
Disruptive behaviors in the classroom setting Tend to be reserved and cooperative at school
Frequent repetitive motor behaviors that are directly observable Lower frequency of these motor behaviors
Lack of interest in imaginary play Very much engaged in imaginary play
Restricted interests may seem unusual – e.g., train schedules, maps, windmills Restricted interests may seem “age appropriate” – e.g., horses, unicorns, ballet
Trouble making friends Might have a few friends
Likely to exhibit angry outbursts when frustrated/anxious Likely to engage in self-harm or other behaviors that are not observed by others when frustrated/anxious
Lack of awareness of being different or not fitting in More motivated to fit in and “hide” social difficulties – might try to imitate the behavior of a peer that is perceived as popular

 

Due to these differences, the diagnosis of ASD is often missed in young girls. Adults might agree that a girl is “odd” or “quirky,” but dismiss these concerns because she has good eye contact, has some friends, and does not engage in hand flapping or other unusual behaviors. Unfortunately, other girls might be misdiagnosed, which could lead to ineffective or inappropriate treatment interventions. Most commonly, they might be misdiagnosed with ADHD or Anxiety Disorder.

In many cases, girls with ASD have increasing difficulties with social interactions as they get older and demands get higher. A young girl with ASD might be able to “get by” in social interactions but by the time she reaches adolescence, she is not able to navigate the intricacies of the social milieu. This can lead to social isolation and high risk of being bullied or rejected by peers.

Unfortunately, a missed diagnosis of ASD for a young girl can have long-reaching ramifications. She might experience depression, anxiety and/or low self-esteem, wondering why she doesn’t “fit in” and “feels different” from other girls. She might start to struggle in school or disconnect from activities that she used to enjoy. Moreover, missing the diagnosis in childhood means that she did not receive services to support her social and peer interaction skills during her formative years.

As always, when parents or other caregivers have concerns about a child’s development, it is important to seek an evaluation from a professional. And if the findings do not feel quite right, parents should never feel uncomfortable about seeking a second opinion.

 

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 Dr. Gibbons or another NESCA neuropsychologist, 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.

10

Transition Planning for Adulthood—It Starts at Birth

By | NESCA Notes 2019

 

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist

There are many transitions throughout a person’s life, but as a transition specialist working at a pediatric neuropsychology practice, my focus is most often on helping students who have struggled with learning, social and/or emotional difficulties to plan for and successfully navigate the transition from secondary school to whatever comes next in life (e.g., employment, transition program, community college, apprenticeship, etc.). I focus on helping young people envision their future selves and set short- and long-term goals for themselves—putting them into the driver’s seat for their own lives and helping them manage the risks and responsibilities that come with making choices for themselves.

When a family walks into my office for the first time, it is common for one parent or caretaker to worry aloud that they are starting transition planning for their child “too late.” I consistently respond that it is never too late to start planning and to begin transferring responsibility from one generation to the next. But today, I also want to emphasize that “it’s never too early” to start to plan for your child to be a more independent and competent adult—the best transition planning starts at birth.

Some common examples of transitions that start at a very early age that many parents and caregivers can relate to are: a child sleeping through the night for the first time unsupported, holding a cup and drinking without spilling, feeding oneself with a spoon, and/or riding a bicycle. Each of these activities is an example of a child building competence and independence while their parents simultaneously relinquish some amount of control. Often times, mistakes, messes and even pain are a natural part of the process.

From a young age, there are many skills that children can learn that will make a big difference for them later in life. Some examples include:

  • Picking out clothes for the next morning
  • Putting dirty clothes in a hamper
  • Loading the washing machine
  • Putting clean clothes away in drawers
  • Washing hands before eating, after using the bathroom and after playing outside
  • Setting the table (maybe not plates or glasses, but perhaps napkins, forks and spoons)
  • Carrying dishes to the counter and placing them next to the sink after dinner—or even in the dishwasher
  • Putting their own garbage in the trash
  • Collecting small trash bins to dump into a larger bin/bag on trash day
  • Helping to pack their own lunch
  • Helping to prep a meal (e.g., washing veggies, pouring ingredients, etc.)
  • Getting condiments from the refrigerator and putting them away after dinner
  • Getting a snack for self or a sibling from the refrigerator or pantry
  • Wiping down the table after a meal
  • Feeding/providing water for pets
  • Weeding
  • Raking leaves
  • Shoveling snow
  • Helping to get the mail
  • Brainstorming for/making a shopping list
  • Finding assigned items at the grocery store
  • Carrying light grocery bags
  • Helping to pack belongings for a family trip
  • Making gifts/cards for a celebration
  • Budgeting a few dollars to buy inexpensive but thoughtful gifts for family members

Some of these will apply to your child and some of them will not. And some of these may require adding time to your schedule, allowing a child to complete tasks at their own pace, or doing some household reorganization, allowing a child to access items necessary to complete tasks. Finally, a lot of deep breathing and patience—for both you and your child—will be required!

At any point in time, you can identify a task  you regularly do for your child and consider where there are pieces they can do for themselves. If your only role in the task is to prompt your child, consider whether there might be a low-technology tool (post-it, photograph) or high-technology tool (alarm, phone reminder) that could take the place of your prompt. If you are not sure how to make a change, it may be a good time to get help from a teacher, pediatrician, behavioral therapist, special educator, etc.

The important thing is that you are starting to think about where there is a potential for increasing competence, independence, confidence and self-esteem for your child. You are starting to plan for your own obsolescence in your child’s life, or at least in their carrying out every day self-care activities and chores. While that is a scary thing, it is also a beautiful and empowering thing!

 

If you are interested in working with a transition specialist at NESCA for consultation, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

 

About the Author:

Kelley Challen, Ed.M., 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 additionally 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. Ms. Challen is 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. She is also a proud mother of two energetic boys, ages six and three. 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.

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

Visual Skill and Academic Success – Looking Past 20/20 Vision

By | NESCA Notes 2019

By: Sophie Bellenis, OTD, OTR/L
Occupational Therapist; Community-Based Skills Coach

When a school nurse pulls a child into his or her office to complete a basic eye screening, he or she may write, “20/20 vision in both eyes. No visual concerns.” This child has successfully looked at an eye chart and read the letters; demonstrated the ability to look straight ahead, from an appropriate distance without things becoming blurry or illegible; and demonstrated visual acuity, or the ability to see with acceptable clarity.

But does this necessarily mean there are no concerns?

Visual acuity measures whether a stimulus is being seen – not necessarily if the information is truly being understood. The visual system is a complex part of the central nervous systems that incorporates the eyes, ocular pathways and brain to produce and interpret sight. It requires consistent communication between all of these individual anatomical pieces, the vestibular system and the skeletomuscular system. Essentially, vision is complicated and messy and requires many many different skills.

Breaking It Down

In terms of visual skills needed for academic success, we often break things down into three main areas: ocular motor control, visual perception and visual motor integration.

  • Ocular motor control describes the ability to physically move the eyes using the 9 ocular muscles. It encompasses the ability to track an object across a screen or a line of text across a book, or the ability to look up at the board and then quickly refocus on a sheet on paper on the desk. Imagine trying to watch a basketball game without the ability to track the ball across the screen smoothly. It quickly becomes tiring and frustrating. Occupational therapists often refer to these specific eye movements with technical terms, such as visual saccades, pursuits, convergence/divergence and accommodation. But in essence they describe eye movement.
  • Visual perception or visual processing is in many ways more nuanced. It focuses on the brain’s ability to organize, interpret and fully understand the information it receives from the eyes. Two main skills needed at school are visual figure ground and visual closure.
    • Visual figure ground is the ability to discern relevant information from a busy or cluttered background. A student with visual figure ground difficulty may not be able to search a busy white board and find a homework assignment. These students may also be visually overwhelmed by a worksheet with 20 math problems, but successful with the same problems presented individually.
    • Visual closure is a skill that specifically helps with reading efficiency and fluency. It is the ability to identify or visualize a complete form or picture when given incomplete visual information or when only a small piece of the image is shown. Visual closure allows us to read a sentence quickly without stopping to decode each individual letter. It is aslo oen raeosn taht mnay pelope can raed setneces wtih julmbled up ltetres. We recognize the form, not simply the sequential letters.  :  )
    • Visual closure plays a role in sight words and reading partially-covered papers or street signs in the community. While there are many more important visual perception skills, these two examples have functional, measurable effects in the classroom setting and are commonly identified through occupational therapy testing.
  • Visual motor integration (VMI) describes the ability to use all of these foundational visual skills in conjunction with foundational motor skills. It is the ability to interpret visual information and produce a precise motor response. In the classroom, this affects a student’s ability to copy shapes, produce legible handwriting and use scissors to cut along a line. Not only can these things be difficult, they can be exhausting as a child tries to use all of these skills at once.

While all of these visual components have multiple layers and intricacies, it is important to simply acknowledge that there’s more than the eye can see when it comes to vision. A child who “can’t see the board,” but has 20/20 vision, may just be visually overwhelmed. A child who looks at a page full of small block text and immediately gives up may not have the visual skill to read across a line. And a child who is learning to read beautifully, but still has difficult forming the letters in his name may have poor visual motor integration. Fortunately, there are many interventions and accommodations that can help build on and develop these skills further to foster confidence and success in the class and community.

About the Author:

Dr. Sophie Bellenis is a Licensed Occupational Therapist in Massachusetts, specializing in pediatrics and occupational therapy in the developing world. Dr. Bellenis joined NESCA in the fall of 2017 to offer community-based skills coaching services as well as social skills coaching as part of NESCA’s transition team. Dr. Bellenis graduated from the MGH Institute of Health Professions with a Doctorate in Occupational Therapy, with a focus on pediatrics and international program evaluation. She is a member of the American Occupational Therapy Association, as well as the World Federation of Occupational Therapists. In addition to her work at NESCA, Dr. Bellenis works as a school-based occupational therapist for the city of Salem Public Schools and believes that individual sensory needs, and visual skills must be taken into account to create comprehensive educational programming.

 

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.

 

1

State Dyslexia Laws – What do they aim to do and how can we aid their success?

By | NESCA Notes 2019

 

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

While in 2013 there were only 22 states that had laws regarding dyslexia, as of March 2018, 42 states have dyslexia-specific laws, and as discussed in the article Dyslexia Laws in the USA: A 2018 Update by Martha Youman and Nancy Mather, 33 legislative bills related to dyslexia were introduced between January and March 2018 alone. These dyslexia laws address such things as dyslexia awareness, teacher training, early screening of risk factors, interventions and accommodations, and rights of individuals with dyslexia. In addition to identifying the need to address these matters, at least 10 states have developed dyslexia handbooks, and New Hampshire (where I practice as an evaluator and consultant) has developed a dyslexia resource guide. With Governor Charlie Baker’s signing of S2607 on October 19, 2018, Massachusetts now joins the list of states with dyslexia training, screening, and intervention mandates.

To see such progress in the identification and intervention of dyslexia is exciting for everyone who is connected to this community. As a pediatric neuropsychologist, I have worked with individuals with dyslexia and related disorders for many years, and in 2017 I had the pleasure of being one of the many professionals involved in the development of the NH dyslexia resource guide. Since that time, it has been encouraging to see a number of school districts embrace training opportunities and develop early screening efforts. While that is so, across the nation several states still do not have dyslexia-specific laws, and most states that do have them continue to experience uncertainty about how to implement said laws. Based on my personal experience and observations, there appear to be some basic steps or efforts that may improve the effectiveness of these efforts:

  • Use the term “Dyslexia.” Historically, the term “dyslexia” has been rejected or discouraged by most schools, instead preferring to label the associated learning profile as a Specific Learning Disability in reading; however, dyslexia specialists and advocates have long argued that this latter term is problematic because it fails to acknowledge the neurobiology of dyslexia and it does not inform interventions, accommodations, and related services with the level of specificity that is dictated by the defined diagnosed label. To address this concern, in 2015 the U.S. Department of Education issued a formal letter clarifying that “there is nothing in the IDEA or [the] implementing regulations that would prohibit IEP Teams from referencing or using dyslexia, dyscalculia, or dysgraphia in a child’s IEP.” Until schools are willing to routinely use the term “dyslexia,” the potential success of dyslexia laws is significantly challenged.
  • Educate families about universal screening and differentiated instruction. The screening and intervention requirements outlined in most dyslexia laws fall within the purview of general education, aiming to identify children with risk factors for learning disabilities and support their needs through multi-tiered systems of support, such as Response to Intervention (RTI). As such, there are not as many defined requirements regarding progress monitoring and reporting, or the coordination of the child’s “team” (i.e. parents, teachers, and other pertinent school personnel), as there would be within special education procedures. Families need to be educated about these universal screening procedures and methods of differentiating instruction within the general education curriculum so that they can understand their child’s challenges and monitor progress in a more informed manner.
  • Coordinate general education and special education screening and evaluation procedures. While the screening and intervention procedures discussed in dyslexia laws are generally within general education, a child should be referred for special education consideration if he or she is not making progress with the increased levels of RTI support. To optimize the utility and impact of the early screenings and to ease the referral process, the criterion that is measured within the general education setting should map onto the criterion for special education eligibility as much as possible; however, should a child require referral for special education consideration, it will also be critical to conduct a comprehensive evaluation of why the child is not progressing, allowing for more individualized and appropriate interventions.
  • Ensure the dissemination of dyslexia handbooks or resource guides. While the dyslexia community is enthused by state dyslexia laws, many teachers and school personnel are not aware of these mandates or the associated resources. These resources are a treasure trove of information about how to delivery differentiated instruction and integrate instructional methods and accommodations that are likely to be helpful for all students.
  • Continue raising awareness. Parents, teachers, and school personnel should all be educated about learning profiles, early warning signs, screening procedures, and interventions. School districts should take advantage of the resources provided by their state, which often includes the availability of a state-appointed reading specialist who can provide training or aid the dissemination of information or development of screening and intervention procedures.

There has been great progress in the recognition, identification, and remediation of dyslexia within American schools; however, this work is only just beginning. At the core of this issue is the need to recognize dyslexia as a defined, neurologically-based learning disability that can be identified at an early age and can be effectively remediated through targeted, evidence-based interventions.

Through our evaluations with students in New Hampshire and Massachusetts, clinicians at NESCA aim to identify and define learning profiles such as these and provide recommendations for targeted instruction as well as systemic support and training. Please visit our website at www.nesca-newton.com for more information.

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. 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.

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

1

Addressing Anxiety through the IEP Process

By | NESCA Notes 2019

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

Anxiety disorders are becoming more and more common among children and adolescents. Recent data from the National Institute of Mental Health (NIMH) reported that 31.9% of adolescents between 13-19 have an identified anxiety disorder. Although fewer statistics are available, it is clear that students who have a developmental, learning, or attention disorder are at high risk for developing clinically significant anxiety in light of their struggles with academics, learning, and/or social development. Given the rising numbers of affected children and adolescents, it has become increasingly important that a student’s emotional health is addressed both at home through private counseling, as well as through the provision of school-based services. When students experience a high level of unmitigated anxiety throughout the day, they are less able to learn and meet their potential.

When parents are seeking services for anxiety through their school system, there are different levels of support. First, teachers can provide classroom supports and address emotional health with all students, whether or not they have an identified anxiety disorder. Some examples of useful classroom strategies include:

  • Create predictable routines and clear expectations.
  • Provide warnings about upcoming transitions.
  • Have a “cool down space” available in the classroom or another room in the school.
  • Incorporate movement into lessons throughout the day.

There are also programs designed to address emotional regulation that can be used throughout the school or district. For example:

If these supports are not sufficient to meet a student’s needs, then it is necessary to develop goals through the IEP process. In order to make needed progress, it is important that the goals and benchmarks in the IEP are specific. For example, a benchmark might state: “Johnny will show better emotional regulation in stressful situations.” A more specific benchmark might state: “When Johnny starts to shut down or refuse to participate during a math class, he will identify his current emotion(s) in 4 out of 5 opportunities.”

When parents seek supports for their child’s anxiety through the IEP, they should consider whether their child needs accommodations, specialized instruction or both.

Examples of accommodations for anxiety include:

  • Extra time in testing situations.
  • Opportunities to take tests in a quiet setting.
  • Access to breaks as needed.
  • Access to the school counselor as needed.
  • Student does not need to sign out of class to use the bathroom.
  • Student is prompted to take breaks when showing signs of distress.
  • Student has modified homework.
  • Teacher will check in with student before independent work blocks.
  • Specialized instruction can be provided in the classroom (push-in) or in a different setting (pull-out).

Push-in services might include:

  • Provision of an instructional aide to support emotion identification and regulation.
  • The school counselor/psychologist works with the entire class once or twice a month to discuss emotional health.

Pull-out services might include:

  • Regular sessions with the school counselor/psychologist.
  • Social skills groups.

Consultation services are also important, especially if a student participates in private therapy outside of school. Parents should consider giving permission for the private therapist to speak with the school counselor to discuss common treatment goals and ways in which the student’s coping skills can be supported and reinforced in school.

About the Author:

GibbonsErin 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.

Dr. Gibbons recently began serving clients in NESCA’s newest location in Plainville/Foxborough, MA. She is thrilled to bring her expertise in evaluating and supporting children with a wide range of abilities to this area of the state.

 

To book an evaluation with Dr. Gibbons or one of our many other expert neuropsychologists and transition specialists, 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.

 

4

Why does my neuropsychologist need that? What do the tests measure and why is previous testing important?

By | NESCA Notes 2019

 

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

When a family books an intake for neuropsychological evaluation, they are typically asked to complete a few pieces of paperwork and to bring previous testing and other educational documents such as an Individualized Education Program (IEP) for their intake appointment. Despite this request, many parents will come to the intake session with empty hands. Understanding that parents have an enormous number of tasks on their plate, one could expect that paperwork was left at home due to timing or organization difficulties. However, when I ask parents about the missing paperwork decision, the reasons for leaving it behind generally fall into two groups: (1) lack of knowledge about the purpose of testing; and (2) concerns about creating some form of bias in the examiner’s mind. Some parents don’t share prior testing with me because they don’t have a clear idea of what the testing is and how it is going to be used for my evaluation. This is very common with families who are new to the special education or mental health process. Some parents are reluctant to share past testing because they want a “fresh view” and are concerned that looking at someone else’s work may create a bias. This often comes up when there is disagreement between parents and their school or past provider as to the nature of the child’s difficulties. Sometimes the parents and child have had a bad previous experience with testing and/or with the examiner, and they do not feel that the test results accurately (or at least empathetically) describe their child. In any of these situations, I find that parents feel more comfortable if they know more about how the tests we use are developed and why we find it helpful to view previous testing.

Purpose of Testing: The purpose of neuropsychological testing is to find out if a child (or adolescent or adult) is developing skills at a rate and capacity commensurate with their age and ability level. In order to do this in an efficient, equitable, and consistent manner, test developers identify skills they think are important in learning, devise a task that appears to quantifiably measure that skill, give that task to children in different age groups and then transform the raw scores attained by the children into a common scale. This allows them to compare different children within an age group, and this also allows them to compare the same child at different ages. Some common measurement scales are standard scores, scaled scores, Z scores, T-scores and percentiles. All of these formats are based on a normal distribution (remember the bell curve?) in which the majority of scores fall within a certain area with increasingly fewer scores falling at either end. The “bump” where most scores fall is described as average (between 25th and 75th%ile) with the tails receiving an above or below average description. While these descriptions do not begin to capture the whole child, they do convey information about how a child is performing relative to developmental expectations based on what we know about children of the same age. They can also tell us if the child is making age expected progress according to their unique learning curve. Furthermore, most people are good at some things and not so good at others, and the pattern of their scores can often give us valuable information about their learning profile.

Question of Bias: The concern about bias is important, given that neuropsychological tests are often used to classify people and make decisions about providing or denying services. There are a number of ways in which we try to control for bias, starting with trying to make sure that the group of people that are used as test subjects when developing norms are representative of the population at large. Test makers are getting better at this, but we have a long way to go, which means that it is important that evaluators know how each test has been developed and normed. Test selection is also extremely important; some tests are not appropriate for some groups. Think about giving a Calculus test to someone who has not completed Algebra 1; this kind of mismatch is going to result in a spuriously low score on math ability.

The main way that neuropsychologists and psychologists try to control for bias is through what is referred to as standardized administration—giving the test in the same way to each child. A good deal of the training of graduate students, interns, and post-doctoral fellows involves learning and practicing these skills so that the test is given to every child in the same way, regardless of who gives it. At the same time, children are children, and sometimes they need something different. It is up to the evaluator to decide when to engage in “non-standardized administrative procedures.” One example of non-standard administration could be starting a child who has trouble catching on to novel tasks at a lower age starting point in order to help them master the task demands. Another example would be stopping a task before a ceiling of errors is reached because the child is very anxious and is having a hard time staying with the activity. It is important to make note of that break in protocol in the report; while it may somewhat reduce the validity of the scores, it also tells us something very valuable about the child’s learning style and tolerance.

Value of Having Previous Testing: Having the opportunity to review all previous testing is extremely valuable to neuropsychologists because it gives up some insight as to a child’s developmental trajectory. Scores that are higher than in previous testing may suggest improvement in a skill set. Scores that are consistent with previous testing indicate that a child is making age-expected progress along their unique learning curve. However, they may be falling farther and farther behind their same-age peers or progressing more quickly. Scores that are significantly weaker than in previous testing need to be closely examined. This could be a result of an imbalance between the environmental demands and the child’s internal resources. For instance, smart kids with executive function deficits are often not prepared for the organizational challenges of middle and high school. Significantly lower scores could also indicate stalled development due to ineffective educational interventions. It could also be a sign of emotional distress that is interfering with a child’s functioning. Rarely, it could be a sign of a medical or neurological problem. There are also some times when a change in average scores reflects a change in the exact tests or subtests used for the child. For example, when a teenager turns 16, it is common to begin administering adult intelligence scales and these tests may place higher value on slightly different skills (e.g., mental math). Without reviewing previous testing, a current evaluator may be able to provide a snapshot of a child’s current functioning, but might miss a critical developmental pattern important for understanding if/how the child is learning, what is needed to enhance their performance, and what can reasonably be expected over time for the child.

 

About the Author:

Formerly 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. he is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

 

 

To book an evaluation with Dr. Monaghan-Blout or one of our many other expert neuropsychologists and transition specialists, 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.

 

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