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11

Busting a Common Autism Myth

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

I often hear from parents and caregivers that their child has several friends and likes going to social events, leading them to wonder how they could have autism.

First, let’s take a look at what autism is:

Autism spectrum disorder is a neurodevelopmental disorder classified by persistent deficits in social communication and social interaction skills.

To meet criteria for an autism spectrum disorder, one must exhibit the following social communication deficits across multiple contexts:

  1. Deficits in social-emotional reciprocity—this may include feeling unsure or uncomfortable when approaching others, having difficulty initiating social interactions, or having difficulty responding appropriately when approached by others. When engaged in conversation with others, it may be difficult to engage in back-and-forth conversation and share interests/emotions.
  2. Deficits in nonverbal communication skills—examples include poor eye contact, poorly integrated gestures in conversation, reduced facial expressions, difficulty reading the facial expressions and gestures of others, and not picking up on subtle body language cues.
  3. Deficits initiating, maintaining, and understanding relationships—characterized by difficulties making new friends, not wanting to engage with peers in any capacity, or difficulties maintaining long lasting friendships.

One must also demonstrate evidence of at least two of the following: repetitive behaviors, inflexibility/rigidity, restricted and intense interests, and sensory sensitivities.

Next, let’s look at what autism isn’t:

While individuals with autism experience social challenges, it is a common misconception that having autism means not having any friends or social skills at all. Contrary to this popular misconception, I evaluate many children, adolescents, and adults who are on the autism spectrum, are socially motivated, and have numerous friendships.

It is important to remember that while a diagnosis of autism requires social communication deficits, that does not mean a complete lack of skills must be evident. For example, I see many individuals on the autism spectrum who have several longstanding friendships but have difficulty making new friends. Conversely, some individuals find that they initiate friendships well, but have difficulty maintaining friendships over time. It is also possible for an autistic individual to demonstrate appropriate eye contact and facial expressions but have difficulty reading subtle nonverbal cues of others. With high social motivation, it still may be challenging to know how to participate in social conversation, how to build on the interests of others, and how to respond to emotional reactions.

Individuals with high-functioning autism often get overlooked as they have learned to “mask” or “camouflage” really well. That is to say that they work hard to “fit in” or hide areas of vulnerability. It might not feel comfortable for them to participate in group conversations or to interpret nonliteral language. They may feel as though there are written social rules that everyone else has access to except for them. When observing them, it may appear as though they are social and well-integrated into social environments; however, they may report a vastly different internal experience.

Taken together, having an autism diagnosis does NOT mean there is a complete inability to form friendships or participate in social settings. Rather, aspects of social communication can be challenging and warrant supports and services designed to enhance these skills.

If you have any questions or concerns regarding your child’s social development, speak with your pediatrician and/or schedule an evaluation with one of our neuropsychologists at NESCA.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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

 

10

Understanding the Neuropsychological Evaluation Process When an Autism Spectrum Disorder is Suspected

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In January, Dr. Folsom published a blog post detailing the reasons why so many females on the autism spectrum are misdiagnosed in childhood. Here at NESCA, we are continuously working to improve our testing practices and administration protocols to ensure that we accurately capture one’s diagnostic picture when they come in for a comprehensive neuropsychological evaluation regardless of gender identity, age, or diagnostic presentation. As clinicians, tailoring an appropriate testing protocol is only one piece of the puzzle when working with our clients. From the moment we review your intake paperwork and questions/concerns, we work diligently to make sure we are teasing apart each component of a child’s neuropsychological profile to ensure clarity and accuracy for diagnoses and tailored recommendations. Here is a look into some of what that process looks like:

Initial Paperwork: Before your first intake appointment, your clinician will thoroughly review all of the intake paperwork and supporting documents you have submitted to us. We make sure to read all of your questions and concerns, while also making our own notes of questions that we will have for you during the intake appointment. All neuropsychologists here at NESCA are trained to identify “red flags” or areas of potential concern that we want to know more about through our interviews with you, your child, teachers, and our testing protocols.

Intake Appointment: During this appointment, we will ask you more in-depth questions about your responses and questions from the intake paperwork you provided. This is an opportunity for us to explore any concerns we may have. For many diagnoses, there are overlapping diagnostic features that are important to tease apart. For example, inflexibility and rigidity (not handling transitions well, struggling with changes in routine) may be related to an anxiety diagnosis, a mood disorder, an autism spectrum diagnosis, and/or executive functioning weaknesses.

Speaking with Collaterals: Oftentimes, clinicians will ask for permission to speak to other caregivers who have knowledge of your child, such as teachers, therapists, and pediatricians. Because we only see your child for a “snapshot” in time, it is important for us to also consider the perspectives of those who have longstanding relationships with them in a variety of contexts and environments.

Developing a Testing Battery: After the intake appointment, clinicians put together a tentative list of assessment measures that we may want to utilize. Tentative is the key word because oftentimes testing batteries change throughout the course of the assessment as a diagnostic picture becomes clearer or when specific areas of deficit become more apparent.

At NESCA, we have access to multiple testing tools that allow us to tailor our testing battery to capture any nuanced constellation of symptoms or diagnostic profile. For example, when thinking about how to accurately diagnose someone who is “high functioning” or “masking” areas of vulnerability related to an autism spectrum diagnosis, clinicians have access to the following batteries:

  • Autism Diagnostic Observation Schedule—2nd (ADOS-2): The ADOS-2 is one of the most well-known assessments for autism as it utilizes a semi-structured format to assess social communication skills as well as restricted interests, repetitive behaviors, sensory sensitivities, and rigidity. The ADOS-2 relies on standardized observations to capture any difficulties in the aforementioned categories.
  • Childhood Autism Rating Scale—2nd (CARS-2): The CARS-2 is another measure that involves a standardized rating scale based on direct observations of the child. While playing and interacting with your child, the clinician is able to fill out this rating scale to assess symptoms associated with an Autism Spectrum Disorder. The CARS-2 also includes a parent questionnaire to allow for qualitative parent observations.
  • Monteiro Interview Guidelines for Diagnosing the Autism Spectrum—2nd (MIGDAS-2): The MIGDAS-2 assesses qualitative observations of language and communication skills, social relationships, emotional responses, as well as sensory interests and/or sensitivities. The MIGDAS-2 can be particularly helpful for children and adolescents who are “high-functioning,” or do not fit the presentation of the “male prototype” described in Dr. Folsom’s blog.
  • Social Language Development Test (SLDT): The SLDT measures social communication skills such as the ability to make inferences, interpret social situations, and navigate peer conflicts.

In addition to the above measures, clinicians may also choose to administer subtests related to social thinking, perspective taking, and/or emotion identification. Examples of these subtests include:

  • Affect Recognition and Theory of Mind from the NEPSY-II
  • Inferences, Meaning from Context, Idiomatic Language and Pragmatic Language on the CASL-2

For older children and adolescents, clinicians may ask them to fill out/answer questions about their own perceptions of their lived experiences. This can be done through an unstructured interview or by one of the following:

  • Camouflaging Autistic Traits Questionnaire (CAT-Q)
  • Ritvo Autism Asperger Diagnostic Scale—Revised (RAADS-R)
  • Autism Spectrum Quotient (ASQ)

Parent Questionnaires: Whenever there are any questions or concerns related to social communication and interpersonal relatedness, your clinician may ask you to fill out rating scales assessing your perception of your child’s ability to interact with others, engage in age-appropriate play, be flexible in their responses to change or new environments, and have a variety of interests. These questionnaires include:

  • Social Responsiveness Scale—2nd (SRS-2)
  • Social Communication Questionnaire (SCQ)
  • Autism Diagnostic Interview—Revised (ADI-R)
  • Gilliam Autism Rating Scale—3rd (GARS-3)
  • Gilliam Asperger’s Disorder Scale (GADS)
  • Autism Spectrum Rating Scales (ASRS)

As you can see, we have a wide variety of measures available at NESCA to look at symptoms of an Autism Spectrum Disorder. Based on the discretion of your clinician, one or more of these may be used to further assess social communication concerns. While you may have heard of some of these being referred to as “the gold standard,” your clinician will use their knowledge, experience, and training to tailor a testing battery for the individual needs of your child. There is never a one size fits all approach to neuropsychological testing!

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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

 

5

Neurodevelopmental Evaluations for Children under Age 5

By | Nesca Notes 2023

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

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

Why Would a Young Child Need an Evaluation?

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

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

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

What Does a Neurodevelopmental Evaluation Entail?

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

Where to Go

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

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

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

Related resources and links to help track developmental milestones:

 

About Lauren Halladay, Ph.D.

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

 

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

 

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

10

Signs and Symptoms of Common Eating Disorders

By | Nesca Notes 2023

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In today’s world with the toxicity and normalization of diet culture, it can be difficult to identify possible signs and symptoms of a more serious problem such as an eating disorder. At what point does counting calories cross over into anorexia? When does binge eating meet criteria for bulimia? Listed below are the criteria for several eating disorders, possible warning signs, as well as information on how to seek help if you believe your child needs further help/treatment.

Anorexia nervosa is an eating disorder characterized by the restriction of food intake and is characterized by two subtypes: restrictive and binge-purging.

For both presentations, criteria for anorexia nervosa include:

  1. Restriction of food intake leading to a significantly low body weight for age, sex, and developmental trajectory
  2. Intense fear of gaining weight that interferes with one’s ability to gain weight
  3. Feeling disturbed by one’s weight or shape, reduced self-worth second to weight/body shape, or a lack of recognition of the seriousness of their low bodyweight

Criteria for the restricting type include not having recurrent binge eating or purging within the last 3 months

Criteria for the binge eating/purging type include recurrent episodes of binge eating or purging within the last 3 months

Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating that include the following:

  1. Eating a “definitively” larger amount of food in a 2-hour period than what most other individuals would eat in similar circumstances
  2. Feeling as though one cannot stop eating or control how much they are eating
  3. Recurrent and inappropriate behaviors aimed at preventing weight gain (e.g., self-induced vomiting, misusing laxatives, fasting, excessive exercise) that occur, on average, at least once a week for 3 months
  4. Self-evaluation being dependent on body shape/weight
  5. Symptoms not occurring exclusively during episodes of anorexia nervosa

Bulimia nervosa is also characterized by two subtypes: purging type and nonpurging type.

To meet criteria for the purging type, one must have regularly engaged in self-induced vomiting, the misuse of laxatives, diuretics, or enemas.

To meet criteria for the nonpurging type, one must have used inappropriate behaviors, such as fasting or excessive exercise without self-induced vomiting, the misuse of laxatives, diuretics, or enemas.

Binge eating disorder and avoidant restrictive food intake disorder (ARFID) are also eating disorders recognized in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).

Binge eating disorder is characterized by:

  1. Recurrent episodes of binge eating (defined by eating an amount of food in a 2-hour period larger than what most people would eat in a similar period of time under similar circumstances as well as feeling a lack of control during the binge eating episode)
  2. Three or more of the following: eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone due to embarrassment over the amount of food being consumed, feeling disgusted, depressed, or guilty after overeating.
  3. Distress regarding binge eating
  4. Binge eating occurring on average at least 1 day a week for 3 months
  5. Binge eating not associated with the regular use of inappropriate compensatory behaviors, such as purging, fasting, and/or excessive exercise, and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa

Avoidant restrictive food intake disorder (ARFID) is characterized by:

  1. A lack of interest in eating or food, avoidance of food based on sensory characteristics, and/or concern about consequences of eating that lead to one or more of the following:
    1. Significant weight loss or failure to achieve expected weight gain
    2. Dependence on enteral feeding or oral nutritional supplements
    3. Interference with psychosocial functioning
  2. The eating challenges should not be attributable to a medical condition or better explained by another mental health diagnosis. If there is another mental health diagnosis, the severity of the eating disturbance must exceed what is routinely associated with the mental health condition
  3. The eating challenges should not be better explained by a lack of available food or associated with cultural practices
  4. The eating challenges should not occur exclusively during the course of anorexia nervosa or bulimia nervosa

What are warning signs of an eating disorder that I should be looking out for?

  • A preoccupation with weight loss, dieting, exercise, and/or controlling food consumption
  • Refusing to eat certain foods, such as carbohydrates or fats
  • Not being comfortable eating around others, skipping meals, or eating smaller portions
  • Withdrawing from friend groups and/or typical activities
  • Noticeable fluctuations in weight
  • Stomach complaints/digestive concerns
  • Menstrual irregularities
  • Difficulties concentrating
  • Sleep challenges
  • An increase in dental problems

If you suspect your child has an eating disorder, begin by talking to a medical or mental health professional. You can also contact the National Eating Disorders Association (NEDA) Helpline at 1-800-931-2237 or by texting NEDA to 741-741. The Multi-Service Eating Disorders Association (MEDA) is another source of information with support groups and resources. More information can be found at https://www.medainc.org/.

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Warning signs and symptoms. National Eating Disorders Association. (2021, July 14) https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

 

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

 

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

 

10

How Do I Know If My Child Needs Early Intervention?

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

During the first few years of life, parents and caregivers are often tracking baby’s exciting first milestones, such as their first steps or first words. Routine well-child visits at the pediatrician’s office will often include the doctor asking what new skills you have noticed since baby’s last visit—Are they sitting unsupported yet? Crawling? Saying Mama or Dada? It can be stressful when your child is not yet meeting their milestones. It can be especially challenging when you notice they may be behind their peers at childcare or when around same-aged children at family functions.

The Centers for Disease Control and Prevention is a great resource to utilize as reference for what is expected of children by age. You can access more information here: https://www.cdc.gov/ncbddd/actearly/milestones/index.html or through their developmental milestone checklist.

What are age-appropriate milestones?

At a glance, several notable milestones listed by the CDC are as follows:

6 months:

  • Recognize familiar caregivers
  • Reach for toys/objects of interest
  • Roll from their belly to their back

9 months:

  • Respond when you call their name
  • Smile/laugh in response to interactive games, such as peek-a-boo
  • Babble (mama or dada)
  • Bang objects together
  • Sit on their on

1 year:

  • Call their parent by name (e.g., mama or dada)
  • Pull themselves up to stand
  • Walk while holding on to furniture

18 months:

  • Point to show you something interesting
  • Following one-step directions
  • Imitating your actions (e.g., putting on makeup, vacuuming, hammering)
  • Walking unassisted
  • Climbing on and off couches and chairs without support

2 years:

  • Look to you for your reactions in new situations
  • Putting two words together, such as “more milk”
  • Using gestures like nodding/shaking their head
  • Running
  • Eating with a spoon

Should you have any concerns regarding your child’s development, talk to their pediatrician! Your baby may qualify for a referral to Early Intervention (EI), which can help them to gain the appropriate skills in a way that supports you, your child, and your family.

What is EI?

EI is a federal grant program that was established in order to identify children at risk for developmental delays and to help families meet their children’s needs and maximize their potential. EI serves children ages 0-3 and provides a multitude of services depending on a child’s needs. Referrals for EI can be made by caregivers and/or providers for children who are exhibiting delays in their developmental milestones OR for children who have a medical condition that places them at risk for a developmental delay. EI referrals can be made as early as birth for medical conditions, such as prematurity, low birth weight, and Down syndrome. Many children receive referrals for EI from their parents, pediatricians, and/or childcare providers when there are observable delays in meeting speech milestones, motor milestones, speech milestones, and/or social milestones.

Who qualifies for EI?

Once referred to EI, your child will likely undergo a developmental evaluation. They will qualify for services if they have a diagnosed medical condition with a risk for developmental delays OR a delay in one or more areas of development of at least 30% OR a delay in one or more areas at least 1.5 standard deviations below the norm OR there is a questionable quality of skills based on the informed clinical opinion of the multidisciplinary team. Children can also meet criteria if there is a risk for delays due to four or more child or family risk factors (e.g., NICU stay, feeding challenges, chronic illness of a caregiver, lack of social supports for the caregiver).

At the end of the day, you know your child best. If you have concerns, reach out to their pediatrician. You can also reach out to a local EI provider on your own. In MA: https://www.mass.gov/info-details/ei-program-contact-information. In NH: https://www.dhhs.nh.gov/family-centered-early-supports-services.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, including attention deficit disorders, communication disorders, intellectual disabilities, and learning disabilities. She particularly enjoys working with children and their families who have concerns regarding an autism spectrum disorder. Dr. Milana has received specialized training on the administration of the Autism Diagnostic Observation Schedule (ADOS).

Dr. Milana places great emphasis on adapting her approach to a child’s developmental level and providing a testing environment that is approachable and comfortable for them. She also values collaboration with families and outside providers to facilitate supports and services that are tailored to a child’s specific needs.

Before joining NESCA, Dr. Milana completed a two-year postdoctoral fellowship at Boston Children’s Hospital in the Developmental Medicine department, where she received extensive training in the administration of psychological and neuropsychological testing. She has also received assessment training from Beacon Assessment Center and The Brenner Center. Dr. Milana graduated with her B.A. from the University of New England and went on to receive her doctorate from William James College (WJC). She was a part of the Children and Families of Adversity and Resilience (CFAR) program while at WJC. Her doctoral training also included therapeutic services across a variety of settings, including an elementary school, the Family Health Center of Worcester and at Roger Williams University.

Dr. Milana grew up in Maine and enjoys trips back home to see her family throughout the year. She currently resides in Wrentham, Massachusetts, with her husband and two golden retrievers. She also enjoys spending time with family and friends, reading, and cheering on the Patriots, Bruins, Red Sox, and Celtics.​

 

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.

 

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

 

23

ASD Diagnosis Disclosure with Children

By | NESCA Notes 2022

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

All brains are different. Thus, there is no “one way” to disclose a diagnosis of an Autism Spectrum Disorder (ASD) to a child. The when, where, and how of diagnosis disclosure depends on the child and family’s preferences, values, and experiences. In addition, families do not have to feel alone in this process. Many families find it helpful to consult with parent support groups and professionals (e.g., therapist, neuropsychologist, speech and language pathologist, in-home ABA provider) to collaborate and discuss how to best approach diagnosis disclosure based on an individual child’s needs.

In my experience, I have found that disclosing a diagnosis of ASD to a young child is helpful when a child’s support network is integrated and involved in the process. As a family therapist, I see diagnosis disclosure as a family process and a potential to create and develop a conversation for the child and family that does not focus on identification and labeling of deficits but rather a conversation that is focused on understanding how each individual in the family thinks, feels, regulates, and relates to the world. The narratives we tell ourselves influence our well-being, and it is thus very important that children and families have a narrative or story to help guide their personal understanding and meaning of an ASD diagnosis.

Following a neuropsychological evaluation, I often provide child and family feedbacks to children and their caregivers to discuss the diagnosis. These meetings are designed to be “therapeutic feedbacks.” Here are key components of my “therapeutic feedback” sessions for “making meaning” of the diagnosis of ASD which may be helpful for some parents and providers:

  1. Normalize that all family members have unique learning styles and brains. Encourage parents and siblings to share what they know about their own learning styles of strengths and challenges. For example, a caregiver might say, “All brains are different, and I can’t wait to learn about how your brain works, how your sister’s brain works, and how my brain works.”
  2. Create a story about how the child thinks, feels, regulates, and relates to the world. Assist your child in developing a strength-based individualized narrative or story of their diagnosis, a narrative which also validates and acknowledges challenges. This can help the child and family see and understand how strengths can be used to meet challenges. The diagnosis of ASD becomes secondary to the process of describing the child’s perspective and experience – or describing their learning style. This idea stems from narrative therapy – a therapeutic treatment which helps individuals and families “edit and re-author” the stories we tell about ourselves, others, and our environment to increase well-being. It is important to remember that all stories are unique to the child and depend on the child’s experience and learning style. Examples that children and families have developed include, understanding ASD as “superpower,” “awesome awe-sism,” “data brain,” “legomaster,” “detective,” and “Ms. Feel Big.”
  3. Recognize the child as the “expert” of their experience. Many children with ASD experience heightened feelings of “being misunderstood” which can produce stress and significant emotional difficulties. It is thus very important to connect with the child’s own point of view, language, play themes, and description of their experience. Therefore, think developmentally – use play, videos/movies, books, art, or a written/visual outline (e.g., one column of “superpower” strengths and one column of “superpower” challenges). Here is an example of a book, which has been used in therapeutic feedbacks for diagnosis disclosure for some children depending on the child’s learning profile and special interests.
  4. Externalize the challenges that children experience and identify themselves. Do this by separating “problems” from the child. For example, a child I was working with identified that their “superpower” (ASD) makes them “just do it,” which in diagnostic terms reflects “impulsivity.” The family and I talked about “just do it” to create a story in which the child had a “jumpy monkey” (this child loved monkeys). This “jumpy monkey” needed “help” from the child’s “superpower” to “stop and think,” which in clinical terms means developing the child’s “impulse control.” This is a good example of how a child and family identified an ASD strength that could be used to meet a challenge.
  5. Review and revisit the conversation. Keep the conversation open and accessible to the child in every-day life. Practice normalizing and discussing every family member’s story of strengths and challenges at dinnertime, in the car, and during therapies (speech therapy, occupational therapy, psychotherapy, etc.).

These therapeutic feedback tips are just some of many. For an additional list of tips, please visit the University of Washington Autism Center’s Dr. Sarah Woods’ “Tips for Talking to Your Child About Their Autism Diagnosis.”

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

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

 

22

Anxiety Reducers for Children and Teens with ASD

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Research indicates that children and teens with Autism Spectrum Disorders (ASD) are more sensitive to heightened physiological sympathetic arousal (the “fight or flight” response), including increased heart rate, breathing rate, feeling “on edge” and body-based tenseness. Heightened physiological arousal is neurologically connected to sensory processing and emotional responses. This is why some children with ASD have “high startle responses” or sensitivities to specific sensations, such as touch or sounds. This is also why some children and teens with ASD are vulnerable to feelings of anxiety, particularly within social situations and settings.

There is growing research focusing on possible strategies and interventions that reduce anxiety and “buffer” the “fight or flight” response that can be activated for many children and teens with ASD.

5 Research-driven Anxiety Reducers:

Animals: Include companion or therapy animals in social groups or social outings (particularly new social events). In one study, children with ASD showed a 43% decrease in skin conductance responses during free play with peers in the presence of animals, as compared to toys (O’Haire, McKenzie, Beck, & Slaughter, 2015).

Exercise: Make a plan to engage in a “warm up” body-based activity right before a social event when anxiety levels are increasing (e.g., jumping jacks, burpees, squats). Research indicates that exercise calms the amygdala and decreases physiological arousal.

Relax or Distract: Practice progressive muscle relaxation (PMR). Recent research has indicated that regular and routine engagement in PMR sessions can be a useful strategy for individuals with ASD. Distract yourself from the anxiety-producing situation for the short term (e.g., count by 3s, name three things you can see and hear in the room, repeat words from your favorite song in your head).

Plan to Take a Break: Children and teens can benefit from having a healthy “escape plan” to take a break from socially-demanding and sensory-demanding settings (e.g., a large event like a play or concert, a college lecture, an interview for a job). Research indicates that “rest breaks” during mentally demanding tasks result in increased alertness, decreased fatigue and heightened relaxation.

Social Stories: Social stories provide the opportunity to practice and prepare for stressful situations, decreasing “fight or flight” responses. Read more about examples and applications of social stories in my colleague, Dr. Erin Gibbons’ previous blog post.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Click here to learn more about NESCA’s ASD Diagnostic Clinic.

 

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.

 

22

Myth Busters: Bilingualism and Language Delays in Young Children

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Bilingual and multilingual children are often diagnosed with both language disorders and autism spectrum disorders later in development than monolingual children. There are a variety of reasons for later diagnosis, such as disparities in service access or structural inequities in society which limit diagnostic or treatment services for bilingual and multilingual families as well as disparities in the availability of providers and experts capable of diagnosing communication disabilities and language delays in bilingual and multilingual children. Another main factor I often see in practice as a neuropsychologist is a “myth” related to language development in bilingual/multilingual children. The myth is that “bilingualism or multilingualism causes language delay.” This is not accurate and not concordant with the scientific research. If a parent, educator, pediatrician, or therapist raises concern about a bilingual or multilingual child’s language development, do not delay an evaluation to consider the presence of a language delay, communication disability, autism spectrum disorder, or a neurological or cognitive disability. It is likewise critical to not delay access to helpful interventions for language development (e.g., speech/language therapy, early literacy/phonics interventions, social skills/play interventions). Early detection of language delays improves outcomes for monolingual and bilingual/multilingual children.

Here are important key facts about language delay and bilingual/multilingual children which can be helpful for parents, educators, therapists, and other professionals:

  • While there are some differences in bilingual and multilingual language development from monolingual development in the brain, those differences do not produce speech delays.
  • Bilingual/multilingual children and monolingual children develop expressive language skills and reach early speech and language milestones at similar times in early development. For example, single-word vocabulary size of bilingual/multilingual children is equitable to vocabulary size of monolingual children.
  • Language regression (a “red flag” for autism spectrum disorders) occurs regardless of language status and is not dependent on a child’s monolingual or multilingual abilities.
  • There is much scientific research indicating that bilingualism/multilingualism enhances social communication skills (including children with autism spectrum disorders). Likewise, bilingualism/multilingualism does not in itself produce or explain social communication challenges for children.

Additional Resources

If you want to learn more about bilingualism and language delay, Dr. Brenda Gorman, Associate Professor in Communication Sciences and Disorders at Elmhurst College, and Dr. Alejandro Brice, Professor in the Department of Education at the University of Florida at St. Petersburg offer an informative YouTube video for parents and clinicians regarding bilingualism, “late talkers,” and language delay: https://www.youtube.com/watch?v=zT0x-EqanGg

This scientific article is also a helpful resource for parents and professionals: “Bilingualism in the Early Years: What the Science Says” (Byers-Heinlein and Lew-Williams, 2013): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168212/

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

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

 

23

Executive Function Skills in the Outdoors

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Executive functioning skills are a “family” of skills that operate in a “top-down” process, controlling and regulating brain regions associated with attention, impulse control, emotion regulation, and meta-cognition or “thinking about thinking.” For more information about executive function skills, please refer to my previous NESCA blog “Teenage Stress and Executive Functioning.” As an evaluator, I often emphasize two key points about executive function skills: (1) Developing executive function skills is a combination of brain development and life experience; and (2) These skills are built through interactions (with others and our world) and practice.

Now with more access to New England summer weather, there are plenty of opportunities for children and teens to grow executive function skills in interaction with the natural world. I recommend a “must-download” if you want to review practical, science-based activities and games for children from the ages of six months old through adolescence, “Enhancing and Practicing Executive Function Skills with Children from Infancy to Adolescence.” This is a wonderful resource that provides a clear list and description of practical activities to strengthen executive function skills based on a child’s age. This resource was developed by The Center on the Developing Child at Harvard University, a multidisciplinary team supporting research, policy, and practice for childhood development. Their website also provides excellent free resources for parents, clinicians, and educators related to topics such as stress, resiliency, play, and brain structure/development.

Here is a short list of outdoor summer executive function activities based on your child’s developmental age:

  1. 6-18 months-old: Peekaboo and Patty-Cake on the grass and other textures, such as dirt, mud, water, or wood (a multi-sensory experience), encourage joint attention and object focus by naming, pointing, and sustaining focus on natural objects at the beach or in the woods.
  2. 18-36 months-old: Match/sort natural objects, such as placing rocks in one bucket and flowers in another bucket, blow bubbles with a variety of wand shapes, pretend play as fishermen, construction workers, or farmers/gardeners.
  3. 3-5 years-old: Pretend to be an outdoor superhero in an obstacle course or race (e.g., running through Hula Hoops or around traffic cones), assist with cooking/preparing an outdoor picnic, or make a nature bracelet.
  4. 5-7 years-old: Play the I-Spy game and participate in scavenger hunts, use strategy board games (e.g., Uno, Concentration) on land or maybe even in the water, go on a sensory walk (name something you see, hear, smell, taste, and touch).
  5. 7-12 years-old: Star-gaze and find/name constellations, create a bird house or other wood structure through woodworking activities, garden one or more plants, play with a super soaker toy or laser/flashlight tag.
  6. Adolescents: Maintain a summer sketching and drawing journal of natural objects, participate in sunrise or sunset yoga or dance classes, outdoor animal-assistant yoga (e.g., Goat Yoga), or sports-oriented camps and activities.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form. 

 

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

 

22

Anxiety Reducers for Children and Teens with ASD

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Research indicates that children and teens with Autism Spectrum Disorders (ASD) are more sensitive to heightened physiological sympathetic arousal (the “fight or flight” response), including increased heart rate, breathing rate, feeling “on edge” and body-based tenseness. Heightened physiological arousal is neurologically connected to sensory processing and emotional responses. This is why some children with ASD have “high startle responses” or sensitivities to specific sensations, such as touch or sounds. This is also why some children and teens with ASD are vulnerable to feelings of anxiety, particularly within social situations and settings.

There is growing research focusing on possible strategies and interventions that reduce anxiety and “buffer” the “fight or flight” response that can be activated for many children and teens with ASD.

5 Research-driven Anxiety Reducers:

Animals: Include companion or therapy animals in social groups or social outings (particularly new social events). In one study, children with ASD showed a 43% decrease in skin conductance responses during free play with peers in the presence of animals, as compared to toys (O’Haire, McKenzie, Beck, & Slaughter, 2015).

Exercise: Make a plan to engage in a “warm up” body-based activity right before a social event when anxiety levels are increasing (e.g., jumping jacks, burpees, squats). Research indicates that exercise calms the amygdala and decreases physiological arousal.

Relax or Distract: Practice progressive muscle relaxation (PMR). Recent research has indicated that regular and routine engagement in PMR sessions can be a useful strategy for individuals with ASD. Distract yourself from the anxiety-producing situation for the short term (e.g., count by 3s, name three things you can see and hear in the room, repeat words from your favorite song in your head).

Plan to Take a Break: Children and teens can benefit from having a healthy “escape plan” to take a break from socially-demanding and sensory-demanding settings (e.g., a large event like a play or concert, a college lecture, an interview for a job). Research indicates that “rest breaks” during mentally demanding tasks result in increased alertness, decreased fatigue and heightened relaxation.

Social Stories: Social stories provide the opportunity to practice and prepare for stressful situations, decreasing “fight or flight” responses. Read more about examples and applications of social stories in my colleague, Dr. Erin Gibbons’ previous blog post.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Click here to learn more about NESCA’s ASD Diagnostic Clinic.

 

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.

 

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