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Headshot of Dr. James Lynch and a quote from him about joining NESCA

NESCA Welcomes James Lynch, Ph.D., to its Pediatric Neuropsychology Team

By | NESCA Notes 2026

Headshot of Dr. James Lynch and a quote from him about joining NESCABy: Jane Hauser
Director of Marketing & Outreach, NESCA

I recently had the opportunity to learn more about NESCA’s latest addition to its Pediatric Neuropsychology staff, Dr. James Lynch. We are thrilled to have Dr. Lynch on our team at NESCA! I hope you enjoy getting to learn more about him here as well.

What are your areas of expertise in pediatric neuropsychology?
I have worked with many individuals with a wide range of ages and ability areas from my previous educational and professional experiences. Most of my experience is with children and adolescents who show signs of Attention-Deficit/Hyperactivity Disorder (ADHD), autism spectrum disorders (ASD), learning disorders, developmental delays, and intellectual disabilities, as well as the interventions that are used to support those students.

How did you get your start in pediatric neuropsychology?
I started in clinical psychology by training in evaluating children and adolescents with concerns for ADHD and/or autism. While that is my area of specialty, I was also doing a lot of evaluations during my fellowship at Boston Children’s Hospital with complex presentations in children who were often considered “difficult to test” for many reasons, whether due to behavioral challenges, language abilities, or other factors.

What is your approach in evaluating children and young people?
I try to optimize the performance of the evaluations for the students with whom I work. I like to focus specifically on what I am trying to measure and whether I am getting the information that will help me identify the root cause of the challenges the individual is experiencing. I try to look for the patterns of skills – whether they are strong or need support to find out what we are looking for.

What kind of guidance do you offer to parents and caregivers about going through the evaluation process for their child?
It can be scary for families. I try to help parents and caregivers understand that we know how to work with kids and that we understand that the challenges they and their child are experiencing can be very difficult. I explain that our aim is to help them better understand what is causing those struggles and recommend a treatment plan that is targeted specifically to their child. I assure them that while their child’s challenges may be new to them, we are very used to working with kids with similar presentations and that they are not alone.

You have a lot of research experience. Can you tell us more about that?
I’ve done a lot of research into neuropsychological functioning – and how that may help explain differences in real-world outcomes. For example, kids with ADHD tend to have executive functioning (EF) challenges, but there is so much variability in this… so how can we use this variability to make predictions about real-world outcomes. For example, I’ve conducted research examining whether children with ADHD are more susceptible to EF challenges or post-concussive symptoms after a season of high school football or soccer. I’ve also done a study on whether EF can predict which teenagers with ADHD are more or less likely to have automobile crashes or near-crashes when they begin to drive. I’ve also conducted research examining whether differences in reinforcement processing and temperament predict which kids are more likely to respond to an external reward system or develop future anxiety or mood symptoms.

I have also been involved in a lot of caregiver-focused research, such as whether the outcomes for autistic children were better when families participated in an adapted Applied Behavior Analysis (ABA)-based program and if participating had downstream impacts on other services for the child or the wellness of parents of kids with autism.

You join NESCA from Boston Children’s Hospital. What did that experience give you and how will that support you in your work at NESCA?
Working at Children’s for two years allowed me to see a wide range of kids with highly complex challenges, including those with ADHD and ASD, as well as those who were also experiencing GI, genetic, and neurological complexities. We also frequently worked with children whose symptoms made it difficult to tease apart exactly what the underlying issues were.

Children’s also gave me the training on and regular opportunity to make decisions on the fly. This has been extremely beneficial in being able to select the individualized battery of tests we use in our evaluations. Based on behavioral observations mid-testing, I have learned to easily pivot, incorporating additional tests that will allow me to better identify cognitive challenges, which helps to home in on an accurate diagnosis. It’s those in-the-moment choices that I’ve become very accustomed to that are so helpful in getting to the bottom of what’s actually going on with a child.

Finally, the interdisciplinary experience Children’s provided has also been extremely helpful in understanding a child as a whole during evaluations so I can create a targeted treatment plan that will support them once the evaluation is concluded.

What drew you to NESCA?
I was drawn to the focus on helping families in areas that other neuropsychology practices may not focus on, mainly how we can support children with their education based on our evaluation findings. I really wanted to move my career forward in a place where I could make an impact on a child’s everyday life, whether behaviorally, developmentally, or helping them thrive academically.

I also really appreciate the efforts that NESCA makes in keeping its clinical staff trained and current on evidence-based treatments, school-based interventions, among other areas from internal and external experts. The case conference and seminar trainings were very familiar to me from the hospital setting, and I greatly appreciate that I can continue to further my education in this manner.

Finally, I saw first-hand in the interview process and throughout my onboarding at NESCA how closely connected NESCA clinicians are with the kids and families they work with. That is something deeply important to me.

 

About Dr. James Lynch

Headshot of James Lynch, Ph.D.Pediatric Neuropsychologist Dr. James Lynch, Ph.D., conducts comprehensive evaluations of toddlers, preschoolers, school-aged children, and adolescents with developmental concerns. These include challenges with cognitive functioning, behavior and emotion regulation, communication skills, and academics. He has expertise in the evaluation of neurodevelopmental disorders such as ADHD, autism, developmental delays, intellectual disabilities, and learning disorders.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.
Image of a student having a hard time initiating homework. Quote from a NESCA clinician.

Understanding LBLD and Executive Functioning: Securing the Right IEP or 504 Support

By | NESCA Notes 2026

Image of a student having a hard time initiating homework. Quote from a NESCA clinician.By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

When a student struggles to start writing, loses track of directions, or takes hours to complete homework, the immediate assumption is often: “This is an attention or ADHD issue.” While ADHD and executive functioning (EF) challenges frequently co-occur with learning differences, there is often a deeper, misunderstood culprit: Language-Based Learning Disability (LBLD).

For parents, advocates, and educators, understanding the relationship between language processing and EF is critical. Without this insight, schools risk implementing accommodations that merely bypass the problem, rather than providing the specialized instruction a student needs to build independence.

What are LBLD and Executive Functioning?

An LBLD is a neurodevelopmental spectrum of difficulties affecting how individuals process, understand, and use spoken and written language. It is a processing difference entirely unrelated to intelligence, motivation, or instructional quality. LBLD typically impacts:

  • Reading (Dyslexia): Decoding, phonics, and comprehension.
  • Written Expression (Dysgraphia): Mechanics, spelling, and organizing thoughts.
  • Spoken Language: Receptive (understanding instructions) and expressive (word retrieval) language.
  • Organization & Memory: Working memory deficits and difficulty planning multi-step tasks.

Executive Functioning is the brain’s “management system” – housed in the prefrontal cortex – enabling individuals to plan, focus, remember instructions, regulate emotions, and prioritize tasks.

The Intersection: How Language Weaknesses Disrupt EF

To support these students, we must distinguish between primary ADHD and LBLD-driven executive dysfunction:

  • Primary ADHD: Driven by global deficits in behavioral inhibition and executive control.
  • LBLD: Executive dysfunction is a secondary consequence of the high cognitive load of language processing.

When a student expends immense energy decoding words, retrieving vocabulary, or analyzing syntax, it rapidly drains their cognitive battery. This cognitive fatigue manifests as apparent executive dysfunction (task avoidance, distractibility, or poor initiation). Treating this solely as an attention issue misses the opportunity to provide necessary language-based instruction.

This breakdown occurs in three key areas:

  1. Working Memory Overload: Weaknesses in word meaning require so much conscious effort to decode that the student’s working memory overflows, causing them to lose track of multi-step directions.
  2. The Processing “Bottleneck”: Translating auditory language into an internal concept, and then into a written response, takes longer. This delay acts as a bottleneck when trying to get ideas onto paper.
  3. The Absence of “Internal Language”: Cognitive flexibility and task initiation rely on “internal language” (self-talk used to plan and organize). Students with LBLD lack strong internal language, resulting in task initiation paralysis.

Moving Beyond Accommodations to Specialized Instruction

Schools often default to accommodations, such as providing extra time, pre-filled graphic organizers, or reduced assignments. While these accommodations act as a passive bypass – altering the environment or format to circumvent a deficit – they do not teach skills. By bypassing the weakness without remediating it, accommodations can create prompt-dependency, where the student relies on an adult or a tool to do the cognitive heavy lifting.

In contrast, specialized instruction serves as active remediation by explicitly and systematically teaching cognitive and linguistic strategies. For example, instead of simply handing a student a graphic organizer, specialized instruction teaches the metacognitive process of how and when to use it. This approach targets the deficit directly, transforming the student from a passive recipient of support into an active, self-regulating learner.

To foster independence, students must learn to internalize strategies through:

  • Explicit Strategy Instruction: Teaching how to identify and map the relationship between main ideas and details.
  • Self-Monitoring Training: Teaching students to use self-talk checklists (e.g., “Stop, Review Prompt, Check”) to monitor their own progress.
  • Working Memory Strategies: Instructing students in verbal rehearsal, visualization, and chunking.

Drafting Measurable EF/LBLD Goals for IEPs and 504s

IEP goals must shift from passive task completion to active skill acquisition by targeting the underlying cognitive-linguistic process, not just the final academic product.

Goal Comparison

  • Weak Goal (Product-Oriented): “Student will use an organizer to complete writing assignments with 80% accuracy.”
    • Why it fails: Focuses on worksheet completion (the product), not the planning skill. It does not define independence level or the specific strategy used.
  • Strong Goal (Skill- & Strategy-Oriented): “Given a multi-step writing prompt, the student will independently apply a 3-step planning strategy (brainstorm, categorize, sequence) to initiate writing within 5 minutes, in 4 out of 5 opportunities.”
    • Why it works: Targets the executive functions of planning and initiation, defines the exact strategy, and measures independence to build internal language.

Three Essential Elements of an EF/LBLD Goal

When advocating for IEP goals, ensure these three elements are explicitly defined:

  1. The Specific Strategy (The “How”): Name the exact cognitive tool (e.g., verbal rehearsal, a 3-step planning strategy, a self-monitoring checklist).
  2. The Level of Independence (Prompt Fading): Quantify the support required using precise, observable terms (e.g., independently, given no more than one verbal prompt), avoiding vague terms like “with minimal assistance.”
  3. Measurement of the EF Skill: Directly measure the executive function deficit (e.g., task initiation latency, planning time) rather than curriculum accuracy.

By shifting the focus of IEPs and 504 plans from passive accommodations to explicit, strategy-based specialized instruction, we can help students with LBLD build the internal language and executive functioning skills they need to navigate school – and life – independently.

 

About the Author

Alissa Talamo headshotWith 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 daughter.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of an anxious child and a quote from a NESCA clinician

Anxiety: It’s Not Always Obvious

By | NESCA Notes 2025

Image of an anxious child and a quote from a NESCA clinicianBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

When we hear the word anxiety, we often picture someone who is visibly worried – someone who says, “I’m scared,” asks a lot of “what if?” questions, or seems nervous about what might happen next. But anxiety doesn’t always present that way – especially in children. Anxiety can manifest as physical symptoms, behavioral challenges, emotional outbursts, sleep disruptions, school avoidance, or changes in relationships. A child may not have the words to say, “I’m anxious.” Instead, they may complain of a stomachache, become unusually irritable, refuse to go to school, have frequent meltdowns, or suddenly need much more reassurance.

It is also important to remember that a behavior or symptom that looks like anxiety isn’t automatically anxiety. Symptoms that may appear anxiety-related can have many possible explanations – and sometimes more than one diagnosis is present at the same time.

Anxiety in Young Children

Young children often don’t have the ability to identify and explain anxiety. Instead, adults may see it through behavioral challenges or physical complaints such as:

  • Complaining frequently about a stomachache, headache, nausea, or feeling sick
  • Becoming clingy or having difficulty separating from caregivers
  • Resisting school, daycare, activities, or unfamiliar places
  • Having trouble sleeping or experiencing nightmares
  • Becoming irritable or emotional
  • Having more frequent tantrums or meltdowns
  • Asking for repeated reassurance
  • Becoming upset when plans change
  • Avoiding things that make them uncomfortable
  • Seeming quiet, cautious, or tense

For example, a child who says, “My tummy hurts,” every Sunday night may not simply have a sensitive stomach. Their body may be responding to the anticipation of school the next morning.

It is important to note that physical symptoms are very real. Emotional distress can produce genuine physical sensations, and children may experience symptoms such as stomachaches, nausea, headaches, dizziness, or changes in appetite.

Anxiety in School-Age Children

As children enter elementary school, there are greater academic expectations, more complexities in friendships, increasing extracurricular activities, new environments, and often an increasing awareness of how other people perceive them.

Anxiety may begin to look more like avoidance or shut down/withdrawal.

You might notice:

  • Frequent complaints of feeling sick before school
  • Asking to stay home or repeatedly visiting the school nurse
  • Difficulty separating from caregivers
  • Worrying about making mistakes
  • Perfectionism
  • Reassurance-seeking, asking lots of questions about what is to come
  • Difficulty falling asleep because of worries about the next day
  • Irritability or large reactions
  • Trouble concentrating
  • Avoiding activities
  • Becoming upset when plans change

Sometimes children who seem “defiant” are actually overwhelmed.

A child who refuses to participate in an activity may be avoiding something that feels scary. A child who melts down over homework may be overwhelmed by the possibility of getting something wrong. A child who says they hate school may be experiencing significant anxiety about academics, social situations, separation, bullying, or another aspect of the school environment.

Importantly, while avoidance can provide short-term relief, it can also allow anxiety to become more entrenched over time.

Anxiety in Teens

Adolescence brings a different set of challenges. Friendships become more complicated. Academic expectations increase. Social comparison becomes significant. Teens may be thinking more about who they are, their relationships, wanting more independence, and transitioning into adulthood. In teens, sometimes anxiety looks like:

“Leave me alone.”

“I don’t care.”

“I’m not going.”

“I hate everyone.”

“My stomach hurts.”

A teen experiencing anxiety may become more irritable, withdraw from others, have difficulty sleeping, struggle to concentrate, or avoid situations they once enjoyed. For teens, it may appear as though they have an “attitude problem” when what they actually are experiencing is internal distress.

With that said, that doesn’t mean every argument, eye roll, withdrawal, or change in mood is anxiety. Adolescence is marked by ever-changing hormones and a complicated period of development. To this end, irritability can have many causes. If you are noticing a significant change in behavior; however, it is worth paying attention to – especially when it persists or begins interfering with everyday life.

Anxiety in Adults

Adults may be better able to identify worry, but anxiety can still present in less obvious ways.

An adult may experience:

  • Constant “what if?” thinking
  • Irritability or feeling constantly on edge
  • Difficulty relaxing
  • Racing thoughts
  • Trouble concentrating
  • Insomnia or disrupted sleep
  • Muscle tension
  • Headaches
  • Stomachaches or digestive symptoms
  • Fatigue
  • Avoidance
  • Excessive reassurance-seeking
  • Difficulty making decisions
  • Feeling overwhelmed by ordinary responsibilities

In adults, anxiety can also feel so familiar that you may have thoughts such as:

“I’ve always been a worrier.”

“I’m just a perfectionist.”

“I just like to know what to expect so I can plan accordingly.”

“I’ve always been bad at relaxing as I prefer to stay busy.”

Not Everything That Looks Like Anxiety Is Anxiety

Something important to note about anxiety symptoms is that they often overlap with other possible conditions as well. This is where things can get complicated. For example, an upset stomach could be anxiety, but it could also be a gastrointestinal condition. Irritability could be anxiety, but it could also be related to sleep deprivation, depression, ADHD, hormonal changes, or learning difficulties. Difficulty concentrating could be anxiety, but it could also be ADHD, learning challenges, inadequate sleep, depression, or stress. School avoidance could be anxiety, but it could also be bullying, academic difficulties, social challenges, depression, or an environment that isn’t meeting the child’s needs.

Another important piece of the puzzle is that conditions don’t always exist in isolation. For example, ADHD and anxiety can occur together. Anxiety can also co-occur with learning disorders, sleep problems, depression, and other conditions, which can make it more difficult to determine what is driving a particular set of challenges.

For example, imagine a child who can’t complete homework. Is the child anxious about getting the answers wrong? Are they struggling to sustain their attention because of ADHD? Is the assignment particularly difficult because of an underlying learning disorder? Are they exhausted? Or maybe a few of these things are happening all at once. The answer matters because the most helpful support may look very different depending on what’s underneath the behavior. A good assessment looks beyond the most obvious symptom.

When Is It Time to Get Help?

Everyone experiences anxiety. Fear and worry are normal parts of development and everyday life. The concern is when anxiety (or the behaviors associated with it) becomes persistent or disruptive. Should symptoms persist, cause significant distress, or interfere with school, work, relationships, sleep, activities, or daily functioning, it is time to seek out an evaluation to better understand the root cause. An evaluation can also be particularly helpful when you’re unsure what you’re seeing. You don’t have to start the evaluation process knowing whether it’s anxiety, ADHD, autism, depression, a learning disorder, a medical issue, or something else. That’s precisely what an evaluation is for.

The bottom line is that anxiety doesn’t have one look. And sometimes what appears to be anxiety isn’t anxiety at all – or isn’t only anxiety. Understanding the whole picture matters. Through better understanding and an appropriate evaluation, we can begin on the road to providing supports that addresses the underlying need – not just what we see on the surface.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children, adolescents, and young adults with a wide range of concerns, includingMiranda Milana Headshot 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 and related services practice in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables/Miami, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Image of parents meeting with educators

From Report to Classroom: Translating Your Child’s Evaluation into Real-World School Supports

By | NESCA Notes 2026

Image of parents meeting with educatorsBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

A comprehensive neuropsychological evaluation offers a clear, objective look at how your child learns, processes information, and navigates their environment. However, receiving the evaluation report is only the first step in the journey to ensuring those findings translate into meaningful, everyday classroom support. The next crucial phase is working alongside educators to transform these clinical insights into real-world, school-based strategies. By understanding how to utilize the recommendations provided within the report, parents are equipped to foster a collaborative relationship with the school team and establish the precise structural and academic supports their child needs to succeed.

Navigating the educational landscape and special education terminology can sometimes feel like learning a foreign language. Bridging the gap between a clinical diagnosis and school-based eligibility requires a structured, team-based approach. By gaining insight into school procedures, clarifying the difference between support frameworks, and using targeted clinical recommendations, parents can confidently advocate for the resources and learning environment their child requires.

Understanding the Frameworks: 504 Plan vs. IEP

The first step in advocacy is understanding the two primary pathways for school-based support. While both provide essential assistance, these public school documents are governed by different federal laws and serve distinct purposes:

  • The 504 Plan (Section 504 of the Rehabilitation Act): This civil rights statute is designed to prevent discrimination by ensuring “equal access” to learning. A 504 Plan provides accommodations, which are changes to how a student learns, without altering the curriculum. Examples include extra time on tests, preferential seating, or sensory breaks. It is appropriate for students who can access the general education curriculum but need environmental adjustments to do so.
  • The Individualized Education Program (IEP; Individuals with Disabilities Education Act): An IEP is a specialized blueprint for students who require specialized instruction. This involves changes to what they are being taught, where they are being taught, or the delivery of direct services (such as speech-language therapy, occupational therapy, or specialized reading instruction). To qualify for an IEP, a student must have a documented disability that directly impacts their ability to make effective progress in school, requiring targeted, specialized instruction.

A comprehensive neuropsychological evaluation is invaluable for both pathways, as it provides the objective, standardized data necessary to document a child’s functional limitations and academic needs. A primary goal of our evaluation report is to clearly connect your child’s profile directly to appropriate recommendations, including practical classroom strategies.

Translating Clinical Findings into Classroom Supports and Placement

A high-quality neuropsychological report does not simply list test scores and diagnoses; it outlines the underlying cognitive, learning, and social-emotional factors driving a student’s classroom challenges. At NESCA, what sets our reports apart is our commitment to understanding the whole child, including the complex, interacting variables that shape their daily experience. This holistic view allows us to provide highly individualized, detailed recommendations rather than generic lists of accommodations. We specify the exact nature of the support your child needs, including the recommended frequency of services, the provider best suited to deliver the intervention, tailored environmental accommodations, and the specific setting where the support should occur.

A comprehensive evaluation can also inform appropriate classroom placement. For some students, making effective progress requires a specialized language-based, co-taught, or therapeutic classroom setting rather than a standard general education environment.

You do not need to be a clinical expert to advocate effectively during this process. A high-quality report does the heavy lifting by reframing classroom struggles into clear, actionable solutions. For instance, a student who appears “disorganized” or “unmotivated” is often actually experiencing executive dysfunction. Thus, the report may reframe this difficulty to advocate for structured scaffolding, like breaking long-term projects into mini-deadlines with daily staff check-ins.

Similarly, a child labeled “inattentive or slow to finish work” may be managing the impact of slow processing speed, meaning they comprehend the material well but require significantly more time and cognitive energy to show what they know. The report can use this insight to justify pacing accommodations, such as reduced homework volume to prioritize concept mastery over repetitive task completion.

Even emotional vulnerabilities, such as presenting as “withdrawn or resistant to participate,” may be reframed within a report through the lens of underlying sensory overload or social fatigue, pointing the school team toward proactive supports like a designated safe space or scheduled sensory breaks throughout the day. Ultimately, by translating complex behaviors into these precise, real-world connections, the evaluation report provides you and the school with a shared, compassionate roadmap towards supporting the student’s success.

Collaborative Advocacy: Partnering with the School Team

Preparing for a multidisciplinary team meeting can be a deeply personal process, and it is completely natural to want to ensure your child’s needs are fully understood. The most productive school meetings are often built on a foundation of partnership, where everyone brings valuable expertise to the table. Successful advocacy relies on uniting two distinct areas of expertise: the school team’s deep knowledge of curriculum and classroom dynamics, and your unmatched understanding of your child’s unique personality, strengths, and history. By uniting these unique perspectives, you and the school team can work together to build the best possible path forward. To foster a collaborative partnership during your next team meeting, consider these strategies:

  1. Share the Report Early to Build a Collaborative Bridge (Preparation): When possible, provide the school’s multidisciplinary team with the neuropsychological report at least two weeks prior to the scheduled meeting. This gives the educators and specialists adequate time to digest the findings and formulate thoughtful, proactive service proposals. To foster a true partnership, consider sending a brief, friendly email along with the report highlighting your top two or three priorities or questions, ensuring your voice is integrated into the meeting agenda from the very start.
  2. Reframe Behavior Through a Clinical Lens (During the Meeting): Use the evaluation findings to identify the root cause of certain behaviors, allowing the team to reframe classroom challenges and guide targeted, proactive interventions. If it is noted that your child is “disengaged” or “refuses to write,” pointing to the objective data showing fine-motor fatigue, language-retrieval deficits, or underlying performance anxiety helps the team view the behavior as a skill deficit rather than a compliance issue. Reframing these challenges empowers the team to focus on teaching coping strategies and providing proactive supports that set your child up for success.
  3. Focus on “Effective Progress” and Accountability (The Goal): Under special education guidelines, eligibility and services hinge on whether a child is making meaningful, “effective progress” in school. Use the standardized, objective data in your report to highlight where your child is struggling, both compared to their peers and relative to their own capabilities. Rather than asking for generalized help, frame your requests around helping them close these specific developmental and academic gaps, and ask the team how the success of any new accommodations or interventions will be actively measured and tracked.

Translating a neuropsychological evaluation into a school-based plan is a journey that requires patience, clarity, and persistence. Ultimately, your child’s report is far more than a diagnostic document; it is a powerful roadmap designed to align parents and educators around a shared vision. By using objective clinical data to guide the conversation, you can ensure your child receives the precise, individualized support required to build academic self-efficacy, emotional resilience, and the foundation they need to thrive.

School Meeting Support

Are you preparing to navigate an upcoming multidisciplinary school meeting to discuss an IEP or 504 plan for your child? To bridge the gap between our clinical findings and your child’s classroom, neuropsychologists at NESCA are available to attend school team meetings. In these meetings, our role is to succinctly present the objective evaluation findings directly to the school team, illustrate how your child’s unique profile impacts their classroom learning, and walk educators through our tailored recommendations.

Please note that school meeting attendance is a distinct clinical service and is not included in the core evaluation and report process. Clinicians participate strictly in an advisory, clinical capacity rather than as educational advocates. To inquire about your clinician’s availability and the rates for this service, please reach out to our intake team at NESCA.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image showing a father with two daughters, one of whom has special needs, A quote also follows.

Supporting Sibling Relationships in Families with Special Needs

By | NESCA Notes 2026

Image showing a father with two daughters, one of whom has special needs, A quote also follows.By: Erin Gibbons, Ph.D. 
NESCA MA Clinical Director; Pediatric Neuropsychologist

I am a parent of two amazing children, one of whom is neurotypical and one of whom is neurodiverse. Finding the balance between supporting my neurodiverse child while also giving my other child enough attention can feel like walking a tightrope. Siblings of children with developmental or learning challenges often experience a unique family dynamic.

  • To foster healthy sibling relationships, it’s crucial to promote open communication. Creating a safe and open environment for discussions helps them understand the situation and feel heard.
  • Providing age-appropriate information about the sibling’s disability can help demystify behaviors and challenges, fostering empathy and reducing misconceptions or frustrations.
  • Recognizing and validating the emotions of siblings, whether positive or negative, is also important. It’s natural for them to have mixed feelings, and acknowledging these emotions helps them process and cope effectively.
  • Encourage siblings to pursue their own interests, reinforcing their identity outside of the family role.
  • Try to dedicate individual time with each child to strengthen personal bonds and make them feel special and attended to.
  • Encourage siblings to support each other and work as a team.

If you find that sibling dynamics are causing family discord, it might be helpful to connect with sibling support groups where children can meet others in similar situations. Consulting a family therapist or counselor can also be helpful and provide tailored strategies to facilitate improved family interactions.

 

About the Author

Since 2011, Dr. Gibbons has been a trusted expert at NESCA where she evaluates children presenting with a range of attentional, learning,Erin Gibbons headshot and developmental disabilities. She has a particular interest in children with autism spectrum disorders, intellectual disabilities, and those with complex medical histories. In addition, she evaluates adults who have concerns about whether they meet criteria for an ASD or ADHD diagnosis.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Hingham, and Plainville, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of teo children reading outside on the grass with a quote from NESCA Pediatric Neuropsychologist Alissa Talamo, Ph.D.

How to Encourage Summer Reading with Your Child

By | NESCA Notes 2026

Image of teo children reading outside on the grass with a quote from NESCA Pediatric Neuropsychologist Alissa Talamo, Ph.D.By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

Summer is an important time for children to relax and recharge, but it also provides a valuable opportunity to make reading enjoyable. Research consistently shows that students who do not read over the summer are at risk for the “summer slide,” which is a decline in reading skills acquired during the school year. In contrast, children who continue to read during the summer not only maintain but can even improve their literacy abilities.

The benefits of summer reading extend well beyond academics. Regular reading helps expand general knowledge, improve vocabulary and spelling, and strengthen focus and attention. According to Dr. Sally Shaywitz, author of Overcoming Dyslexia, children who read for just 20 minutes a day are exposed to approximately 1.8 million words each year, compared to only 8,000 words for those who read just a few minutes daily. This increased exposure to language supports both language development and writing skills.

Reading for just 20 minutes each day offers numerous advantages. Children experience significant vocabulary growth, encounter diverse perspectives that foster empathy, and develop stronger critical thinking skills as they engage with stories and information. Additionally, reading can be a relaxing activity, particularly before bedtime, helping children unwind after a busy day.

Despite these benefits, some children may be reluctant to read due to reading difficulties, uncertainty about their interests, or a preference for other activities. To encourage reading, it is important to let children choose books that interest them, set aside time to read together, and create a cozy reading environment at home. Pairing reading with interactive activities, such as visiting a museum, landmark, or travel destination related to a book’s topic, characters, or setting, can also make reading more appealing. Regular library visits, audiobooks, and a variety of reading materials—including magazines, comics, and graphic novels—can also help sustain interest. Introducing children to book series and modeling your own enjoyment of reading are additional strategies to foster a positive reading culture.

Helpful Resources and Tools

There are many excellent websites and apps that can support your child’s reading journey. Here are some sites to consider:

  • Unite for Literacy: A collection of audio/picture books read aloud to your child.
  • Reading Rockets—Reading Adventure Packs: Downloadable guides with book suggestions and activities.
  • Starfall.com: Early literacy games and books, ideal for young children.
  • Talking is Teaching: Encourages parents to talk, read, and sing with children to boost early brain and vocabulary development.

Other Resources:

Conclusion

Encouraging your child to read over the summer—and throughout the year—can have lasting benefits for their academic, social, and emotional development. By making reading enjoyable and accessible, and by supporting their individual interests and needs, you can help your child build a lifelong love of reading.

 

References:

  • Sally Shaywitz, MD, Overcoming Dyslexia (2020 Edition): Second Edition, January 4, 2005
  • https://specialedresource.com/benefits-of-reading-20-minutes-a-day
  • https://www.k12reader.com/why-read-20-minutes-a-day/
  • https://www.understood.org/articles/en/14-ways-to-encourage-your-grade-schooler-to-read

 

About the Author

Alissa Talamo headshotWith 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 college-aged daughter.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

a roadmap wirh a treatment plan sign showing the way; quote from Dr. Ann Helmus

Beyond Recommendations: Creating a Roadmap for Change

By | NESCA Notes 2026

a roadmap wirh a treatment plan sign showing the way; quote from Dr. Ann HelmusBy Ann Helmus, Ph.D.
Founder & Director, NESCA

I recently attended a continuing education course on the treatment of sleep problems. The instructor shared something not altogether surprising, but genuinely thought-provoking: simply giving people a list of “sleep hygiene” recommendations has not been shown to be particularly effective.

Most of us have heard these recommendations before:

  • Turn off screens before bed
  • Keep the room cool and dark
  • Avoid caffeine late in the day
  • Maintain a consistent sleep schedule

The problem isn’t that these recommendations are wrong. The problem is that they are often delivered as a generic list. So, what does work? A personalized approach to a plan.

For example, instead of handing someone a list of 10 recommendations, an effective approach by a clinician might be to say: “Let’s focus on one thing this week – moving your afternoon coffee a little earlier in the day. We’ll see how that goes, what obstacles come up, and whether it makes a difference before we add anything else.”

Here, the recommendations are tailored to the individual, prioritized based on what is most likely to help, and then followed up on to determine what is working and what needs adjustment.

The same can be said about the recommendations that are provided after a neuropsychological evaluation. After an assessment, families receive evaluation reports that often contain pages of recommendations. While many of those suggestions may be reasonable, a long list can leave parents wondering where to start, which recommendation matters the most, or which recommendation will make the biggest difference for my child right now. It can be overwhelming.

At NESCA, our goal is not simply to generate recommendations. Our goal is to develop a treatment plan.

A treatment plan factors in the full understanding of the child’s unique strengths and challenges, identifies the issues that are having the greatest impact on daily functioning, and prioritizes the interventions that are most likely to improve quality of life and long-term improvement.

For one child, improving sleep may be the most important first step. For another, it may be anxiety management, executive functioning support, social skills coaching, speech-language intervention, or school accommodations. The recommendations may look similar on paper, but the strategy is very different.

A thoughtful evaluation should answer not only what to do, but why, when, and in what order.

Most importantly, meaningful change rarely comes from a report sitting on a shelf. It comes from partnership, implementation, progress monitoring, and adjustments as needed.

Just as effective treatment for sleep difficulties involves more than a list of sleep hygiene tips, effective support for a child involves more than an exhaustive list of recommendations.

It requires a roadmap. At NESCA, our goal is to help families build one.

 

About the Author

NESCA Founder and Director Ann Helmus, Ph.D., is a licensed clinical neuropsychologist who has beenAnn Helmus headshot practicing neuropsychology for 35 years and has been director of NESCA’s Neuropsychology practice for nearly three decades, continuously training and mentoring  neuropsychologists to meet the highest professional standards.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services group practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of a Neuropsychological Evaluation Report with the question, What's Next? There is also a quote from Dr. Maggie Rodriguez

Navigating Life After a Neuropsychological Evaluation: What Comes Next?

By | NESCA Notes 2026

Image of a Neuropsychological Evaluation Report with the question, What's Next? There is also a quote from Dr. Maggie RodriguezBy: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Going through the process of getting a neuropsychological evaluation can be a big investment of time, energy, and money.  Once it’s completed, you should have some important information about your child and a detailed report. But now what? What do you do with this information and who do you share it with?

As a parent who has been through the neuropsychological evaluation process with two of my children, I know firsthand how overwhelming it can feel to move from diagnosis to action. The report you receive is often extensive and should be filled with valuable insights and recommendations. But translating those findings into real-world support for your child is the next crucial step. Here are some thoughts and practical tips on what to do next:

1) School: The Starting Point for Support

For many families, the primary motivation for seeking a neuropsychological evaluation is to better understand their child’s learning profile and needs in the school setting. The report can be a powerful tool in advocating for appropriate accommodations, interventions, and support.

  • Share the report with your child’s teacher, special education coordinator, and/or school psychologist. If you don’t know where to start, reach out to the school to ask who your contact person should be.
  • Use the findings to inform IEP (Individualized Education Program) or 504 Plan meetings. NESCA neuropsychologists are available to present the findings directly to your child’s team at meetings and can be a valuable resource in this regard.
  • Ask for specific classroom strategies or modifications based on the recommendations. You may want to consider collaborating with an educational advocate as well.

2) Treatment Providers: Building a Collaborative Team

Your child may already be working with therapists, counselors, psychiatrists, or other healthcare professionals. Alternatively, you may be working on setting up treatment. Sharing the neuropsychological report with providers can help them tailor their interventions and monitor progress more effectively.

  • Consider providing copies or summaries of the report to your child’s treatment team.
  • Discuss how the findings might impact therapy goals, medication management, or behavioral strategies.
  • Ask for their input on how best to support your child at home and in other settings.

3) Family: Creating Understanding and Empathy

Sometimes, the people closest to us—grandparents, step parents, siblings—may not fully understand the challenges your child faces. Sharing relevant parts of the neuropsychological evaluation can foster empathy and support within your family.

  • Choose what information is most helpful for family members to know.
  • Have open conversations about your child’s strengths and challenges.
  • Ask for support in implementing strategies at home, such as routines or communication techniques.

4) Care Providers: Ensuring Consistency Across Settings

If your child regularly spends time with nannies, babysitters, or other caregivers, it may be important that they understand your child’s needs and the best ways to support them.

  • Consider sharing key takeaways and practical recommendations from the report that will help caregivers respond effectively.
  • Provide written instructions or checklists if needed.
  • Maintain open communication about what works and what doesn’t.

A Few Final Thoughts

Receiving a neuropsychological evaluation report can be both a relief and a challenge. It offers clarity, but also raises new questions about how to move forward. Here are some tips to help you navigate the next steps:

  • Take time to review and digest the report. Don’t hesitate to ask the neuropsychologist for clarification or a follow-up meeting.
  • Organize the information. Consider making a summary sheet of key findings and recommendations for easy reference.
  • Empower your child. Depending on their age and understanding, talk to your child about their strengths and areas for growth in a positive, supportive way.
  • Remember that you are not alone. There are many resources and communities available for parents navigating similar journeys.

Ultimately, the goal of a neuropsychological evaluation is to help your child thrive. By sharing the findings thoughtfully with the right people, you can build a team of support around your child and help them reach their fullest potential.

 

 

About the Author

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

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

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

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

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

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

Image of a student taking a test and quote from Dr. Hernandez Medellin

What English Language Learners Really Need: A Parent’s Guide

By | NESCA Notes 2026

Image of a student taking a test and quote from Dr. Hernandez MedellinBy Luisa Hernandez Medellin, Psy.D., PMH-C
Bilingual Pediatric Neuropsychologist; PSYPACT-authorized

If your child is learning English at school while also using another language at home, you are not alone. Millions of children in the U.S. are English Language Learners (ELLs). These students bring rich language skills, culture, and life experiences into their classrooms, but they also face unique challenges that schools don’t always understand well.

As a parent, understanding what your child truly needs can help you advocate more effectively and feel more confident working with schools.

English Learners Are Not All the Same

One of the biggest misunderstandings about English learners is the idea that they are all similar. In reality, ELL students come from many different backgrounds. Some were born in the United States, while others arrived recently. Some had strong schooling in their home country, and others experienced interruptions due to migration, poverty, or trauma.

Children may speak one language, two languages, or several. Some can speak well but struggle to read or write. Others understand more than they can say. All of this matters when teachers and specialists try to figure out how a child is doing in school.

Speaking English Isn’t the Same as Doing Schoolwork in English

Many parents hear, “Your child speaks English just fine,” and assume that means they should also be doing well academically. But everyday conversation and school language are very different.

Children often learn social English (chatting with friends, answering simple questions) within a few years. Academic English, the language needed for reading stories, writing essays, solving math word problems, and taking tests, takes much longer to develop. This means a child can sound fluent but still may struggle with schoolwork, and that struggle may be completely normal.

When a Child Is Struggling, What Should Happen?

Teachers are usually the first to notice when a child is having a hard time. The key is figuring out why.

Is the child still learning English? Is the instruction matched to the child’s language level? Has the child had access to consistent schooling? Or is there something more, like a learning or language disorder?

Schools should never rush to label a child with a disability just because they are learning English. At the same time, children who truly have learning challenges should not be ignored because “they just need more time.”

The goal is to understand the whole child, not just test scores.

Parents Must Be Part of the Process

Families play a critical role in helping schools understand a child’s strengths and challenges. However, many parents feel left out because of language barriers or unfamiliarity with the school system.

Schools are responsible for making sure parents understand what’s happening. This includes:

  • Providing interpreters and translated documents
  • Explaining processes step by step
  • Avoiding educational jargon
  • Checking for understanding, not just agreement

Parents should never be expected to rely on their child to translate important information.

Evaluations Should Be Fair and Culturally Sensitive

When a child needs testing (for learning difficulties, speech and language, or attention concerns), the evaluation must match the child’s language and background. Testing a child only in English when they are stronger in another language can give misleading results.

Good evaluations consider:

  • Which language the child is strongest in
  • How long the child has been learning English
  • The language used at home and at school
  • Cultural differences that may affect test performance

Sometimes, no formal diagnosis is given, and that’s okay. Evaluations can still identify areas of need and lead to helpful supports and accommodations.

Understanding Results and Moving Forward

Test results should be explained in plain language. Parents deserve to understand what the findings mean, how English learning affects their child’s performance, and what steps can help next.

Recommendations should be realistic and respectful of family values, beliefs, and resources. The most important part of the process is collaboration – parents, teachers, and specialists working together for the child’s success.

The Bottom Line

Children who are learning English are capable, resilient, and full of potential. What they need most is time, appropriate instruction, fair assessment, and adults who understand the difference between language learning and learning problems.

When schools take a whole‑child approach – one that respects language, culture, and family – English learners don’t just catch up. They thrive.

If you ever feel unsure, ask questions. Your voice matters, and you are your child’s strongest advocate.

 

Headshot of NESCA Pediatric Neuropsychologist Dr. Luisa Hernandez MedellinAbout the Author

As a bilingual pediatric neuropsychologist, Dr. Hernandez Medellin conducts comprehensive and culturally sensitive neurodevelopmental and neuropsychological assessments, comprehensive diagnostic evaluations, and effective care plans, providing appropriate recommendations for the client’s school, home, and the community. She specializes in the identification and assessment of neurodevelopmental disorders such as Autism Spectrum Disorders, ADHD, developmental and learning disorders, and their co-occurrence with anxiety and mood disorders. She also works with children and young adults with acquired brain injuries, epilepsy, brain tumors, strokes, general medical conditions, and genetic disorders affecting the nervous system. She is a native Spanish-speaker, passionate about serving the eclectic and vibrant South Florida community, as well as international patients looking for high-quality and compassionate care.

To book evaluation services at NESCA in Coral Gables, Florida, complete NESCA’s online intake form. 

To book a neuropsychological evaluation or other services at NESCA’s New England offices, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of a feedback session with a parent and neuropsychologist along with a quote from Dr. Rodriguez

Beyond a Label: The Value of Neuropsychological Evaluation Even When There’s No Clear Diagnosis

By | NESCA Notes 2026

Image of a feedback session with a parent and neuropsychologist along with a quote from Dr. RodriguezBy: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

Why Diagnosis Matters

Most parents seek out a neuropsychological evaluation because they’re looking for answers. Often, someone in the child’s life—whether a parent, teacher, or caregiver—has noticed something that doesn’t quite add up. Pursuing testing is a wise and proactive step toward understanding the root of a child’s challenges. In many cases, families hope to find a diagnosis that explains what’s going on. To borrow a phrase from psychiatrist and author Dan Siegel, “You have to name it to tame it.” Having a name for a child’s difficulties is often the first step toward effective support and intervention. Many parents describe feeling validated and relieved when a professional can identify and explain what their child is experiencing. Knowing there is an understandable reason behind their child’s struggles can be both reassuring and empowering.

Why A Clear Diagnosis Isn’t Always Possible

Despite everyone’s best efforts, sometimes a child’s challenges don’t fit neatly into a single diagnostic label. There are several reasons for this:

  • Human complexity: Diagnoses can be helpful frameworks, but they don’t always capture the full picture. Children are wonderfully complex, and their unique mix of strengths and challenges often doesn’t align perfectly with one specific category.
  • Overlap between conditions: Diagnoses are often presented as distinct “boxes,” but in real life, there is a lot of overlap between conditions. It’s often more accurate to picture diagnoses as overlapping circles in a Venn diagram, with many children’s experiences falling in the spaces where these circles intersect. It’s not always possible—or even helpful—to fully separate features into distinct diagnoses.
  • Gradual emergence of symptoms: Some conditions develop slowly and may not be fully recognizable until later in life. For example, mild Autism Spectrum Disorder can be subtle and hard to identify, especially in gender-conforming girls and women. Social challenges may not be obvious in early childhood but can become clearer as social demands increase in adolescence, delaying a clear diagnosis.
  • Lack of formal diagnostic labels: There are profiles commonly seen in clinical settings that don’t yet have formal diagnostic labels. For instance, significant executive functioning weaknesses can greatly impact daily life and academics, but there is no official diagnosis for this. Similarly, while we may use the term “Non-Verbal Learning Disorder” to describe certain patterns of difficulty with visual-spatial skills, organization, social cues, or motor abilities, this label isn’t formally recognized in current diagnostic systems.

What To Do Next

Receiving an evaluation without a clear diagnosis can be disappointing and even anxiety-provoking for parents; however, a neuropsychological assessment still offers significant value. The true strength of a thorough evaluation lies in its ability to provide a detailed understanding of your child’s unique strengths and challenges, and to clearly outline the supports and interventions that will be most helpful. Even among children who share a diagnosis, there can be important differences in how their difficulties present. A high-quality assessment goes beyond simply assigning a label; rather, it paints a comprehensive picture of your child as an individual. Ultimately, the most effective recommendations are those tailored specifically to your child’s needs, regardless of whether they meet criteria for a particular diagnosis.

If you find yourself in this situation, allow yourself space for your feelings. It’s natural to crave clear answers, and it can be difficult to live with uncertainty. Yet, there are concrete steps you can take:

  • Recognize challenges independently of diagnosis: Throughout history, people have faced real and significant difficulties long before science could provide official explanations. For example, prior to advanced imaging, vision problems caused by multiple sclerosis were often mislabeled as “hysterical blindness” until CT scans revealed nervous system lesions. Similarly, before HIV was identified as the cause of AIDS, individuals suffered and died from the illness without a clear diagnosis. Sometimes, it takes time for science to catch up. In the same way, your child’s needs are real and valid, regardless of whether a formal diagnosis has been made.
  • Advocate for your unique child: Similarly, focus on addressing their specific areas of need, rather than waiting for a label.
  • Seek appropriate support services: There’s no need to wait for a formal diagnosis to pursue executive function coaching, psychotherapy, occupational or speech therapy, or specialized academic support. In some cases, early intervention may even help prevent a difficulty from becoming a full-blown diagnosis.
  • Try to be patient and stay open to change:  Remember that your child is still developing in very significant ways. Consider re-evaluation in a few years, as more information may become clear over time.

Remember, your child is more than a label. The insights from a neuropsychological evaluation can guide you in supporting their growth and well-being, even when there isn’t a specific diagnostic term to describe their unique profile. If you have questions or want to discuss whether a neuropsychological evaluation might be helpful, our team is here to support you.

 

About the Author

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

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

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

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

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

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, NY, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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