Due to our recent staff expansion, NESCA has immediate availability for pediatric and adult Neuropsychological Evaluations! To book an evaluation or inquire about our other services, complete our Intake Form.

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Image of a tortoise studying on a notebook with a quote from Miranda Milana, Psy.D., NESCA Neuropsychologist

Smart Doesn’t Always Mean Fast: Understanding Intelligence and Processing Speed

By | NESCA Notes 2024

Image of a tortoise studying on a notebook with a quote from Miranda Milana, Psy.D., NESCA NeuropsychologistBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

Picture what it means to be intelligent.

Do you imagine someone who knows many facts about a variety of topics? Someone who has quick wit? The first person to offer up answers? Chances are that you picture someone who not only knows a lot of information—but thinks fast on their feet. Maybe you envision someone who finishes tests before everyone else, completes homework effortlessly, or could dominate any round of Jeopardy.

Those are all common examples of what comes to mind when someone is described as “smart.” Society often rewards efficiency and how fast someone is to provide answers and results, which is why we equate efficiency and speed with high intellect. The fact of the matter is that intelligence does not always mean fast, and there are many extremely bright individuals who perform slower when it comes to tasks like timed tests, fast-paced conversations, or quick decision-making.

This might seem confusing—how can someone so clearly intelligent struggle to perform tasks efficiently? If they have so many answers, why can’t they provide them quickly?

The answer to this question lies in how our brains are wired. Your cognitive profile is complex and includes many factors. Someone can be intellectually gifted, or considered a “genius,” but still be slow to process information.

If you imagine the brain as a car:

  • Core cognitive abilities—things like reasoning, memory, and language—are the engine. They represent how powerful, thoughtfully designed, and capable the car is.
  • Processing speed is the acceleration. It’s how fast that car can go.

Some people might have a powerful engine that takes longer to accelerate. Once it gets going, however, and gains momentum, it can go far and handle any road it encounters. Others might have very fast acceleration but a reduced capability of maneuvering on complex routes.

How Does This Happen?

Many individuals with this “smart but slow” learning profile have exceptional cognitive skills but need more time to show what they know as it takes them longer to take in, make sense of, and respond to information (functions of processing speed).

This discrepancy between intellect and processing speed can cause significant frustration, both for the individual and for those around them. It can be especially difficult in environments that place an emphasis on speed, such as classrooms, standardized testing, or high-pressure workplaces with fast work deadlines/turnaround times.

Factors that Affect Processing Speed

Some brains are simply wired for a slower pace. But other factors can influence processing speed as well, including:

  • Anxiety
  • ADHD and attentional differences
  • Autism spectrum traits
  • Depression and mood disorders
  • Fatigue or chronic stress
  • Substance use or medications

These factors can cause weaknesses and/or variability in processing speed—even in individuals with otherwise high cognitive reasoning abilities. Unfortunately, this “smart but slow” presentation often leads to incorrect labels, such as laziness or reduced capabilities, when in fact, they just need more time to showcase what they know.

No matter the reason for slower processing speed, these individuals benefit from accommodations and strategies such as:

  • Extended time on tasks, tests, or writing assignments
  • Flexible expectations in fast-paced discussions or decision-making settings
  • Alternative ways to demonstrate knowledge, like untimed projects or creating visuals

Now that we have taken some time to understand how intelligence is defined, I encourage you to consider expanding your idea of what comprises intelligence as a whole the next time someone asks you what it means to be intelligent. Some of the most insightful, creative, and capable thinkers are the ones who take their time to pause, reflect, and dive deep before they respond. These individuals might be the smartest people in the room who just move at their own pace and deserve just as much recognition.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, includingMiranda Milana PsyD 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 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.

 

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Map of Hingham, MA and quote by Dr. Moira Creedon

Strengthening the South Shore Community: Supporting Our Children, Teens, and Young Adults

By | NESCA Notes 2024

Map of Hingham, MA and quote by Dr. Moira CreedonBy: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

It was an exciting dream realized when our NESCA South Shore office in Hingham opened in November 2023. As a resident of the South Shore, I was looking forward to connecting to my community closer to home. I was expecting to enjoy a shorter commute and great location. Pausing to reflect after 16 months with our doors open in Hingham, I realize that it is so much more.

I am grateful for how quickly we were welcomed by pediatricians, therapists, psychiatrists, tutors and executive functioning coaches, attorneys, advocates, and public and private schools. We have all quickly aligned on the needs of our communities. There are many children and teens struggling with gaps in learning, trouble with social connections, high anxiety, depressed mood, and behavioral troubles. Many of these collaborations have also communicated the frustration and sense of burnout facing families who feel like they have been working hard and trying to make changes. Teachers feel discouraged when they have dedicated their hearts and minds to support students, and yet students continue to struggle. The experience in our community is universal – it’s so hard to watch our kids and teens struggle.

This can leave many wondering if neuropsychological testing is just one more “hoop” to jump through. Within the trenches of the daily struggle, it can be hard to see how testing might help – especially when change is so slow. I do all that I can to explain why neuropsychological testing is way more than a hoop; it can be a roadmap. How?

  1. Even if your child has had “evaluations before,” neuropsychological testing is a chance at an integrated and comprehensive evaluation. What does that mean? It means that if you have had pieces of testing before, you still have a pile of pieces – an educational evaluation from school, a private OT evaluation, an early speech evaluation, a diagnostic interview with a therapist, etc. My goal is to take all of those pieces, plus the new ones I add, and put them together into one cohesive puzzle demonstrating how a child or teen thinks and learns.  This is one of the reasons NESCA does academic testing as part of its testing batteries, because these pieces are essential for diagnostic clarity, to see how the profile impacts a person’s real life skills/functioning, and because being a student is a kid or teen’s full time job. It’s not a piece to be overlooked.
  2. Neuropsychological testing can be a chance to understand the “why” when there are many complicated layers. When a child or teen is struggling, we often start in the middle of the process. Often, parents and/or schools want to try to solve the problem with school support, or interventions such as a referral to a therapist or connection to a social skills group. When those efforts stall, the impulse is to try a different solution.  Neuropsychological testing lets us step back, learn about a larger profile or picture of all aspects of a child’s learning or thinking to make meaning of what is happening. Then, we can choose a path for intervention that has the best chance of success.  When a child is struggling, trying to see what works in a way that’s not fully informed or that addresses the child as a whole, is often not the best use of time and resources.
  3. Neuropsychological testing uses the data collected from the testing to outline the steps for what to do next. Any good plan needs a detailed understanding of a problem. Oftentimes, it’s a combination of services that are needed – in the community, at home, and/or at school. It can be hard to figure out how to prioritize the steps, and it’s important to consider what is realistic and feasible. Neuropsychological evaluation can help make those steps clearer.
  4. Neuropsychological testing can give us a good baseline and measure of progress. Caretakers know their children best, so they can often spot subtle issues before they bloom into the bigger issues. Neuropsychological testing can be proactive, and it can help to track how a student responds to interventions. We can also use neuropsychological testing to maximize potential, including how students find their strengths, build their “academic diet” of courses in high school and college, and build stronger study skills along the way.
  5. At NESCA, neuropsychological testing involves important collaboration, perspective, and insight. The reason I mention the community that I’ve met through our South Shore office is because collaboration is key. The observations and insight offered by anyone who comes in contact with a child or teen is invaluable. Standardized test measures are a critical piece of the puzzle, but it’s one part of the critical triad of history, observations, and testing. These collaborations are also helpful to keep the neuropsychological test report “alive” as the community putting the recommendations into action works best through communication.

In the upcoming year, we set many goals for NESCA as a leader in our field. I want to pledge to my community that we will continue to provide the highest quality care and to respect and value our clients and families.  We will continue to build connections to our community members to join the efforts in supporting children, teens, and young adults. I am thrilled for upcoming opportunities to learn and grow alongside you all.  I am deeply grateful to be part of the South Shore community supporting children, teens, and young adults.

 

About the Author

Dr. Creedon offers her expertise in evaluating children and teens with a variety of presenting issues. SheMoira Creedon headshot is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. She tailors each assessment to address a range of referral questions, such as developmental disabilities, including Autism Spectrum Disorder, learning disabilities, attention challenges, executive functioning deficits, and social-emotional struggles. She also evaluates college-/grad school-age individuals with developmental issues, such as ASD and ADHD, particularly when there is a diagnostic clarity or accommodation question.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, 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; the greater Burlington, Vermont region; and Brooklyn, NY (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.

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Neuropsychologist observing the behavior of a child being evaluated

The Importance of Behavioral Observations in Neuropsychological Evaluations

By | NESCA Notes 2024

Neuropsychologist observing the behavior of a child being evaluatedBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Neuropsychological evaluations integrate information collected from multiple sources: (1) history and presenting concerns obtained during clinical interviews with a parent/guardian and the patient, (2) information from a review of records (e.g., past testing reports, school plans, such as IEPs or 504 plans, medical documentation), and (3) neuropsychological and psychological test findings. While these sources of information are important components of an evaluation, behavioral observations are essential to truly understanding a child’s strengths and weaknesses.

Behavioral observations are the qualitative observations made by a clinician that help to understand the child’s unique set of strengths and weaknesses. This includes overall impressions of the child throughout the evaluation process, such as their cooperation level and general attentiveness, their mood/affect and interpersonal skills, any nuances noted in their expressive or receptive language skills, and their fine motor abilities. This provides a “big picture” context to help the interpretation of more specific test findings. For example, if a child appears depressed and, as a result, thinks and completes tasks slowly, this can provide context for test scores which indicate processing speed deficits. In addition, these “big picture” behavioral observations can highlight the daily life impact that results from a weakness. For example, a child may be observed having difficulty opening a food container during a snack break which relates to the fine motor weaknesses seen during direct testing. Lastly, observations during unstructured times (e.g., waiting room behavior, separation from parents, social chit chat in between tasks) can often contribute invaluable information that would otherwise not be elicited from structured standardized testing.

Behavioral observation during testing tasks is necessary to look for any factors that may help elucidate the specific strengths or challenges a child may be experiencing. For example, a child may receive a Low Average score on a “Block Design” task in which they are asked to use blocks to recreate a visual-spatial design within a time limit. However, this Low Average performance could occur for many reasons. First, it could be due to a child having a hard time perceiving the correct angles and shapes within the design, suggesting a visual-spatial deficit. Second, a child may answer all items correctly but had done so after the time limit, suggesting a processing speed weakness. Third, a child may make an error as they rush through each item, suggesting difficulties with attention to detail or impulsivity.

Behavioral observations allow the clinician to identify a child’s unique profile of strengths and weaknesses to a greater specificity, which, in turn, allows for more tailored treatment recommendations. For example, knowing a child has a fine motor weakness that results in difficulty opening food containers could suggest a more specific and targeted treatment goal for a school-based intervention plan or private occupational therapy than simply knowing the child scored below age expectations on a fine motor task. In addition, three children who performed similarly on a block design task would require very different treatment approaches (e.g., visual-spatial accommodations, extended time, attention/impulsivity accommodations). As such, good behavioral observations are the key to a comprehensive evaluation that can provide the most tailored treatment recommendations.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

 

To book a consultation with Dr. Burns 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, 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.

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Map of Massachusetts with Plainville identified on the map and a quote from Dr. Erin Gibbons

Why Choose Plainville?

By | NESCA Notes 2024

Map of Massachusetts with Plainville identified on the map and a quote from Dr. Erin GibbonsBy: Erin Gibbons, Ph.D.
Pediatric Neuropsychologist, NESCA

NESCA opened in 2007 in beautiful Newton, Massachusetts, which is a central location for many residents of the state, who are coming from different directions. Over the last 17 years, we have expanded both in Massachusetts and beyond to Londonderry, NH, Plainville, MA, and Hingham, MA (our newest location).

Our amazing intake coordinators frequently tell me that when they are talking with new clients on the phone and explain that their evaluation will take place in NESCA’s Plainville location, they commonly hear, “Where is that?!”

So, I am here to extol the many benefits of coming to NESCA in Plainville!

  • We are conveniently located off I-495 and Route 95. Since Plainville is in the suburban metropolitan areas of both Boston and Providence, there is very little traffic getting to the office. We also have ample free parking.
  • Miranda Milana, Psy.D. and I both work in Plainville. Between us, we evaluate clients ranging from 12 months to 30+ years of age. We both have extensive experience testing clients who have historically struggled to participate in traditional testing; for example, clients who are nonverbal, behaviorally dysregulated, or medically complex.
  • We receive frequent referrals for challenging diagnostic questions related to autism spectrum disorders (ASD), mood disorders, or intellectual disabilities and are comfortable taking on these often-complicated cases.
  • Both Dr. Milana and I evaluate toddlers for autism spectrum disorders in our ASD Diagnostic Clinic in Plainville. Our goal in the clinic is to help provide early detection of autism in children under three-years-old, when interventions are most effective.
  • Our fantastic occupational therapist, Jessica Hanna, MS, OTR/L works in the Plainville office. She is available for both OT evaluations and treatment. She also allows our testing clients to use the sensory gym during their breaks in their evaluation.
  • While your child is engaging in testing sessions during their evaluation, there are several stores, such as Target, that are only a 5-minute drive from our office. If you are looking to get some self-care in during their testing, you can even catch a 60-minute yoga or barre class in the plaza next door.
  • Finally, Patriot Place is a 10-minute drive from NESCA’s office in Plainville. If your child is a football or soccer fan, a visit to Gillette Stadium/Patriot Place is a great way to reward them for their hard work during the evaluation!

We invite you to learn more about the services we offer at NESCA in Plainville, MA, who we serve, and the many benefits of our convenient location. If you have any questions about our Plainville location, please let us know. We are happy to discuss the options for evaluations in Plainville.

 

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. 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Hingham, and Plainville, Massachusetts; Londonderry, New Hampshire; and staff in Burlington, Vermont and Brooklyn, NY, 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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Headshot of Alison Burns and a quote by her

Introducing Alison Burns, Ph.D., NESCA Pediatric Neuropsychologist

By | NESCA Notes 2024

Headshot of Alison Burns and a quote by herBy: Jane Hauser
Director of Marketing & Outreach, NESCA

I had the chance to interview Dr. Alison Burns, a pediatric neuropsychologist who joined NESCA earlier this year. I learned a lot about Dr. Burns, both personally and professionally in my interview. I invite you to learn more about her, her approach to pediatric neuropsychological evaluation, and her expertise in ADHD and concussion, among other domains.  

You returned to the workforce this year after having children. How was your experience returning to work, and how was NESCA instrumental in doing so?

When I had my second and final child, I wanted to take a more extended parental leave to really soak up that precious early childhood time before returning to the workforce. Throughout my time out of the workforce, I completed continuing education classes and remained involved with a research project from my time at Children’s National in Washington DC. Because of the excellent supports at NESCA, it was a smooth transition back to work! I had the support of Dr. Moira Creedon, who served as a mentor for the first six months. In addition to the larger collaborative group of colleagues, I had someone I could go to with any specific questions I had.

Why did NESCA feel like the best fit for you?

I knew that I wanted to join a group practice because I wanted the ability to consult and collaborate with colleagues, particularly when working with more complex patients. It was important to me to join a team that is multidisciplinary as the unique perspectives that other disciplines at NESCA offer allow me to think more holistically about a patient’s profile and needs. NESCA has a culture of professional development and encourages clinicians to continue to learn through continuing education which fit with my core belief in the importance of staying up to speed with new evidence-based research.

I was also looking for a practice that understood family balance, because even though I am working, I am still the primary caregiver for our children, particularly during those morning and afterschool shifts. I knew I would need some flexibility, and everyone I met at NESCA really understood what it’s like to be a working mom and the load that comes with that role. At NESCA, I can make my work schedule fit my family’s needs.

What types of issues do you enjoy figuring out and unraveling for families?

My favorite population of kids to work with is those who have or are showing signs of ADHD. I trained at Children’s National with Gerard Gioia, Ph.D., who is an expert in the field of executive functioning. It was a big focus of my training, and I had the opportunity to evaluate many kids with ADHD throughout my post-doctoral training. It’s a very important population to assess because often times children are diagnosed with ADHD based on a symptom checklist alone. However, there are many other things that cause symptoms of ADHD such as anxiety/depression, learning disorders, or language difficulties just to name a few. This overlap in symptoms can lead to a misdiagnosis which is problematic as interventions for these disorders are wildly different. It’s important to tease apart these symptoms through a comprehensive evaluation so children receive the correct interventions and supports.

You’ve talked about the importance of behavioral observation during evaluations? What makes that so important?

Test scores, or data, can only tell me so much. Really watching a child and understanding how and why they performed a certain way adds critical information that fine tunes my understanding of a child’s neuropsychological profile. While it is important to consider a person’s history and current symptoms from clinical interviews, questionnaire data from a variety of sources, and direct testing scores, I think behavioral observations allow us to “look under the hood” so to speak. Seeing how a child works and thinks often provides me with excellent insight that helps me develop very targeted and specific recommendations for that individual.

You were previously part of a hospital-based multidisciplinary team. Can you explain how your experience with that team helps you in your work at NESCA?

I completed my internship and postdoctoral fellowship at Children’s National and had the opportunity to be a member of two multidisciplinary medical specialties (i.e., epilepsy and hematology/oncology). So far at NESCA, I’ve had the opportunity to work with one child who is post-chemotherapy, and it was rewarding to be able to support that patient with an understanding of the neuropsychological risks that chemotherapy can pose. It’s such a wonderful, unique population to work with. The resilience of child cancer survivors is just remarkable.

In addition, I worked with a range of medical providers across my other training opportunities, including therapists, psychiatrists, speech and language therapists, occupational therapists, physical therapists, behavioral health specialists, and primary care physicians. This experience taught me the importance of working with all providers who may be associated with a given patient in order to provide the most integrated care.

My training in a children’s hospital also taught me how important it is to rule out any medical explanations for the challenges we may see in the individuals we evaluate. For example, while I was a post-doc, I was evaluating a child who came to our ADHD clinic for a general ADHD evaluation. I noticed some things that had me concerned about the possibility of absence seizures. After further testing, it was determined that this child was actually experiencing absence seizures and not ADHD. Thankfully, we were able to refer them to the epilepsy team to get the correct treatment.

How did you gain expertise in evaluating students with concussions and supporting those who have lingering effects from concussion?

That specialty came out of my internship and post-doctoral fellowship at Children’s National. I was fortunate to have been able to work with some of the leading experts in the field of concussion, both clinically and in research pursuits. I am part of a “sports family,” so it was a natural fit for me. It’s also a booming area of research that was so interesting to me. During my fellowship, I saw patients who had suffered a concussion recently (often around a week after injury), following them serially through to the point of recovery. I provided them with guidance about how to safely return to school and physical activities, adapting the plan each week as their recovery progressed. Some children took much longer to recover from their concussion and had ongoing struggles and negative impacts long after the injury. In doing a full neuropsychological evaluation with these kids, we were able to consider the full scope of their needs and whether they needed a 504 plan or IEP in place.

It’s become an increasingly important population to think about because it’s not just kids who play sports that get concussions. It could be anything from a child who falls on ice or runs into playground equipment. It is not uncommon to learn that a patient being seen for an evaluation has a history of concussion at some point in their childhood. Having this training and expertise helps to tease apart what may be related to concussion and what is most likely unrelated to concussion.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

 

To book a consultation with Dr. Burns 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, 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.

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Image of clinicians collaborating around a conference table

Why I Started a Group Pediatric Neuropsychology Practice

By | NESCA Notes 2024

Image of clinicians collaborating around a conference tableBy Ann Helmus, Ph.D.
Founder and Director, NESCA

In the field of pediatric neuropsychology, the complexities of child development and the wide array of diagnoses children may face can often be overwhelming for any one practitioner to fully grasp. With this in mind, I chose to open NESCA’s doors as a group practice back in 2007. The advantages of a group practice model were clear to me then and have become even more critical in today’s environment – and with today’s challenges facing children – particularly when it comes to addressing the varied and intricate needs of our young clients and their families.

When I was creating NESCA, I was a mother with much younger children than they are now and thought about the concept of breaking out as a solo practitioner. I was skilled and had plenty of years of education and experience by that time. I knew I could have done it – and likely had much more flexibility and far less stress in my life at a time when that was hard to come by – but, I loved (and still do) the concept of “group think” far too much to go that route.

Group think – or today’s “hive mind” – to me meant bringing together multiple minds to tackle a problem. A group allows for different perspectives to come together, often leading to creative, outside-the-box solutions for families that may not have been considered by me alone, even after seeking outside consultation with another practitioner. My decision to build NESCA as a group practice has since led to a constant cross-pollination of ideas among our group of expert clinicians, through scheduled weekly seminars and case conferences as well as the more casual in-office discussions. All of this collaboration enhances the care we provide and ensures that the recommendations we make are as comprehensive, vetted, and tailored as possible.

From the beginning, we have been and remain committed to offering the highest level of care, and one of the key ways we do this is by nurturing the collaborative environment that NESCA was founded on. We started out as a small group practice with several colleagues who had been working together in a separate organization. Since then, we have grown into a larger team of diverse clinicians and specialists who together have expertise in every diagnosis that presents itself. Each NESCA clinician has their own strengths and areas of focus, allowing our entire team to draw from this collective pool of knowledge. No matter what challenge a child is facing – whether it’s ADHD, autism, a specific learning disorder, or an emotional regulation issue – we can pair them with a clinician who has in-depth experience and a keen understanding of that particular diagnosis.

In addition to specialized knowledge, working as part of a group also provides the invaluable opportunity to check our thinking. Even as highly seasoned professionals who have been assessing and evaluating clients for decades, we still benefit from feedback and fresh perspectives of our colleagues and their own networks. And in a group setting, colleagues are available to consult, offer second opinions, and share resources and recommendations. This collaborative approach ensures that our evaluations and recommendations are not only thorough but also well-rounded, and likely discussed among our team, leading to more accurate diagnoses and more effective interventions and treatment plans.

Ultimately my choice to develop and grow a group practice means that our clients receive the benefit of our individual and collective expertise, collaboration, and shared insights. I’m so grateful that families who come to NESCA are able to benefit from our many minds working together toward the same goal: helping each child or individual reach their full potential. This level of care is why we believe so deeply in the group practice model.

 

About the Author

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 30 years. In 1996,Ann Helmus headshot she jointly founded the Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost 10 years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

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

She is an active participant in the Trauma and Learning Policy Initiative, a collaborative effort between Massachusetts Advocates for Children and Harvard Law School’s Education Law Clinic, a project involving a multi-disciplinary group of professionals working together to better define and meet the educational needs of children who have been traumatized.

She received her undergraduate degree in Neural Science from Brown University and earned her doctorate at Boston University School of Medicine. Her postdoctoral fellowship in pediatric neuropsychology was completed at Children’s Hospital in Boston, where she remained on staff for seven years. Concurrently, she served as neuropsychologist to the Pediatric Brain Tumor Clinic at Dana-Farber Cancer Institute in Boston.

To book an appointment with NESCA’s expert neuropsychologists, 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.

 

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school student frustrated over the work

Navigating the Post-Honeymoon Phase: Signs Your Child May Need Support This School Year

By | NESCA Notes 2024

school student frustrated over the workBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

With the start of the school year well underway, we are beginning to see students and teachers settling into their classroom routines. Along with this increase in familiarity and comfortability, parents often start to see bits and pieces of challenges arise around this time of year that may have gone unnoticed during the initial “honeymoon period.” You may be wondering what challenges you should be looking out for and when those challenges warrant an evaluation to determine further supports and services. Let’s take some time to explore what to keep an eye on, and when it might be time to reach out to schedule an evaluation to dive a bit deeper into what is going on. 

Academics

No matter their age, if you ever feel your child is inundated and overwhelmed with schoolwork, it is a great idea to reach out to their teachers; ask how long homework should be taking and whether it should feel like review vs. new material. If homework starts to consistently become a battle, it might be worth taking a closer look into why. It could be because it’s a new and appropriately challenging course. It could also be because there are underlying language-based learning disabilities, a nonverbal learning disability, executive function challenges, or increasing symptoms of anxiety or depression. Some specific things to watch for:

  • Frequent tears during homework that appear to get worse instead of better
  • Not appearing to “get it” even after review and repetition
  • Difficulty studying/holding information in memory
  • Dysfluent reading or not understand what they’ve read
  • Challenges understanding math concepts or memorizing math facts
  • Difficulty applying and generalizing concepts
  • Opposition to handwriting tasks or when asked to compose a writing assignment
  • Poor penmanship that is illegible and/or immature for age
  • Not meeting benchmarks on assessments

Social Skills

At this point in the school year, children are typically starting to be interested in other peers within their classrooms. For younger kids, they are likely to feel more comfortable interacting with other children in their play. Common social concerns can include:

  • Not remembering any names or faces of kids in their class
  • Preferring to play alone, hesitant to join in with a group
  • Appearing unaware of social cues or how to initiate conversation with others
  • Rigidity in play—always wanting to play their own game by their own specific rules
  • Frequent peer conflicts and feeling rejected or left out

Emotional Functioning

A new school year often elicits feelings of anxiety in kids no matter how outgoing and social they may be! When might it be a sign that there is something more?

  • Continued and persistent resistance to going to school
  • Frequent somatic complaints with no apparent cause (e.g., headaches, stomachaches)
  • Change in sleeping patterns – not being able to fall asleep at night or waking up frequently
  • Difficulty with regulating their emotions/frequent tantrums
  • Changes in appetite
  • Negative statements about themselves
  • Increase in irritability
  • Withdrawal from others or previously preferred activities
  • Always wanting to know what is happening next and struggling with changes in routine (i.e., Does a substitute teacher derail their whole day? If a friend is out sick, is there a perseveration on where they are? Do you wait to tell them about changes in plans so they don’t worry in advance?)

Attention/Focus

Have you ever found yourself feeling restless and distracted when sitting through a work meeting? Kids are no different! Sitting still and paying attention for extended periods of time can be really tough – especially after being on summer break! Here are a few things to keep an eye on:

  • Frequently fidgeting in their seat or needing a fidget item to increase concentration
  • Difficulty with multi-step directions
  • Not remembering information presented during lectures
  • Acting impulsively
  • Easily distracted/daydreaming
  • Acting as if run by a motor
  • Blurting out thoughts, interrupting conversations
  • Teacher feedback that they are interrupting other students or not able to sit quietly and attend to class discussions

As always, you know your child best! If you feel like this year is off to a rocky start, or you’re starting to have questions regarding their functioning, do not hesitate to reach out and schedule an evaluation. A comprehensive neuropsychological evaluation is designed to look at ALL aspects of a child to determine what is getting in their way of reaching their potential. We are always here to help!

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents 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 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.

 

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Individualized Education program written on blocks, IEP Symbol

Guide to Transition Planning and the New Massachusetts IEP

By | NESCA Notes 2024

Individualized Education program written on blocks, IEP SymbolBy: Kelley Challen, Ed.M., CAS
Director of Transition Services, NESCA

Transition planning has long been a critical component of special education, mandated by the Individuals with Disabilities Education Act of 2004 (IDEA 2004). Its purpose is to prepare students for life beyond high school in the areas of postsecondary education and/or training, employment, and independent living. While federal law requires transition services to begin at age 16, Massachusetts has gone a step further, requiring that postsecondary goals and transition services be included in a student’s individualized education program (IEP) by age 14.

However, the previous Massachusetts IEP format made it difficult to effectively integrate transition planning. Even with the introduction of a Transition Planning Form (TPF) to facilitate discussions, there was no consistent practice for embedding contents of the TPF into the IEP itself.  As a result, much of the transition planning that was included ended up in the “additional information” section, limiting its visibility and coherence within the broader IEP process.

After over a decade of development, the Massachusetts Department of Elementary and Secondary Education (DESE) released a new IEP document last school year, which all districts are required to adopt during the 2024-2025 academic year. One of the most promising features of this new IEP is its heightened emphasis on transition planning, now driven more clearly by the student’s vision and voice. Notably, the new format embeds transition planning directly into the structure of the IEP, making transition assessments a more visible and integral part of the process. While the legal requirements for transition planning remain unchanged, the new IEP format makes it easier to document these critical steps, ensuring that important aspects of transition planning are not overlooked.

So, what’s important to know about transition planning in the New MA IEP?

Student Voice and Vision are Up Front
One of the most significant improvements in the new IEP is its emphasis on the student’s voice and future vision. The “concerns” section is clearly labeled Student and Parent Concerns, empowering students to express what they want out of their IEP process. This is immediately followed by the Student and Team Vision, placing the student’s aspirations firmly at the center of the IEP process. Students ages 3-13 are encouraged to participate in visioning, fostering earlier goal setting, and encouraging teams to think explicitly about the student’s goals at younger ages. For students who will be ages 14-22, the IEP now more explicitly asks for the student’s postsecondary goals in key planning areas: education and/or training, employment, and independent living. This focus ensures that the IEP reflects the student’s ambitions and drives a more outcome-oriented process for postsecondary success.

Disability Categories are Transparent
The new IEP introduces a more transparent Student Profile section, where teams no longer need to select one “primary” disability category, making a student’s full profile more visible to all team members. While students can participate in the IEP process without fully understanding their disabilities, they can be more fully engaged if they know that they have one or more disabilities as defined by IDEA. Learning to disclose their disability and understand how it affects their learning, work, and daily life is a critical component of the transition process, empowering students to self-advocate and seek the supports they need. The transparency in the new IEP can help students gain a clearer understanding of the connection between their disabilities, their disability-related needs, and the accommodations and services they receive. Although transition-aged students are not required to participate in all aspects of their IEP, they must be invited when transition planning is discussed. Research shows that students who learn to lead their team meetings and self-advocate regarding their disabilities experience more success when transitioning to adulthood. This revision to the IEP offers a more balanced view of how multiple disabilities shape a student’s overall profile and enhances transparency in disability disclosure.

Assistive Technology as a Critical Component of the Student Profile
Assistive technology (AT) plays a vital role in helping students build independence and reduce reliance on prompting and support from adults or paid providers. The new IEP appropriately increases the visibility of assistive technology within the Student Profile. Whether used to support communication, mobility, learning, daily living skills, or work-related tasks, assistive technology empowers students to succeed both in school and in adulthood. The updated IEP format requires teams to specify whether these needs will be addressed through accommodations/modifications, goals/objectives, the service delivery grid, or another method, as documented in the Additional Information section. By thoroughly considering and documenting a student’s assistive technology needs, the IEP ensures students have access to the tools they need for greater independence and long-term success—a critical step in transition planning.

Life Skills and Self-Determination Can Be Explicitly Included at Early Ages
The new IEP organizes a student’s present levels of performance into four main areas—Academics, Behavior/Social/Emotional, Communication, and Additional Areas, including “activities of daily living.” Even before age 14, teams now have more explicit opportunities to describe strengths and needs in a broad range of areas that impact transition planning. Many students with disabilities require earlier planning and support to build independence in areas like personal care, home living, and community integration. When skill development takes longer, being thoughtful about life skills instruction, parent training, referrals to community resources, and assistive technology is crucial at earlier ages. While not explicitly in the document, the new format also provides an opportunity for teams to evaluate self-determination skills at younger ages. Self-determination—encompassing self-awareness, self-advocacy, self-efficacy, choice-making, decision-making, goal setting, and self-regulation—is one of the strongest predictors of successful transition to adulthood. Current performance with these skills can be addressed across various categories (Academics, Social, Communication) or as a key “Additional Area.”

Current Performance Levels for Transition Services are Built-in
A major improvement in the new IEP is the explicit integration of transition assessment data and transition services within the IEP itself. For students turning 14 to 22, the IEP now includes a dedicated postsecondary transition planning section, which can also be used earlier if the team determines transition planning should start sooner. This section starts with documentation of the student’s current performance, strengths, preferences, interests, and disability-related needs in each postsecondary planning area—education/training, employment, and community experiences/postschool independent living. All of this documentation is informed by transition assessment data. Teams will also specify whether accommodations/modifications, goals/objectives, services, or other activities—documented in Additional Information—are needed to support the student’s transition planning. This ensures that all team members know exactly where to find details on how transition services will be implemented. As a caveat, all skills developed through special education support transition planning; thus, all general content in the IEP is relevant. Teams can confidently reference other parts of the IEP when completing the Postsecondary Transition Planning section to avoid unnecessary duplication of content.

Course of Study and Projected Graduation/Exit Date are Centrally Documented
Federal law has always required teams to identify a “course of study” that aligns with the student’s postsecondary goals, but there was no obvious place to include this in the old IEP. The course of study—a semester-by-semester plan of the classes the student will take—is a critical part of transition planning. For instance, a student aspiring to become a doctor will likely need lab science and advanced mathematics in high school. The new IEP provides places for teams to document the student’s course of study, the anticipated type of completion document (diploma, certificate of attainment, etc.), the student’s expected graduation date, and the student’s progress toward meeting exit requirements. This information is essential for monitoring and informing transition planning and creates a clearer link between the student’s transcript and progress toward their individualized postsecondary goals.

Transfer of Rights and Decision-Making
Adult decision-making is a significant milestone, and the new IEP emphasizes discussing the Transfer of Rights at least a year before the student turns 18. The IEP now includes designated space to document when both the student and family have been provided notice of this transfer and a copy of procedural safeguards. In addition, the new IEP encourages teams to discuss and document the student’s Decision-Making Options for adulthood. Although this is a requirement once the student turns 18, its more visible presence in the IEP encourages earlier conversations. This is crucial, because preparing for adulthood may require putting legal, educational, medical, and financial decision-making frameworks in place—processes that can take time to complete.

Community and Interagency Connections
Transition planning takes a village, and a central part of effective planning is to build a supportive network that extends beyond the protections of special education. The new IEP includes a dedicated section for community and interagency connections, ensuring that teams discuss and document connections to community partners (such as independent living centers, job centers, pre-employment transition service providers, etc.) that are supporting the student. Additionally, the IEP incorporates prompts to ensure timely referrals to adult service agencies well before the student’s exit. In Massachusetts, Chapter 688 Referrals—referrals to adult human services to engage in transition planning for students who will need continued support—must be completed at least two years before the student’s expected exit from special education. The new IEP provides even more guidance to ensure that teams can make and document these referrals on time.

Final Thoughts

The new Massachusetts DESE IEP represents a significant advancement in integrating transition planning into the IEP process. As teams implement the new IEP, prioritizing adequate transition assessments will be crucial, as effective transition planning relies on thorough assessment processes that reflect each student’s strengths, needs, and aspirations for the future. The law requires the use of age-appropriate assessments to identify the student’s strengths, interests, preferences, disability-related needs, and, most of all, their postsecondary goals. Involving diverse voices, such as guidance counselors, is also essential for ensuring a seamless connection between a student’s course of study and postsecondary goals. While the law has not changed, the new IEP makes transition planning more transparent. More importantly, it places the student’s vision and voice at the forefront of the process.

Additional Resources

To download a PDF-Version of this Guide, visit https://nesca-newton.com/wp-content/uploads/2024/10/Guide-to-Transition-Planning-and-the-New-MA-IEP.pdf 

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker with over 20 years of experience supporting youth andKelley Challen headshot young adults with diverse developmental and learning abilities. Since 2013, she has served as Director of Transition Services at NESCA, offering individualized transition assessments, planning, consultation, coaching, and program development. She specializes in working with students with complex profiles who may not engage with traditional testing tools or programs. Ms. Challen holds a BA in Psychology and a Minor in Hispanic Studies from The College of William and Mary, along with a Master’s and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard Graduate School of Education. She is a member of CEC, DCDT, and COPAA, believing it’s vital for all IEP participants to have accurate information about transition planning. Ms. Challen has also been actively involved in the MA DESE IEP Improvement Project, mentored candidates in UMass Boston’s Transition Leadership Program, and co-authored a chapter in Technology Tools for Students with Autism.

To schedule an appointment with one of NESCA’s transition specialists, please complete 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; the greater Burlington, Vermont region; and Brooklyn, NY (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.

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an image of a child thinking about how different each side of his brain is, used to describe the difference in functioning between both sides when nonverbal learning disability is present

What is a Nonverbal Learning Disability?

By | NESCA Notes 2024

an image of a child thinking about how different each side of his brain is, used to describe the difference in functioning between both sides when nonverbal learning disability is presentBy Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

At August’s Democratic National Convention, Gus Walz, the teenage son of Democratic Vice Presidential nominee Tim Walz and his wife Gwen, melted hearts throughout the country with his outward show of emotions upon his father’s nomination. He exhibited deep love and pride for his dad in that moment. His tearful cheers evoked a sense of tenderness among many, confusion for others, and, sadly, public mockery, as well. At that time, many people were unaware that Gus carries the diagnosis of Nonverbal Learning Disability (NLD or NVLD) – a cognitive processing profile that often impacts emotion regulation and social cognition; however, his family’s openness about his condition has brought new attention to this profile.

There is often lack of awareness or confusion about what a NLD is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management.  As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning – On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception – In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration – Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills – Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive Functioning – Executive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning – With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges – Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD?

The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. One comprehensive resource is the NVLD Project (https://nvld.org/), a nonprofit organization that conducts research, offers educational workshops and community outreach, and has an extensive list of NLD-related resources for parents, clients, and schools.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at www.nesca-newton.com.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in greater Burlington, Vermont and Brooklyn, New York, 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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Image of the MA State House with quote from the blog

Access to Mental Health Care in Massachusetts: Challenges and Opportunities

By | NESCA Notes 2024

Image of the MA State House with quote from the blogBy: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

Access to mental health care is an increasingly critical issue across the United States, and Massachusetts is no exception. While the state is often lauded for its comprehensive healthcare system and progressive policies, barriers to mental health care still persist. In this blog post, we will explore the current landscape of mental health services in Massachusetts, the challenges faced by individuals seeking care, and the initiatives being implemented to improve access.

The State of Mental Health Care in Massachusetts
Massachusetts has made significant strides in mental health care over the years. The state boasts some of the country’s leading hospitals, research institutions, and mental health professionals. Organizations such as the Massachusetts Department of Mental Health (DMH) and the Massachusetts Behavioral Health Partnership (MBHP) work to ensure that residents have access to necessary services, yet many still find it difficult to access care. There are also continuing racial inequities in medical and mental health care and a significant shortage of mental health providers of color.

Types of Services Available
Massachusetts offers a range of mental health services, including:

  • Inpatient Treatment: Hospitals provide acute care for individuals in crisis.
  • Outpatient Services: Clinics and private practices offer therapy and counseling sessions.
  • Community Support: Programs that focus on recovery and support that are community-based.
  • Telehealth Services: An increasingly popular option, especially since the COVID-19 pandemic, allows individuals to access care remotely.

Despite this variety of resources available, the gap between those in need and those receiving care remains significant.

Barriers to Accessing Mental Health Care

  1. Stigma and Misunderstanding

Stigma surrounding mental health issues is a significant barrier. Many individuals hesitate to seek help due to fear of judgment or misunderstanding by others. This stigma can come from family, friends, or even within professional environments. Education and awareness campaigns are essential to reducing stigma and encouraging individuals to seek the care they need.

  1. Insurance Limitations

While Massachusetts has implemented laws requiring insurance companies to provide equal coverage for mental and physical health services, discrepancies still exist. Many individuals find that their insurance plans have high deductibles, limited provider networks, or caps on the number of therapy sessions covered.

  1. Workforce Shortages

There is a notable shortage of mental health professionals in Massachusetts, particularly in rural areas. While urban centers like Boston have many providers, individuals in more remote locations often face long wait times or a lack of available services altogether. The distribution of resources is uneven, exacerbating access issues.

  1. Financial Barriers

Even with insurance, the cost of mental health care can be prohibitive. Copays, deductibles, and uncovered services can add up quickly, making it difficult for individuals to afford the care they need. Paying privately often leads to shorter wait times but is more expensive. Often families find themselves caught in a cycle where they need help but cannot afford it.

Current Initiatives and Improvements
To address these challenges, Massachusetts is taking steps to improve access to mental health care. Various initiatives are being implemented across the Commonwealth.

  1. Legislative Efforts

The Massachusetts State Legislature has been active in introducing bills aimed at improving access to mental health care. The “Mental Health Parity” law ensures that mental health care is treated on par with physical health care in terms of coverage. Advocacy groups continue to push for reforms that address loopholes and improve enforcement.

  1. Telehealth Expansion

The COVID-19 pandemic accelerated the adoption of telehealth services, which have proven to be a valuable tool for increasing access to mental health care. Telehealth allows individuals to connect with therapists and psychiatrists from the comfort of their homes, reducing barriers related to transportation, location, and time constraints.

  1. Community-based Programs

Community-based mental health programs are essential in providing support and resources. Initiatives, like the Massachusetts Community Behavioral Health Center (CBHC) program, aim to create a network of services that meet the diverse needs of communities. These centers offer a variety of services, including crisis intervention and case management.

  1. Educational Campaigns

Efforts to combat stigma and raise awareness about mental health are crucial. Organizations like the National Alliance on Mental Illness (NAMI) Massachusetts work tirelessly to educate the public about mental health issues, promote resources, and advocate for policy changes. These campaigns foster understanding and encourage individuals to seek help.

Looking Ahead: The Future of Mental Health Care in Massachusetts
The landscape of mental health care in Massachusetts is continually evolving. While significant challenges remain, the state is committed to addressing these issues through comprehensive reforms and community-based approaches.

  1. Continued Advocacy

Ongoing advocacy at both the grassroots and legislative levels is essential in pushing for systemic changes. By uniting voices and sharing personal stories, advocates can influence policies that prioritize access to mental health care.

  1. Innovative Solutions

As technology continues to advance, innovative solutions, such as mobile apps for mental health monitoring, digital therapy platforms, and AI-driven resources, could enhance accessibility.

Conclusion
Access to mental health care in Massachusetts is a multifaceted issue that requires ongoing attention and action. While challenges persist, the State legislature is committed to improving access to community programs and public awareness campaigns. By addressing stigma, financial barriers, and workforce shortages, Massachusetts can move closer to a system where mental health care is truly accessible for all. This journey continues. With continued advocacy and innovation, a brighter future for mental health care in the state is on the horizon.

How to Access Care
If you are or someone you love or care for is experiencing a mental health issue, you need to know how and where to find services. First, contact your primary care doctor or pediatrician. For parents or caregivers, the next contact should be someone at the child’s school. It could be an administrator, a teacher, or a mental health professional. Seek out additional information about what school personnel have observed about the child and find out about available resources at the school. This is an important part of treatment for a child.

 If you or the person you’re seeking to assist requires a crisis response to meet immediate safety needs, call 911, go to your local emergency room, or find your local Emergency Service Program by calling 877-382-1609.

Call or text the Massachusetts Behavioral Health Help Line (MBHHL) at 833-773-2445 for free, confidential support 24/7. Live chat is available at: https://www.masshelpline.com/. This helpline is useful even if you’re not sure what kind of help you need. Interpretation in over 200 languages is available in real time. Deaf or hard of hearing individuals can contact MassRelay at 711.

NAMI Compass is the information and referral helpline at NAMI Massachusetts. They provide resources and support to help people navigate the complex mental health system and problem solve in challenging situations. The COMPASS helpline is available Monday through Friday, 9 AM – 5 PM. Call the helpline at 617-704-6264 or 1-800-370-9085, or email them at compass@namimass.org.

SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

The Massachusetts Substance Use Helpline is a good resource for finding substance use treatment and recovery services. Helpline services are free and confidential. Call 1-800-327-5050.

The William James INTERFACE Referral Service aims to increase access to mental health and wellness services for individuals. Call the helpline at 888-244-6843 or 617-332-3666 from 9 AM- 5 PM on Monday, Wednesday and Friday, and 8 AM- 6 PM on Tuesday and Thursday, to work with a Resource and Referral Counselor who will help you navigate the challenges of finding mental health services. Communities served can be found on their website, https://interface.williamjames.edu/communities.

 

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents,Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

 

If you are interested in booking an appointment for an evaluation with Dr. Dautoff 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; 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.

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