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Neuropsychological Evaluation

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10

Paying Proper Attention to Inattention

By | NESCA Notes 2022

By: Maggie Rodriguez, Psy.D.
Pediatric Neuropsychologist, NESCA

One of the most common referral questions I see in my work as a neuropsychologist is, “Does my child have ADHD?” When a child has trouble focusing, Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of the first things that comes to mind, and for good reason. However, ADHD is only one potential underlying cause of inattention. In fact, there are many cases in which attentional difficulties are present as part of another underlying issue. Some of these include:

  1. Anxiety—On a physiological level, anxiety involves activation of the “fight or flight” response. This adaptive process is designed to alter attention in order to prioritize survival. When the brain senses a threat, it tunes out everything else so it can focus on dealing with the danger at hand. This is extremely useful when the threat is something like a wild animal chasing you. In that case, you need to momentarily shift all of your attention to survival. It’s the worst possible time to be distracted by anything that could divert your attention from escaping a dangerous situation. But when students are anxious, especially for extended periods of time, the same process can make it difficult to focus on day-to-day tasks, including learning.
  2. Learning Disorder—Students who lack the academic skills to engage with the curriculum can appear to be simply not paying attention. If a student’s reading skills, for instance, are several grade levels below expectations, they won’t be able to actively engage with written assignments or materials in class.
  3. Communication Disorder—Deficits in receptive and/or expressive language often manifest in ways that mimic inattention. If a child cannot grasp what is being communicated, they will have significant difficulty following verbal instructions, answering questions, and retaining important information. This can easily be misinterpreted as a sign of an attentional issue when, in reality, the underlying problem has to do with communication.
  4. Autism Spectrum Disorders (ASD)—Many individuals on the Autism spectrum tend to be more attuned and focused on internal experiences (e.g., their own thoughts and specific interests) than to the external environment. As a result, they can miss important information, ranging from social cues to expectations communicated at home or within the classroom.
  5. Other neurocognitive disorders—Weaknesses in other cognitive functions, particularly those we refer to as “cognitive proficiency” skills (e.g., processing speed) and executive functions (e.g., working memory, organization) can also result in apparent inattention. Students who cannot process information quickly are sometimes unable to keep up with the pace of instruction, which causes a diminished ability to comprehend and retain information. Similarly, students who cannot hold information in working memory or organize ideas and concepts can demonstrate reduced comprehension.

There is a range of other issues that can contribute to children or adolescents appearing inattentive. Some of these include trauma, absence seizures, hearing impairments, thought disorders and/or hallucinations, and Tourette’s Syndrome. It is important to thoroughly evaluate the potential causes of inattention and to consider an individual’s full history and presentation.  Because different underlying issues will necessitate different treatment approaches, getting to the root of the issue can be tremendously important.

 

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.

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

10

Receiving, Understanding, and Sharing Diagnostic Labels and Profiles

By | NESCA Notes 2022

By Yvonne M. Asher, Ph.D. 
Pediatric Neuropsychologist

A recent New York Times article described a trend, noticed by many mental health professionals, where adolescents and young adults have been exploring mental health on social media. The article references the explosion of TikTok videos in which individuals disclose their psychiatric diagnoses and symptoms. For young people searching on social media, these videos are shown at an increasing rate, based on algorithms. Young people are finding a great deal of validation and connection by watching these videos. Many begin to seek out mental health support, often entering the therapeutic relationship with a clear idea of what their diagnosis will be.

As a mental health professional, I see a great deal of complexity coming from this trend. Certainly, the dissemination of information about mental health and reduction in stigma seems to be positive. Allowing individuals to more readily learn about psychiatric conditions will hopefully reduce fear, embarrassment, shame, and avoidance of mental health care. In addition, promoting self-understanding is important, particularly for young people who are in a developmental stage of identity exploration.

However, there are also concerning implications. First, self-diagnosis can be problematic in mental health, as it is in the medical field. There is a fine balance between being an informed health care consumer and a patient unwilling to listen to the expert opinion of their physician. Entering a physician’s office, unwavering in certainty of your diagnosis, can lead to friction and frustration. In contrast, entering with relevant personal and family history, a thoughtful list of your current symptoms, and readily accessible notes on recent changes in your lifestyle can be invaluable in partnering with your doctor to determine the origin of the problem. This is paralleled in mental health. Entering a therapeutic or evaluation process with information and an open mind is vital to the partnership between clients and clinicians.

The other implication of this trend involves the necessity of a formal diagnosis. I hear from many individuals, after a comprehensive neuropsychological evaluation is completed, that they feel relief at “finally knowing what is wrong.” This validation is entirely understandable, and is not restricted to times when I have provided a diagnostic label. An in-depth exploration of neurocognitive strengths and weaknesses can provide invaluable information that can help individuals understand themselves, access what they need, and plan for their future. Sometimes, a client’s symptoms are best captured by a diagnostic label. However, other times, a person’s comprehensively evaluated profile does not warrant a formal diagnosis. The latter does not mean that a person’s symptoms are any less valid or impactful. Formal diagnoses generally require multiple symptoms, occurring within specified timeframes, and occurring in the presence or absence of other important factors. There are many instances where a symptom is clearly impactful and interfering for a client, without the client’s profile meeting the full range of criteria necessary for a diagnosis. At other times, a symptom that appears, on the surface, to indicate one diagnosis, may in fact indicate a very different diagnosis after a person’s full neuropsychological profile is explored.

As a wise mentor once told me that, in the evaluation process, we must “hold our hypotheses lightly.” We enter a therapeutic relationship, either as a client or a clinician, with a sense of what we might discover or be told. Our initial sense can be entirely accurate, or shockingly incorrect. Therefore, it is vital for all of us to hold our ideas about what may come from an evaluation lightly.

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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

 

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

 

39

College Myth Buster: Four-Year College Degrees Are Most Often Not Completed in Four Years

By | NESCA Notes 2022

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

One of the biggest challenges in supporting students with disabilities, and their families, as they contemplate the transition from high school to college is combatting the many “myths” that exist in our culture and brains about college. Chief among those myths is the expectation that a 17- or 18-year-old should be able to:

  • Select “the right” college—which is a “fit” for their interests and personality during a period of time when they are quickly changing and forming a new view of themselves and their identity.
  • Easily bridge the transition from high school to college—even though the expectations for time management, class and study hours, life skills, extracurricular participation, meeting graduation requirements, etc., are completely different.
  • And, successfully complete 120 or more college credit hours within just four years.

The reality is that the majority of students who enroll at a “four-year” college in the United States will not finish their bachelor’s degree in four years. Instead, according to the National Center for Education Statistics, just 49 percent of first-time, full-time college students earn a bachelor’s degree in four years. To rephrase, the majority of students who enroll at a college expecting to graduate with a bachelor’s degree in four years will be disappointed, although there are some differences in retention at public and private institutions. Given that colleges are excellent at marketing, you may notice when researching schools, that it is far more common for public and private universities to advertise their “six-year” graduation rate, rather than the four-year rate. Even so, the National Student Clearhouse Research Center data indicates that the six-year completion rate for full-time undergraduate students in 2023 in the United States was 62.2 percent overall—which is effectively unchanged since 2015. There is essentially a more than one in three chance that a student who enrolls at a particular college, will not end up with a degree from that college six years later.

While these numbers can be somewhat startling, it is important to go into the college process with eyes wide open and to pay attention to each college’s retention rates from freshman to sophomore year as well as their four-year and six-year graduation rates. There is also a great opportunity here to rethink college planning and college paths. Rather than trying to find “the right” college for seeking a bachelor’s degree, students might instead look for “the right” college to start being a college student at. Sometimes, this is the community college right down the street where the student can trial classes of interest to narrow down their choices of major and also trial classes in areas of challenge (such as math, or a lab science) if the student is worried about being able to pass such classes at a four-year college. Another possibility for students with learning disabilities can be to start at a college that is designed for students with learning disabilities or that has a great learning disabilities program. We have the opportunity to help students forge a college path that looks a lot more like a career path, starting with an “entry-level” school and working up to a school that offers the student the rigor and academic concentration that reflects the student’s highest potential. For students interested in this type of planning, familiarity with transfer rates and transfer agreements between colleges can be an important part of the college research process. Financial planning is also critical—rather than a student needing to fund six years of college at a private institution, participation in a community college as a starter school or taking classes at a community college or public college during the summer might help to curb overall college costs.

In addition to thinking creatively about college planning, I think it is important to talk earnestly about college retention and graduation rates with teenagers—to let students know that there is actually a good chance they might not like the college they choose, might decide to change colleges, or might not graduate in four years. These are the facts of college, and we need to normalize the experience of trying college and deciding it’s not the right school or right time, needing to take a semester off for mental health reasons, or simply needing more time to get through it. Because that is what’s normal!

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

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

6

Pediatric Neuropsychologist Ferne Pinard, Ph.D., Joins NESCA

By | NESCA Notes 2022

By: Jane Hauser
Director of Marketing & Outreach

I recently had the opportunity to learn more about Pediatric Neuropsychologist Ferne Pinard, Ph.D., who joined NESCA in this August. We are thrilled to have her on board and hope you learn more about her background and specialty areas in today’s blog interview.

How did you choose pediatric neuropsychology as a profession?

I’ve had an interesting journey to get to where I am today professionally. I started working with adolescents in the West Indies as a high school teacher. There I quickly learned that meant not just teaching to the curriculum, but also looking at each student as a whole person – often along with their parents – providing counseling to them and additional academic support as needed to meet their needs. That sparked my initial interest in working to support children.

That spark turned into a deep interest in psychology. In college I decided to major in psychology. I became involved in research examining various aspects of child development and learned about statistical methods.

In graduate school, I worked with my mentor on research projects that involved administration of neuropsychological tests and examining how performance on these tests were related to various outcomes (e.g., academic performance, externalizing behaviors). I enjoyed doing assessment as part of the research project and other training experiences. Although I toyed with the idea of becoming a therapist – as I was trained to provide therapy and conduct assessment – I decided to further my knowledge in the brain/behavior relationship

How have your previous work experiences prepared you to be a neuropsychologist with NESCA?

I spent the last 11 years at Boston Children’s Hospital, first as a post-doctorate fellow and later as an attending neuropsychologist.

As a fellow at Boston Children’s, I had the opportunity to work in various specialty clinics, gaining exposure to patients with a range of medical and genetic conditions, including neurofibromatosis, cancer, etc.

Later, I went on to gain specialty experience in the Pediatric Neuro-immunology and Learning Disabilities programs. As an attending neuropsychologist, I worked with, trained, and supervised pre-doctorate psychology interns and post-doctoral fellows.

As part of the neuroimmunology program, you assisted with research on the impact of post-acute sequelae of COVID-19 (PASC) – also known as Long Haul Covid – on children and their education. Tell us about that.

Yes, I had the opportunity to provide consultation to a previous colleague examining the cognitive impact of Long Covid. I also conducted a few assessments of adolescent struggling with persistent symptoms after being diagnosed with Covid. Difficulties with attention, mood, executive functioning (e.g., working memory and slow processing speed), and fatigue are commonly reported among individuals with Long Covid. These students also experienced disruption in school due to their illness then ongoing symptoms and understandably find it difficult to keep up and meet academic expectations. So many young people were sadder and more anxious throughout Covid…layer Long Haul Covid on top of that, and it’s a huge problem.

How do you see your previous work experiences translating to the families we work with at NESCA?

I bring a lot of knowledge and evaluation experience to NESCA, but most importantly, I bring expertise and compassion in working with families – creating and maintaining relationships with them. The greatest thing I can do for a family is to listen to their concerns, let them feel heard, and allow them to express their feelings about what they and their child are going through. This helps the parents and the child’s school gain a better understanding of the child.

How do you tailor your evaluations for different children, say an anxious child?

Patience and validation are key. I think it is also important to include the child and their caregiver in the discussion. Perhaps I add additional structure to the evaluation (e.g., use of a checklist, breaks at predetermined times), integrate strategies to reduce anxiety (e.g., deep breathing, use of fidgets), or modify the evaluation to take place over three sessions instead of two. Sometimes, the child is allowed to have the parent in the room with them throughout the evaluation. There are different approaches that can be taken based on each individual, and it’s my role to work with the child and caregiver to identify what would work best for the child.

You’ve had a lot of experience evaluating medically complex children and children who are dealing with medical conditions that many think only affect adults. Tell us about that.

It’s true. I’ve worked closely with children who have gone through cancer treatments, including chemotherapy, radiation, and surgery. These are always very touching experiences. These children have been through so much medically that sometimes the medical experiences lead to mental health challenges. They may have gotten through the cancer itself, but there can be residual and sometimes long-term fears of a reoccurrence. Often, there is an intensely emotional component to these assessments because of what the children and their families have endured. I’ve heard the fear in the voices of both the children and their parents’ voices. It’s my job to listen and provide them with a safe space.

Some of the children seen may not be able to maintain engagement for a typical evaluation due to fatigue related to their medical condition and treatment, for example. In these cases, the evaluation will need to be carefully tailored to address the referral question (s). And again, the approach to the evaluation would have to be modified to meet the child where they are.

I’ve also worked with children who have been diagnosed with Multiple Sclerosis and other autoimmune conditions. With these children, I always factor in the amount of stress they are experiencing in life and school as well as the fears they have about how MS may impact them later in life. The stress they feel, whether at school or based on their diagnosis, can have a negative impact on their symptoms. There’s a cascading effect from the brain and all of its thoughts and worries, and that is what we help them deal with. I am always eager to advocate for these children who bear such a heavy load.

What is the most rewarding part of your job as a neuropsychologist?

I feel that I have added value to a child’s life, when I can provide them and their families with a meaningful and comprehensive understanding of their profile—one that includes strengths, not just a focus on weaknesses. I think this is essential as it enables the family and child to advocate for their needs.

Why did you want to be part of NESCA’s team?

Initially, I was really drawn to the integrative approach to care for the children who are with NESCA. Coordination of care, whenever possible, and consultation among professionals involved in a child’s care leads to better outcomes. I was also excited to work with the professionals who specialize in different areas than I am accustomed to working with, such as postsecondary transition. The team here is very willing to collaborate so we can all teach and learn from each other. While I know I will gain great knowledge from the group, it really best serves the families with whom we work.

 

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

Dr. Pinard provides comprehensive evaluation services for children, adolescents, and young adults with learning disabilities, attention deficit/hyperactivity disorders (ADHD), and psychiatric disorders as well as complex medical histories and neurological conditions. She has expertise in assessing children and adolescents with childhood cancer as well as neuro-immunological disorders, including opsoclonus-myoclonus-ataxia syndrome (“dancing eyes syndrome”), central nervous system vasculitis, Hashimoto’s encephalopathy, lupus, auto-immune encephalitis, multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), and acute transverse myelitis (ATM), and optic neuritis.

To book a neuropsychological evaluation with Dr. Pinard or another expert neuropsychologist at NESCA, complete NESCA’s online intake form. 

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

4

The Importance of SMEDMERTS

By | NESCA Notes 2022

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

While supporting a friend who was recently diagnosed with bipolar disorder, I have come to appreciate how challenging it is for people with this disorder to maintain a stable mood state. One of the most helpful resources I discovered in my search for information to help me support my friend was a TEDx talk by Ellen Forney, an author who has successfully managed her bipolar disorder for two decades by following SMEDMERTS, an acronym for: Sleep, Medication, Eat Well, Doctor/therapy, Mindfulness/Meditation, Exercise, Routine, Tools (coping), and Support System. I was struck that only 25% of the solution for managing her mental illness involves the mental health system: medication and doctor. The bulk of her treatment system relates to lifestyle choices.

While attention to SMEDMERTS is important for all of us, especially in these stressful times, consistent focus on these lifestyle choices is particularly critical for the many children and adolescents who we see at NESCA presenting with anxiety, mood disorders, ADHD, and behavioral issues. Most of us struggle to achieve our daily goals for sleep, diet, meditation, exercise, sticking to a routine, practicing adaptive coping strategies, and nurturing our support system, even though we know how much better we feel and how much better our children function when we are focused on SMEDMERTS in our daily life. While the impact of medications and doctors on functioning is largely outside of our control, we can control our lifestyle choices, which are critical to the success of managing any mental health issue.

How can we help the children in our lives to embrace SMEDMERTS?

  • Modeling it for them. As Robert Fulgham said, “Don’t worry that your children never listen to you; worry that they are always watching you.”
  • Praising their efforts. Offer positive feedback, such as, “Great idea to get up early to go for a run,” or, “I like how you called a friend when you were upset to get some advice.”
  • Enlisting the help of a coach. NESCA offers real-life skills coaching, executive functioning coaching, and health coaching to help children, adolescents, and young adults build and maintain habits to support positive lifestyle choices.

Health coaching is available to parents of NESCA clients who are seeking support in developing positive health habits, such as exercise, diet, stress management, and meditation.

If you are interested in coaching services at NESCA to support your quest for SMEDMERTS, please contact Crystal Jean: cjean@nesca-newton.com or fill out our intake form at www.nesca-newton.com.

 

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

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

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

To book an evaluation with one of NESCA’s many expert neuropsychologists, complete NESCA’s online intake form. 

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

8

October is Dyslexia Awareness Month

By | NESCA Notes 2022

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

According to the International Dyslexia Association (IDA), “Dyslexia is a language-based learning disability. Dyslexia refers to a cluster of symptoms, which result in people having difficulties with specific language skills, particularly reading. Students with dyslexia usually experience difficulties with other language skills such as spelling, writing, and pronouncing words. Dyslexia affects individuals throughout their lives; however, its impact can change at different stages in a person’s life. It is referred to as a learning disability because dyslexia can make it very difficult for a student to succeed academically in the typical instructional environment, and in its more severe forms, will qualify a student for special education, special accommodations, or extra support services.” Also, it is important to recognize that dyslexia is not due to either a lack of intelligence or a lack of desire to learn, and with appropriate and sufficient teaching methods, students with dyslexia can learn successfully.

Fortunately, there are effective strategies to help students with dyslexia. However, some common approaches to teaching reading (e.g., guided reading, balanced literacy) have not been found to be effective enough for the struggling reader. What research has found to be most effective is Structured Literacy. Structured Literacy instruction includes specific elements that are necessary for a dyslexic reader to make reading progress. Such elements include phonemic awareness (the ability to notice, think about, and work with individual sounds in words, such as separating the spoken word “cat” into three distinct phonemes), phonological awareness (the ability to recognize and manipulate the spoken parts of sentences and words), sound-symbol association (e.g., identify printed letters and what sounds they make), syllable instruction, morphology (smallest unit of meaning in the language), syntax (e.g., grammar), and semantics (meaning). In order to be most effective, students with dyslexia need to be taught using an explicit instruction method, with a teacher trained in a program that meets that student’s specific needs, the instruction needs to be taught in a logical order (basic concepts before more difficult ones), and each step needs to be based on previously learned concepts (cumulative).

According to the IDA, a comprehensive evaluation to assess for dyslexia, as well as to assess for any other potential language challenges or learning disabilities, should include intellectual and academic achievement testing, as well as assessment of critical underlying language skills that are closely linked to dyslexia, such as receptive and expressive language skills, phonology (phonological awareness, phonemic awareness), and rapid naming (e.g., quickly reading single letters or numbers). Additionally, a full evaluation should assess a student’s ability to read a list of unrelated real words as well as a list of pseudowords (made up pretend words to assess a child’s ability to apply reading rules), in addition to a student’s ability to read in context (e.g., stories). If a student is found to demonstrate that they meet criteria for a diagnosis of dyslexia, a specialized program should be developed by the school in order to provide appropriate services and accommodations.

Sources:

https://dyslexiaida.org/dyslexia-basics-2

https://dyslexiaida.org/effective-reading-instruction-for-students-with-dyslexia

www.readingrockets.org

 

About the Author

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

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

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

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

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

She is the mother of one teenage girl.

 

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

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

4

Meet Pediatric Neuropsychologist Lauren Halladay, Ph.D.

By | NESCA Notes 2022

By: Jane  Hauser

Director of Marketing & Outreach, NESCA

I recently had the opportunity to learn more about Pediatric Neuropsychologist Lauren Halladay, Ph.D., who joins NESCA in September. Learn more about her background and specialties in today’s blog interview.

How did you choose pediatric neuropsychology as a profession?

My interest was originally piqued when I was younger, as early as my high school years. I volunteered at a therapeutic riding program for kids with disabilities. That’s what initially sparked my desire to work with kids, and those with disabilities, in particular. My mother was a third grade teacher, which also imparted the desire to work with kids and help them overcome their challenges at school.

I went on to major in psychology and had a strong interest in pediatrics for the reasons I mentioned previously. Based on some of the work I did in graduate school, I learned that I really enjoyed the assessment piece, especially with the younger kids, helping them in life by identifying the right diagnosis (when applicable) and helping to put the right interventions in place for them to build skills that will equip them for the future.

How have your previous work experiences prepared you to be a neuropsychologist?

I’ve had a wide breadth of work experiences where I was supervised by neuropsychologists, whether it be in satellite health systems, the hospital setting, etc. While in those clinics, I had the opportunity to work with a variety of populations and presentations, including those who have experienced trauma, or have developmental or learning disabilities.

Having worked in several states throughout the country, including Oregon, Ohio, New York and Massachusetts, I’ve had the pleasure of working closely with a variety of families who present with unique backgrounds, experiences, and cultural values, which I always consider when making diagnostic decisions and developing recommendations.

What areas of neuropsychology have you most enjoyed to date? What would you consider your specialty area?

There are several areas that I am very passionate about. I really enjoy working with young kids, those under the ages of five or six. I also have a great interest in working with families who have concerns about their child potentially having an autism spectrum disorder or an intellectual or developmental disability. In addition, I find it incredibly rewarding to work with and help families whose children are medically complex or have moderate to severe cognitive impairments.

Regardless of how the child or student presents or what challenges they may have, I always individualize my approach so that I can meet the needs of each child. This is especially true in cases where families have had a hard time getting assessments done in the school setting or even privately in the past.

What is the most rewarding experience in neuropsychology that you’ve had to date?

I find it rewarding to hear from families when the strategies I’ve recommended are or are not working for them. For example, hearing that parents achieve success in implementing behavior management strategies, accessing support in the community, and/or learning about their child’s diagnosis and how to create an environment that suits their needs is a wonderful feeling. On the other hand, when the initial recommendations are not as helpful as intended, I enjoy approaching the problem-solving process together and discussing alternate approaches.

I also find it incredibly rewarding to offer parents and caregivers a deeper perspective on a child who has a moderate to severe cognitive impairment or is medically complex. Being able to give them a sense of where their child is developmentally in relation to their peers can be enlightening. Additionally, having more information about a child’s developmental level can help families and school staff establish appropriate, and individualized, expectations that set the child up for success. I strive to make a difference in these cases by developing strong partnerships with families, as well as serving as a trusted resource and advocate as they navigate how to best access supports in the community and in school.

What benefits, having been trained in a school psychology department, do you bring to families at NESCA?

My school psychology background allows me to bring a deep awareness and perspective on how the IEP process works. My experience and knowledge of special education rights allows me to be a true partner to families who are trying to navigate and understand the IEP process. I am able to share that knowledge and better advocate for my clients in Team meetings.

Why did you decide to join the team at NESCA?

I knew that in my next career move, I wanted to be part of a collaborative community that puts an emphasis on work/life balance—I feel that both allow clinicians to produce the highest quality work. At NESCA, I will also have the opportunity to use my school psychology skills and be an active participant in the IEP process on behalf of our clients.

NESCA is known for creating and building long-lasting relationships with the families they work with. I look forward to working with families and their schools/districts for the long-term, helping students to build skills along the way that will help them throughout their lives.

Finally, not being a native Bostonian, I am excited to learn more about and partner with the different school systems on behalf of the families and students we work with at NESCA.

 

About Lauren Halladay, Ph.D.

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

 

If you are interested in booking an appointment for an evaluation with a 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 and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

3

What Do We Mean by Individualized Neuropsychological Evaluations?

By | NESCA Notes 2022

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

Previous blogs in our recent series addressing frequently asked questions during the intake process, have covered the important differences between school-based testing and an independent neuropsychological evaluation. A neuropsychological evaluation should always be comprehensive, meaning that it covers various aspects of the student’s learning profile: cognition, language, memory, attention, and social-emotional functioning. However, the evaluation should also be individualized. Essentially, a good evaluation should aim to answer the questions that are specific to that student, not just a cookie-cutter list of tests.

Prior to starting testing, the clinician reviews any previous records and holds an intake appointment with the student’s parents or caregivers. Through this process, the clinician gathers information about the student’s early developmental history, medical background, and current challenges. If the student is already receiving services – either privately or through the school district – that is also important information. All of this helps to shape the “Referral Questions” for the evaluation. In some cases, the questions are very specific; for example, “Does my child have dyslexia?” or “Does my child have ADHD?” In other cases, the question is less defined, such as when we are asked “What is going on with my child and how do I help them?”

We often get asked by parents or caregivers if their child can have all of the tests available performed during their child’s neuropsychological evaluation. As clinicians, we understand that temptation. An evaluation is both an investment of time and money for the parents or caregivers. But neuropsychological evaluations are a lot of work for children, so we want to be sure to tailor the tests to what is actually going to yield beneficial findings for them or will help answer the referral question.

Some families request the list of tests that will be included in the evaluation. Unfortunately, this is not always possible until after testing is underway. Following the intake process, the clinician starts to develop the “battery” – the specific tests that will be administered to the student. Most clinicians have a skeleton battery of tests that they include for every client – an intelligence test, some academic tests (reading, writing, and math), and tasks that assess skills, such as language, memory, and attention – as described above. The clinician then fills in the testing battery based on the specific questions for that student. For example:

  • An evaluation designed to test for dyslexia should include several tests of reading as well as tests that look at very specific skills related to reading (e.g., phonological processing). When there are no concerns about reading, this aspect of the evaluation would be briefer.
  • An evaluation designed to assess for autism spectrum disorder should include a variety of tasks that examine social communication and reciprocal social skills. These types of tasks would likely not be included for a student who has never had any challenges in the social domain.

If a school district or another provider is asking for the list of tests that will comprise the neuropsychological evaluation, please talk to your clinician about this during the intake process. The final list might not be available until testing is complete, but this is definitely something that your clinician can provide as soon as possible.

 

About the Author

Erin Gibbons, Ph.D. is a pediatric neuropsychologist with expertise in neurodevelopmental and neuropsychological assessment of infants,

children, and adolescents presenting with developmental disabilities including autism spectrum disorders, Down syndrome, intellectual disabilities, learning disabilities, and attention deficit disorders. She has a particular interest in assessing students with complex medical histories and/or neurological impairments, including those who are cognitively delayed, nonverbal, or physically disabled. Dr. Gibbons joined NESCA in 2011 after completing a two-year post-doctoral fellowship in the Developmental Medicine Center at Boston Children’s Hospital. She particularly enjoys working with young children, especially those who are transitioning from Early Intervention into preschool. Having been trained in administration of the Autism Diagnostic Observation Schedule (ADOS), Dr. Gibbons has experience diagnosing autism spectrum disorders in children aged 12 months and above.

 

If you are interested in booking an evaluation with 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 and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

10

IEP or 504: What Do They Mean and How Can They Apply to My Child?

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

If your child has ever undergone an evaluation through their school system or received an outside neuropsychological evaluation, chances are you have heard the terms “504 plan” or “IEP” thrown around. Given that it can be difficult to understand the differences between the two, we will break down what both of these terms mean and how they might apply to your child.

What is an IEP?

IEP stands for Individualized Education Program and provides specialized instruction, program modification, and accommodations through the public school system based on a student’s disability and how it impacts access to the curriculum. IEPs must include:

  • Annual goals that are measurable via benchmarks
  • Progress reports of the student’s current performance
  • Descriptions of how services will be provided
  • Outlined transition services as the child ages

In addition, IEPs must detail what academic environment would be the least restrictive, and therefore, most suitable for the student to appropriately access the educational curriculum.

Who is eligible for an IEP?

In order to qualify for an IEP, students must receive an evaluation either through the school system or through an outside provider that outlines the student’s disability status and how it negatively impacts accessing the educational curriculum. Importantly, a diagnosed disability is not enough to quality for an IEP on its own. Instead, the disability must be impacting the student’s ability to make effective progress in the general education program, which includes both academic and non-academic offerings of the district. Some examples of qualifying diagnoses include (but are not limited to):

  • Autism
  • Emotional Disturbance
  • Intellectual Disability
  • Specific Learning Disability

A parent or caregiver may ask what happens if  their child has a diagnosed disability but does not require special education services? Instead, the team may determine, through the eligibility process, that the student only requires accommodations, such as extended time on tests.

This is a perfect example of when a student might not qualify for an IEP and would instead be considered for a 504 plan. Simply put, IEPs and 504 plans both provide accommodations; however, 504 plans do NOT provide for specialized instruction or program modifications.

 What is a 504 plan?

A 504 plan is referred to as such because it is covered under Section 504 of a federal civil rights law called the Rehabilitation Act. This law works to ensure that students receive appropriate supports and accommodations within the academic setting. 504 plans outline accommodations for students which can include some of the following (but again, accommodations are not limited to the following):

  • Preferential seating
  • Extended time on tests and quizzes
  • Reduced distraction testing environments
  • Access to class notes
  • The use of a calculator during exams

As you can see, none of these accommodations is modifying the curriculum or providing a student with educational services as would be the case with an IEP.

Who is eligible for a 504 plan?

Any student with a disability impairing functioning in one or more areas is eligible for a 504 plan. One common example would be a student with diagnosed Attention Deficit Hyperactivity Disorder (ADHD) who requires distraction-reduced testing environments and/or other associated accommodations but does NOT require specialized academic instruction.

Another example is a parent of a child with an autism spectrum diagnosis may find that their child was found to be ineligible for an IEP through the special education eligibility determination process. Shouldn’t the student qualify for an IEP based on the autism disability?

The answer is not necessarily. If a student has a diagnosis of autism but is showing no signs of impairment within the academic setting (i.e., making appropriate academic progress, showing no signs of emotional distress, doing well with their peers, etc.), an IEP would not be warranted. Instead, a 504 plan would likely be considered (but again, is not guaranteed if academic functioning is not impaired).

If you feel your child requires a 504 plan or IEP and you are not sure where to start, contact your child’s special education program at their school. You may also wish to consult with an educational advocate or attorney who has a thorough understanding of special education laws.

References:

Massachusetts Department of Elementary and Secondary Education. (2018, June 29). Education Laws and Regulations. 603 CMR 28.00: Special Education – Education Laws and Regulations. Retrieved August, 2022, from https://www.doe.mass.edu/lawsregs/603cmr28.html?section=05

Massachusetts Department of Elementary and Secondary Education. (2014, July 14). Section 504 and the Americans with disabilities act. Section 504 – Special Education. Retrieved August, 2022, from https://www.doe.mass.edu/sped/links/sec504.html

 

About the Author

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

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

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

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

 

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

 

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

 

1

Why Delay a Diagnosis?

By | NESCA Notes 2022

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

As part of NESCA’s ongoing blog series addressing some of the most frequently asked questions about neuropsychological testing, today we are addressing why neuropsychologists may choose to delay a diagnosis.

At NESCA, I often supervise neuropsychology trainees, and one of the first questions I asked them is: “What is the goal of a neuropsychological evaluation?” I often hear answers, such as “to identify strengths and weaknesses” or “to determine appropriate diagnosis.” These answers are not wrong, per se – they are what we are taught in graduate school. However, I often explain that while these may be part of our goal, the primary goal is to tell a client’s story and help them understand a path for moving forward. While this may sound a bit aspirational, it is the approach that best appreciates developmental, systemic, and individual factors that may come into play. As addressed by Dr. Moira Creedon in the first blog within this series, this is also one of the reasons why neuropsychologists want to review all prior evaluations and documentation, as this helps to elucidate the developmental timeline.

When a neuropsychologist is approaching an evaluation through the above developmental lens, it is not always possible to land on a specific diagnosis. This may sometimes be referenced as a “deferred diagnosis” or “differential diagnosis,” meaning there is evidence to possibly support the diagnosis, but not enough evidence at this time to decide for certain. Another term that may be used is “provisional diagnosis.” This indicates that there is enough evidence to support the diagnosis at this time, and there is clinical utility to diagnosing (e.g., informs intervention, qualifies for services, etc.); however, more information or monitoring may be needed to be completely confident, so future reassessment is warranted.

There are several reasons why a diagnosis may be deferred or deemed provisional. First, children are constantly developing, and sometimes the challenges they are demonstrating may be developmental in nature. This may be particularly so when evaluating young children. For example, if a young child has significant language delays, it may be difficult to assess whether they are also on the autism spectrum or have early signs of a learning disability, as their observed weaknesses in these areas may be accounted for by their language. Often times these are children who may “catch up” in skills once provided intervention, meaning their difficulties were related to delayed acquisition, rather than an being an issue of innate impairment.

Similarly, another reason diagnosis may be deferred is if a child’s self-regulation challenges interfere with their ability to engage in typical daily demands. For example, for a child who has significant anxiety or behavioral dysregulation that interferes with their ability to engage in school, it may be difficult to determine if academic delays are related to a learning disability or are a secondary consequence to their dysregulation. While provision of targeted instruction may still be necessary in order to help the child regulate and close gaps in skills, a full understanding of their innate learning profile may not be possible until such supports are in place.

Deferred diagnosis is quite common when more significant psychiatric diagnoses are in question, such as whether a child or adolescent is presenting with a mood or thought disorder, such as bipolar or emerging psychosis. There are many other conditions that may “look like” these disorders, including trauma or co-occurring anxiety and ADHD. When diagnosing more significant, often life-course disorders, it is important to ensure that all other potential explanations are identified and addressed. This is important for informing the appropriate treatments while also allowing the evaluator to outline some of the “red flags” that should be monitored by the client, their parents, and their care team over time.

Another reason why a diagnosis may be deferred is that there may be systemic factors at play. In other words, there may be things going on within the child’s home, peer setting, school, or other surroundings that interfere with the evaluator’s ability to understand the child in isolation. This is a particular issue when evaluating a client with a trauma history. Developmental trauma can often “mimic” other symptom profiles, and so it may be important to first address issues within the system before providing a diagnosis for the individual.

There are other less common situations in which diagnosis may be deferred, but they warrant mention. One is when the neuropsychologist is concerned about possible malingering, which is when certain symptoms are being falsified or exaggerated for personal gain (e.g., a child with learning disability exaggerating mood symptoms to avoid school). Another less common situation is when prescribed medication or recreational drugs may be inadvertently causing the symptoms of concern (e.g., depression occurring as a side effect).

A final reason why a diagnosis may be deferred is simply that things can sometimes be messy. We often evaluate children and teens who have several presenting concerns, and sometimes it takes time to peel away the layers of the onion. In any of the above scenarios, we start with “what we know” and then describe “what is possible.” Regardless of whether or not a diagnosis is certain, as neuropsychologists, we are still able to tell the client’s story, describing how they “got here” and how to move forward. This developmentally-sensitive approach allows us to make recommendations based on their need, not just their diagnostic label. We are then able to assess how their profile and symptoms change as they access intervention. It is for this reason that we enjoy the opportunity to develop long-term relationships with our clients, helping to monitor growth over time. Children do not develop in one finite time point, and the neuropsychological evaluation process sometimes has to be patient and continue to develop alongside them.

 

About the Author

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

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

 

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

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