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

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

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neuropsychological evaluations Archives - NESCA

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Image of someone who could head in multiple directions; quote from Dr. Jessica Greene about where to start with recommendations from neuropsychological evaluations

What to Do with All the Recommendations?

By | NESCA Notes 2025

Image of someone who could head in multiple directions; quote from Dr. Jessica Greene about where to start with recommendations from neuropsychological evaluationsBy: Jessica Greene, Psy.D.
Postdoctoral Fellow, NESCA

Your child’s neuropsychological evaluation is complete, and your family now has a greater understanding of your child – and a long list of recommendations. After you review the list, it can feel as though every recommendation is the most important one. How do you know where to start? The steps outlined below are general guidance; your team may recommend a different timeline based on your child’s needs.

Prioritize

Recommendations are meant to provide a roadmap for the next two to three years. Step back and ask yourself, “What is most important for my child and for my family right now?” Choose one to two recommendations that make the most sense and gradually find ways to work them into your routine. Making intentional changes, at a reasonable pace, gives everyone time to adjust. Also, it is much easier to tell whether a strategy, intervention, or service is helping when you try one thing at a time.

Reflect

After you have tried the chosen recommendations for a reasonable amount of time, take a moment to consider your child’s progress. Day-to-day life can make growth easy to overlook, particularly when there are still other pressing needs. But, before returning to your list of recommendations, consider the changes that have occurred. Growth is not always linear, so perhaps your child has made growth in one area, but something new has presented itself. On the other hand, perhaps things have moved forward for the better and there is time to focus on recommendations that were less pressing.

Review

When ready, return to recommendations and consider what to implement next. Again, choose one or two items, so as not to overwhelm yourself or the family system.

Set Boundaries with Others (if needed)

Caregivers often tell me they feel flooded with opinions from everyone they know. While outside input can be helpful at times, it’s also okay to set boundaries. You might simply thank people for their advice and say you have a plan you intend to follow. That response acknowledges their concern without letting you get derailed.

Need Help Choosing a Next Step?

If you are unsure where to start or what to focus on next, reach out to a trusted provider that understands your child’s needs. That may be the NESCA neuropsychologist who completed the evaluation, an outside provider (occupational therapist, counselor, speech-language pathologist), your pediatrician, or a school contact (special education teacher or school counselor). They can help you plan next steps.

If you’d like more details about next steps and who to share the report with, see Dr. Maggie Rodriguez’s post, which outlines practical actions to take after a neuropsychological evaluation. Read her full article here: https://nesca-newton.com/navigating-life-after-a-neuropsychological-evaluation-what-comes-next/.

 

About the Author

Dr. Jessica Greene is a licensed clinical psychologist who has worked After working with Dr. Angela Currie in NESCA’s Londonderry, N.H. office from 2023-2024 as a practicum student, Dr. Jessica Greene re-joins NESCA to complete her postdoctoral fellowship in pediatric neuropsychological assessment. Dr. Greene has a particular interest in understanding clients’ strengths as well as differences, integrating a therapeutic assessment approach, when appropriate.

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

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

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Image of a student being testing in school

When School-based Testing Is Not Enough

By | NESCA Notes 2024, NESCA Notes 2025

Image of a student being testing in schoolBy: Sean Hyde O’Brien, Psy.D., ABPdN 
Pediatric Neuropsychologist, NESCA

Often when a child is struggling at school — whether related to academic, behavioral, or social-emotional functioning — they may be referred for testing by a member of their educational team (often at the parents’ request). Such testing can include psychological, educational, speech-language, occupational, and physical therapy assessments conducted by qualified school personnel, as well as more specialized transition, functional/adaptive behavioral, and autism-related assessments. These evaluations are generally conducted to determine a student’s eligibility for special education services, identify appropriate supports, and establish goals to monitor progress.

In many cases, school-based testing is sufficient to meet the needs of the student and family by facilitating access to services and supports. However, there are situations in which school-based testing may not be sufficient on its own:

Need for a Clinical Diagnosis
School evaluations are designed to determine eligibility for special education services under educational categories (e.g., “Health Impairment,” “Specific Learning Disability,” or “Sensory Impairment”), rather than to establish diagnoses for medical or treatment purposes. When a formal diagnosis is needed to guide treatment, medication decisions, or access to private insurance-based services, a neuropsychological evaluation may be necessary.

Complex or Co-occurring Issues
Neuropsychological evaluations are designed to integrate information across multiple domains, offering a more comprehensive understanding of the student as a whole.

Disagreement with School Findings
If parents have concerns about the conclusions or recommendations from a school evaluation, they may pursue an Independent Educational Evaluation (IEE) or seek private testing with a neuropsychologist to obtain an additional perspective.

Evaluation of Non-academic Concerns
Concerns such as anxiety, depression, trauma, or family stressors — which can significantly affect learning — may fall outside the primary scope of school-based testing and may be more fully explored through a comprehensive neuropsychological evaluation.

Legal or Eligibility Requirements
Certain services, accommodations, or agencies (such as Social Security Disability benefits, specific therapies, or independent schools) may require documentation or diagnoses from a licensed clinical provider. Neuropsychologists are licensed psychologists with specialized doctoral and post-doctoral training in brain-behavior relationships who can provide this type of documentation when needed.

In summary, school-based testing is often a valuable and important first step in understanding a child’s needs within the educational setting. In some cases, however, a comprehensive neuropsychological evaluation can provide additional insight into a student’s profile as well as medical documentation needed to access a variety of services.

 

About the Author

Dr. Sean O’Brien has been providing comprehensive neuropsychological evaluations in the GreaterSean Hyde O'Brien Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as  Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To schedule an appointment with one of NESCA’s neuropsychologists, 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 Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

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image of adoption papers and a quote from Sean Hyde O'Brien

Myth vs. Reality: Adoption, Development, and the Role of Neuropsychology

By | NESCA Notes 2024

image of adoption papers and a quote from Sean Hyde O'BrienBy: Sean Hyde O’Brien, Psy.D., ABPdN 
Pediatric Neuropsychologist, NESCA

Adoption is a wonderful way to create family. I say this both as a psychologist who has extensive research and clinical experience working with this population, as well as a person who was adopted. However, my experience working with children and families in the “adoption triad” over the past 20 years has made me aware of the negative stereotypes that are perpetuated by well-meaning professionals that are simply not based in fact and can, in fact, have a deleterious impact on the health and development of those children whom they are trying to serve.

In simplest terms, there is nothing inherently pathological about the process of adoption or individuals who were adopted. Yes, there can be particular family dynamics and developmental issues unique to the adoptive experience (for an interesting perspective on child development through an adoptive lens, see Dr. Joyce Pavao’s “The Family of Adoption”). However, these can be thought of much like other demographic factors that contribute to our development but do not define who we are in totality, such as ethnicity, gender, sexual orientation, or socioeconomic status.

So, if adoptive status is not a causal factor for later psychopathology, why do some children who were adopted display emotional, behavioral, and learning challenges? This is where neuropsychology comes into play. Research suggests that children adopted at older ages, from foster care, or from institutional settings have a higher risk for certain psychological challenges compared to non-adopted peers. However, this increased risk is not due to adoption itself but rather to neurobiological factors that are known to result in developmental challenges regardless of adoptive status. These can include sensory, cognitive, and social deprivation; chronic early stress; attachment disruptions; and teratogenic exposure (e.g., factors that can cause developmental abnormalities in a fetus); all factors that are known to impact the developing brain.

For example, a child who has been separated from their primary caregiver during an early sensitive period of development may show delays in social cognition, understanding others’ emotions, and their ability to form peer relationships. While this child could have been adopted after living in an orphanage, they may also be a non-adoptive child who was separated from their birth parent secondary to an injury/illness and subsequent hospitalization or had a birth parent who was not consistently available due to their own medical or mental health issues. The adoptive status of the child is not the issue at hand, rather the specific experiences of the individual, and for a professional to simply label a child’s challenges as a result of their adoptive status is overly simplistic and possibly unethical.

Thus, as with all children, it is important to understand the “whys” (e.g., why are they having this particular problem) to figure out the “hows” (e.g., how do parents and professionals best address it) when working with children who were adopted. This often requires a comprehensive evaluation of neuropsychological functioning that goes beyond the label of “adopted child” and helps to identify both the risk and protective factors unique to that individual that will impact their health and development.

 

About the Author

Dr. Sean O’Brien has been providing comprehensive neuropsychological evaluations in the GreaterSean Hyde O'Brien Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as  Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To schedule an appointment with one of NESCA’s neuropsychologists, 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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Images of a neuropsych eval and questionnaires and quote from Sean Hyde O'Brien

Beyond the Scores: The Comprehensive Approach to Neuropsychological Evaluations

By | NESCA Notes 2024

Images of a neuropsych eval and questionnaires and quote from Sean Hyde O'BrienBy: Sean Hyde O’Brien, Psy.D., ABPdN 
Pediatric Neuropsychologist, NESCA

When parents think of a Neuropsychological Evaluation, they often envision their child completing a series of tests that generate scores. These test scores tell parents how their child is performing compared to a large group of other students their age across a wide range of cognitive and academic domains. While this is accurate, the evaluation process also integrates data from multiple sources beyond quantitative test scores to develop a comprehensive picture of your child. These other sources of data may be less obvious but are highly essential to developing an accurate “diagnostic formulation” of your child’s strengths and weaknesses, as well as interventions specifically tailored to support their individual neuropsychological profile.

Here’s an overview of the types of data typically involved:

  1. Clinical Interview:
  • Symptoms and Concerns: The individual’s description of their cognitive, behavioral, emotional, and academic symptoms, as well as those reported by family members or caregivers.
  • Birth, Developmental, and Medical History: Information about the individual’s birth, medical, psychological, and developmental history, including any past or current health conditions, injuries, or psychiatric disorders.
  • Family History: Information about any family history of neurological or psychological conditions that may help understand potential genetic or hereditary factors.
  • Academic and Psychosocial History: Insight into the individual’s social relationships, educational background, and occupational history to understand the impact of cognitive or emotional issues on daily functioning.
  1. Standardized Psychological/Neuropsychological Tests:

These are structured tasks designed to measure different aspects of cognitive and academic functioning. They provide objective data that help evaluate brain-behavior relations.

  • Intelligence Tests (IQ Tests): Assess overall cognitive ability and intellectual functioning. A common test is the Wechsler Intelligence Scale for Children (WISC-V).
  • Speech-Language Tests: Evaluate expressive, receptive, and pragmatic language skills, including verbal fluency, comprehension, and naming. Examples are the Boston Naming Test and the Clinical Evaluation of Language Fundamentals (CELF-V).
  • Visual-Spatial Tests: Measure spatial processing, visual memory, and the ability to integrate visual and motor functions. Examples include the Rey-Osterrieth Complex Figure Test and the Block Design subtest from the WISC-V.
  • Sensory-Motor Tests: Assess motor skills, coordination, and fine motor skills (e.g., the Grooved Pegboard Test).
  • Memory and Learning Tests: Evaluate short-term, long-term, and working memory. Examples include the Wide Range Assessment of Memory and Learning (WRAML) and the California Verbal Learning Test (CVLT-C).
  • Attention and Executive Function Tests: Measure selective-sustained attention and cognitive flexibility, such as the Continuous Performance Test (CPT); as well as assess higher-order cognitive functions, such as planning, decision-making, problem-solving, and impulse control. Examples include the Wisconsin Card Sorting Test (WCST) and the Tower of London task.
  • Academic Tests: Assess reading, writing, and mathematical skills. An example is the Wechsler Individual Achievement Test (WIAT-IV).
  1. Behavioral Observation:
  • Behavioral Observations During Testing: The examiner notes the individual’s behavior, mood, and engagement during the testing process. This can provide insight into areas, such as attention, motivation, or emotional regulation.
  • Classroom/Program Observations: This can involve observing a child’s functioning in a “real life” setting and provide insight about their ability to apply the skills noted in their test findings to more complex environments.
  1. Behavioral Rating Scales and Self-Report Questionnaires:

These are used to assess subjective experiences related to mood, behavior, and cognitive functioning.

  • Broad Band Rating Scales: Provide information about the individual’s functioning across multiple domains, which can be helpful to identifying areas of concern for additional investigation. An example is the Child Behavior Checklist (CBCL).
  • Targeted/Narrow Band Rating Scales: Provide information about specific domains, such as depression and/or anxiety, which can be helpful for gaining a deeper understanding of an individual’s particular symptom profile. One example is the Beck Depression Inventory (BDI).
  1. Collateral Information:
  • Reports from Family Members, Teachers, Coaches, and Tutors: Provide insight from those who know the individual well, often providing information about changes in behavior, memory, or mood.
  • School or Occupational Records: Include academic performance, work-related difficulties, or other performance metrics that may be reviewed to understand the functional impact of cognitive or emotional difficulties.
  1. Neuroimaging and Medical Data (if applicable):
  • Brain Imaging (e.g., MRI, CT scans, PET scans): Used to identify brain abnormalities, such as lesions, atrophy, or structural damage, which may contribute to cognitive impairments.
  • EEG or Evoked Potentials: Sometimes used to assess electrical activity in the brain, particularly if seizures or other neurological concerns are present.
  • Medical Reports: Data on neurological conditions, medications, or surgeries that may impact cognitive or emotional functioning.

By combining these different types of data, a neuropsychologist can create a comprehensive picture of an individual’s cognitive strengths and weaknesses, helping to identify any underlying neurological conditions or psychological factors that are contributing to their difficulties. While test scores are always important, interpreting your child’s performance on neuropsychological tests without the additional data outlined above can lead to misdiagnosis, ineffective treatment, and other unforeseen complications.

 

About the Author

Dr. Sean O’Brien has been providing comprehensive neuropsychological evaluations in the GreaterSean Hyde O'Brien Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as  Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

To schedule an appointment with one of NESCA’s neuropsychologists, 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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