Tag

neuropsychologist

The Power of a List

By | NESCA Notes 2021

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

For so many children, adolescents, and young adults, I find myself recommending something that seems too simple to be of much use – a list. The power of lists has been identified and described in depth by several experts, such as Atul Gawande (The Checklist Manifesto – an excellent read). These books often discuss efficiency in the workplace, health and safety practices, and maintaining consistency in products or services. As adults, these are the things we often care about – ensuring that we are efficient, consistent, and getting things done.

In my practice, I recommend lists for different reasons. I recommend lists to teach executive functioning skills, such as planning, task initiation, organization, and task monitoring. Lists are also incredibly helpful for children who struggle to hold on to information. These children often miss information that is stated aloud, such as a parent giving directions or a teacher explaining instructions. Their brains often struggle to “keep up” with the pace of information presented in the world. Having the information written down in an organized manner, such a list, can help them access the information without time constraints.

Here is a quick example:

On a typical weekday morning, parents alternate checking on their 8-year-old as he gets ready for school. They give reminders of all the things left to do – “Brush your teeth!” “Get dressed!” “Put your homework in your backpack!” Time before the bus becomes shorter and shorter, as does everyone’s patience. Parents think, “We do the same things every single morning! Why is it so hard for him to remember?” Child thinks, “Why can’t they just leave me alone!” Voice volumes increase, tone shifts, and before anyone knows it or means to, there is a shouting match as the bus is pulling up.

Of course, a list won’t stop hurt feelings or eliminate frustration. However, if the child’s “morning routine” is posted somewhere easy to see, he may need far fewer reminders from his parents of all the tasks he has left to do. Frustration may be reduced, and the child can feel successful completing tasks with greater independence.

A list may be steps in a routine, as illustrated above. A list could also be of materials the child needs for baseball practice, the chores that should be done each week, or the limits and expectations around “screen time.” I often spend time with parents discussing the contents of a list, where the list should be placed, and the format it might take. For example, do you want checkboxes next to each item? Do you want the steps to be numbered? Maybe you love arts and crafts, and you want to laminate the list and have Velcro tabs with a “checkmark” that can be placed next to each completed task. The format and purpose vary, but lists are infinitely useful.

For many children, practice using lists is not only helping them to build skills in the moment, but is excellent practice for later life. Developing comfort with the tools and strategies that work best for you is an invaluable aspect of raising our children to become independent adults who can achieve their goals.

 

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.

 

Rating Scales/Questionnaires – Why Do We Give Them and Why Do They Matter?

By | NESCA Notes 2021

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

When you request a neuropsychological evaluation, you are undoubtably inundated with paperwork. Consent forms, confidentiality forms, COVID forms, and credit card forms. Then, to your surprise, you bring your child to their first appointment, and the neuropsychologist hands you…more forms! Why? What are these forms for, and what will you do with the information? These are great questions, and always feel free to ask your neuropsychologist. Here are some answers I give when I am asked:

Why do you need so many forms?

Our goal in completing a neuropsychological evaluation is to have as comprehensive picture of a child as possible. This means gathering information from many sources, including what you and/or others are noticing that is raising concerns (what we discuss in the intake appointment), prior evaluations and documentation (e.g., their IEP, testing done at school), your child’s performance on our assessment measures (what they do when they come to the office), and important people’s perceptions of your child’s functioning in daily settings – this is what we assess through the rating scales (also called questionnaires). The parent/teacher rating scales are an important source of information because they not only capture your concerns, but also show us how your concerns may be similar to or different from parents (or teachers) of same-age children. For example, concerns with “attention and focus” are common for us to hear. Attentional skills develop gradually over time, and having a standardized rating scale that evaluates your concerns (or your child’s teacher’s concerns) with attention helps us understand how far off your child’s skills are from what is expected for their age.

What do the forms ask about?

This depends on why your child is being referred for a neuropsychological evaluation. For example, if your child is referred for a question around autism, you will likely be given forms that ask about their social functioning, such as how they do at playdates, birthday parties, the playground, or other community spaces with peers. Your child’s teacher would also likely be given forms to evaluate how your child interacts with peers at school, such as how they do during lunch, snack, and recess; how well they work in groups; and if they have been successful in forming strong friendships. If the concerns are more related to mental health, you may be given forms that ask about their symptoms of anxiety, depression, etc.

What will you do with the forms?

We will take your ratings (or your child’s teacher’s ratings) and compare them to normative data. This is a fancy way of saying “we will see how your child compares to kids their age.” Then, we will take that information to help us form a more comprehensive picture of your child’s profile and our recommendations for how to best help and support them. For example, something I see often is a concern with kids following directions, remembering what they are told to do, and finishing all the steps necessary for a task or project (e.g., getting ready for school or bed). This can be (though certainly isn’t always) a difficulty with working memory or, holding information in mind. We assess working memory in many ways during testing. However, we can’t always see the deficits that parents and teachers see, because testing is inherently different from “real life.” So, rating scales serve as an important source of information in understanding what is going on day-to-day, which helps us to make more comprehensive recommendations.

How do I fill these out?

Please, please, please – read the directions carefully! Each form is meant to evaluate something different. For example, some ask you about your child’s emotional state “in general,” others ask about how they have been behaving over the last two weeks, and others ask about how well they can complete tasks independently (i.e., without any help or guidance). Do your best to complete each question – skipping questions that seem “irrelevant” or “inappropriate” may impact how well we can use the information later on. We realize that not every question will apply to every child – we are using the best tools we have, and some are designed to assess a wide range of children. If you have questions about the wording or phrasing, please ask your neuropsychologist – we really don’t mind!

I have a teenager. Why don’t you just ask them about how they are feeling?

If your child is old enough, we will absolutely talk to them about their perceptions of what is going on, what their concerns are, and what has been helpful for them. Many rating scales have a “child” or “self-report” version, and we may have them complete those, in addition to talking more conversationally about how they are doing.

 

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.

 

Cyberbullying and Autism Spectrum Disorders

By | NESCA Notes 2021

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

I recently had the opportunity to attend a webinar by Justin Patchin, Ph.D., one of the foremost cyberbullying researchers. I have used his work myself in designing both my master’s thesis and doctoral dissertation research, so it was wonderful to hear him speak. He began with a story about his childhood and some of the rules he was taught – don’t meet up with strangers that you meet online, don’t get into anyone’s car if you don’t know them well – lessons I was also taught as a child. These are the kind of rules that individuals with Autism Spectrum Disorders (ASD) often crave – black and white, clear, no middle ground. The online world, he argued, does not allow for such stark and rigid rules. Rather, he says, it calls for “guidelines.” Working with children with ASD, when I hear “guidelines,” I think, “grey,” “fuzzy,” and “it depends.” These can be some of the toughest situations for an individual who is not neurotypical.

I think he’s right. The online world is fast, fluid, ever-changing, and highly dependent on specific circumstances. It calls for the kind of flexible thinking and evaluation of context that kids with ASD are so often challenged by. Yet, as the adults parenting, educating, and supporting these young people, these are exactly the skills that they need. The online world is not going anywhere anytime soon, and it is not likely to slow down either.

Cyberbullying is one of the difficult online phenomena to manage, as youth who are bullied online are most frequently also bullied in “real life,” usually at school. The bullies are often peers they know and must see on a regular basis. For children with social challenges, navigating bullying that is occurring across settings is an especially difficult task. And the solution is not to take away technology. Now more than ever, children need access to technology for homework, classwork, enjoyable peer activities, and hobbies. Where does that leave us?

Unfortunately, Dr. Patchin did not give any practical advice for how to support individuals with autism around cyberbullying. I think that one important starting point is to help these individuals learn to check in with themselves. Time and time again, I hear from students, “I’m not really sure what was going on, but I think they were being mean.” (In fact, I hear this from children who are decidedly not on the autism spectrum, especially when bullying is occurring by older peers.) Bullying is hurtful (intentionally so), and recognizing that hurt is an important first step. Once children and adolescents identify that something is hurtful, adults can help and support them in navigating through the situation.

Whether bullying, cyberbullying, or a misunderstanding, it is important for adults to listen carefully when children come to us with social concerns. In addition, we must have a solid understanding of the online world in which students are living, learning, and engaging. Social media shifts rapidly, with new platforms becoming wildly popular in a matter of weeks. Working with youth requires us to keep as current as we can, making certain that we understand the “ins and outs” of each platform. It is also incumbent upon us to ensure that all children and adolescents (not just those with an autism diagnosis) learn guidelines that will allow them to safely make their way through a constantly evolving world of platforms, apps, and services. Safety online is as critical as safety in person.

 

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.

 

Helping Your Anxious Child through COVID-19

By | NESCA Notes 2020

 

Almost a year into Covid-19, many of us can use this blog as a reminder when our children exhibit signs of anxiety from learning of new developments with the pandemic; friends, family or others testing positive for Covid-19; or returning to school. The guidance shared in this blog still holds true, nearly one year since many of us went into lockdown and schools shuttered. 

 

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

A recent New York Times article by Jessica Grose discusses ways to support your child, specifically helping them to feel less anxious, during the COVID-19 situation. Their “top 4” suggestions are great ones – validate their feelings, manage your own anxiety, aim for some kind of predictable routine and try mindfulness or progressive muscle relaxation activities.

The larger consideration in this case is this: anxiety, particularly in the current situation, is normal. We can label it with clinical words, give you our best clinical tools and recommend that you seek help (and please do!). At the same time, if we take a large step back, being anxious right now is exactly how we are meant to feel. We are social beings, designed to live in the community and support one another through face-to-face social interactions. When something threatens our safety, or the safety of our families, it is normal to respond with fear, worry and hypervigilance. Everyday interactions that would typically result in no response, like hearing someone nearby cough or sneeze, all of a sudden have become indicators of a threat. Even having others in close proximity to us is now a threat, meaning that the social communities in which we are supposed to thrive have now become potentially dangerous places. In this new environment, our bodies, well-attuned and primed to handle threats, are doing what they should do – they are putting us on “hyper-alert mode,” keeping us exceedingly sensitive to these threats so that we can avoid them and preserve our safety.

Children are in this mode, too, albeit with far fewer resources to help mitigate their fear and worry. As adults, we have far more lived experience with threats, anxiety, fear and worry, and we can use this experience to manage our responses to this novel situation. For children, this may be the first time they are struggling with persistent worry and fear. Or, they may have struggled to cope with other fears and worries for a long time, and this new stressor has overwhelmed their system. In either case, it is important to normalize fear and anxiety, in addition to the myriad of other emotions that children may be experiencing.

The key is balance. We have to balance validating and normalizing feelings with reinforcing unhealthy habits. What does that look like? One dimension to consider is time – validating and normalizing feelings is a short acknowledgement that the child is heard, understood and believed. On the other hand, repeatedly discussing the same questions or topics, engaging in persistent conversations about the threats and explaining “adult” information to children (especially dire predictions, long-term impacts, etc.) is not healthy. These behaviors may appear to decrease anxiety in the short-term, but over time, can be detrimental.

Another important consideration is space – focusing on what is happening in the present is important to help children process and understand the radical changes that are impacting their day-to-day lives. However, if you find that your conversations linger on the past or the future, try to shift back to the present. Your mind may be filled with regrets from the past (e.g., “I knew we should have stocked up on their favorite snack last time we were at the store”) or fears for the future (e.g., “My parents are elderly and at high risk”), and these thoughts are entirely normal. At the same time, when talking with children, it is important to try as much as possible to focus on the here and now. Of course, it is important to give children the space to express their fears for the future, and we can and should acknowledge and validate these fears. We can also, simultaneously, bring children’s focus back to the present and back to tangible, concrete things that they can do (e.g., “I know you are really worried about grandma, and it’s sad that we can’t see her right now. Everyone is working hard to keep her safe, and we are going to call and talk to her later today”).

For some children, advanced intellectual abilities may allow them to understand (at least, in some sense) a great deal of the information that is portrayed on the television and news media. However, it is important to remember that, while their cognitive abilities are years ahead of their peers, their emotional development is not. It may be necessary to closely monitor their online activity, as they may be seeking out information (which is a normal response to fears, especially fear of the unknown) without having the critical thinking abilities to understand the source or potential biases in the way the information is presented. On the other hand, some children may struggle to understand the situation, either because of their young age, learning disability or other developmental delays. If this describes your child, consider putting together a story, with pictures and words, to help them understand some basic information (e.g., why we can’t go to school right now, why we can’t go play with friends). This is often referred to as a “social story,” and clinicians at NESCA can help you create one specifically for your child.

Last, and most certainly not least, seek help and support for yourself, your child or anyone in your family who is struggling. While experiencing anxiety during these times is normal, when these thoughts and feelings are taking over your child’s daily life (or your own), it may be time to look for assistance. Many clinicians, including here at NESCA, are available via phone or videoconferencing, and we can assist with a range of concerns. Whether you want a brief consultation to help you respond to persistent questions from your child or whether your child has a pre-existing anxiety disorder that is exacerbated by these challenging times, we are here to help.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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.

 

Teens Online: Participation vs. Observation

By | NESCA Notes 2021

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

As we enter the beginning of 2021, the COVID-19 pandemic continues to shape our world. More and more, events, activities and interactions are pushed online – onto videoconferencing apps, social media and academic learning  platforms. Online social interactions are not new, and they won’t disappear anytime soon. With this, how do we, as adults, understand and navigate these oddly draining electronically-mediated gatherings, and how do we help our teens do the same?

One unique characteristic of online interaction is the ability to be present without being visible. In traditional social settings, to be present with the group is to be seen and, often times, noticed. Joining a Zoom or Google Meet offers one the ability to listen, watch and take the information presented without offering anything of yourself – no one has to see you, hear you, know where you are or know what you are doing. As many adults have noticed, this gives incredible freedom to the multi-taskers – listen to your meetings while getting the dishes done or the laundry folded.

For some adolescents, though, this is an opportunity to bypass many of the core tasks of social development, while still engaging with the material needed to accomplish one’s academic goals. A high schooler, acutely aware of how they are perceived and what others think of them, can sit silently, invisibly in social studies class. They can hone in on the economic impacts of World War I without the crushing anxiety of worrying about being teased or ostracized. However, that same high schooler may never have to confront the developmentally-expected challenges of venturing out of their “comfort zone” socially. They may not learn to ask someone out on a date, explore a new friendship or show up to the first meeting of a club.

How can we help our teens learn to take the best from online interactions while also pushing them to fully engage with others? There is no one, clear-cut answer – no “10 things…” or similar checklist. In any situation, we must look holistically at the teen, the context and the goals, and, from there, determine the best path forward. Sometimes, the anonymity of the online world is a welcome respite for teens looking to explore a new facet of their identity. Other times, it undercuts the core tasks of adolescence – building deep bonds with peers, taking responsibility for one’s social relationships and developing independence. Having direct, open conversations with our teens helps them understand and begin to own the challenges of the online world. If cameras are always off and microphones are always on mute, maybe it is time for a chat about participation versus observation.

 

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.

 

Helping Your Anxious Child through COVID-19

By | NESCA Notes 2020

By Yvonne M. Asher, Ph.D. 

Pediatric Neuropsychologist

A recent New York Times article by Jessica Grose discusses ways to support your child, specifically helping them to feel less anxious, during the COVID-19 situation. Their “top 4” suggestions are great ones – validate their feelings, manage your own anxiety, aim for some kind of predictable routine and try mindfulness or progressive muscle relaxation activities.

The larger consideration in this case is this: anxiety, particularly in the current situation, is normal. We can label it with clinical words, give you our best clinical tools and recommend that you seek help (and please do!). At the same time, if we take a large step back, being anxious right now is exactly how we are meant to feel. We are social beings, designed to live in the community and support one another through face-to-face social interactions. When something threatens our safety, or the safety of our families, it is normal to respond with fear, worry and hypervigilance. Everyday interactions that would typically result in no response, like hearing someone nearby cough or sneeze, all of a sudden have become indicators of a threat. Even having others in close proximity to us is now a threat, meaning that the social communities in which we are supposed to thrive have now become potentially dangerous places. In this new environment, our bodies, well-attuned and primed to handle threats, are doing what they should do – they are putting us on “hyper-alert mode,” keeping us exceedingly sensitive to these threats so that we can avoid them and preserve our safety.

Children are in this mode, too, albeit with far fewer resources to help mitigate their fear and worry. As adults, we have far more lived experience with threats, anxiety, fear and worry, and we can use this experience to manage our responses to this novel situation. For children, this may be the first time they are struggling with persistent worry and fear. Or, they may have struggled to cope with other fears and worries for a long time, and this new stressor has overwhelmed their system. In either case, it is important to normalize fear and anxiety, in addition to the myriad of other emotions that children may be experiencing.

The key is balance. We have to balance validating and normalizing feelings with reinforcing unhealthy habits. What does that look like? One dimension to consider is time – validating and normalizing feelings is a short acknowledgement that the child is heard, understood and believed. On the other hand, repeatedly discussing the same questions or topics, engaging in persistent conversations about the threats and explaining “adult” information to children (especially dire predictions, long-term impacts, etc.) is not healthy. These behaviors may appear to decrease anxiety in the short-term, but over time, can be detrimental.

Another important consideration is space – focusing on what is happening in the present is important to help children process and understand the radical changes that are impacting their day-to-day lives. However, if you find that your conversations linger on the past or the future, try to shift back to the present. Your mind may be filled with regrets from the past (e.g., “I knew we should have stocked up on their favorite snack last time we were at the store”) or fears for the future (e.g., “My parents are elderly and at high risk”), and these thoughts are entirely normal. At the same time, when talking with children, it is important to try as much as possible to focus on the here and now. Of course, it is important to give children the space to express their fears for the future, and we can and should acknowledge and validate these fears. We can also, simultaneously, bring children’s focus back to the present and back to tangible, concrete things that they can do (e.g., “I know you are really worried about grandma, and it’s sad that we can’t see her right now. Everyone is working hard to keep her safe, and we are going to call and talk to her later today”).

For some children, advanced intellectual abilities may allow them to understand (at least, in some sense) a great deal of the information that is portrayed on the television and news media. However, it is important to remember that, while their cognitive abilities are years ahead of their peers, their emotional development is not. It may be necessary to closely monitor their online activity, as they may be seeking out information (which is a normal response to fears, especially fear of the unknown) without having the critical thinking abilities to understand the source or potential biases in the way the information is presented. On the other hand, some children may struggle to understand the situation, either because of their young age, learning disability or other developmental delays. If this describes your child, consider putting together a story, with pictures and words, to help them understand some basic information (e.g., why we can’t go to school right now, why we can’t go play with friends). This is often referred to as a “social story,” and clinicians at NESCA can help you create one specifically for your child.

Last, and most certainly not least, seek help and support for yourself, your child or anyone in your family who is struggling. While experiencing anxiety during these times is normal, when these thoughts and feelings are taking over your child’s daily life (or your own), it may be time to look for assistance. Many clinicians, including here at NESCA, are available via phone or videoconferencing, and we can assist with a range of concerns. Whether you want a brief consultation to help you respond to persistent questions from your child or whether your child has a pre-existing anxiety disorder that is exacerbated by these challenging times, we are here to help.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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.

 

When Parents and Kids Have BIG Emotions

By | NESCA Notes 2020

By Miriam Dreyer, Ph.D.

Pediatric Neuropsychologist Fellow

Brianna Sharpe’s recent essay for the New York Times – Parenting section titled, “I’d Like to Melt Down When My Kids Do,” captures an essential challenge of parenting – managing one’s own emotions when your child is having big and difficult feelings. Ms. Sharpe writes about her own extensive training as a mental health professional and how even with lots of experience working with children, she was not prepared for the emotional demands of parenting. She writes, “. . . like all preschoolers, my son needs an anchor when the waters get rough. But just when he needed me most, I found myself being pulled under by my own emotions. Although I never called him names or outright accused him of being at fault, I would yell in anger when hurt. My irrational response was often, ‘Why would you do that?!’ Once the red haze faded, I knew he was doing just what preschoolers are designed to do – but I had a hard time reconnecting with him.”

Ms. Sharpe beautifully depicts the intricate link between a child and a parent’s emotions. As parents, one of our essential roles throughout our children’s lives is to help them regulate. From birth, our job is to love, soothe, feed, attend and help our kids make sense of their feelings. This is a hard job, made even more complicated by the nuances and complexities of our own emotional lives.

Emotion regulation is a multifaceted process. As defined by Gross (1998), emotion regulation involves conscious and unconscious processes that operate both before an emotional response is generated and after it occurs. He writes that emotion regulation consists of “processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions.” Challenges with emotion regulation are a component of many of the presenting problems we see at our center. Children with ADHD can struggle with emotional impulsivity, shifting and modulating emotional responses. Individuals with depression and anxiety face challenges balancing positive and negative feelings, as well as controlling irrational thoughts and worries. Difficulties with emotion regulation for individuals on the Autism spectrum are also common and intersect with social/emotional and behavioral problems that can arise with symptoms related to rigidity, self-direction and repetitive, self-soothing behaviors.  Symptoms associated with traumatic stress, such as dissociation, mood lability and alexithymia, all interfere with one’s ability to regulate emotionally. Even challenges like communication disorders and other learning disabilities are related to emotion regulation since they generate anxiety and can impede expressing oneself using language, which is a key regulatory process. In fact, theorists are now conceptualizing emotion regulation as a possible unifying, underlying component across psychological disorders (Aldao, Nolen-Hoeksema, & Schweizer, 2010).

What are we, as parents, to do then in the face of our children’s and our own stormy emotions?  How do those of us caring for children who are struggling help them while attending to our own complicated emotional processes? A helpful framework for considering these questions comes from researchers who focus on attachment relationships in parenting, mentalization, as well as the mindfulness and self-compassion literature. 

  • Cultivate self-compassion. Parenting is hard, as is childhood. A stance of self-compassion which acknowledges challenges and encourages kindness to oneself helps move out of cycles of self-blame and anger.
  • Encourage curiosity about your own and your child’s emotions. Developing awareness of our own and our children’s emotional lives helps create a buffer in moments of heightened emotional arousal and can shed light on challenging patterns and interactive cycles.
  • Take a pause. Try breathing and mindfulness exercises to regain calm in difficult moments.
  • Consult with a therapist for parent guidance. There are many different types of parenting programs and support that can help tailor strategies and target complicated dynamics within family systems.

 

References

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review30(2), 217-237.

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of general psychology2(3), 271-299.

Sharpe, B. (2019, June 21). I’d like to melt down when my kids do.  The New York Times.

 

About the Author

Dr. Dreyer enjoys working with children, adolescents and families who come to her office with a wide range of questions about learning, social and emotional functioning. She is passionate about helping children and parents understand the different, often complex, factors that may be contributing to a presenting problem and providing recommendations that will help break impasses – whether they be academic, therapeutic, social or familial.

Dr. Dreyer joins NESCA after completing her Doctorate in Clinical Psychology at the City University of New York.  She most recently provided psychological assessments and comprehensive evaluations at the Cambridge Health Alliance/Harvard Medical School for children and families with a wide range of presenting problems including trauma, anxiety, psychosis, and depression.  During her training in New York, she conducted neuropsychological and psychological testing for children and adolescents presenting with a variety of learning disabilities, as well as attentional and executive functioning challenges.  Her research focused on developmental/complex trauma, as well as the etiology of ADHD.

Dr. Dreyer’s experience providing therapy to children, adolescents and adults in a variety of modalities (individual, group, psychodynamic, CBT) and for a wide range of presenting problems including complex trauma/PTSD, anxiety, depression, ADHD, and eating disorders informs her ability to provide a safe space for individuals to share their concerns, as well as to provide tailored recommendations regarding therapeutic needs.

Before becoming a psychologist, Dr. Dreyer taught elementary and middle school students for nine years in Brooklyn, NY.  She also had an individual tutoring practice and specialized in working with children with executive functioning challenges, as well as providing support in writing, reading and math.  Her experience in education informs both her understanding of learning challenges, as well as her capacity to make specific and well-informed recommendations.

She received her Masters in Early Childhood Education from Bank Street College, and her B.A. in International Studies from the University of Chicago.

 

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 one of our expert neuropsychologists, please complete our Intake Form today. For more information about NESCA, please email info@nesca-newton.com or call 617-658-9800.

 

When Grandparents Become Parents Again

By | NESCA Notes 2020

By Yvonne M. Asher, Ph.D. 

Pediatric Neuropsychologist

Grandparents can hold a special place for any child. For some, though, grandparents play a central role in their day-to-day lives. When grandparents raise a child, it is often related to parental challenges, tragic circumstances or government intervention. This brings inherent, understandable stressors for grandparents. Additionally, grandparents face the more typical challenges of child-rearing, such as managing educational experiences, ensuring emotional well-being and navigating health care.

When concerns with educational achievement, behavior, emotional or social functioning arise, there are many obstacles with which grandparents must wrestle. Feelings of guilt may arise, which can stem from a variety of sources. Grandparents may question their own parenting practices, worrying about past “mistakes” in raising their children. They may be especially sensitive to shielding their grandchildren from exposure to risky situations that their children may have faced without their knowledge. Grandparents may struggle when grandchildren are given diagnoses such as ADHD, autism or learning disabilities, wondering if their children faced these same challenges without formal diagnosis or intervention. Many grandparents express understandable fears around their grandchildren’s future, particularly their level of independence. While many caregivers have concerns with the independence of the children in their care, grandparents are often acutely aware of the limited time they will have to support, counsel and assist their grandchildren through their young adult years.

In navigating the special education and mental health care systems, grandparents can face many complex situations. Complexity may be increased if grandparents are in a caregiving role due to parents’ substance use or dependence. Depending on the timing and extent of substance use, there can be long-lasting impacts on grandchildren’s educational, cognitive or emotional health. This can substantially increase the difficulties that grandparents encounter, both in terms of accessing necessary services and supports, as well as coping with the stresses of caregiving.

There are also a number of strengths that grandparents can bring to their time as caregivers. They may be more aware of their rights as caregivers within the educational system, seeking out services and interventions when the “first signs” of difficulty arise. They may have a broader perspective on the school system, potentially having raised children who went through the same schools in the past. With the wisdom that comes in later adulthood, grandparents may be more discerning and skeptical about the opinions of professionals. They may ask more pointed questions, with less reserve or fear. Grandparents may also have built stronger support networks and have deeper connections to community organizations. These strengths can serve grandparents well in managing the complex systems that all caregivers face.

Several states have created advisory councils or legislation specifically designed to support grandparents raising grandchildren. In addition, there are many resources available to grandparents who are caring for and raising grandchildren, including:

https://www.helpguide.org/articles/parenting-family/grandparents-raising-grandchildren.htm

https://www.grandfamilies.org

http://www.massgrg.com/massgrg_2019/index.html

https://sixtyandme.com/resources-for-grandparents-raising-grandchildren/

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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.

 

When is it Actually Bullying?

By | NESCA Notes 2019

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

Autumn holds excitement for many students – heading back to school to see old friends, meet new teachers and learn new skills. However, for some, a new school year holds more apprehension than enthusiasm. Students worry that their teacher will be mean, their math homework will be hard or that their recess time cut short by bad weather. One fear that is described more and more often by parents and children is the fear of bullying.

What is bullying?

There is no single definition of bullying, but most researchers describe the following necessary and sufficient characteristics:

  • unwanted, intentionally aggressive behavior that is aimed at harming another person
  • carried out repeatedly
  • in a relationship where there is a power differential

The quintessential example of this is the hulking, five-foot-five elementary schooler who pushes, shoves and steals the lunch money of a short, scrawny younger child every day. Luckily, this kind of aggression is rare; however, the rarity of “classic” bullying requires us to be somewhat more mindful of what childhood behaviors are (and, are not) considered bullying.

First and foremost, behavior must be unwanted and intended to harm. This means that the rambunctious children rough-housing on the playground is generally not a bullying situation. Playful acts, or acts with the intent of friendly, physical play, are not bullying. Certainly, there are times when children may misunderstand the intent of their peers or friends and perceive an action as hurtful. In that case, a frank discussion of intended message versus experienced consequence is required, but there is no immediate concern for bullying. If a child did not intend to hurt their peer, bullying is not the issue.

When researchers use the term “aggressive behavior,” it should be clarified that aggression is not always physical. Aggression comes in three forms: physical, verbal and relational. Physical aggression is exactly what you are imagining – punching, kicking, hitting and similar behaviors. This kind of aggression occurs in very young children (think: toddlers), most often as a means of communication due to their limited verbal skills. By early childhood, kids rarely use physical aggression to communicate, as most children are able to talk and verbalize their wants, needs and feelings.

The second type of aggression is verbal aggression. This can involve things like yelling, screaming, swearing, threatening and name-calling. This kind of aggression occurs throughout childhood and adolescence, with the frequency decreasing as children mature.

The last form of aggression is the most complex. It is called relational aggression. Researcher Nicki Crick defined relational aggression as any act that uses the social relationships, social standing or social experiences of an individual to harm them. The stereotypical examples of relational aggression come from films like Mean Girls. Gossip, social exclusion, humiliation, embarrassment, rumor spreading and intentional ignoring are all examples of behaviors that fall into the category of relational aggression. This frequency of relational aggression generally increases as children develop, as relational aggression requires more sophisticated verbal and social skills to carry out. In addition, relational aggression is rarely noticed by adults and often does not carry the same disciplinary consequences as physical or verbal aggression. Children learn quickly that refusing to play with a peer or spreading a nasty rumor is unlikely to get them “in trouble,” making this type of aggression far more effective for older children and adolescents.

It is important to note that both boys and girls engage in aggressive behavior. Girls tend to start using relational aggression younger, and use it consistently throughout their lives. Boys tend to start out using physical aggression, and shift to relational aggression as they mature. However, both boys and girls engage in aggressive behavior at all developmental stages.

Back to our definition of bullying – the next element is “happens repeatedly.” Bullying is not a one-time occurrence. The behavior, or harm caused by the behavior, must happen over and over. Two children who are angry and get into a fight in the cafeteria may well be intending to harm one another. However, if the fight is a one-time occurrence, there is no immediate concern for bullying. One challenging aspect of this part of the definition is how we handle online or cyberbullying (i.e., bullying that happens through electronic media such as text or social media). Because posts to social media, texts and images online can be viewed multiple times by multiple people, a single act carried out online may meet the definition of bullying. For example, posting a message that conveys a nasty rumor about a peer to one classmate’s profile can have untold impact on the victim’s social relationships depending on how many times that post is forwarded, tagged, “liked,” discussed or otherwise shared across the social network.

The last part of the definition of bullying is that it occurs “in a relationship where there is a power differential.” Power differentials exist in many relationships – parent/child, teacher/student, employer/employee, landlord/renter, therapist/patient and so on. In children, power differentials may exist when a child is:

  • older
  • physically larger
  • more popular
  • more socially skilled

While this is not an exhaustive list, these are the most common situations where we find power differentials in children. Without a power differential present in the relationship, bullying is not an immediate concern. It is not uncommon for children to have challenges in their friendships, such as teasing, unwanted horseplay, sitting with other friends at lunch and choosing to work with a different partner on a project. However, these challenges typically do not meet the “power differential” criterion of bullying. They are better defined as normal, healthy obstacles in relationships that, when worked through productively, can help children develop more sophisticated social problem-solving skills.

What to do when it is bullying

We’ve discussed many examples of what is not bullying, so what should happen when behaviors are best characterized as bullying? First and foremost, assess your child’s safety. If physical aggression is part of the bullying, consider immediate action, such as talking to your child’s teacher or school administrator. Note that bullying is now a legal matter in many states, including Massachusetts. When talking to your child, remember that bullying comes with plenty of shame and anxiety, so make every effort to ask simple, clear, direct questions with as calm a tone as possible.

If your child’s safety is not a primary concern, ask your child if they want your help to solve the problem. If so, consider helping your child map out the social dynamics of what is happening. Who is saying what? To whom? Is it just you who is the victim, or are the bullies doing the same thing to other children? Does the teacher notice? If so, do the bullies get in trouble? Depending on the answers, help your child work toward a strategy to solve the problem. Younger children may require more adult intervention, such as a parent reaching out to the teacher. Older children and adolescents may be able to try out problem-solving strategies independently, with your support at home.

If your child does not want your help, consider letting them try to solve the problem on their own. Remind them that you love and trust them, and have confidence in their ability to figure out tough situations. Encourage your child to participate in other social activities where they experience more positive interactions, such as martial arts, Girl or Boy Scouts, team sports or clubs outside of school. Having strong, positive friendships is one of the most important resiliency factors when a child is the victim of bullying.

It may help to know that upwards of 90% of adults report having been the victim of bullying at least once in their lifetime. Interestingly, over 70% also report having bullied someone else.

 

About Pediatric Neuropsychologist Dr. Yvonne Asher:

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.

 

Parenting Orchids and Dandelions

By | NESCA Notes 2019

By: Nancy Roosa, Psy.D.
Pediatric Neuropsychologist, NESCA

I recently evaluated a 15-year-old boy, who we’ll call Sam, whose parents brought him in due to some concerning new behaviors, including failing classes, disobeying his parents’ rules – particularly around curfew and technology use – and smoking marijuana on a daily basis. When meeting Sam, I was amazed at how engaging, polite and good-natured he was. It was hard to imagine this young man disobeying his parents and staying out all night, which he was also doing frequently.

Sam had grown up in an affluent and supportive family, the third of four children. The other three were, like their parents, easy-going, adaptable and successful – academically, socially and athletically. They were on the path to becoming independent and successful adults. Sam had always been a bit different. He was the child who had colic as an infant, sleep disturbances throughout childhood, separation anxiety at preschool, and extreme sensitivity to sensory stimuli. His parents cut tags out of his clothes, bought him loose-fitting pants, and avoided birthday parties at Chuck E. Cheese’s – or almost anywhere there would be crowds of loud children, as these situations could reduce Sam to tears.

When evaluating Sam, I was impressed by his intelligence, quick reasoning and solid academic skills.  There was nothing obvious that standard neuropsychology tests uncovered. But Sam was also open and articulate about his difficulties. He explained that he was easily overwhelmed – “jangled,” he called it – in social situations, in a fast-paced classroom or on an athletic field. When he started ninth grade in a challenging parochial school, he was faced with more stressful situations, academically and socially. He became extremely anxious about tests and lengthy homework assignments, so he fell behind academically and developed pretty serious school anxiety. Given his sensitive nature, he was particularly likely to struggle in a class where the teacher was, in his words, “too strict,” or even “mean.” He wasn’t successful enough socially or athletically to sustain his self-esteem in these areas, particularly compared to his talented siblings. He found himself becoming angry and anxious, and he started using marijuana to calm himself. As he described it, getting high was the only time he felt happy and relaxed.

Sam was clearly struggling, easily meeting criteria for an anxiety disorder and a substance use disorder.  But I wanted to explain some of the “why” behind his struggles, so, in talking to his parents, I relied on the explanation put forth by Dr. W. Thomas Boyce, in his book, Orchids and Dandelions: Why Some Children Struggle and How All Can Thrive. He explains that most children are like dandelions, born with sturdy, resilient temperaments so that they, like dandelions, grow and thrive wherever they land –  assuming there’s some minimal level of appropriate conditions. But about 20% of children are more like orchids. They are born with a very sensitive nervous system, which is highly attuned to all the stimulation in the world around them. Dr. Boyce found that for these children, lower levels of stress precipitated a full-fledged anxiety response, involving the release of stress hormones that create a Fight, Flight or Freeze response – an appropriate response for a life-threatening situation, but not much help when facing, say, a strict teacher or a hard test. These children are therefore much more likely to develop full-blown anxiety disorders. On the positive side, their high level of sensitivity to the world around them means they are typically very empathic and emotionally attuned. Like an orchid with careful nurturing, they will develop into exceptional adults.

Fortunately, many orchids do naturally gain resilience as they grow, according to Elaine Arons, Ph.D. In her book The Sensitive Child, she cites studies that find most children who are shy as preschoolers – suffering social and separation anxiety – will develop coping strategies and not appear shy by the time they reach school age. These orchids gain resilience without losing their sensitivity.

But this positive evolution requires good parenting. While dandelions do fine with the average “good-enough” mother, as famously defined by psychologist Donald Winnicott, orchids need parents to be just a bit better.

How does one do this? How can a well-meaning, good-enough parent help these orchids become better able to manage the squalls, large and small, that occur in any one’s life?

Fortunately, there is a wealth of research – contained in books and articles – on building resilience in children. Most emphasize that we need to allow children to struggle with challenges, even to the point of sometimes failing, so they learn that they can cope and succeed in the face of adversity. This message is clear from the title of several such books: e.g. The Blessing of the Skinned Knee: Using Timeless Teachings to Raise Self-Reliant Children, by Wendy Mogel and The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed by Jessica Lahey.

We also have a neurobiological explanation for this process. We know that continued exposure to a stressful situation allows the body to habituate and the terrible feelings – such as fear and panic – that accompany a stress response gradually recede. As this happens, the previously scary situation becomes routine, and the child’s self-confidence and willingness to tackle new risks grows. Every preschool teacher knows this. The crying child who is being left by his parents in an unfamiliar preschool will eventually calm down and start to enjoy himself. The process goes more quickly if parents calmly and confidently reassure the child, then leave. The parent who is also anxious, who hovers over the child, attempting to sooth his fears, only increases the child’s anxiety by sending the message that this IS a scary situation. This phenomenon was dramatically illustrated in a study by Susan Crockenberg and Esther Leerkes (Development and Psychopathology, 2006). They found that 6-month-old children had different levels of reactivity – or startle – in response to unfamiliar stimuli. These infants also showed differences in how much they tried to avoid the situation, versus distracting themselves while staying in the presence of the stimuli. Children with high reactivity and a tendency to withdraw from novel stimuli, along with parents who were less sensitive, were more likely to show high anxiety at 2.5 years of age. Exposure to challenge causes the body to habituate and builds resilience. Trying to avoid stressful situations only exacerbates fears.

However, this can be counterintuitive for parents of very sensitive children. In fact, the more attuned a parent is to his/her child’s sensitivity, the harder it becomes. Sam’s parents had always coddled him a bit more than their other children. Knowing that he didn’t like loud birthday parties, his mother tended to decline these invitations. When he became upset and started to cry at a soccer game, his father felt so sorry for him that he didn’t insist that Sam return the next week. This avoidance did not allow Sam to grow and master new situations, but instead narrowed his world.

This is not to say that Sam’s parents should have been less emotionally attuned. Rather, it’s important for parents of children like Sam to walk a fine line between exposing the child to moderate challenges that he can manage but do not overwhelm him. It’s also important that they stay calm themselves, empathizing with the child’s fears but reassuring him at the same time. Not an easy task.

Fortunately, Sam has many strengths, not the least of which are his sensitivity and his intelligence, as well as great artistic gifts. He also has a solid relationship with his parents, even though it has been quite strained of late. After our evaluation, Sam and his parents decided to place him in a therapeutic wilderness program so he could withdraw from daily pot use in a safe place and learn skills from therapists there, as well as learn from peers who were going through similar struggles. This coming year, he will not return to the challenging parochial school he attended for ninth grade and will instead start at an independent school that offers some academic supports and a flourishing arts program. Sam’s roots are well-established, and with a bit more awareness of the gifts and challenges inherent in his sensitive nature, he is expected to grow into a self-confident and resilient young man.

 

About the Author: 
Roosa

Dr. Roosa has been engaged in providing neuropsychological evaluations for children since 1997. She enjoys working with a range of children, particularly those with autism spectrum disorders, as well as children with attentional issues, executive function deficits, anxiety disorders, learning disabilities, or other social, emotional or behavioral problems. Her evaluations are particularly appropriate for children with complex profiles and those whose presentations do not fit neatly into any one diagnostic box. As part of this process, Dr. Roosa is frequently engaged in school visits, IEP Team Meetings, home observations and phone consultations with collateral providers. Dr. Roosa has also consulted with several area schools, either about individual children or about programmatic concerns. She speaks to parent or school groups, upon request.

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.