NESCA has unexpected availability for Neuropsychological Evaluations and ASD Diagnostic Clinic assessments in the Plainville, MA office in the next several weeks! Our expert pediatric neuropsychologists in Plainville specialize in children ages 18 months to 26 years, with attentional, communication, learning, or developmental differences, including those with a history or signs of ADHD, ASD, Intellectual Disability, and complex medical histories. To book an evaluation or inquire about our services in Plainville (approx.45 minutes from NESCA Newton), complete our Intake Form.

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pandemic

How the Pandemic Changed In-Person Learning

By | NESCA Notes 2024

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

Among the parts of my job that I find most meaningful are the conversations I get to have with parents during intake and feedback sessions. During an intake, much of the emphasis is on history taking. Some of it isn’t very exciting; trust me, I get that it can be tedious to review information like how much your child weighed at birth, how many ear infections they had, and when they learned to walk. Yet so often the information parents are able to share about a child’s history is crucial. There’s a quote attributed to Michael Ventura that says, “Without context, a piece of information is just a dot. It floats in your brain with a lot of other dots and doesn’t mean a damn thing. Knowledge is information-in-context… connecting the dots.” The history parents share provides essential context that helps us piece together and make sense of the data we get from doing an assessment in the office.

In recent years, we’ve added questions about COVID-19 to help us understand how that experience has impacted the children and teens we work with. I regularly ask parents, “How old was your child when COVID-19 hit? What grade were they in and how long did remote learning go on? When did they return to in-person instruction?” During a recent intake with a parent, I got an answer I wasn’t expecting. A very thoughtful and perceptive mom gave me some dates and ages then paused for a moment and added, “But even though they’re back in school, I don’t think learning has ever been the same since COVID.” I asked her to tell me more, and we had a wonderfully thought-provoking conversation. As so often happens, I learned a great deal from a parent. Since that time, I’ve extended the discussion to include some of my very insightful colleagues, who have also shared their thoughts. The consensus is that “in-person learning” in 2024 doesn’t mean the same thing it did in 2019. So, what’s changed?

Yes, students are, for the most part, sitting at desks inside classrooms rather than connecting remotely from their desks (or kitchen tables or couches) at home, but what happens in the classroom and beyond is different in some important ways.

  • Technology: In speaking with parents and colleagues in different fields, I’ve repeatedly heard that pandemic-related school closures “accelerated the use of technology” and “online learning platforms” in education. There was certainly a need to use online learning platforms during the pandemic, and the extent to which schools incorporated technology speaks to ingenuity and flexibility in the face of an unexpected and incredibly challenging situation. Moreover, technology is a wonderful tool that can be used to enhance learning in many ways. That being said, many parents and colleagues have observed that schools never went back to “how information and tasks were managed pre-COVID.” That is, technology and online platforms have remained a part of the learning experience. The challenge for some students is that even within the same school system, there can be a great deal of variability between the specific platforms individual teachers use and how they make use of them. Especially for students who struggle with anxiety or executive functioning weaknesses, keeping track of and switching between different platforms and applications for different classes can be overwhelming.
  • Different Teaching Methods: One of the trends I’ve observed directly and have gotten feedback on from others has to do with how teachers provide instruction in the classroom. Compared to “the before times,” the post-pandemic years have seen a rise in independent learning, even within the context of the classroom. More often, teachers have students work independently, whether that means reading through Google slides at their desks or completing worksheets and tasks on their own. There seems to be less direct teacher-led instruction and an increased reliance on independent learning, which often incorporates use of technology, such as Chromebooks, in the classroom. While some students thrive when given the freedom and flexibility to learn on their own, many students learn best when provided with instruction using more direct, structured, and an interactive approach.
  • The Boundaries are Blurred: Working adults will relate to this phenomenon. Back before COVID-19, many of us had pretty clear boundaries separating our work lives from our personal lives. We commuted to an office or other workplace, worked for a set time period, then went home. That all changed when many non-essential employees pivoted to working from home at the start of the COVID-19 lockdown. Suddenly our kitchens or bedrooms were transformed from private living areas to undefined spaces that housed both our personal lives and our work lives. And our work and home lives bled into each other as we tried to fit in work when we could, especially if we were also home-schooling or caring for children all day. Though many employees are back to the office at least to some extent, the boundaries remain somewhat blurred. The same phenomenon has happened for students. There is a “24-7 connectedness” that technology enables, which has both pros and cons. Because a lot of schools still use online platforms for assigning, submitting, and grading homework, teachers can post assignments at any time. One parent described a sense of assignments popping up online “like Jenga blocks, one layered in after another.” Similarly, students can turn in assignments at any hour of the day or night. One of my colleagues has observed that this has negatively impacted sleep habits for some students. Another colleague astutely pointed out that, not only can this be overwhelming for students, but it may also be contributing to some of the burn-out many teachers are experiencing.

Education has been perhaps permanently altered by the pandemic, just as many of us have been. The changes that have occurred bring benefits and challenges that our students and teachers are still adjusting to. I don’t have answers or solutions, but I know that I’m going to be adding to the questions I ask parents about COVID-19, education, and the impact on their student. It’s still important for me to learn when a student resumed “in-person learning,” but I’m no longer going to assume that phrase means the same thing it’s always meant. Instead, I’ll be asking parents to tell me what in-person learning looks like now, because the reality is that none of us has gone back to life circa 2019. Just like all of us, our students are living in the “new normal,” and we need to understand it so that we can support them in benefiting from the opportunities it brings and in navigating the challenges it poses.

 

About the Author

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

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

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

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

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

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

Why Teletherapy?

By | Nesca Notes 2023

By: Carly Edelstein, MSW, LCSW
Licensed Clinical Social Worker and Executive Function Coach

During the pandemic, providers all over the world implemented virtual services. While some therapy clients preferred and/or needed to shift back to in-person once deemed safe, others grew fond of meeting with their therapist virtually. Given the effectiveness, convenience, and flexibility, teletherapy is here to stay. Unlike medical doctors, most therapists don’t need to check your temperature or blood pressure when they see you. Rather, therapists aim to create a physical space where their clients feel safe and comfortable. That said, what if you feel the most comfortable being vulnerable in your home? While not everyone sees the appeal in teletherapy, having the option increases accessibility, and studies show clients attend teletherapy more consistently than in-person, yielding more desired outcomes.

Feeling emotionally and physically comfortable at home during teletherapy is just as important as its convenience. Perhaps you’re a college student or working parent with limited free time in your busy schedule. Teletherapy offers flexibility by removing transportation and wait times. With rates of anxiety, depression, and other mental health conditions rapidly rising, teletherapy is an option to consider if you’re seeking support.

Tips for preparing for your first teletherapy session:

  1. Consider privacy; place yourself in a room or space where you can discuss confidential information without others overhearing your conversation. Sound machines that make white noise can help to prevent sound waves from escaping the room.
  2. Limit any distractions; sign into the teletherapy platform in a brand new window versus a tab, so you’re not tempted to browse the web or check emails during your session. You want to set yourself up for success when it comes to being focused and staying present.
  3. Notice what’s in your background; in order to feel as comfortable as possible, make note of what your therapist may see behind you while on video.
  4. Sit back, relax, and trust the process!

Sources:

https://www.forbes.com/health/mind/teletherapy-for-mental-health-treatment/

How well is telepsychology working? (apa.org)

 

About the Author

Carly Edelstein is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Ms. Edelstein provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, 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; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Why are Some Youths More Susceptible to Anxiety and Anxiety Disorders?

By | Nesca Notes 2023

By: Ferne Pinard, Ph.D.
NESCA Pediatric Neuropsychologist

Anxiety disorders are one of the most commonly diagnosed disorders in childhood and adolescence. According to the Centers for Disease Control and Prevention (CDC), 9.4% of children aged 3-17 years (approximately 5.8 million) were diagnosed with anxiety between 2016-2019. These numbers have increased significantly during the COVID-19 pandemic. Some studies estimate that the prevalence of child and adolescent anxiety disorders nearly doubled during the pandemic.

Why are some individuals more susceptible to anxiety than others? The development of anxiety and anxiety disorders during youth is not simple or straightforward but involves complex interactions among the following variables:

  • Temperament: Children with the behavioral inhibition temperamental style described as timidity, shyness, and emotional restraint when with unfamiliar people and or in new places are more likely to develop anxiety disorders.
  • Parent-child Attachment: Children who did not experience a trusting and secure parental bond, but received inconsistent responses from caregivers and are preoccupied with the caregiver’s emotional availability (Ambivalent attachment) are at increased risk for developing an anxiety disorder.
  • Parental Anxiety: Children with anxious parents are at higher risk of developing an anxiety disorder. This relation is partly influenced by genetics. The risk of developing specific anxiety disorders has been associated with various genes. These can be passed to the child, thereby increasing their genetic vulnerability to anxiety disorders. However, parental behavior and practices are also important in understanding this link.
  • Parenting Behavior/Practices: When parents model anxious, overcontrolling, or demanding behavior, their children are more reluctant to explore new situations and display more avoidance behaviors.
  • Adversity: Trauma, negative/stressful life events as well as low socio-economic status are also risk factors for childhood anxiety. The more adverse life events an individual experiences in childhood, the greater the likelihood that they will develop an anxiety disorder. They also experience higher levels of anxiety.
  • COVID-19: The combination of social isolation and lack of support networks increased anxiety among youth during the COVID-19 pandemic.
  • Bullying: Being the victim or perpetrator of bulling is also associated with anxiety symptoms later on in life
  • Externalizing Disorders: Adolescents with early externalizing disorders are at increased risk for later anxiety disorders. Attention Deficit/Hyperactivity Disorder (ADHD), in particular, is a significant risk factor.
  • Sleep: Sleep disturbance often predicts the emergence of anxiety disorders.
  • Cognition: Maladaptive cognitive responses (e.g., inability to tolerate distress, negative beliefs about uncertainty, avoidance of new/unfamiliar people/things, and repetitive negative thinking) are associated with impaired emotion regulation and a greater risk of developing anxiety disorders.

Supportive relationships with family and peers as well as problem-focused coping strategies can guard against anxiety disorders. Problem-focused coping refers to strategies that directly address the problem to minimize its effect.

Parents, caregivers, and other adults involved can also help by:

  • being aware of the signs of anxiety
  • being mindful of expectations set for children and teens
  • encouraging participation in sports teams, clubs, community- or religious-based groups
  • supporting a healthy lifestyle, including a nutritious diet, exercise, and adequate sleep
  • providing access to support services

 

References:

Donovan, C. L., & Spence, S. H. (2000). Prevention of childhood anxiety disorders. Clinical psychology review20(4), 509-531.

Vallance, A., & Fernandez, V. (2016). Anxiety disorders in children and adolescents: Aetiology, diagnosis and treatment. BJPsych Advances, 22(5), 335-344. doi:10.1192/apt.bp.114.014183

Warner, E. N., & Strawn, J. R. (2023). Risk Factors for Pediatric Anxiety Disorders. Child and Adolescent Psychiatric Clinics. Published: February 26, 2023 DOI: https://doi.org/10.1016/j.chc.2022.10.001

 

 

About Pediatric Neuropsychologist Ferne Pinard, Ph.D.

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

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

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

Screen Time’s Impact on Child Development and How Play Can Be One Solution

By | NESCA Notes 2022

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

The pandemic has made the already complex job of parenting even more challenging. With parents having to balance working from home and remote learning, many families relied on screens for learning, socialization, and entertainment. Questions about screen time and the impact on child development were already hot topics in our digital age, but the pandemic brought about new and perhaps more compelling concerns.

It is common for children of all ages to engage with digital devices. Even prior to the pandemic, approximately 80% of parents reported that their child between the ages of five and 11 interacted with a tablet or computer, and 63% used a smartphone. For children under the age of five, 48% engaged with a tablet or computer, and 55% with a smartphone (pewresearch.org, July 2020).

While screens are an inevitable part of 21st century life, too much screen time can have a detrimental impact on child development. The American Academy of Pediatrics recommends no screen time for children younger than two years of age. Older children should limit their screen time to no more than one or two hours a day. According to the American Academy of Pediatrics, too much screen time can be linked to:

  • Obesity
  • Irregular sleep
  • Behavioral problems
  • Impaired academic performance
  • Desensitization to violence
  • Less time for play

It has been established that excessive screen time may lead to obesity due to inactivity and increased snacking that often coincides with screen use. Using screens too close to bedtime may disrupt the body’s biological preparation for sleep, making it difficult to fall asleep and disrupting sleep schedules. Research has shown that elementary school students who spend more than two hours a day watching TV, playing video games or using a computer or smartphone are more likely to have emotional, social, and attention problems. Furthermore, increased time spent on screens results in less time available for learning and practicing skills important for academic and social development. Such skills include, but are not limited to, managing emotions and behavior, paying attention, solving problems effectively and independently, dealing with conflict, and resilience. So, what is the remedy? Limited screen time and more opportunities for play.

The benefits of play are almost limitless. Play is brain building and leads to changes in even the smallest structures. Play develops skills in planning and organization, cooperation, self-control, and communication. Often play involves trying and failing, and learning from mistakes, which enhances children’s capacity for solving problems and learning to focus attention, ultimately promoting the growth of executive functioning skills. Play also provides opportunities for learning to cope with adversity, resulting in increased resilience. There are many great blog articles on NESCA’s website offering information and tips for engaging in play and its benefits. They are written from a range of perspectives, which aids in understanding the wide-ranging value of play.

References:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://publications.aap.org/pediatrics/article/119/1/182/70699/The-Importance-of-Play-in-Promoting-Healthy-Child

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form

 

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

 

Social Skill Concerns in a Time of Reduced Social Opportunities

By | NESCA Notes 2021

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

Even in pre-pandemic times, we saw many children and adolescents where social difficulties were the primary concern. Now, almost two years into the life-altering changes brought on by COVID-19, it is rare that I see a young person whose parents do not raise social concerns. Some common concerns include:

My child does not know how to play with peers.

My child is anxious/fearful around peers.

My child avoids peers and/or would rather play alone.

My child does well with 1-2 peers but cannot handle a group.

My child does not have friends and/or does not seem to know how to make friends.

These are all important, valid concerns. Social development is critical to evaluate and understand when we look at a child’s overall functioning, and early social skills lay an important foundation for later independent functioning, fulfilling interpersonal relationships, and vocational/academic success. Concerns about social presentation (i.e., how your child “looks” or behaves socially) can have many varied causes. Sometimes the cause is clear and relatively straightforward to determine with a neuropsychological evaluation. For example, an evaluation may lead to an autism diagnosis, explaining why a child is struggling socially. Other times, the exact cause is unclear, and probably related to many different factors all coming together. For example, children with ADHD very often present with social challenges, though the path from ADHD to social problems is not always “cut and dry.”

For children coming in to testing now (and over the past 18 months), some of the biggest complicating factors are the social isolation, online learning, and reduced social opportunities related to the pandemic. This is not to say that there are no longer clear cases where a child has autism at the root of their social difficulties – there certainly are. However, for each child now, we must consider the impact that COVID has had on their specific social development. This will depend on the child’s age (and age at the onset of the pandemic), school placement and educational environment, family structure (e.g., siblings and/or other children in the home), and community policies. For example, young children who are attending daycare/private preschool may actually not have missed as much socialization time, as many daycares re-opened after only a few months of closure. This is not to minimize the disruption or extreme challenge of such closures to families; for young children, however, it is likely that their social development is not radically impacted by a few months of reduced social opportunities. In contrast, an elementary-age child may have experienced well over a year of reduced socialization, with remote learning in place for many communities until the fall of 2021.

In all cases, pre-existing and/or co-occurring areas of difficulty are extremely important in our conceptualization of why a child is struggling socially. If your child will have an evaluation soon and you have social concerns, you can prepare by thinking about:

  • What was my child like socially before COVID?
    • Did they have strong friendships? Did they have conflict or “drama” with peers often? Were they invited to playdates and/or birthday parties?
  • What was my child like emotionally before COVID?
    • Happy? Easy-going? Quiet and shy? Sensitive? Irritable?
  • What were the practical, observable things that changed from March 2020 through the present?
    • How much time did they spend doing online learning? Did someone in their family become very ill? Lose a job? How isolated were they?
  • What was my child’s response to the things that happened above?
    • Did they enjoy online learning? Were they fearful about becoming sick? Did they miss spending time with friends or family?
  • What other areas seem to be challenging for them?
    • Communicating? Reading? Managing feelings? Paying attention?

All of these are helpful pieces of information that you can communicate to an evaluator. This will build context for the concerns that you see now, and help us move through the web of complex possibilities that may be contributing to your child’s social challenges. Remember that it is always good to be watchful and thoughtful when your child is struggling. At the same time, keep in mind that many individuals (children, adolescents, and adults alike) will require long periods of time to rebuild their skills, stamina, strength, and sense of safety. It is still OK not to be OK quite yet.

 

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.

 

Getting Back in the Swing of Things

By | NESCA Notes 2021

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

The past 22 months have brought more transitions and changes to our daily lives than ever before. Whether children and parents have had to transition from routine school breaks, or to unprecedented remote learning environments, we have all dealt with our fair share of the unexpected since the COVID-19 pandemic began. As we prepare to enter yet another transition with winter break ending (and February break not too far away), these changes in schedule and routine can be difficult adjustments for entire families. Not to mention the seemingly never-ending worries wondering whether virtual learning will resume once again. In order to help ease these times of transition, try utilizing the following tips:

Consider sticking to similar routines when possible. Sleeping in, unusual mealtimes, and later bedtimes are all tempting (and sometimes unavoidable!) when we don’t have our regular school or work routines during breaks and vacations. Try to implement some sort of routine whenever possible if routine is what works best for you and your family. It might mean that you can still sleep in, but mornings start consistently at 7am instead of 5am. Maybe dinner is no longer eaten at 7pm but at 6pm. Whatever the changes may be, consistency is key.

Schedule time for fun! As much as routine and schedules can be important, don’t forget to leave time for enjoyable activities! The holiday season can bring numerous obligations between holiday parties, visiting with family/friends, and previously scheduled extracurricular activities. Take some time to plan preferred family activities as well! After all, a break is supposed to be just that…a break!

Don’t wait to start transitioning back to school day routines until the morning of. Going back to work or school after extended time off can be really challenging. There is often a sense of dread and “Sunday Scaries” that accompany a return back to our daily responsibilities. Don’t wait until the night before or morning of to resume a typical bedtime and wakeup call. Instead, gradually shift the nighttime and early morning routine over a few days so that the night before/morning of doesn’t feel so daunting and overwhelming! By pushing back bedtime and setting the alarm 15 minutes earlier over the course of several days, the difference won’t seem as insurmountable.

Create visual calendars and talk about the transition ahead of time. Creating visuals can be crucial in helping children to prepare for what is to come. For younger children who do not yet have an appropriate conceptualization of time, a visual can be a particularly useful resource in preparing them for what to expect and when. Make reviewing the visual calendar a part of the nighttime or morning routine.

Provide validation and have patience with yourself. No matter how hard we try to prepare, seeing an increase in problematic behaviors, temper tantrums, and emotional outbursts is to be expected throughout times of change. Helpful strategies during times of dysregulation include naming the emotion, validating it, and creating space for safe and appropriate expression. Try using statements such as:

  • Labeling the emotion: “It looks like an earlier bedtime is really frustrating for you.”
  • Validating the feeling: “It’s okay to feel this way.”
  • Normalize the feeling: “Sometimes I feel overwhelmed when I have to do things I don’t like.”
  • Modeling appropriate strategies: “Something that can be helpful for me is deep breathing. Do you want to try and see if this is helpful for you, too?

 

About the Author

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

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

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

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

 

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

 

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

 

When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form

 

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

 

The Path Back to Fitness

By | NESCA Notes 2021

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

One of the well-known impacts of the pandemic has been the loss of physical fitness in children and adolescents because of the loss of opportunities to play sports and generally move around. In addition, many children and adolescents have gained weight during this time. Maintaining a healthy weight and being physically fit offer many benefits for social-emotional development as well as academic performance. Numerous research studies link physical exercise to significant improvements in the regulation of mood and anxiety as well as attention and executive functioning.

Parents are often at a loss for how to help their child get back into good habits to lose weight, exercise regularly, or get back into a sport. Common parenting approaches, such as offering “helpful suggestions,” encouraging, nagging and bribing usually don’t work for long term—or even short term—positive change. Instead, these approaches often “back fire,” making the child feel even more ashamed or powerless—emotions that are not likely to fuel motivation to change habits.

So how do we support children and adolescents in developing the positive habits that are necessary for maintaining health and fitness? The key lies in empowering the child to determine his or her own goals and establishing their “why” through discussion of why they would like to reach this goal, what they will get by achieving the goal, and, perhaps most important, how they will feel when they reach this goal. This type of motivational interviewing builds internal motivation, which beats external motivators every time in terms of creating long term change.

Once the child or adolescent is clear on what they would like to achieve and why, the next step is determining the behavior changes that will help the child achieve their outlined goal and working with the child to figure out what’s manageable so that success can be ensured. For example, one adolescent might easily commit to a 30-minute daily bike ride, whereas another might want to start with a daily 10-minute walk. Success breeds success, so it is important to set goals that are challenging but also achievable. Throughout this process, the focus is on creating a positive mindset and positive emotional state of empowerment, hopefulness, optimism, and pride.

Some children may be open to this type of process with their parents; however, most adolescents will likely not want to be involved at this level with a parent. NESCA offers health and life coaching, aimed at helping adolescents and young adults with this process. Coaching offers a structured approach to helping an adolescent or young adult define his/her own goals and motivations as well as understanding the obstacles that they have encountered in reaching those goals, which are usually limiting beliefs (e.g., “I can never stick to things.”) or faulty self-identities (e.g., “I’m not athletic.”). The coaching process works through a combination of structured activities as well as a highly supportive personal relationship. To learn more, please join us for a webinar on Thursday, September 23 at 1:00 PM ET, view a previous webinar on this topic on our website or contact Health & Life Coach Billy Demiri for a free 30-minute consultation to determine if health coaching might be helpful for your child.

 

About the Author

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

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

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

To book an evaluation with Dr. Helmus, NESCA Founder and Director, or one of our many other expert neuropsychologists or therapists, complete NESCA’s online intake form

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

The Uncertainty, Stress and Anxiety About What School Will Look Like

By | NESCA Notes 2020

*This blog post was originally published prior to the start of in-person school last fall for some. While many students have returned to their school buildings, many others are just now returning or will be in the coming weeks. 

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

Much of adjusting to the world in the midst of a global pandemic has been learning to live with nearly constant uncertainty. Undoubtedly, this pandemic and ensuing uncertainty has caused significant stress for youth and their families. The experience of persistent stress can result in increased vulnerability to anxiety and depression. Symptoms may become magnified in those who already faced mental health challenges. There is little doubt that there will be increases in mental and behavior health problems for children and families both in anticipating the re-opening of schools, and when schools reopen their physical buildings.

We all wonder what school will look like in the fall. The anticipation of returning to school can be especially stressful, and will likely be so for most youth. Given that students will not have been in schools with their peers for several months, it can be anticipated that they might feel a heighted sense of insecurity and uncertainty. Even in “normal times,” returning to the complex social and educational environment of school can be worrisome for many children and adolescents.

Each individual child will have had their own experiences while schools were closed. Some children and/or staff members may have been impacted by COVID-19 and some families and/or staff may be experiencing financial hardship due to parental unemployment or loss of household income. It is important to realize that regardless of their experience, each individual will have a unique response. It is helpful to recognize the signs of stress and help children learn positive ways of coping with it.

Signs of stress in preschool children include, but are not limited to, anger, nervousness, eating and sleeping problems (including nightmares), fear of being alone, irritability and uncontrollable crying.

In elementary age children, stress may manifest as increased complaining of headaches and stomachaches, feeling insecure, reduced appetite and difficulty sleeping, withdrawal and worrying about the future.

Signs of stress in pre-teens and teens may include anger, disillusionment, distrust of the world, low self-esteem, stomachaches and headaches, panic attacks and rebellious behavior.

As each person works through this very challenging situation, it is more important than ever to adopt a position of acceptance, as we never truly know what another person is experiencing or has experienced. The following are offered as suggestions on how to help children and teens cope with stress.

  • Help them identify how they are feeling and acknowledge and validate those feelings.
  • Encourage them to talk about what is bothering them.
  • Share strategies you use to cope with stress.
  • Talk openly and, as appropriate, share stories about stress in your day.
  • Find a physical activity and/or hobby that they enjoy and encourage them to participate.
  • Encourage them to eat healthy foods and emphasize the importance of a healthy lifestyle, especially as it relates to stress.
  • Make sure they get plenty of sleep.
  • Set clear expectations, without being overly rigid, and allow for “down” time.
  • Spend time outdoors, encourage them to do something they love – read a book, ride their bike, bake, etc.
  • Learn and teach your children relaxation skills, such as breathing exercises, muscle relaxation exercises, meditating, yoga, drawing or writing.

Our world will have changed by the time children re-enter their classrooms. No matter what happens in the fall, when it is time for school to start, it will inevitably be stressful. Learning to cope with and manage stress is important for physical and emotional health. However, if you are concerned about your child or are struggling yourself, seek help and support for yourself, your child or anyone in your family who is struggling.

Below are some helpful resources:

https://www.apa.org/topics/children-teens-stress

https://nesca-newton.com/helping-your-anxious-child-through-covid-19/

https://childmind.org/article/how-to-ask-what-kids-are-feeling-during-stressful-times/

https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.stress-in-children-and-teens.ug1832

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form

 

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