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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Working to Make Traffic Stops for Autistic Drivers Less Stressful

By | NESCA Notes 2024

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Services, NESCA

Any driver who has ever cruised down a highway and suddenly sees flashing blue lights and hears the siren of a police car pulling up behind them knows that feeling of panic and dread – that immediate stress response that runs through your body. The internal questioning begins…What did I do wrong?, Was I speeding?, Did I not use my turn signal?, etc. The flight and fight response courses through our body. We pull over and wait while the officer gets out of their car and approaches. We know to keep our hands visible, wait patiently, and wait to be spoken to. These “unwritten rules” may not be specifically taught, but we just know to do them. Now, imagine for a moment that you are autistic and unwritten rules are difficult for you in general – never mind in this stressful situation. This situation is exacerbated in intensity by the very nature of their Autism Spectrum Disorder (ASD) diagnosis, which may lead to the driver experiencing difficulty with communicating, their ability to manage the stress of the situation, interacting as expected socially, and managing the total flooding of their sensory systems. If the driver is a minority and autistic, the stress may be further compounded.

Recently in Massachusetts, The Blue Envelope initiative was unanimously passed by both the House and Senate. This initiative assists autistic drivers in auto accident situations and traffic stops. While it is voluntary for police departments and autistic individuals to participate, the hope is that both groups will avail themselves of this potential to support and be supported in driving situations that arise. It is designed to make experiences like the one outlined above safer, and to ease communication between autistic drivers and police officers. The program began through a collaborative effort among autistic individuals, their parents, and multiple agencies and organizations, including the Massachusetts Chiefs of Police Association, Massachusetts State Police, Advocates for Autism of Massachusetts, and The Arc of Massachusetts.

The Blue Envelope Program is literally based on a blue envelope that autistic drivers keep in their vehicle with their important papers inside (i.e., driver’s license, registration, insurance card, and a contact card). The Blue Envelope isn’t just an ordinary envelope to keep things organized. Rather, it’s meant to be a “life saver and game changer,” as it is specially designed to provide critical communication guidelines and support as well as other important information about ASD. The communication information is printed on the outside of the envelope, thus alerting the officer that they are interacting with an autistic person. Along with general information about ASD, the information in the envelope can be personalized –  since we know that each person’s strengths and challenges are never the same from one individual with autism to the next. Also included on the outside of the envelope are “instructions/guidelines” for the individual. The intent of this program, by alerting officers that they are interacting with an autistic individual, is so they may potentially modify their interaction approach and style; possibly averting the individual becoming escalated, leading to more serious encounter. The Blue Envelope Program is available in many states, including RI, CT, ME, NJ, PA, AZ, and CA. It is currently in use by the Massachusetts State Police and some local communities. The program also includes training for law enforcement officers on how to approach and interact with individuals should they have a Blue Envelope.

The Blue Envelope Program hopes to, “enhance understanding, reduce anxiety, streamline communication and encourage preparedness,” and create a “positive outcome” for all. There are tips for officers that include things like, “use simple, direct language, avoid idioms, be observant, allow drivers longer time to respond, and clearly tell the driver when the stop is done.” If signs of distress are visible, try to reduce sensory inputs (turning off flashlights, sirens, etc.). Tips for drivers include handing the officers the Blue Envelope and telling them you’re autistic, following instructions, and asking for clarification if they do not understand something the officer is saying. The general guidance remains to always keep your hands visible – on the steering wheel; and if you need to reach for anything, tell the officer what you are doing before doing it.

The goal of the Blue Envelope Program is to create an outcome that is safe, respectful, and positive for all parties involved in a traffic stop, whether it be an accident or a traffic violation. Its aim is that autistic drivers will feel safer, calmer, more secure, and less stressed during traffic stops and that the officer training will help them be more aware of whom they are interacting with, be more prepared, exhibit greater empathy, and be more patient when interacting with an autistic driver. It has the potential to be a win-win program for all involved.

If you would like to apply for a Blue Envelope in Massachusetts, visit: https://www.mass.gov/info-details/blue-envelope-program#tips-for-a-safe-traffic-stop-

Additional Resources:

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

To book a consultation with Ms. Lucci or one of our many expert clinicians, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant/service in the referral line.

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; 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.

 

The Importance of Building Grit

By | NESCA Notes 2024

By: Alissa Talamo, PhD
Pediatric Neuropsychologist, NESCA

“I’ve missed more than 9,000 shots in my career. I’ve lost almost 300 games. Twenty-six times I’ve been trusted to take the game-winning shot and missed. I’ve failed over and over and over again in my life. And that is why I succeed.”

Michael Jordan

 “Our potential is one thing. What we do with it is quite another.”

– Angela Duckworth, “Grit: The Power of Passion and Perseverance

What is it that separates those who succeed and those who give up? Is it talent? Is it luck? In the book, “Grit: The Power of Passion and Perseverance,” psychologist Angela Duckworth examined why some people are more successful than others, and she concluded that the common denominator is ‘grit.’ She defines grit as “passion and perseverance for long-term goals” and notes that “bouncing back from failure turns out to be one of the best lessons a kid can learn.” While we, as parents, sometimes focus on academic success to help our children succeed, Angela Duckworth believes that grit “matters more to a child’s ability to reach his full potential than intelligence, skill, or even grades.” Research into grit also finds that, unlike IQ, which is relatively fixed, grit is something everyone can develop.

While some children seem to be naturally grittier than others, we can help our children develop the habits of persistence and perseverance that will allow them opportunities to be successful in whatever it is they feel passionate about. So, how do we help our children develop the ability to push through when things get hard, recognize that making a mistake is an opportunity to learn rather than a ‘failure,’ and stay focused on goals even during times of disappointment?

One important thing parents and teachers can do is to model and encourage goal setting. It is important to encourage children to set realistic and achievable short-term goals, so that they can experience small successes that will keep them motivated to reach their long-term goals. For example, a short-term goal could be to practice the piano for 20 minutes per day with the long-term goal of participating in the school talent show.

As parents or caregivers, we tend to want to ‘fix’ things for our children, or make the path easier for them, but to truly develop grit, a child must be provided opportunities to attempt difficult things. According to Duckworth, “It has to be something that requires discipline to practice,” and she reminds parents to remember that the actual activity doesn’t matter as much as the effort, and that it is effort that should be rewarded over achievement.

It is also important to model to children that success does not occur right away, that practice and perseverance are needed, and that learning something new is hard but that does not mean they will not be good at it. Additionally, when a child does come across a problem, rather than solve the problem for them, encourage them to figure out a way to solve it themselves. According to Paul Tough, author of “How Children Succeed,” “It’s so much more powerful for a child to be able to deal with adversity and overcome it. What the child takes from that experience is, ‘Hey, I can solve things.’”

Most importantly, children learn what they see, so demonstrate to your child that you are able to take on tasks that are sometimes scary. And while sometimes you may have difficulty with those tasks or even fail to complete them, your ability to persevere, problem solve, and bounce back from these experiences will go far in allowing children to believe that they also can try hard things, that failing is not a lack of success but a stepping stone to gaining a skill, and that perseverance and grit are traits that will serve them well as they continue to grow and develop.

Sources:

https://www.scholastic.com/parents/family-life/social-emotional-learning/social-skills-for-kids/power-defeat-how-to-raise-kid-grit.

https://psycnet.apa.org/record/2021,Grit and academic achievement: A comparative cross-cultural meta-analysis

“Grit: The Power of Passion and Perseverance,” Angela Duckworth, Scribner, 2016

“How Children Succeed: Grit, Curiosity, and the Hidden Power of Character,” Paul Tough, Houghton Mifflin Harcourt, 2012

 

About the Author

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

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

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

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

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

She is the mother of one college-aged daughter.

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

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

A Little Coaching for Caretakers Goes a Long Way When Building Executive Function Skills for Students

By | NESCA Notes 2024

By Jasmine Badamo, MA
Educational Counselor; Executive Function Coach

In my work as an executive function tutor, a priority is to foster collaborations with the other adults in my clients’ lives. Every relationship brings something different to a young person: different perspectives, areas of expertise, support abilities, opportunities for conflict management, etc. But while every person in your child’s life plays a unique role in their growth, family members often serve as the “control tower” for communication between the various environments of a child’s life. That’s why, of all the collaborations I engage in, parent/guardian collaboration can have the most significant impact on my clients’ executive functioning progress.

When I start working with an executive function client, I work to establish a clear line of communication with caregivers at the outset so they are well-informed of our session work. But direct parent/guardian coaching allows for collaboration on a much deeper and consistent level. Similar to executive function tutoring, parent/guardian coaching is regularly scheduled, has established goals, and serves as a space to discover and learn different strategies for supporting executive functioning skill development. Furthermore, because of the individualized nature of coaching, it can address a wide range of family needs, such as assistance with school documentation; brainstorming and creating home supports for a neurodivergent child; receiving reassurance and guidance in difficult-to-navigate or novel parenting situations; and managing your own daily demands so that you have more bandwidth for supporting your child, etc.

Here are some example situations demonstrating when and how parent/guardian coaching can have a big impact:

→ Your child is in elementary school and is still developing their self-awareness and ability to self-reflect. In their weekly executive function tutoring, they cannot always accurately self-report the daily demands they face or struggle with. You’ve set up brief weekly parent/guardian coaching in order to share important background/contextual updates that will help me direct my tutoring focus and strategy suggestions. I offer weekly tips that help you to practice accurate self-reflection with your child. It also allows you to share any new concerns that arise.

→ Your 9th grade child has been working with an executive function tutor for a little over a year now and has learned several executive function management strategies. They’ve reached the point in their development where they need to generalize their knowledge. You’ve decided to start parent/guardian coaching because you are uniquely positioned to support this generalization at home. I touch base with school staff to also support generalization at school.

→ Your high school child is struggling with executive functioning, and you want them to get support, but they are not open to meeting with an executive function tutor. You start parent/guardian coaching in order to learn concrete strategies to support your child with the executive function demands of school and home. The parent coaching is also helping you to reflect on the ways you can facilitate a better communication dynamic with your child.

As you can see in the above examples, even though the coaching sessions are attended by the parent/guardian, the purpose of the work is to supplement the executive function (EF) development of your child. Here are just a few ways in which parent/guardian coaching contributes to your child’s success. Coaching can:

→ help you further create a home environment that is supportive of your child’s EF needs and skill development

→ help you know how to “lend” your prefrontal cortex to your child in a way that reduces overwhelm, but still provides limits so that they have opportunities to develop and practice skills for managing EF tasks with greater independence

→ help you expand your strategies for responding to challenges or conflicts that arise while working on EF goals between tutoring sessions

→ help you know how to prioritize your focus in supporting your child’s goals (there are so many resources, it can be a challenge to know which to start with)

→ help you use strategies that promote a mindset of growth, reflection, and self-compassion (all important for your child’s EF skill development)

→ help normalize the act of receiving help and support. Your commitment to coaching models for your child the importance of getting support for your needs, being open to feedback, and embracing personal change/growth.

The list can go on because the opportunity to work with clients and caretakers in tandem offers exponential benefits for the client. What parent/guardian coaching does on a fundamental level is support families in developing a new filter, perspective, and framework for approaching and supporting the young person’s executive function needs.

 

About the Author

Jasmine Badamo, MA, is an educational counselor and executive function coach who works full-time at NESCA supporting students ranging from elementary school through young adulthood. In addition to direct client work, Ms. Badamo provides consultation and support to parents and families in order to help change dynamics within the household and/or support the special education processes for students struggling with executive dysfunction. She also provides expert consultation to educators, special educators and related professionals.

Ms. Badamo is a New York State Certified ENL and Special Education teacher. She has more than 10 years of teaching experience across three countries and has worked with students and clients ranging in age from 7 to adulthood. She earned her bachelor’s degree in Biological Sciences from Cornell University and her master’s degree in TESOL from CUNY Hunter College. She has also participated in graduate coursework focusing on academic strategies and executive function supports for students with LD, ADHD, and autism as part of the Learning Differences and Neurodiversity (LDN) certification at Landmark College’s Institute for Research and Training. In addition to being a native English speaker, Ms. Badamo is also conversationally fluent in verbal and written Spanish.

Having worked in three different New York City public schools, Ms. Badamo has seen firsthand the importance of executive function skills in facilitating student confidence and success. Her coaching and consultation work focuses on creating individualized supports based on the specific needs and strengths of each client and supporting the development of metacognition (thinking about one’s own thought processes and patterns), executive function skills, and independence. She will guide clients to generate their own goals, identify the barriers to their goals, brainstorm potential strategies, advocate for support when needed, and reflect on the effectiveness of their applied strategies.

Ms. Badamo is a highly relational coach. Building an authentic connection with each client is a top priority and allows her to provide the best support possible. Additionally, as a teacher and coach, Ms. Badamo believes in fostering strong collaborations with anyone who supports her clients including service providers, classroom teachers, parents, administrators, and community providers.

To book executive function coaching with Jasmine Badamo or another EF or Real-life Skills Coach at NESCA, complete NESCA’s online intake form

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

Creating a Kinder, Gentler New Year

By | NESCA Notes 2024

By Dot Lucci, M.Ed., CAGS
Director of Consultation and Psychoeducational Counseling Services, NESCA

We use the start of every new year as motivation to set goals for ourselves, and we often ask children to do the same thing. A New Year’s Resolution is a tradition, in which we set our mind, heart, and spirit to change an undesired trait or behavior, accomplish a personal goal, or otherwise improve ourselves in some tangible way. We may set a goal to lose weigh, exercise more, eat less sugar, meditate daily for five minutes, do homework without a fuss, help out with chores around the house, or walk the dog when my parents ask, etc. Often, we make New Year’s Resolutions, but we don’t usually accomplish them. Within a month or so, we start slipping back into our old ways. Habits are hard to change, and we are resistant to change – it is partly due to our wiring. So, if you are one of these people who has good intentions and sets New Year’s Resolutions then fails, know you are not alone. Hopefully, this fact can help you feel less shame and guilt when you “fail” at keeping them.

I’d like to suggest that if you decide to set a New Year’s Resolution, you do it with yourself and other people in mind. There is so much angst and strife in the world right now that if we resolve to be kinder, gentler, and more patient with ourselves and each other, the world would be a better place.

One idea is to make group resolutions that impact the functioning of the collective. For instance, we could consider Family New Year’s Resolutions or Classroom New Year’s Resolutions. With this in mind, here are some sample suggestions for New Year’s Resolutions for families, classrooms, parents, teachers, and children. Keep your resolution(s) manageable – i.e., only pick one that you are truly committed to working on and putting the energy into changing, as your brain is partly “against you” changing! As they say, “May the Force Be With You!”

General New Year’s Resolutions

  • Sleep – It’s important for everyone, so try to set bedtimes for everyone and stick to them (parents included). Bedtimes should be different depending upon the ages of each child. Getting more sleep may afford us the ability to be more patient with others.
  • Unplug – Take time to unplug from your devices for an hour or more every day. Go for a walk, talk to each other, get the kids involved in preparing the dinner, play a board game. (i.e., take part in old fashioned “family time”). Unplugging affords us the opportunity to be more connected with each other, and being with others (Social Engagement) has been proven to improve one’s quality of life.

For All of Us:

  • Develop patience and compassion when you mess up, as you will mess up.
  • Develop patience and compassion with others because they, too, will mess up.
  • Develop a calming practice if you do not currently have one. Stress happens and is a “silent killer” (i.e., higher blood pressure, poor eating habits, etc.). We have smart watches that can remind us to take a breath…set it to remind yourself. Come back to your breath in moments of stress. Just a few minutes a day mindfully breathing can lower your heart rate and, over time, lower your blood pressure and reduce cortisol (a stress hormone) in your body.
  • Listen more/Talk less.

For Classrooms:

  • Encourage each student to identify one area related to Personal Growth (i.e., ask more questions in class, volunteer to help another classmate, remain calm when challenged academically, etc.). I will ___Settle Down___ when asked by the teacher by the end of the count; show ___Kindness___ to others in my class by___; Ask more questions; volunteer to ___.

For Teachers:

  • Start the New Year off with renewed energy and reimagine equity in your classroom.
  • Talk about fairness – Fair doesn’t mean equal; it means everyone gets what they need to succeed.
  • Talk about school-based stressors/triggers for students (i.e., a certain subject/activity type, tests/quizzes, speaking in front of the class, etc.). Teach them that stress is a normal part of life, then teach them simple stress-reduction techniques (i.e., mindfulness, deep breathing, yoga poses, etc.) they can weave into their day.
  • Teach students about perseverance, grit, and effort and how they are all entwined. Involve students in identifying when they are using them.

For Parents:

  • Self-care – Priority #1 for parents. Just like the airlines say, “Put your own oxygen mask on first.” Define what this means for you and make a plan to stick with it. One small step at a time.
  • “Be Present” with your kids. Often, we are “with” our kids a lot, but are we truly present in mind and body? Usually not; we are doing something else when they are talking to us (i.e., cooking, paying attention to our phones, packing lunches, etc.), so our attention is split. Try taking 10 minutes every day with each of your kids to be truly present in mind and body with your attention solely on them in the moment.
  • Talk with your children about home/life stressors/triggers (i.e., not getting to do what they want, having to do something they don’t want to do, moving from a preferred to non-preferred activity, etc.). Teach them that stress is a normal part of life, then teach them simple stress-reduction techniques (see above) and work together to weave them into the day. Model practicing them yourself!
  • Show gratitude for their words and actions.

Here’s to hoping we are blessed in 2024 with more peace in our hearts and a kinder, gentler, and more compassionate family, classroom, and world!

Resources on these topics:

Keeping Resolutions

Family Resolutions

Stress & the Body

Awesome Year by Kid President

 

About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.

 

To book a consultation with Ms. Lucci or one of our many expert clinicians, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician/consultant/service in the referral line.

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and 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.

 

Navigating Screen Time: Understanding the Impact on Child Development

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

At school, we have had increasing difficulty with children refusing to leave their car at drop-off because they are on their tablets and do not want to stop what they are doing to go to school. Screen time has long been discussed regarding how much is too much and recommendations offered for limiting screen time. Now, with mobile devices, screens can be taken anywhere. Furthermore, there is never a shortage of entertaining options to engage with, from games like Minecraft, Roblox, and Fortnite to YouTube, all of which draw children in and make it difficult to stop. This article aims to provide a nuanced exploration of the impact of screen time on child development. While screen time is not inherently negative, it requires thoughtful management and consideration, particularly in the context of the developmental needs of children.

Screens are pervasive in daily life and have become integrated into the fabric of 21st century family dynamics, mostly due to the numerous ways of engaging with screens. According to the American Academy of Child and Adolescent Psychiatry (AACAP), children between the ages of eight to 12 spend at least four to six hours a day watching or using screens. According to Common Sense Media, children between birth and eight spend an average of two and one-half hours per day, with children two and under spending approximately 49 minutes on average. While screens can teach and entertain, too much may lead to problems.

Excessive screen time can have a variety of effects on child development. These effects can be physical, cognitive, emotional, and social, and vary depending on the content and purpose of screen time. The is largely due to what children are not doing when they are using screens. Extended periods of screen time can lead to a sedentary lifestyle, which can lead to obesity, poor posture, and disrupted sleep patterns. In terms of cognitive development, overuse of screens with fast-paced and visually stimulating content can overwhelm a child’s developing brain and potentially affect attention span, impulse control, and the ability to concentrate.  It can also impede the development of language and communication skills. When children spend too much time in front of screens, they may have fewer opportunities to engage in real-life conversations and interactions, which are crucial for language development. And, while educational content can have benefits, excessive screen time can still disrupt the learning process. It may lead to reduced engagement with traditional forms of learning and limit a child’s ability to exercise critical thinking and problem-solving skills.

It is important to note that not all screen time is detrimental. Age-appropriate and high-quality content, as well as supervised and interactive screen time, can have educational and social benefits. Additionally, technology can be a valuable tool for learning and creativity when used in moderation and with parental guidance. Parent and caregivers can help mitigate the potential negative effects of screen time by setting limits, monitoring content, and encouraging a balanced lifestyle that includes a variety of activities, such as physical play, reading, and face-to-face interactions. Sometimes the best conversations happen in the car.

References:

 

About the Author

Dr. Cynthia (Cindy) Hess conducts neuropsychological evaluations as a pediatric neuropsychologist at NESCA. Dr. Hess enjoys working with children and young adults with complex emotional and behavioral profiles. She is skilled at evaluating social and emotional challenges as well as a range of learning profiles. Her experience allows her to guide families in understanding the supports and services their child requires to be successful in school.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; 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.

 

Questionnaires, Rating Scales, and Checklists, Oh My!

By | Nesca Notes 2023

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

Before I had children, I knew parenting would bring with it new demands. If you’d asked me what tasks I imagined would take a lot of my time and energy as a parent, I would have listed things like feeding hungry little mouths, washing adorable clothes, driving kids to and from school and activities, dealing with bath time, and reading stories at bedtime. What I would never have guessed is how much time and mental effort I would spend filling out paperwork. From the moment a child enters a parent’s life—regardless of what process brings them together as a family—it seems like there are unending forms to complete. As a parent of three children, I cannot begin to calculate how many hours I’ve spent filling out forms for doctors, daycares, schools, camps, babysitters, and extracurriculars. It’s a lot.

Perhaps that’s why I sometimes notice a very relatable subtle sigh when I hand parents forms to complete as part of their children’s neuropsychological evaluation. I get it, and I never want to add to a parent’s already overwhelming list of tasks to complete. Nevertheless, carefully selected questionnaires are an important part of a thorough neuropsychological assessment. Here are a few of the reasons why.

  1. Simply put, parents are the experts on their children. No doubt about it, a parent (or primary caregiver) knows a child better than just about anyone else could. Parents are uniquely qualified to provide invaluable information about their children and are a tremendous resource.
  2. Parents have more data points. During an evaluation, I typically spend about five hours with a child over the course of two testing sessions. It’s a limited glimpse into mere hours out of years of a child’s life. Parents are typically positioned to observe their children much more frequently and on many more occasions. I may see a child at their best or on a particularly bad day, and I don’t want to rely on my observations alone. Having information from many points in time, and from different settings, is incredibly useful and helps capture a more complete picture of a child.
  3. I want and need to know what happens outside the testing office. By design, the testing environment is deliberately developed to be a quiet space as free of distractions as possible to maximize a child’s ability to focus and participate in formal testing. It’s a highly structured situation and a one-on-one interaction. Life outside the office is…well, quite different. I want to get a sense of what happens during the hectic morning rush to get out the door, on the playground and the soccer field, and at the family dinner table.
  4. On a related note, people present differently in different settings, and having data helps us make sense of this. Many parents can relate to the concept of “restraint collapse.” Essentially, kids often work hard to keep it together in the academic setting throughout the day and “fall apart” when they come home after a long day of school. Similarly, children are often on the “best behavior” in public settings and with adults other than their parents. For this reason, I often don’t get to see this important aspect of things, so I rely on parent reports.
  5. Some things simply cannot be readily assessed using standardized testing measures in an office environment. Two skill sets that fall into this category are executive functions and social skills. Executive functions, which include skills like working memory, are not easily captured through tests in the somewhat artificial environment of an office. To assess working memory, we rely on tasks such as asking a child to recall strings of numbers. In the real world, working memory applies to more complex tasks, such as following multi-step instructions in a busy classroom or home setting. A child may do well remembering single digit numbers, but this doesn’t always translate to being able to remember and complete a series of directions in the “real world.” Similarly, interacting with one adult in a highly structured environment doesn’t allow a glimpse into a child’s social skills within the more complex, unstructured situations they face day to day.

In short, neuropsychologists rely on information from parents to gain a clear and complete picture of a child and to provide answers to the questions that bring a family to us. One of the ways we obtain this information is through questionnaires, symptom rating scales, and checklists. So, parents, thank you, for taking the time to give us your unique and invaluable perspective. We couldn’t do our jobs without it or without you.

 

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 and Plainville, Massachusetts, Londonderry, New Hampshire, and 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.

Understanding Behavior as Communication

By | Nesca Notes 2023

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist

School is out for many, and it is no surprise to many that it was a challenging year for teachers, parents, and children. One word that captures the experience of the 2022-2023 school year is stress. Teachers were stressed as their students continued to contend with the academic and social deficits that resulted from the pandemic. Many students have struggled to adapt to post-pandemic learning, and incidents of acting out behavior have increased precipitously. How do we make sense of children’s behavior while helping them develop and effectively manage the academic, social, and behavioral expectations of an ever-changing world?

Ross Greene, Ph.D., states, “Children want to do well and would if they could.” Behavior is not just random or meaningless. It serves as a way for children to express their needs, feelings, and experiences, especially when they have not yet developed strong verbal or communication skills. When the demands of the environment exceed a child’s capacity to manage them, they are apt to become stressed, increasing the likelihood that they will act out. Stress is a complex concept that is a response to perceived or anticipated demands or pressures that exceed an individual’s coping abilities.

When stressed, the adrenal glands release cortisol, a stress hormone that helps mobilize energy reserves for the fight-or-flight response. Fear and anxiety also increase individuals’ vulnerability to responding with fight or flight. So, while fear is focused on a specific threat, physiologically, it feels much the same as stress. Behavior is, therefore, a way of communicating that something is amiss. For instance, a child who acts aggressively may express frustration, which is stressful. And a child who becomes withdrawn might feel overwhelmed or anxious, triggering a stress response. Behavior is a natural way for children to communicate their needs, emotions, or reactions to the environment.

Our job as adults is first to check our own emotional status, because if we are tired or stressed, it will likely influence how we respond when children behave badly. Observing and interpreting behaviors with a curious and open mindset is important. By paying attention to patterns, triggers, and context, adults can gain insights into what a child might be trying to communicate through their behavior. Our job is not to manage the behavior but to understand, per Dr. Greene, what skills are lagging or what problems need to be solved, build relationships, and work collaboratively with children to solve problems and change behavior.

Resources:

The Explosive Child, Ross Greene, Ph.D., 2021

Beyond Behaviors; Mona Delahooke, Ph.D., 2019

Podcast: Two Sides of the Spectrum; episode dated April 5, 2023; “Safety as the Foundation for Everything

 

About the Author

Dr. Cynthia Hess (Cindy), a licensed psychologist, worked as an elementary counselor and school psychologist for 15 years before starting her doctorate. In this role, she developed extensive expertise and aptitude for working with individuals and groups struggling with a wide range of emotional and learning challenges.

She completed her pre-doctoral internship with Rochester Institute of Technology in Rochester, N.Y., where she trained at Hillside Family of Agencies in a therapeutic residential school. At Hillside, she worked with youth ages 5-17 who had experienced complex developmental trauma.

She earned her Psy.D. in Counseling and School Psychology from Rivier University in 2018. Having a strong interest in the impact of social media on children and our culture, her doctoral dissertation studied the impact social media has on social skills development in fourth- and fifth-grade children.

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 and young adults.

Dr. Hess joined NESCA’s Londonderry, N.H. office in 2019, where she completed a second two-year fellowship in pediatric neuropsychological assessment. Dr. Hess now conducts neuropsychological evaluations as a pediatric neuropsychologist and has a particular interest in working with children and young adults with complex emotional and behavioral profiles. Her experience allows her to guide families in navigating the complicated options for school and other support services.

 

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

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, Londonderry, New Hampshire, and the greater Burlington, Vermont area, serving clients from preschool 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.

Testing Outside the Box—Vocational Assessments for Nonverbal, Nonreading and/or Hard-to-Test Students

By | NESCA Notes 2022

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

My colleague Tabitha Monahan and I have dedicated several recent blog entries to vocational assessment—a vital tool for helping students to learn about career planning and employment and to set career goals for themselves. Previous blogs have included an overview of vocational assessment as well as an in depth look at career interest inventories, career aptitude testing, assessing work motivation and values and real-life experiences, such as informational interviews and job shadows.

However, many of the most “popular” or common tools for vocation assessment are intended for use with students who have functional reading abilities (i.e., basic reading skills at or above 5th grade levels). While there are many accommodations a skilled evaluator might use to help a wide range of students effectively access these tests, there are also students who receive special education services and cannot access these word-based and rating-based assessment tools. So, what tools can be used effectively with these students? How do we assess interests and aptitudes for students who are nonverbal, have reduced reading skills, or may provide unreliable responses to language-based testing methodologies? Below are a few of the methods that we find particularly useful at NESCA.

  • Picture-based Interest Inventories

Instead of using text-based items and rating scales, picture-based career interest inventories help individuals to express their occupational interests by selecting preferred pictures of people at work or people performing work-related tasks. Pictures are presented in sets of two, three, or more, and the student points to or circles the picture that seems most interesting. Based on the number and types of pictures selected, the test identifies work themes that are most appealing to the student. Evaluators can also look for themes among pictures selected, such as a student who selects a high number of pictures that have multiple people, computers, vehicles, outdoor activities, etc. Three popular picture-based assessments are the Picture Interest Career Survey (PICS) published by JIST, the Reading-Free Vocational Interest Inventory-Third Edition (RFVII-3) by Katherine Synatschk and Ralph Becker, and the Career Interest Inventory – Pictorial Version by Shasta Twenty-first Century Career Connections.

  • Video-based Interest Assessment

Video-based career interest assessments are more difficult to find but can be incredibly useful nonverbal tools for vocational evaluation and career planning. A tool that we use at NESCA is Your Employment Selections (YES), which is a CD-ROM-based reading-free job preference and career exploration program that has 120 videos of different jobs which are viewed and compared strategically in pairs. Through initial video-based trial, students indicate preferences, such as a desire to work indoors or outdoors, work alone or with coworkers, interact with the public or coworkers, and do light or heavy lifting work. These preferences are used to determine which subset of job videos the student will view. Traditional testing involves the student watching two videos and pointing to, or clicking on, the one they like more. However, the evaluator can work with a student who has limited verbal abilities to determine some of the features or tasks the student likes most, or dislikes most, within the specific job videos shown. While this video program is no longer available for retail, there are plenty of great career videos that can be used to carry out similar informal assessment on web sites, such as CareerOneStop, Dr. Kit, MassHire Career Information System, and even YouTube.

  • Functional Assessments and Observations

For all students, regardless of communication or self-determination skills, functional assessments and real-world observations play a vital role in career assessment and planning. For students who struggle with reading- and writing-based assessments, it can be important to have access to more hands-on standardized assessments of employment strengths and abilities. One such assessment tool is the Skills Assessment Module (SAM) published by Piney Mountain Press, which includes an auditory directions screen to determine how well a student can follow verbal directions and 12 work-related activities that simulate actual work aptitudes required in training and jobs (e.g., mail sort, ruler reading, assembling small parts, etc.). However, evaluators who do not have access to formal assessments can purchase or create pre-vocational and vocational kits for assessing and learning work skills and can carry out functional assessment of real or simulated work-related tasks in school, community, and work settings.

Observing students performing work-related behaviors and tasks is one of the most powerful evaluation tools that we have for determining strengths and needed areas for growth. If a student is performing vocational activities at school or has a volunteer or paid job during the week, that can be critical for an evaluator to observe. There are also protocols that can be used to formally assess students’ skills during observations, such as the Vocational Skills Assessment Protocol from The Assessment of Functional Living Skills (AFLS), and the Becker Work Adjustment Profile – Second Edition (BWAP-2).

  • Interviews and Parent/Educator Participation in Interest Inventories

While some transition-aged students may have trouble clearly expressing interests using words or inventories, all students have some way of communicating information to people who know them well. Transition and vocational assessments often require creativity and effort to gain informal, subjective, and anecdotal information from educators, parents, and other stakeholders who know the student well. It is useful to interview several people, asking questions about the student’s preferred leisure and school activities, areas of strength, preferences that need to be taken into account when planning for future employment, and specifically asking if there are any jobs that the interviewee is aware of that they think might be a good fit for the student in the future. Another technique is to use career interest inventories which are intended for self-report, such as the O*Net Interest Profiler (IP) or RIASEC, and ask parents or educators to fill out the inventory with what they believe the student’s preferences would be. Having a high level of correlation between parent report, educator report, and the student’s responses on picture-based or video-based testing can be extremely helpful in knowing where to focus career planning energy for the student.

Conducting vocational assessment, or any assessment, for this population of students—when tests are often not explicitly designed for them–is difficult. There are some tremendous tools specifically designed for testing students who are nonverbal or nonreaders, and there are many other assessment tools which can be made, modified, or used in nontraditional ways to gain a more complete picture of the student. The most important aspect of assessment is to choose the tools that are going to best suit the student.

For more information about vocational assessment and transition assessment at NESCA, visit our transition services page and our transition FAQs.

 

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

 

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

The Importance of Self-care for Parents

By | NESCA Notes 2021

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

As a working mother of two young children, I often feel as if I am being pulled in a million different directions. When I am at work, I want to be present for my clients and families and not distracted by personal problems. When I am at home, I want to leave my work at the office and be available to play with my children. In an ideal world, I would have the energy to be fully alert and attentive in both settings. In reality, I often find myself distracted and then the guilt sets in. If I’m thinking about my own kids while I’m sitting with a client, does that make me a bad psychologist? If I’m thinking about my clients while I’m with my children, does that make me a bad parent?

Parent guilt is not going to go away, but we can do things in our everyday lives to help combat it. Something that we all need to practice is self-care!

Self-care can take many different forms depending on what you find relaxing or enjoyable. Personally, I use exercise as my daily self-care routine. I subscribe to an online fitness program which means no hassle commuting to/from the gym, and I know I can commit to 30 minutes a day even when I’m busy. Some other examples of self-care might include:

  • Going to bed at a reasonable time every night
  • Scheduling a massage/manicure/pedicure/facial, etc. on a regular basis
  • Take a walk in the evening
  • Write in a journal
  • Meditate
  • Use a self-care app

Whatever you decide to try – remember that self-care is extremely important. We can’t be there for the ones we love if we are not taking care of ourselves. Further, by practicing self-care, we are teaching our children healthy habits that they will take with them and incorporate into their own lives as they grow up.

 

About the Author

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

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

 

If you are interested in booking an appointment for the ASD Diagnostic Clinic or an evaluation with a NESCA neuropsychologist/clinician, please fill out and submit our online intake form

 

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