Wrap up the school year on a high note with NESCA’s Executive Function Coaching and Functional Occupational Therapy! We offer support in EF, Real-life Skills, Parent/Caregiver Coaching, and OT.

Time is running out to schedule a Transition Assessment before the school year ends—gain valuable insights to guide the IEP process.

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pediatric neuropsychologist

10
Map of Hingham, MA and quote by Dr. Moira Creedon

Strengthening the South Shore Community: Supporting Our Children, Teens, and Young Adults

By | NESCA Notes 2024 | No Comments

Map of Hingham, MA and quote by Dr. Moira CreedonBy: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

It was an exciting dream realized when our NESCA South Shore office in Hingham opened in November 2023. As a resident of the South Shore, I was looking forward to connecting to my community closer to home. I was expecting to enjoy a shorter commute and great location. Pausing to reflect after 16 months with our doors open in Hingham, I realize that it is so much more.

I am grateful for how quickly we were welcomed by pediatricians, therapists, psychiatrists, tutors and executive functioning coaches, attorneys, advocates, and public and private schools. We have all quickly aligned on the needs of our communities. There are many children and teens struggling with gaps in learning, trouble with social connections, high anxiety, depressed mood, and behavioral troubles. Many of these collaborations have also communicated the frustration and sense of burnout facing families who feel like they have been working hard and trying to make changes. Teachers feel discouraged when they have dedicated their hearts and minds to support students, and yet students continue to struggle. The experience in our community is universal – it’s so hard to watch our kids and teens struggle.

This can leave many wondering if neuropsychological testing is just one more “hoop” to jump through. Within the trenches of the daily struggle, it can be hard to see how testing might help – especially when change is so slow. I do all that I can to explain why neuropsychological testing is way more than a hoop; it can be a roadmap. How?

  1. Even if your child has had “evaluations before,” neuropsychological testing is a chance at an integrated and comprehensive evaluation. What does that mean? It means that if you have had pieces of testing before, you still have a pile of pieces – an educational evaluation from school, a private OT evaluation, an early speech evaluation, a diagnostic interview with a therapist, etc. My goal is to take all of those pieces, plus the new ones I add, and put them together into one cohesive puzzle demonstrating how a child or teen thinks and learns.  This is one of the reasons NESCA does academic testing as part of its testing batteries, because these pieces are essential for diagnostic clarity, to see how the profile impacts a person’s real life skills/functioning, and because being a student is a kid or teen’s full time job. It’s not a piece to be overlooked.
  2. Neuropsychological testing can be a chance to understand the “why” when there are many complicated layers. When a child or teen is struggling, we often start in the middle of the process. Often, parents and/or schools want to try to solve the problem with school support, or interventions such as a referral to a therapist or connection to a social skills group. When those efforts stall, the impulse is to try a different solution.  Neuropsychological testing lets us step back, learn about a larger profile or picture of all aspects of a child’s learning or thinking to make meaning of what is happening. Then, we can choose a path for intervention that has the best chance of success.  When a child is struggling, trying to see what works in a way that’s not fully informed or that addresses the child as a whole, is often not the best use of time and resources.
  3. Neuropsychological testing uses the data collected from the testing to outline the steps for what to do next. Any good plan needs a detailed understanding of a problem. Oftentimes, it’s a combination of services that are needed – in the community, at home, and/or at school. It can be hard to figure out how to prioritize the steps, and it’s important to consider what is realistic and feasible. Neuropsychological evaluation can help make those steps clearer.
  4. Neuropsychological testing can give us a good baseline and measure of progress. Caretakers know their children best, so they can often spot subtle issues before they bloom into the bigger issues. Neuropsychological testing can be proactive, and it can help to track how a student responds to interventions. We can also use neuropsychological testing to maximize potential, including how students find their strengths, build their “academic diet” of courses in high school and college, and build stronger study skills along the way.
  5. At NESCA, neuropsychological testing involves important collaboration, perspective, and insight. The reason I mention the community that I’ve met through our South Shore office is because collaboration is key. The observations and insight offered by anyone who comes in contact with a child or teen is invaluable. Standardized test measures are a critical piece of the puzzle, but it’s one part of the critical triad of history, observations, and testing. These collaborations are also helpful to keep the neuropsychological test report “alive” as the community putting the recommendations into action works best through communication.

In the upcoming year, we set many goals for NESCA as a leader in our field. I want to pledge to my community that we will continue to provide the highest quality care and to respect and value our clients and families.  We will continue to build connections to our community members to join the efforts in supporting children, teens, and young adults. I am thrilled for upcoming opportunities to learn and grow alongside you all.  I am deeply grateful to be part of the South Shore community supporting children, teens, and young adults.

 

About the Author

Dr. Creedon offers her expertise in evaluating children and teens with a variety of presenting issues. SheMoira Creedon headshot is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. She tailors each assessment to address a range of referral questions, such as developmental disabilities, including Autism Spectrum Disorder, learning disabilities, attention challenges, executive functioning deficits, and social-emotional struggles. She also evaluates college-/grad school-age individuals with developmental issues, such as ASD and ADHD, particularly when there is a diagnostic clarity or accommodation question.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

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

11
Image of clinicians collaborating around a conference table

Why I Started a Group Pediatric Neuropsychology Practice

By | NESCA Notes 2024

Image of clinicians collaborating around a conference tableBy Ann Helmus, Ph.D.
Founder and Director, NESCA

In the field of pediatric neuropsychology, the complexities of child development and the wide array of diagnoses children may face can often be overwhelming for any one practitioner to fully grasp. With this in mind, I chose to open NESCA’s doors as a group practice back in 2007. The advantages of a group practice model were clear to me then and have become even more critical in today’s environment – and with today’s challenges facing children – particularly when it comes to addressing the varied and intricate needs of our young clients and their families.

When I was creating NESCA, I was a mother with much younger children than they are now and thought about the concept of breaking out as a solo practitioner. I was skilled and had plenty of years of education and experience by that time. I knew I could have done it – and likely had much more flexibility and far less stress in my life at a time when that was hard to come by – but, I loved (and still do) the concept of “group think” far too much to go that route.

Group think – or today’s “hive mind” – to me meant bringing together multiple minds to tackle a problem. A group allows for different perspectives to come together, often leading to creative, outside-the-box solutions for families that may not have been considered by me alone, even after seeking outside consultation with another practitioner. My decision to build NESCA as a group practice has since led to a constant cross-pollination of ideas among our group of expert clinicians, through scheduled weekly seminars and case conferences as well as the more casual in-office discussions. All of this collaboration enhances the care we provide and ensures that the recommendations we make are as comprehensive, vetted, and tailored as possible.

From the beginning, we have been and remain committed to offering the highest level of care, and one of the key ways we do this is by nurturing the collaborative environment that NESCA was founded on. We started out as a small group practice with several colleagues who had been working together in a separate organization. Since then, we have grown into a larger team of diverse clinicians and specialists who together have expertise in every diagnosis that presents itself. Each NESCA clinician has their own strengths and areas of focus, allowing our entire team to draw from this collective pool of knowledge. No matter what challenge a child is facing – whether it’s ADHD, autism, a specific learning disorder, or an emotional regulation issue – we can pair them with a clinician who has in-depth experience and a keen understanding of that particular diagnosis.

In addition to specialized knowledge, working as part of a group also provides the invaluable opportunity to check our thinking. Even as highly seasoned professionals who have been assessing and evaluating clients for decades, we still benefit from feedback and fresh perspectives of our colleagues and their own networks. And in a group setting, colleagues are available to consult, offer second opinions, and share resources and recommendations. This collaborative approach ensures that our evaluations and recommendations are not only thorough but also well-rounded, and likely discussed among our team, leading to more accurate diagnoses and more effective interventions and treatment plans.

Ultimately my choice to develop and grow a group practice means that our clients receive the benefit of our individual and collective expertise, collaboration, and shared insights. I’m so grateful that families who come to NESCA are able to benefit from our many minds working together toward the same goal: helping each child or individual reach their full potential. This level of care is why we believe so deeply in the group practice model.

 

About the Author

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 30 years. In 1996,Ann Helmus headshot she jointly founded the Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost 10 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.

She is an active participant in the Trauma and Learning Policy Initiative, a collaborative effort between Massachusetts Advocates for Children and Harvard Law School’s Education Law Clinic, a project involving a multi-disciplinary group of professionals working together to better define and meet the educational needs of children who have been traumatized.

She received her undergraduate degree in Neural Science from Brown University and earned her doctorate at Boston University School of Medicine. Her postdoctoral fellowship in pediatric neuropsychology was completed at Children’s Hospital in Boston, where she remained on staff for seven years. Concurrently, she served as neuropsychologist to the Pediatric Brain Tumor Clinic at Dana-Farber Cancer Institute in Boston.

To book an appointment with NESCA’s expert neuropsychologists, please complete our Intake Form today. 

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.

 

11
school student frustrated over the work

Navigating the Post-Honeymoon Phase: Signs Your Child May Need Support This School Year

By | NESCA Notes 2024

school student frustrated over the workBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

With the start of the school year well underway, we are beginning to see students and teachers settling into their classroom routines. Along with this increase in familiarity and comfortability, parents often start to see bits and pieces of challenges arise around this time of year that may have gone unnoticed during the initial “honeymoon period.” You may be wondering what challenges you should be looking out for and when those challenges warrant an evaluation to determine further supports and services. Let’s take some time to explore what to keep an eye on, and when it might be time to reach out to schedule an evaluation to dive a bit deeper into what is going on. 

Academics

No matter their age, if you ever feel your child is inundated and overwhelmed with schoolwork, it is a great idea to reach out to their teachers; ask how long homework should be taking and whether it should feel like review vs. new material. If homework starts to consistently become a battle, it might be worth taking a closer look into why. It could be because it’s a new and appropriately challenging course. It could also be because there are underlying language-based learning disabilities, a nonverbal learning disability, executive function challenges, or increasing symptoms of anxiety or depression. Some specific things to watch for:

  • Frequent tears during homework that appear to get worse instead of better
  • Not appearing to “get it” even after review and repetition
  • Difficulty studying/holding information in memory
  • Dysfluent reading or not understand what they’ve read
  • Challenges understanding math concepts or memorizing math facts
  • Difficulty applying and generalizing concepts
  • Opposition to handwriting tasks or when asked to compose a writing assignment
  • Poor penmanship that is illegible and/or immature for age
  • Not meeting benchmarks on assessments

Social Skills

At this point in the school year, children are typically starting to be interested in other peers within their classrooms. For younger kids, they are likely to feel more comfortable interacting with other children in their play. Common social concerns can include:

  • Not remembering any names or faces of kids in their class
  • Preferring to play alone, hesitant to join in with a group
  • Appearing unaware of social cues or how to initiate conversation with others
  • Rigidity in play—always wanting to play their own game by their own specific rules
  • Frequent peer conflicts and feeling rejected or left out

Emotional Functioning

A new school year often elicits feelings of anxiety in kids no matter how outgoing and social they may be! When might it be a sign that there is something more?

  • Continued and persistent resistance to going to school
  • Frequent somatic complaints with no apparent cause (e.g., headaches, stomachaches)
  • Change in sleeping patterns – not being able to fall asleep at night or waking up frequently
  • Difficulty with regulating their emotions/frequent tantrums
  • Changes in appetite
  • Negative statements about themselves
  • Increase in irritability
  • Withdrawal from others or previously preferred activities
  • Always wanting to know what is happening next and struggling with changes in routine (i.e., Does a substitute teacher derail their whole day? If a friend is out sick, is there a perseveration on where they are? Do you wait to tell them about changes in plans so they don’t worry in advance?)

Attention/Focus

Have you ever found yourself feeling restless and distracted when sitting through a work meeting? Kids are no different! Sitting still and paying attention for extended periods of time can be really tough – especially after being on summer break! Here are a few things to keep an eye on:

  • Frequently fidgeting in their seat or needing a fidget item to increase concentration
  • Difficulty with multi-step directions
  • Not remembering information presented during lectures
  • Acting impulsively
  • Easily distracted/daydreaming
  • Acting as if run by a motor
  • Blurting out thoughts, interrupting conversations
  • Teacher feedback that they are interrupting other students or not able to sit quietly and attend to class discussions

As always, you know your child best! If you feel like this year is off to a rocky start, or you’re starting to have questions regarding their functioning, do not hesitate to reach out and schedule an evaluation. A comprehensive neuropsychological evaluation is designed to look at ALL aspects of a child to determine what is getting in their way of reaching their potential. We are always here to help!

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children and adolescents with a wide range of concerns, includingMiranda Milana Headshot 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.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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.

 

8
Child in bed suffering from a concussion, holding their head in pain

What School Supports Does My Child Need After A Concussion?

By | NESCA Notes 2024

Child in bed suffering from a concussion, holding their head in painBy: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Unfortunately, every year, many children and adolescents experience concussions. A concussion is a mild traumatic brain injury that occurs when an individual sustains a blow to the head or body that results in the brain moving rapidly back and forth. This causes the brain to stretch and strain, resulting in a vast array of possible symptoms. Symptoms of a concussion include:

list of physical, cognitive, emotional, and sleep concussion symptoms

Recent studies have shown that while it is important to rest for the initial few days after an injury, slowly reengaging in cognitive activities at a tolerable level helps to promote recovery. This period of rest followed by a slow increase in cognitive activity means that children are often out of school/slowly transitioning back to school for an unspecified period after injury. As such, many children will benefit from support and accommodation at school during the recovery period. Parents are encouraged to talk to their child’s academic team and school personnel to discuss the need for these supports. As children and adolescents experience differing sets of symptoms after an injury, the accommodations and supports should be tailored to the individual’s unique symptom profile.

Physical Symptoms: Students who experience headaches or fatigue may benefit from rest breaks or even a nap during the school day. Dizziness, balance problems, or nausea may necessitate the need for an elevator pass and it may be helpful for the student to transition to class before the bell rings when there are less people to navigate around in the hallway. Light and noise sensitivity can be particularly hard within the school setting. Students may need to wear sunglasses or a hat, be seated away from the window, and may need teacher notes as looking at a smartboard may be painful. In addition, computer-based work may need to be printed during the recovery period for light sensitive students. Students with noise sensitivity may need to wear ear plugs, avoid crowded and noisy areas, such as the lunchroom, assemblies, or music class, and they may need to transition to the next class before the bell rings and the hallway becomes noisy.

Cognitive Symptoms: A concussion can temporarily impact an individual’s attention, executive functioning skills, and processing speed. Therefore, it may be necessary to reduce a child’s workload (e.g., odd/even problems only, outline a paper instead of writing it fully, reduce homework load) and assign only essential work (i.e., waive non-essential assignments, quizzes, and tests). In addition, it may be helpful to break down tasks into smaller “chunks,” repeat information or instructions, and allow for extended time to complete essential classwork, quizzes, and tests. They may need access to teacher notes if they are unable to keep up with the pace of the instruction to take proper notes, and they may need information presented in a slower manner or repeated to ensure comprehension. Teachers should consider alternative ways to ensure mastery of information (e.g., oral discussion, multiple choice instead of open-ended questions) as students may not be able to demonstrate their true knowledge in standard ways while recovering from a concussion. Tests and quizzes should only be given if symptoms do not interfere, and the student is adequately prepared.

Emotional Symptoms: Emotional symptoms following concussion are often overlooked as they are not a commonly known symptom of concussion. Some children and adolescents may become overwhelmed about missing school and the accumulating workload, and they may feel isolated from their friends. This would also suggest the need to reduce a child’s workload for a short period of time, including waiving non-essential assignments, quizzes, or tests. Students should also be allowed to socialize with their peers as tolerated (e.g., quiet lunch setting with a few close friends).

Sleep Symptoms: A child or adolescent experiencing sleep difficulties as a result of their concussion may not have the energy to complete a full day of school. They may need a later start time or only be able to complete a half day of school. Some students with disrupted sleep may be able to complete a full school day, but they may require a nap in the nurse’s office.

In sum, a concussion presents in many ways and often has a significant impact on the day-to-day functioning of a child or adolescent. In particular, school is often disrupted after a concussion, even for children and adolescents who have a short recovery. School supports and accommodations should be tailored to the child’s individual profile of symptoms to best support them throughout their recovery.

 

About the Author

Dr. Burns conducts comprehensive evaluations of school-aged children, adolescents, and young adults with a variety of developmental, learning, and emotional difficulties. She has expertise in the evaluation of individuals following a concussion/mild traumatic brain injury and particularly enjoys working with individuals with attention (ADHD) and executive functioning (EF) difficulties. Dr. Burns is passionate about helping individuals and their families better understand their areas of strength and weakness and provides tailored treatment recommendations based upon that unique profile to make the evaluation most helpful for each client.

 

To book a consultation with Dr. Burns 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.

14
Filled backpack ready for the first day of school

How to Prepare Students with Autism for the New School Year

By | NESCA Notes 2024

Filled backpack ready for the first day of schoolBy: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

I know that summer is about to end here in New England when I see posts on Facebook from my West Coast friends about their children’s first day of school and when every other commercial on TV is heralding back-to-school sales. A little sense of panic sets in, because of all the preparations needed for children going back to school. In my work with children with special needs, one group that often struggles with transitions such as these is children with Autism Spectrum Disorder.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. One of the symptoms of ASD is difficulty with transitions. Some children with ASD get really upset with even slight changes in routines or plans. This is the reason why the start and end of the school year is often difficult for them. Here are some strategies for helping children with ASD transition back to school. They can also be used for any child to prepare for any transition, major or minor.

Visit the new school/classroom – A lot of schools are already doing this, but a visit to a new school or classroom a few days before the official start of school could help your child get acclimated to their new environment or teacher. Teachers usually report for work the week before the first day of school to prepare their rooms. Set a time to meet with the new teacher and let them provide your child with a tour of the room and other areas, such as the library or cafeteria. Show the child their desk and cubby. Tell them about the schedule posted on the board. This will ease some of your child’s fears and anxieties about the first day of school.

Use social stories – Social stories are written or illustrated stories that present information about social situations. Developed by educational consultant, Carol Gray, they instruct students about what to do or say in social situations, for example, the first day of school, together with information about other people’s motives or expectations. Using pictures from the school visit above, you can create a social story about the first day of school that talks about what to expect, directives about what your child can do or say, and the reason behind these actions. Here is an example of part of a social story for the first day of school:

  • This is Ms. Smith, my new teacher. She is very nice.
  • My mom and I walk to my classroom.
  • Smith is there to greet me. I look at her and smile.
  • I say goodbye to my mom and give her a big hug. She will come back at the end of the day to pick me up.
  • I enter the room and place my bag in my cubby. I find my desk and take my seat.
  • I look at the kid next to me and say, “Hi.” I want other kids to like me.

For help with creating social stories, you can go to https://carolgraysocialstories.com/social-stories/what-is-it/ or https://www.autismspeaks.org/templates-personalized-teaching-stories.

Use video modeling – In my work with children with autism, I often find that they are visual learners; they have better developed abilities in thinking and reasoning with pictures. And with the popularity of technology, such as iPads and smartphones, they are usually attracted to videos. Speech and language pathologist Linda Hodgdon, M.Ed., CCC-SLP (www.usevisualstrategies.com) has developed a strategy of using videos to teach skills/competencies for children and adolescents with ASD. In video modeling, you can bring your child to the new school/classroom a few days early with a video camera. You can record walking the hallways from class to class, opening the locker, going to the cafeteria or the gym, and other things they would need to do when school is in session. While you are filming, you can add dialogue explaining each item or place of interest. Then, your child/teenager can watch the video at home to prepare for the first real day of school when students will be there. Video modeling can also be used to prepare for other transitions/novel situations, such as preparing for a holiday or a new experience (e.g., riding a train, watching a movie, visiting a new restaurant).

Transitions are difficult because they require us to leave a place or state that we have been accustomed to and enter something that is unknown or unpredictable. Preparing ourselves for transitions by demystifying some of the unknowns can help us cope better with the anxiety that is inherent in these situations. I hope the suggestions above can help you and your child transition back to school.

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

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

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

 

11

When Average Doesn’t Feel Like Average

By | NESCA Notes 2024

By: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

When we conduct a neuropsychological evaluation with a child, adolescent, or adult, one important component involves administering a battery of assessments. This is certainly not the only, or many times the most important, component, but it is part of the unique skill set of a neuropsychologist. A large percentage of these assessments are interpreted by comparing an individual’s performance to the performance of others who are similar in age. For example, we may compare an 8-year-old’s reading skills to the reading skills of a nationally-representative sample of 8-year-olds. This comparison helps us to understand if the child’s reading skills are generally below their peers, about at the same level as their peers, or above the level of their peers.

A nationally-representative sample of children may not be the most salient comparison for some families. In fact, the concerns that bring parents to a neuropsychologist in the first place can often include comparing their child to friends’ children, classmates, or other children in their community. This is an almost inescapable process. As parents, it is nearly impossible not to compare children – meeting milestones, academic skills, temperament, behavior, sociability, etc. Although it can have significant negative impact when done in front of a child or in a detrimental manner (e.g., “Why can’t you be more like Johnny?” “Susie has already figured that out and she’s younger than you!”), comparing your child to others can be valuable in specific circumstances. Many parents have little experience with child development before having children, and the children in their community and friend group can serve as helpful “guideposts” for what to expect at different ages. Many times, a parent has brought concerns to a neuropsychological evaluation along the lines of “my child seems different than my friends’ children/nieces and nephews/other kids at daycare,” and I have confirmed a significant disability or disorder was present. Parental instincts are valuable and can be an important first step.

However, there are times where comparing a child to a very specific set of other children can be a fraught process, particularly when seeking neuropsychological evaluation. Parents may live in an area or socialize with a group of families who are far from the nationally-representative samples that we utilize in our evaluations. Cousins and the children of close friends may have unusually well-developed skills, unusually calm or easy-going temperaments, or unusually easy progress through school. Children may be learning in a school environment that is extremely competitive, the result of a highly selective admissions process, or inaccessible to most of the general population. Any or all of these can make a child seem more impaired than neuropsychological assessments may indicate.

This is certainly not to discount valid, important parent concerns. A child who is far behind their classmates, even when those classmates are part of a highly selective school environment with academic expectations far beyond most schools, is still struggling and may be suffering. What is vital for parents to understand is the profile of their own child, and from where the challenges that they see are coming. A mismatch between a child and their environment, be it a social environment or an academic environment, can still result in real, impactful struggles – even if the child appears “average” on neuropsychological assessment measures.

 

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.

 

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

 

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

 

11

Busting a Common Autism Myth

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

I often hear from parents and caregivers that their child has several friends and likes going to social events, leading them to wonder how they could have autism.

First, let’s take a look at what autism is:

Autism spectrum disorder is a neurodevelopmental disorder classified by persistent deficits in social communication and social interaction skills.

To meet criteria for an autism spectrum disorder, one must exhibit the following social communication deficits across multiple contexts:

  1. Deficits in social-emotional reciprocity—this may include feeling unsure or uncomfortable when approaching others, having difficulty initiating social interactions, or having difficulty responding appropriately when approached by others. When engaged in conversation with others, it may be difficult to engage in back-and-forth conversation and share interests/emotions.
  2. Deficits in nonverbal communication skills—examples include poor eye contact, poorly integrated gestures in conversation, reduced facial expressions, difficulty reading the facial expressions and gestures of others, and not picking up on subtle body language cues.
  3. Deficits initiating, maintaining, and understanding relationships—characterized by difficulties making new friends, not wanting to engage with peers in any capacity, or difficulties maintaining long lasting friendships.

One must also demonstrate evidence of at least two of the following: repetitive behaviors, inflexibility/rigidity, restricted and intense interests, and sensory sensitivities.

Next, let’s look at what autism isn’t:

While individuals with autism experience social challenges, it is a common misconception that having autism means not having any friends or social skills at all. Contrary to this popular misconception, I evaluate many children, adolescents, and adults who are on the autism spectrum, are socially motivated, and have numerous friendships.

It is important to remember that while a diagnosis of autism requires social communication deficits, that does not mean a complete lack of skills must be evident. For example, I see many individuals on the autism spectrum who have several longstanding friendships but have difficulty making new friends. Conversely, some individuals find that they initiate friendships well, but have difficulty maintaining friendships over time. It is also possible for an autistic individual to demonstrate appropriate eye contact and facial expressions but have difficulty reading subtle nonverbal cues of others. With high social motivation, it still may be challenging to know how to participate in social conversation, how to build on the interests of others, and how to respond to emotional reactions.

Individuals with high-functioning autism often get overlooked as they have learned to “mask” or “camouflage” really well. That is to say that they work hard to “fit in” or hide areas of vulnerability. It might not feel comfortable for them to participate in group conversations or to interpret nonliteral language. They may feel as though there are written social rules that everyone else has access to except for them. When observing them, it may appear as though they are social and well-integrated into social environments; however, they may report a vastly different internal experience.

Taken together, having an autism diagnosis does NOT mean there is a complete inability to form friendships or participate in social settings. Rather, aspects of social communication can be challenging and warrant supports and services designed to enhance these skills.

If you have any questions or concerns regarding your child’s social development, speak with your pediatrician and/or schedule an evaluation with one of our neuropsychologists at NESCA.

 

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.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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.

 

10

Supporting Teens: Helping Them Engage in Treatment

By | NESCA Notes 2024

By: Moira Creedon, Ph.D. 
Pediatric Neuropsychologist, NESCA

I was fortunate to join my colleague, Kelley Challen, Ed.M., CAS, in a recent presentation about fostering self-advocacy and self-determination for young adults. The focus of our conversation was around encouraging teens to participate in the special education process as active members of their IEP team. It got me thinking: what are other ways that teens should be included in decision making? How do we ensure that teens are included in vital treatment decisions? And what do we do about those teens who are reluctant to engage?

There is a robust body of empirical evidence to suggest that the combination of medications and therapy is most effective at reducing symptom severity for emotional health disorders including anxiety and mood disorders. While adults on a treatment team may be well aware of this evidence, teens may look elsewhere to gather information – turning to the less than reliable sources of anecdotal conversations and social media. If we want teens to participate in the treatment planning process armed with greater information, there are a few steps we can follow to support their treatment engagement.

First, when the question relates to medications, I always encourage teens to have very open discussions with their parents and providers about the risks and side effects of medications. It’s incredibly helpful to open conversations by asking teens what they already know or what they have already heard or read about different types of medications. This helps to eliminate any confusion or misperceptions, either about negative side effects or about their unrealistic expectations that things will be “magically cured” in a very short period of time. It is important for teens to understand how long medications may work in their system, how long they need to take the medication to reach the therapeutic dosing, and the risks of not taking it or experimenting with other substances which may interfere with the mechanisms of action. For anxious kids who may not feel comfortable speaking up within an appointment, I encourage families to make a list of their teen’s questions and a plan for who will read the list of questions in the appointment. There are valuable supports that can help with the executive functioning demands needed to remember medications (e.g., daily pill boxes, setting alarms, or reminders on their phone, etc.).

When it comes to therapy, it is relatively common for me to hear a parent state that a child is reluctant or unwilling to attend therapy. There may be many very valid reasons why a teen may feel this way, and it is a sign that they are engaging in the developmental task of individuation when they push back on this recommendation. We don’t need to fear this struggle, and we can use it as an opportunity to invite a conversation. For teens who struggle to explain why they are reluctant about treatment, I might share a few common explanations to see if they resonate with the teen: “Some teens think it’s boring, or it’s too hard, or it’s a waste of time. Some worry their parents will know each thing they say, or feel like they are not in control of the treatment goals.” It may also be as simple as finding virtual sessions to be frustrating and impersonal, or finding the commute to an office for an in-person session to be time consuming. Many of these logistic concerns can be addressed with scheduling. It is also important for teens to know that therapy is not “one size fits all.” There are different forms of therapeutic treatment, and it is important to find a provider with experience delivering evidence-based treatments for the specific diagnosis that your teen carries.

One of the most important factors in treatment adherence is a trusting therapeutic relationship. Those relationships take time to build. If a teen is not feeling well connected to their therapeutic provider, I encourage them to have a discussion either directly with their provider about this or to explore other treatment providers. The same way someone may not wish to be friends with every person they meet, there are certain connections that just “feel right.” Skilled providers also use techniques, such as Motivational Interviewing, to encourage teens to develop their own goals for treatment. This can help to diffuse the argument that a teen is only engaging in a treatment to appease their parent or caregiver. These powerful tactics include important elements of empathy, highlighting discrepancies in thinking (or in conflicting actions and behaviors), accepting (and even expecting) resistance, and promoting self-efficacy.

In helping teens to find their own voice in the treatment process, a power struggle or a demand for engagement from a parent is unlikely to get us very far. Bringing in the support of other trusted people in a teen’s life (e.g., teacher, school counselor, coach, uncle or aunt, older cousin) may also be a useful way to open the discussion about why therapy feels stressful. While teens may wish for things to get better on their own, ignored or avoided struggles do not just go away magically. Treatment can be hard as it does involve facing anxiety-provoking material. However, teens will be facing this content with a trusted adult and armed with new tools to master these triggers. It is important to acknowledge that therapy can be hard work, and they will not be doing it alone. Engaging in special self-care routines after a therapy session, particularly if parents can acknowledge and create space for these, can be a powerful way to encourage commitment to treatment. When teens feel more control in engaging with their treatment, they are far more likely to persist.

For more information on enhancing motivation for treatment engagement, consider the following resources:

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She is interested in uncovering an individual’s unique pattern of strengths and weaknesses to best formulate a plan for intervention and success. With experiences providing therapy and assessments, Dr. Creedon bridges the gap between testing data and therapeutic services to develop a clear roadmap for change and deeper of understanding of individual needs.

 

If you are interested in booking an evaluation with Dr. Creedon or another NESCA neuropsychologist, please fill out and submit our online intake form. 

 

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

14

You’ve Got a Friend – The Importance of a Mentoring Relationship in ASD

By | NESCA Notes 2024

By: Renee Cutiongco Folsom, Ph.D.
Pediatric Neuropsychologist

It is graduation time again. Graduation speeches usually include a portion where the graduates thank their parents, siblings, friends, and teachers for their success. Most of the time they also thank coaches, mentors, and counselors for their accomplishments. Listening to them takes me back to my own graduation experience where I credited part of my success to people who came alongside me to mentor and support me through the various stages of my development. The encouragement and feedback provided by these mentors shaped me in ways that I would not have gotten simply by sitting in the classroom or reading books. The role of mentors is also important, and I should say more so, for children and adolescents who are on the autism spectrum.

Autism Spectrum Disorder (ASD) is a developmental disorder that manifests in problems with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. Children and young people with ASD usually have problems with what are called social pragmatic skills – those skills that are necessary for knowing how to act in social situations, reading social cues, and conducting back-and-forth conversation with others. Some persons with ASD have a hard time appreciating the unwritten “rules” of social engagement, for example, that you should look at a person you are talking to, smile, and nod occasionally to signify that you are paying attention and interested in what other people are saying. It is difficult for persons with ASD to read subtle cues and “feel” the room to know how to react to certain dynamics. Appreciating sarcasm or humor could be difficult for them. These skills are often the hardest to “teach” a child or adolescent with ASD because of the complex and dynamic nature of social interactions. Also, these are skills that come naturally or instinctively for many of us, so it is hard to break down interactions and make subtle behaviors (e.g., eye contact, nonverbal cues, gestures) more salient. This is where an older sibling or a mentor – a camp counselor, a coach, or a tutor – could be a wonderful resource for teaching these skills to a young person with ASD. Have you ever had a camp counselor model for you how to react when you are introduced to a new person? Maybe you had a coach hang out with you after a game to model how to engage in back-and-forth conversation and listen to other people’s interests. These mentoring relationships are a good venue for practicing skills that may have been taught to the person with ASD in the context of a formal speech/language therapy session or in the classroom. Indeed, I have found over the years that children and adolescents with autism and have older siblings or mentors do better in these social pragmatic skills than those without this kind of guidance.

Beyond teaching social pragmatic skills, mentors also provide guidance about practical everyday decisions. Has an older sibling ever given you feedback about how your top does not match your pants? Or that you should slow down eating that burger because you are such a messy eater? You may have had an older friend who has shared with you how they navigated dating. Teenagers, not only those with autism, are usually more open to receiving such feedback or information from those who are a little older than they are as opposed to older adults or parents because of wanting to develop their own personalities apart from parents. Therefore, for these young people I usually recommend having a mentor who is a little older than they are who can serve as a friend/mentor/model.

Many skills that are crucial in navigating social situations – how to behave appropriately, how to make friends, how to be a good team member – are usually learned in the context of organic relationships, such as a mentoring relationship, as opposed to a classroom lesson because the interaction itself is the “content” of the instruction. The mentor must be reminded, though, to be more intentional in modeling/teaching these social pragmatic skills to the client.

There is no better way of learning how to be a good and caring friend than to experience having a friend come alongside you to show you how it is done. As my favorite singer, James Taylor, sings, “Ain’t it good to know you’ve got a friend?”

 

About the Author

Dr. Renee Cutiongco Folsom, Ph.D. has been working with families in the greater Boston area since 2015. Prior to this, she was on staff at Johns Hopkins University and trained at the University of California, Los Angeles (UCLA). She provides comprehensive neuropsychological evaluations of children, adolescents, and young adults who have learning, behavioral, and socio-emotional challenges. Her areas of expertise include Autism Spectrum Disorder and other conditions that usually co-occur with this diagnosis; Attention-Deficit/Hyperactivity Disorder; Dyslexia and other Specific Learning Disabilities; and Anxiety/Depression. She thinks that the best part of being a pediatric neuropsychologist is helping change the trajectory of children’s lives.

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

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

 

10

Understanding the Neuropsychological Evaluation Process When an Autism Spectrum Disorder is Suspected

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In January, Dr. Folsom published a blog post detailing the reasons why so many females on the autism spectrum are misdiagnosed in childhood. Here at NESCA, we are continuously working to improve our testing practices and administration protocols to ensure that we accurately capture one’s diagnostic picture when they come in for a comprehensive neuropsychological evaluation regardless of gender identity, age, or diagnostic presentation. As clinicians, tailoring an appropriate testing protocol is only one piece of the puzzle when working with our clients. From the moment we review your intake paperwork and questions/concerns, we work diligently to make sure we are teasing apart each component of a child’s neuropsychological profile to ensure clarity and accuracy for diagnoses and tailored recommendations. Here is a look into some of what that process looks like:

Initial Paperwork: Before your first intake appointment, your clinician will thoroughly review all of the intake paperwork and supporting documents you have submitted to us. We make sure to read all of your questions and concerns, while also making our own notes of questions that we will have for you during the intake appointment. All neuropsychologists here at NESCA are trained to identify “red flags” or areas of potential concern that we want to know more about through our interviews with you, your child, teachers, and our testing protocols.

Intake Appointment: During this appointment, we will ask you more in-depth questions about your responses and questions from the intake paperwork you provided. This is an opportunity for us to explore any concerns we may have. For many diagnoses, there are overlapping diagnostic features that are important to tease apart. For example, inflexibility and rigidity (not handling transitions well, struggling with changes in routine) may be related to an anxiety diagnosis, a mood disorder, an autism spectrum diagnosis, and/or executive functioning weaknesses.

Speaking with Collaterals: Oftentimes, clinicians will ask for permission to speak to other caregivers who have knowledge of your child, such as teachers, therapists, and pediatricians. Because we only see your child for a “snapshot” in time, it is important for us to also consider the perspectives of those who have longstanding relationships with them in a variety of contexts and environments.

Developing a Testing Battery: After the intake appointment, clinicians put together a tentative list of assessment measures that we may want to utilize. Tentative is the key word because oftentimes testing batteries change throughout the course of the assessment as a diagnostic picture becomes clearer or when specific areas of deficit become more apparent.

At NESCA, we have access to multiple testing tools that allow us to tailor our testing battery to capture any nuanced constellation of symptoms or diagnostic profile. For example, when thinking about how to accurately diagnose someone who is “high functioning” or “masking” areas of vulnerability related to an autism spectrum diagnosis, clinicians have access to the following batteries:

  • Autism Diagnostic Observation Schedule—2nd (ADOS-2): The ADOS-2 is one of the most well-known assessments for autism as it utilizes a semi-structured format to assess social communication skills as well as restricted interests, repetitive behaviors, sensory sensitivities, and rigidity. The ADOS-2 relies on standardized observations to capture any difficulties in the aforementioned categories.
  • Childhood Autism Rating Scale—2nd (CARS-2): The CARS-2 is another measure that involves a standardized rating scale based on direct observations of the child. While playing and interacting with your child, the clinician is able to fill out this rating scale to assess symptoms associated with an Autism Spectrum Disorder. The CARS-2 also includes a parent questionnaire to allow for qualitative parent observations.
  • Monteiro Interview Guidelines for Diagnosing the Autism Spectrum—2nd (MIGDAS-2): The MIGDAS-2 assesses qualitative observations of language and communication skills, social relationships, emotional responses, as well as sensory interests and/or sensitivities. The MIGDAS-2 can be particularly helpful for children and adolescents who are “high-functioning,” or do not fit the presentation of the “male prototype” described in Dr. Folsom’s blog.
  • Social Language Development Test (SLDT): The SLDT measures social communication skills such as the ability to make inferences, interpret social situations, and navigate peer conflicts.

In addition to the above measures, clinicians may also choose to administer subtests related to social thinking, perspective taking, and/or emotion identification. Examples of these subtests include:

  • Affect Recognition and Theory of Mind from the NEPSY-II
  • Inferences, Meaning from Context, Idiomatic Language and Pragmatic Language on the CASL-2

For older children and adolescents, clinicians may ask them to fill out/answer questions about their own perceptions of their lived experiences. This can be done through an unstructured interview or by one of the following:

  • Camouflaging Autistic Traits Questionnaire (CAT-Q)
  • Ritvo Autism Asperger Diagnostic Scale—Revised (RAADS-R)
  • Autism Spectrum Quotient (ASQ)

Parent Questionnaires: Whenever there are any questions or concerns related to social communication and interpersonal relatedness, your clinician may ask you to fill out rating scales assessing your perception of your child’s ability to interact with others, engage in age-appropriate play, be flexible in their responses to change or new environments, and have a variety of interests. These questionnaires include:

  • Social Responsiveness Scale—2nd (SRS-2)
  • Social Communication Questionnaire (SCQ)
  • Autism Diagnostic Interview—Revised (ADI-R)
  • Gilliam Autism Rating Scale—3rd (GARS-3)
  • Gilliam Asperger’s Disorder Scale (GADS)
  • Autism Spectrum Rating Scales (ASRS)

As you can see, we have a wide variety of measures available at NESCA to look at symptoms of an Autism Spectrum Disorder. Based on the discretion of your clinician, one or more of these may be used to further assess social communication concerns. While you may have heard of some of these being referred to as “the gold standard,” your clinician will use their knowledge, experience, and training to tailor a testing battery for the individual needs of your child. There is never a one size fits all approach to neuropsychological testing!

 

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.​

To book an appointment with Dr. Miranda Milana or another expert NESCA neuropsychologist, please complete our Intake Form today. 

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.

 

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