Tag

pediatric neuropsychologist

10 Facts about the Rorschach Inkblot Test

By | NESCA Notes 2022

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

As an evaluator, I receive a number of questions about the usefulness of the Rorschach Inkblot Test. The following “10 facts” are designed to answer some common questions and also incorporate some new and fresh scientific research findings related to the Rorschach.

The Rorschach Inkblot Test is a diagnostic tool that should always be incorporated within a comprehensive evaluation which includes projective or “performance-based” testing. If you are considering if your child or teen would benefit from projective testing, please refer to one of my earlier NESCA blog posts: More Than An Inkblot: Measuring Problem-Solving and Critical Thinking Skills with Projective Tests.”

  1. The Rorschach Inkblot Test is a test that provides data and information about how a child or teen problem-solves situations “in the moment.”
  2. Research indicates that the Rorschach is a valid assessment tool (with validity akin to other personality measures, as well as measures of IQ).
  3. Recent fMRI studies show high levels of brain activation in brain regions associated with emotion, emotion memories, perception, attention and visual processing.
  4. After the Rorschach Inkblot Test is administered, an experienced evaluator uses an evidence-based scoring system to compare a child’s responses to a normative sample to evaluate their performance. RPAS (Rorschach Performance Assessment System) is the most evidence-based scoring system to date and has strong empirical evidence.
  5. The Rorschach evaluates and detects psychotic symptoms.
  6. The Rorschach is helpful for evaluating trauma, including dissociation and intrusive symptoms.
  7. The Rorschach assesses both trait (stable characteristics or patterns) and state (a temporary way of being) variables. For example, the Rorschach tells us about how a person is coping with everyday stressors (e.g. from bullying to family loss to lack of sleep). The Rorschach also tells us if a person has a more pervasive habit of “bottling up” emotions or behaving rashly or impulsively when overwhelmed.
  8. The Rorschach quantifies a child or teen’s strengths, such as capacity for insight and adaptability, or resiliency to stress.
  9. The Rorschach Inkblot Test is not for everyone. More research is needed about the utility of the Rorschach for individuals with expressive language communication impairments or visual-spatial processing deficits.
  10. Not every evaluator is equipped to administer and interpret the Rorschach Inkblot Test. The Rorschach is a powerful diagnostic tool when interpreted in conjunction with observation and other test results by a skilled, experienced practitioner with extensive training in Rorschach administration and interpretation.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, 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, 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.

 

Risk Factors & Warning Signs of Substance Use

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

It is estimated that approximately one third of adults in the United States have met criteria for an alcohol use disorder at some point in their lives, while approximately 10% have met criteria for another substance use disorder. While these numbers are staggering, what is even more astonishing is the fact that consuming substances before the age of 14 increases the likelihood of abusing substances later in life by 400%. In fact, The National Child Traumatic Stress Network reports that 9 out of 10 individuals who abuse substances began using these substances before the age of 18. So, what are the risk factors and early signs to watch out for? What can you do to help?

Risk Factors:

  • Family history—if you have a family history of addiction, it is important to talk about this with your children just as you would have a conversation about a family history of cancer, diabetes, or any other mental illness. Determine when and how to approach this conversation by talking with your pediatrician.
  • Comorbid diagnoses—having an existing mental health diagnosis (e.g., ADHD, depression, anxiety) increases the chances that one will use and abuse substances later in life. Many individuals start using substances as a method of self-medicating if their mental health symptoms are not well managed.
  • Exposure—having easy access to substances, being exposed to peer groups or family members who use substances, or being exposed to media messages encouraging substance use can also increase the risk of substance use and abuse.
  • Additional risk factors include poor coping skills, academic failure, chaotic home or peer environments, as well as impulsivity and risk taking behaviors.

Warning Signs to Watch for:

  • Unexplained and/or extreme mood swings
  • Dilated pupils/bloodshot eyes
  • Changes in appetite
  • Change in sleep patterns or levels of fatigue
  • Changes in friends
  • Loss of interest in previously preferred hobbies
  • Being secretive about friends and activities
  • Withdrawing from family members and loved ones
  • Not respecting curfew or breaking other house rules
  • Running away from home or sneaking out
  • Stealing or having unexplained amounts of money
  • Increased absences from school
  • Decline in grades
  • Increase in behavioral problems

How to Help:

  • Start the conversation when it is appropriate. Talking to your pre-teen or teen about the effects of substances and alcohol/drug laws is essential in keeping the lines of communication open. Ask them first about their level understanding and what they have already learned or heard about.
  • Increase coping skills—having appropriate communication skills, positive social-emotional connections, strong self-esteem, and confidence in dealing with peer pressure are all extremely beneficial in helping children and teens navigate adolescence. If your child struggles in one or more of these areas, it is important to target these vulnerabilities early on through the appropriate therapeutic supports (i.e., psychotherapy, social skills groups, school counseling, occupational therapy, executive function coaching).
  • If you are concerned your child is using substances, you may contact their pediatrician or find support through SAMHSA’s national helpline (call 1-800-662-HELP or text HELP4U to 435748 to receive information on local treatment facilities, support groups, and local community organizations).

References:

Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–766. doi:10.1001/jamapsychiatry.2015.0584

Grant BF, Saha TD, Ruan WJ, et al. Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA Psychiatry. 2016;73(1):39–47. doi:10.1001/jamapsychiatry.2015.2132

 

About the Author

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

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

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

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

 

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

 

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

 

Testing the Limits

By | NESCA Notes 2022

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

In the world of assessment, “testing the limits” means essentially bending the rules of test administration in order to see if the change in administration allows the test-taker to demonstrate their knowledge more effectively. For example, some children and adolescents respond impulsively to multiple-choice tests, picking the first choice that appears to be correct without looking at all of the choices. Standardized test administration dictates that the evaluator accepts that impulsive response and, as such, impulsivity will compromise the client’s score.

In the example above, the student was unable to demonstrate their knowledge or skills effectively on tests because of the standardized administration procedures. While it is important to generate these scores, it is also important to gain an understanding of what the student actually knows, and this is where testing the limits comes in. For the impulsive student, the evaluator would test the limits by reminding the student to slow down and look at all the choices before responding. This is non-standard test administration, and so the score is not considered valid but the results give us a great deal of information about the student’s strengths and weaknesses. There is a big difference between the student who is able to achieve the correct score when cued to slow down and the student who still answers incorrectly, even with reminders to slow down. The former student can be said to have much higher potential than the latter student. However, their ability to demonstrate their potential is hampered by impulsivity, a problem that needs to be addressed.

In the course of most neuropsychological evaluations, we are trying to understand the student’s profile of strengths and weaknesses, which often requires testing the limits. This raises the question of the value of the standardized scores. The standardized scores likely reflect the level at which the child or adolescent is functioning in the “real world.” Impulsive test-takers are almost certainly impulsive students; just as they don’t demonstrate their true potential in testing, they are not doing so in school.

Many students are able to fully demonstrate their skills and knowledge with standardized testing and don’t require “testing the limits.” However, at NESCA, we also see many highly complex students whose ability to access their potential is limited by issues of attention, executive functioning, communication, or emotional/behavioral regulation. In these cases, we routinely “test the limits” and report both standardized administration and non-standardized (“testing the limits”) scores and explain what these scores mean for the individual, what the scores tell us about daily functioning as well as untapped potential.

 

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

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

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

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

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

Neuropsychological Evaluation Results: What, When and How to Share with Children and Teens

By | NESCA Notes 2022

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

During intake and feedback meetings with families, I find the same question comes up often from parents: what do I tell my child about all of this? NESCA’s Dr. Erin Gibbons gracefully tackled how to prepare your child for their neuropsychological evaluation. After an evaluation is done, you as a parent now have more than 20 pages of historical information, test descriptions, tables, summaries, and recommendations. How do you translate that information into something a child or teen will actually understand? It does not need to be a secret code or a hidden message. Feedback about a child’s strengths and weakness can be an incredibly powerful intervention.

Let’s take a page from Carol Dweck’s work and use a growth mindset to frame the experience. A growth mindset tells us that skills can be learned and neural connections can be strengthened. I advise parents to tell children and teens that testing is a chance for a “healthy check-up” for our brain and our learning, just the same way that the pediatrician performs a yearly healthy check-up for our bodies. The same way that a doctor pays attention to how all of our systems grow and interact with each other, a neuropsychologist can see how a child or teen is growing and how parts of the brain can talk to each other. I shape the dialogue right away that this kind of evaluation can tell us how strong some of the parts of our learning are, like a super strong muscle that has been exercised and practiced with gusto. The evaluation can also tell us what muscles or parts of our learning are a little weaker and need some more “exercise.” Pulling in a growth mindset, we can set the frame that any weakness can be made stronger if we have the right types of exercise, the right amount of practice, the right coaches, and a willingness to work hard. Most children and teens are pretty savvy and can often predict what their weak muscles are (e.g., “math is so hard!”; “I can’t spell!”; or “I can’t pay attention in school and I’m always in trouble for getting out of my seat!”).

Now, back to those 20-plus pages of dense text. It’s rarely helpful for a child or teen to read each page. There are parts of the normal curve, standard scores, confidence intervals, on and on that children and teens have not even learned yet! Those scores are an incredibly important source of information for schools, pediatricians, psychiatrists, therapists, and other neuropsychologists. They are not nearly as helpful when sharing information with children and teens, so do not stress about trying to translate it for kids. It is also not as helpful to have this conversation with your children when you are late for a meeting or they cannot find a soccer cleat on the way to practice. Plan your conversation for a time when your stress level is low as a parent and your child or teen is also more relaxed.

Your neuropsychologist can help you in your personal feedback meeting to identify a few important strengths to share with your child or teen – from your child’s positive attitude, to their strong decoding of new words, to their memory for things they see, to their ability to make and keep friends. With a sense of confidence about their strengths, I share what the “weaker muscle” is using language like, “I can see that word problems can be harder for you,” or “Keeping your anxious thoughts quiet when you are at school so you can concentrate on schoolwork is really hard.” Most of the time, children and teens find this validating rather than shaming – finally someone sees that their struggle is not their fault, not because their brain is wrong or bad, not because they are not trying hard enough. They just need more of the right kind of practice.

Knowing their strengths and their weaknesses, it is much easier to shape the game plan for the future. I tell children and teens that the good news is that we know what strategies can help make that weaker area even stronger. So choose your metaphor: coaches have different plays or practices, music teachers have different pieces for someone to play, artists can try out a new medium or set of supplies, or gamers practice different strategies and read tips and tricks from other gamers. By choosing a relatable experience for your child or teen in that moment, we can make the information both relevant and accessible. Your neuropsychologist can speak with you about how you as a parent can share this information with your child, or they can arrange a time to share the information directly from neuropsychologist to client. It is helpful for you to listen, too, so you can hear the language used by the neuropsychologist. Be prepared that these meetings are not very long to suit a child or teen’s attention span. Children and teens need time to process the information the same way adults do. You might expect a child to return to you a few days later with questions, or for the topic to more organically arise when your teen faces a challenge. Feedback is a unique chance for your child to feel validated, encouraged, and empowered!

 

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

 

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.

Avoiding Burn-out

By | NESCA Notes 2022

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

We have hit our third calendar year of COVID. It’s season 3 of this drama series during our Junior Year of COVID. As my colleagues in front line health care discuss ways to avoid burn-out in this lengthy experience, it’s inspired me to think of ways for our kids and teens to avoid burn-out. Typically, we define burn-out as a stage of chronic and overwhelming stress in the workplace. It is the full time job of our children and teens to attend school. So what do we do to support our children who may themselves be experiencing signs of burn-out?

First, let’s understand some signs of burn-out, including:

  • A sense of fatigue or low energy to engage with school or personal activities
  • A sense of “distance” from school, which can include statements such as, “I don’t care,” or withdrawal from activities
  • Negative feelings about school or academic achievement, which can sometimes look like irritability and hatred of school
  • Doubts that school is “worth it” or a sense that what is learned in school is never applicable to real life
  • Reduced efficiency so that tasks take far longer than usual

Given the constant stress of close contact notifications, masking requirements, fears of infection, and disappointment about canceled activities (to name a few), it is not surprising that kids may feel this sense of burn-out. Let’s consider 5 tips to support children and teens with a sense of burn out:

  1. Give it a name. It might feel like a relief to recognize and label the experience for children and teens. Giving the experience the name of “burn-out” can provide some distance from the problem, rather than feeling consumed by it.
  2. Practice mindfulness. It can be easy to get caught up considering the “before-COVID” good old days. It can also be hard to imagine the uncertain future and when one might get to the other side. Practice focusing on this moment of this day. Encourage children to notice any physical signs of stress in their bodies. These moments can pass as the sensation is not permanent. Using meditation and deep breathing can help children to stay rooted in the present moment.
  3. Manage the calendar. It is easy to feel overwhelmed by due dates, projects, and additional activities. As a parent, this may mean that you will have to take over as the “gate keeper” of the calendar. Help to prioritize the necessary and eliminate what is not needed. Protect personal time carefully so that school tasks do not consume all areas of the weekend.
  4. Practice self-care. Self-care can look different for everyone – from vigorous physical activity for one teen to a day of relaxation for another. Encourage discussion about what your child might need and consider ways to change up the ordinary. For example, consider assigning a “home spa day” of relaxation or a warm bath. Consider outside activities for the active child who needs to run or exercise to feel good. Sleep, exercise, and good nutrition are critical ways to care for our bodies when facing chronic stress.
  5. Leave room for the fun. When school feels boring or challenging for children, it can be hard to motivate children and remain committed. Work with your child to identify a staff member or friend who they look forward to seeing. Consider an after-school activity that sparks joy so there is something to look forward to at the end of the day.

 

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

 

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.

ASD Diagnosis Disclosure with Children

By | NESCA Notes 2022

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

All brains are different. Thus, there is no “one way” to disclose a diagnosis of an Autism Spectrum Disorder (ASD) to a child. The when, where, and how of diagnosis disclosure depends on the child and family’s preferences, values, and experiences. In addition, families do not have to feel alone in this process. Many families find it helpful to consult with parent support groups and professionals (e.g., therapist, neuropsychologist, speech and language pathologist, in-home ABA provider) to collaborate and discuss how to best approach diagnosis disclosure based on an individual child’s needs.

In my experience, I have found that disclosing a diagnosis of ASD to a young child is helpful when a child’s support network is integrated and involved in the process. As a family therapist, I see diagnosis disclosure as a family process and a potential to create and develop a conversation for the child and family that does not focus on identification and labeling of deficits but rather a conversation that is focused on understanding how each individual in the family thinks, feels, regulates, and relates to the world. The narratives we tell ourselves influence our well-being, and it is thus very important that children and families have a narrative or story to help guide their personal understanding and meaning of an ASD diagnosis.

Following a neuropsychological evaluation, I often provide child and family feedbacks to children and their caregivers to discuss the diagnosis. These meetings are designed to be “therapeutic feedbacks.” Here are key components of my “therapeutic feedback” sessions for “making meaning” of the diagnosis of ASD which may be helpful for some parents and providers:

  1. Normalize that all family members have unique learning styles and brains. Encourage parents and siblings to share what they know about their own learning styles of strengths and challenges. For example, a caregiver might say, “All brains are different, and I can’t wait to learn about how your brain works, how your sister’s brain works, and how my brain works.”
  2. Create a story about how the child thinks, feels, regulates, and relates to the world. Assist your child in developing a strength-based individualized narrative or story of their diagnosis, a narrative which also validates and acknowledges challenges. This can help the child and family see and understand how strengths can be used to meet challenges. The diagnosis of ASD becomes secondary to the process of describing the child’s perspective and experience – or describing their learning style. This idea stems from narrative therapy – a therapeutic treatment which helps individuals and families “edit and re-author” the stories we tell about ourselves, others, and our environment to increase well-being. It is important to remember that all stories are unique to the child and depend on the child’s experience and learning style. Examples that children and families have developed include, understanding ASD as “superpower,” “awesome awe-sism,” “data brain,” “legomaster,” “detective,” and “Ms. Feel Big.”
  3. Recognize the child as the “expert” of their experience. Many children with ASD experience heightened feelings of “being misunderstood” which can produce stress and significant emotional difficulties. It is thus very important to connect with the child’s own point of view, language, play themes, and description of their experience. Therefore, think developmentally – use play, videos/movies, books, art, or a written/visual outline (e.g., one column of “superpower” strengths and one column of “superpower” challenges). Here is an example of a book, which has been used in therapeutic feedbacks for diagnosis disclosure for some children depending on the child’s learning profile and special interests.
  4. Externalize the challenges that children experience and identify themselves. Do this by separating “problems” from the child. For example, a child I was working with identified that their “superpower” (ASD) makes them “just do it,” which in diagnostic terms reflects “impulsivity.” The family and I talked about “just do it” to create a story in which the child had a “jumpy monkey” (this child loved monkeys). This “jumpy monkey” needed “help” from the child’s “superpower” to “stop and think,” which in clinical terms means developing the child’s “impulse control.” This is a good example of how a child and family identified an ASD strength that could be used to meet a challenge.
  5. Review and revisit the conversation. Keep the conversation open and accessible to the child in every-day life. Practice normalizing and discussing every family member’s story of strengths and challenges at dinnertime, in the car, and during therapies (speech therapy, occupational therapy, psychotherapy, etc.).

These therapeutic feedback tips are just some of many. For an additional list of tips, please visit the University of Washington Autism Center’s Dr. Sarah Woods’ “Tips for Talking to Your Child About Their Autism Diagnosis.”

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, 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, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Social Skill Concerns in a Time of Reduced Social Opportunities

By | NESCA Notes 2021

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

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

My child does not know how to play with peers.

My child is anxious/fearful around peers.

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

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

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

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

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

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

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

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

 

About the Author

Dr. Yvonne M. Asher enjoys working with a wide range of children and teens, including those with autism spectrum disorder, developmental delays, learning disabilities, attention difficulties and executive functioning challenges. She often works with children whose complex profiles are not easily captured by a single label or diagnosis. She particularly enjoys working with young children and helping parents through their “first touch” with mental health care or developmental concerns.

Dr. Asher’s approach to assessment is gentle and supportive, and recognizes the importance of building rapport and trust. When working with young children, Dr. Asher incorporates play and “games” that allow children to complete standardized assessments in a fun and engaging environment.

Dr. Asher has extensive experience working in public, charter and religious schools, both as a classroom teacher and psychologist. She holds a master’s degree in education and continues to love working with educators. As a psychologist working in public schools, she gained invaluable experience with the IEP process from start to finish. She incorporates both her educational and psychological training when formulating recommendations to school teams.

Dr. Asher attended Swarthmore College and the Jewish Theological Seminary. She completed her doctoral degree at Suffolk University, where her dissertation looked at the impact of starting middle school on children’s social and emotional wellbeing. After graduating, she completed an intensive fellowship at the MGH Lurie Center for Autism, where she worked with a wide range of children, adolescents and young adults with autism and related disorders.

 

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

 

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

 

Getting Back in the Swing of Things

By | NESCA Notes 2021

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

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

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

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

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

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

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

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

 

About the Author

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

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

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

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

 

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

 

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

 

Anxiety Reducers for Children and Teens with ASD

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Research indicates that children and teens with Autism Spectrum Disorders (ASD) are more sensitive to heightened physiological sympathetic arousal (the “fight or flight” response), including increased heart rate, breathing rate, feeling “on edge” and body-based tenseness. Heightened physiological arousal is neurologically connected to sensory processing and emotional responses. This is why some children with ASD have “high startle responses” or sensitivities to specific sensations, such as touch or sounds. This is also why some children and teens with ASD are vulnerable to feelings of anxiety, particularly within social situations and settings.

There is growing research focusing on possible strategies and interventions that reduce anxiety and “buffer” the “fight or flight” response that can be activated for many children and teens with ASD.

5 Research-driven Anxiety Reducers:

Animals: Include companion or therapy animals in social groups or social outings (particularly new social events). In one study, children with ASD showed a 43% decrease in skin conductance responses during free play with peers in the presence of animals, as compared to toys (O’Haire, McKenzie, Beck, & Slaughter, 2015).

Exercise: Make a plan to engage in a “warm up” body-based activity right before a social event when anxiety levels are increasing (e.g., jumping jacks, burpees, squats). Research indicates that exercise calms the amygdala and decreases physiological arousal.

Relax or Distract: Practice progressive muscle relaxation (PMR). Recent research has indicated that regular and routine engagement in PMR sessions can be a useful strategy for individuals with ASD. Distract yourself from the anxiety-producing situation for the short term (e.g., count by 3s, name three things you can see and hear in the room, repeat words from your favorite song in your head).

Plan to Take a Break: Children and teens can benefit from having a healthy “escape plan” to take a break from socially-demanding and sensory-demanding settings (e.g., a large event like a play or concert, a college lecture, an interview for a job). Research indicates that “rest breaks” during mentally demanding tasks result in increased alertness, decreased fatigue and heightened relaxation.

Social Stories: Social stories provide the opportunity to practice and prepare for stressful situations, decreasing “fight or flight” responses. Read more about examples and applications of social stories in my colleague, Dr. Erin Gibbons’ previous blog post.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Click here to learn more about NESCA’s ASD Diagnostic Clinic.

 

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.