To accommodate requests for neuropsychological evaluations after the start of the new school year, NESCA has added evaluation dates in its Newton, MA office. Immediate openings are now available for scheduling. Please complete our Inquiry/Intake Form for more information or to start the scheduling process.

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Headshot of Dr. James Lynch and a quote from him about joining NESCA

NESCA Welcomes James Lynch, Ph.D., to its Pediatric Neuropsychology Team

By | NESCA Notes 2026

Headshot of Dr. James Lynch and a quote from him about joining NESCABy: Jane Hauser
Director of Marketing & Outreach, NESCA

I recently had the opportunity to learn more about NESCA’s latest addition to its Pediatric Neuropsychology staff, Dr. James Lynch. We are thrilled to have Dr. Lynch on our team at NESCA! I hope you enjoy getting to learn more about him here as well.

What are your areas of expertise in pediatric neuropsychology?
I have worked with many individuals with a wide range of ages and ability areas from my previous educational and professional experiences. Most of my experience is with children and adolescents who show signs of Attention-Deficit/Hyperactivity Disorder (ADHD), autism spectrum disorders (ASD), learning disorders, developmental delays, and intellectual disabilities, as well as the interventions that are used to support those students.

How did you get your start in pediatric neuropsychology?
I started in clinical psychology by training in evaluating children and adolescents with concerns for ADHD and/or autism. While that is my area of specialty, I was also doing a lot of evaluations during my fellowship at Boston Children’s Hospital with complex presentations in children who were often considered “difficult to test” for many reasons, whether due to behavioral challenges, language abilities, or other factors.

What is your approach in evaluating children and young people?
I try to optimize the performance of the evaluations for the students with whom I work. I like to focus specifically on what I am trying to measure and whether I am getting the information that will help me identify the root cause of the challenges the individual is experiencing. I try to look for the patterns of skills – whether they are strong or need support to find out what we are looking for.

What kind of guidance do you offer to parents and caregivers about going through the evaluation process for their child?
It can be scary for families. I try to help parents and caregivers understand that we know how to work with kids and that we understand that the challenges they and their child are experiencing can be very difficult. I explain that our aim is to help them better understand what is causing those struggles and recommend a treatment plan that is targeted specifically to their child. I assure them that while their child’s challenges may be new to them, we are very used to working with kids with similar presentations and that they are not alone.

You have a lot of research experience. Can you tell us more about that?
I’ve done a lot of research into neuropsychological functioning – and how that may help explain differences in real-world outcomes. For example, kids with ADHD tend to have executive functioning (EF) challenges, but there is so much variability in this… so how can we use this variability to make predictions about real-world outcomes. For example, I’ve conducted research examining whether children with ADHD are more susceptible to EF challenges or post-concussive symptoms after a season of high school football or soccer. I’ve also done a study on whether EF can predict which teenagers with ADHD are more or less likely to have automobile crashes or near-crashes when they begin to drive. I’ve also conducted research examining whether differences in reinforcement processing and temperament predict which kids are more likely to respond to an external reward system or develop future anxiety or mood symptoms.

I have also been involved in a lot of caregiver-focused research, such as whether the outcomes for autistic children were better when families participated in an adapted Applied Behavior Analysis (ABA)-based program and if participating had downstream impacts on other services for the child or the wellness of parents of kids with autism.

You join NESCA from Boston Children’s Hospital. What did that experience give you and how will that support you in your work at NESCA?
Working at Children’s for two years allowed me to see a wide range of kids with highly complex challenges, including those with ADHD and ASD, as well as those who were also experiencing GI, genetic, and neurological complexities. We also frequently worked with children whose symptoms made it difficult to tease apart exactly what the underlying issues were.

Children’s also gave me the training on and regular opportunity to make decisions on the fly. This has been extremely beneficial in being able to select the individualized battery of tests we use in our evaluations. Based on behavioral observations mid-testing, I have learned to easily pivot, incorporating additional tests that will allow me to better identify cognitive challenges, which helps to home in on an accurate diagnosis. It’s those in-the-moment choices that I’ve become very accustomed to that are so helpful in getting to the bottom of what’s actually going on with a child.

Finally, the interdisciplinary experience Children’s provided has also been extremely helpful in understanding a child as a whole during evaluations so I can create a targeted treatment plan that will support them once the evaluation is concluded.

What drew you to NESCA?
I was drawn to the focus on helping families in areas that other neuropsychology practices may not focus on, mainly how we can support children with their education based on our evaluation findings. I really wanted to move my career forward in a place where I could make an impact on a child’s everyday life, whether behaviorally, developmentally, or helping them thrive academically.

I also really appreciate the efforts that NESCA makes in keeping its clinical staff trained and current on evidence-based treatments, school-based interventions, among other areas from internal and external experts. The case conference and seminar trainings were very familiar to me from the hospital setting, and I greatly appreciate that I can continue to further my education in this manner.

Finally, I saw first-hand in the interview process and throughout my onboarding at NESCA how closely connected NESCA clinicians are with the kids and families they work with. That is something deeply important to me.

 

About Dr. James Lynch

Headshot of James Lynch, Ph.D.Pediatric Neuropsychologist Dr. James Lynch, Ph.D., conducts comprehensive evaluations of toddlers, preschoolers, school-aged children, and adolescents with developmental concerns. These include challenges with cognitive functioning, behavior and emotion regulation, communication skills, and academics. He has expertise in the evaluation of neurodevelopmental disorders such as ADHD, autism, developmental delays, intellectual disabilities, and learning disorders.

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

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.
Image of a parent trying to wake his child and get them to school accompanied by a quote from a NESCA clinician

When the Honeymoon Period Is Over: Signs of School Refusal

By | NESCA Notes 2021

Image of a parent trying to wake his child and get them to school accompanied by a quote from a NESCA clinicianBy: Moira Creedon, Ph.D. 

NESCA MA Clinical Director; Pediatric Neuropsychologist, NESCA

As we reach the end of our first month back to school, many of us may be reaching the end of that glorious honeymoon period – the phase when kids are excited to see friends, optimistic for the school year, and reviewing material they likely already know. For some, the return did not start this rosy; the bloom is falling off the rose and kids are getting tired. You and your child are not alone in this. My goal for today’s blog is to share with you some warning signs that your child may be struggling and ways to get support before they grow to become bigger problems. The biggest problem I want to avoid: school refusal.

Have you heard this yet? – “My tummy hurts. I have to stay home.” Or, “I hate school. Please don’t make me go.” Or, “I’m not going!” Or perhaps these messages are communicated more subtly with covers over their heads in the morning, difficulty getting out the door on time, tantrums or disruptive behaviors in the mornings, missed buses, or the overwhelming frustration of homework that erupts into nightly battles. According to researcher Christopher Kearney, these are signs to pay attention to as they can evolve into what he terms “school refusal behavior.” School refusal is an umbrella term used to describe behaviors that interfere with a child being in school for their expected and scheduled time. This is a problem that can impact anywhere between 28-35% of students! While there are the more extreme cases for children or teens who are out of school for months at a time, my purpose here is to address the smaller, but more likely, problems. When we address smaller problems, we can keep them small.

Risky signs that your child is struggling with school:

  • Consistent statements of hating school, their teacher, or specific peers. A casual mention of a bad day is not cause for alarm. We all have bad days. If the statements keep coming and they get louder and stronger, then parents should pay attention.
  • The outward behaviors are getting bigger in the mornings before school or over homework. Behavior is a way for children to communicate with us how they are feeling. So, explosions over homework or tantrums in the morning that lead to tardiness are warning signs. The occasional homework meltdown or rushed morning is normal; we are all human! But, the problem is in the pattern.
  • Avoidance rears its ugly head. While some kids show on the outside that they are uncomfortable through their explosions, others communicate very clearly through their withdrawal. Some kids and teens struggle to get out of bed, are constantly tired, not completing work, falling asleep in class, or sharing every somatic complaint or symptom available on Google. If medical causes are ruled out, anxiety can be a culprit.
  • Consider the role of a major transition. According to Kearney, the riskiest time for a child to develop a pattern of school refusal is during times of significant transition – like starting kindergarten or changing schools from middle to high school. In addition to the social and emotional jump that these transitions bring, there is also a massive leap in demands for academic independence. It is very common for kids to struggle with the leap initially.

Oh no. So now what?

  • First and foremost, keep calm. It is far easier to keep small problems small when we have a clear-headed approach. Pull in anxiety management techniques like deep breathing, sleep, and exercise to support your own anxiety as a parent.
  • Reach out to your child’s teacher or school psychologist. Let them know your child is struggling with homework or coming to school. This is a great chance to gather information on what is going on in your child’s day and put your child on their teacher’s radar. This is critical as the only effective approach to remedy a problem with school refusal is a team approach.
  • Talk to your child honestly about what is going on. This has to include a chance for kids to talk about what might be happening to make them feel stressed or why they dislike school. Don’t shortcut this step. If your child has trouble explaining what is going on (which can be especially true for younger kids), try this approach: you and your child are both going to be detectives to learn together what is making school feel hard. We can’t solve a problem until we understand it. By joining with your child in gathering information, you are demonstrating great empathy and validating that their feelings are real.
  • Be careful of your language and conversation about school. It can be tempting to go too far in validating a child to give the message that the assignment really is stupid or their teacher really is unreasonable and mean. It’s best to stick to the feeling (“that must feel so frustrating”) without reinforcing negative messages about school.
  • Hold the line. As you gather more information, it is really important to maintain the message that it is your child’s job to go to school. It might feel conflicting to both validate the feelings of hating school and give the message to attend school. It might feel something like this: It’s either “I love and support my child OR I’m going to force them to go to school even when it’s hard.” Let’s change that OR to AND. Reframe the thought to: “I love and support my child AND they have to go to school AND they can do hard things.”

If you are trying to determine the root cause of your child’s struggles or avoidance, consider a neuropsychological evaluation. NESCA has immediate openings in its Newton, MA office to accommodate the needs of students at the outset of the new school year. For more information or to begin the scheduling process, complete our Inquiry/Intake Form. An intake coordinator will reach out to answer your questions or assist in scheduling an evaluation.

For more information, please check out:

Kearney, C.A. (2007). Getting your child to say “yes” to school: A guide for parents of youth with school refusal behavior. New York: Oxford University Press.

 

About the Author

Dr. Creedon has expertise in evaluating children and teens with a variety of presenting issues. She isMoira Creedon headshot 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 inquiry/intake form. 

 

NESCA is a pediatric neuropsychology and related services practice in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables/Miami, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of an anxious child and a quote from a NESCA clinician

Anxiety: It’s Not Always Obvious

By | NESCA Notes 2025

Image of an anxious child and a quote from a NESCA clinicianBy Miranda Milana, Psy.D.
Pediatric Neuropsychologist

When we hear the word anxiety, we often picture someone who is visibly worried – someone who says, “I’m scared,” asks a lot of “what if?” questions, or seems nervous about what might happen next. But anxiety doesn’t always present that way – especially in children. Anxiety can manifest as physical symptoms, behavioral challenges, emotional outbursts, sleep disruptions, school avoidance, or changes in relationships. A child may not have the words to say, “I’m anxious.” Instead, they may complain of a stomachache, become unusually irritable, refuse to go to school, have frequent meltdowns, or suddenly need much more reassurance.

It is also important to remember that a behavior or symptom that looks like anxiety isn’t automatically anxiety. Symptoms that may appear anxiety-related can have many possible explanations – and sometimes more than one diagnosis is present at the same time.

Anxiety in Young Children

Young children often don’t have the ability to identify and explain anxiety. Instead, adults may see it through behavioral challenges or physical complaints such as:

  • Complaining frequently about a stomachache, headache, nausea, or feeling sick
  • Becoming clingy or having difficulty separating from caregivers
  • Resisting school, daycare, activities, or unfamiliar places
  • Having trouble sleeping or experiencing nightmares
  • Becoming irritable or emotional
  • Having more frequent tantrums or meltdowns
  • Asking for repeated reassurance
  • Becoming upset when plans change
  • Avoiding things that make them uncomfortable
  • Seeming quiet, cautious, or tense

For example, a child who says, “My tummy hurts,” every Sunday night may not simply have a sensitive stomach. Their body may be responding to the anticipation of school the next morning.

It is important to note that physical symptoms are very real. Emotional distress can produce genuine physical sensations, and children may experience symptoms such as stomachaches, nausea, headaches, dizziness, or changes in appetite.

Anxiety in School-Age Children

As children enter elementary school, there are greater academic expectations, more complexities in friendships, increasing extracurricular activities, new environments, and often an increasing awareness of how other people perceive them.

Anxiety may begin to look more like avoidance or shut down/withdrawal.

You might notice:

  • Frequent complaints of feeling sick before school
  • Asking to stay home or repeatedly visiting the school nurse
  • Difficulty separating from caregivers
  • Worrying about making mistakes
  • Perfectionism
  • Reassurance-seeking, asking lots of questions about what is to come
  • Difficulty falling asleep because of worries about the next day
  • Irritability or large reactions
  • Trouble concentrating
  • Avoiding activities
  • Becoming upset when plans change

Sometimes children who seem “defiant” are actually overwhelmed.

A child who refuses to participate in an activity may be avoiding something that feels scary. A child who melts down over homework may be overwhelmed by the possibility of getting something wrong. A child who says they hate school may be experiencing significant anxiety about academics, social situations, separation, bullying, or another aspect of the school environment.

Importantly, while avoidance can provide short-term relief, it can also allow anxiety to become more entrenched over time.

Anxiety in Teens

Adolescence brings a different set of challenges. Friendships become more complicated. Academic expectations increase. Social comparison becomes significant. Teens may be thinking more about who they are, their relationships, wanting more independence, and transitioning into adulthood. In teens, sometimes anxiety looks like:

“Leave me alone.”

“I don’t care.”

“I’m not going.”

“I hate everyone.”

“My stomach hurts.”

A teen experiencing anxiety may become more irritable, withdraw from others, have difficulty sleeping, struggle to concentrate, or avoid situations they once enjoyed. For teens, it may appear as though they have an “attitude problem” when what they actually are experiencing is internal distress.

With that said, that doesn’t mean every argument, eye roll, withdrawal, or change in mood is anxiety. Adolescence is marked by ever-changing hormones and a complicated period of development. To this end, irritability can have many causes. If you are noticing a significant change in behavior; however, it is worth paying attention to – especially when it persists or begins interfering with everyday life.

Anxiety in Adults

Adults may be better able to identify worry, but anxiety can still present in less obvious ways.

An adult may experience:

  • Constant “what if?” thinking
  • Irritability or feeling constantly on edge
  • Difficulty relaxing
  • Racing thoughts
  • Trouble concentrating
  • Insomnia or disrupted sleep
  • Muscle tension
  • Headaches
  • Stomachaches or digestive symptoms
  • Fatigue
  • Avoidance
  • Excessive reassurance-seeking
  • Difficulty making decisions
  • Feeling overwhelmed by ordinary responsibilities

In adults, anxiety can also feel so familiar that you may have thoughts such as:

“I’ve always been a worrier.”

“I’m just a perfectionist.”

“I just like to know what to expect so I can plan accordingly.”

“I’ve always been bad at relaxing as I prefer to stay busy.”

Not Everything That Looks Like Anxiety Is Anxiety

Something important to note about anxiety symptoms is that they often overlap with other possible conditions as well. This is where things can get complicated. For example, an upset stomach could be anxiety, but it could also be a gastrointestinal condition. Irritability could be anxiety, but it could also be related to sleep deprivation, depression, ADHD, hormonal changes, or learning difficulties. Difficulty concentrating could be anxiety, but it could also be ADHD, learning challenges, inadequate sleep, depression, or stress. School avoidance could be anxiety, but it could also be bullying, academic difficulties, social challenges, depression, or an environment that isn’t meeting the child’s needs.

Another important piece of the puzzle is that conditions don’t always exist in isolation. For example, ADHD and anxiety can occur together. Anxiety can also co-occur with learning disorders, sleep problems, depression, and other conditions, which can make it more difficult to determine what is driving a particular set of challenges.

For example, imagine a child who can’t complete homework. Is the child anxious about getting the answers wrong? Are they struggling to sustain their attention because of ADHD? Is the assignment particularly difficult because of an underlying learning disorder? Are they exhausted? Or maybe a few of these things are happening all at once. The answer matters because the most helpful support may look very different depending on what’s underneath the behavior. A good assessment looks beyond the most obvious symptom.

When Is It Time to Get Help?

Everyone experiences anxiety. Fear and worry are normal parts of development and everyday life. The concern is when anxiety (or the behaviors associated with it) becomes persistent or disruptive. Should symptoms persist, cause significant distress, or interfere with school, work, relationships, sleep, activities, or daily functioning, it is time to seek out an evaluation to better understand the root cause. An evaluation can also be particularly helpful when you’re unsure what you’re seeing. You don’t have to start the evaluation process knowing whether it’s anxiety, ADHD, autism, depression, a learning disorder, a medical issue, or something else. That’s precisely what an evaluation is for.

The bottom line is that anxiety doesn’t have one look. And sometimes what appears to be anxiety isn’t anxiety at all – or isn’t only anxiety. Understanding the whole picture matters. Through better understanding and an appropriate evaluation, we can begin on the road to providing supports that addresses the underlying need – not just what we see on the surface.

 

About the Author

Dr. Miranda Milana provides comprehensive evaluation services for children, adolescents, and young adults 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 and related services practice in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables/Miami, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

Image of student walking into middle school with a quote from Dr. Madeline Manning

Navigating the Transition from Elementary to Middle School with ADHD

By | NESCA Notes 2026

Image of student walking into middle school with a quote from Dr. Madeline ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

The transition from elementary to middle school is a significant developmental milestone, bringing new academic demands, shifting social dynamics, and greater expectations for independence. For students with attention-deficit/hyperactivity disorder (ADHD), who often experience executive function (EF) vulnerabilities, this period can be particularly challenging. Understanding and proactively addressing the academic, social-emotional, and behavioral needs of these students is essential to support their adaptation and long-term success.

Academic Demands and Executive Function

Middle school introduces a significantly more dynamic, fast-paced academic environment, characterized by multiple teachers, changing classrooms, and a heavier workload. Students must manage assignments from various instructors, each with different expectations and communication methods. This environment requires cognitive flexibility and other advanced EF skills, including organization, time management, task initiation, and prioritization. For students with ADHD, these demands can quickly overwhelm existing coping strategies, leading to forgotten assignments, missed deadlines, and difficulty transitioning between classes. This, in turn, can contribute to a reduced sense of self-efficacy as a learner.

Notably, many students have not yet been explicitly taught the EF skills needed for this new level of independence. Evidence shows that many students with ADHD require direct instruction, repetition, clear structure, frequent feedback, and opportunities to practice these skills in real contexts. Early identification of EF difficulties and targeted supports, such as executive function coaching, visual organizers, structured routines, and regular teacher check-ins, can ease the transition and build confidence (Giannakopoulos, 2025).

Social Dynamics and Emotional Development

Middle school is also marked by greater complexity in peer interactions. Friendships shift from more convenience-based connections, often formed through proximity and shared activities in elementary school, to deeper emotional bonds, and students face heightened peer pressure and the formation of social cliques. The onset of puberty, elevated emotional sensitivity, emerging interest in romantic relationships, and the influence of social media can further complicate peer dynamics during this developmental stage.

Students with ADHD are already at increased risk of experiencing challenges with impulse control, emotional regulation, and social problem-solving. The reduced adult scaffolding in middle school means students are expected to navigate social situations with more independence, which can be both empowering and challenging. Difficulties in these areas can negatively affect self-esteem and lead to anxiety or withdrawal.

Fostering resilience involves teaching prosocial coping strategies and promoting self-advocacy. This includes encouraging students to seek support from trusted adults when needed and to practice assertive communication skills. Guidance on managing peer pressure, conflict resolution strategies, and building and maintaining healthy friendships is critical for positive social development and emotional well-being in middle school and beyond.

The Adolescent Brain: Developmental Realities

During early adolescence, the brain undergoes significant changes. The prefrontal cortex (responsible for planning, decision-making, and self-control) is still maturing, while the limbic system (a complex set of brain structures governing emotions and reward systems) develops far earlier. This developmental mismatch means that adolescents are more likely to exhibit heightened emotional responses, increased impulsivity, and a greater sensitivity to rewards and peer influence, often before they have fully developed the cognitive skills necessary for effective self-regulation and long-term planning.

These neurodevelopmental factors mean that even typically developing students may struggle with EF tasks and social functioning during middle school. For those with ADHD, whose brains are already wired for greater difficulty with attention and self-regulation, the challenges can be far more pronounced.

Supporting Skill Development

To help students with ADHD navigate this transition, families and educators can collaborate to provide:

  • Explicit instruction in organizational and planning skills
  • Consistent routines and predictable expectations
  • Visual supports (e.g., checklists, planners)
  • Regular feedback and positive reinforcement
  • Opportunities for guided practice and reflection

These supports help students gradually build independence, resilience, and the executive function skills necessary to meet new demands.

A Critical Window for Evaluation and Intervention

The transition from elementary to middle school is a pivotal time to address concerns around academic, social-emotional, and/or behavioral functioning. A comprehensive neuropsychological evaluation can clarify your child’s unique strengths and challenges, guide targeted interventions, and support the development of formal education plans (e.g., IEPs or 504 Plans) to ensure they are receiving the services they require. Early identification and collaboration between home and school are essential for maintaining self-esteem, fostering self-efficacy, and ensuring access to appropriate supports.

If you have questions or concerns regarding your child’s transition to a new school, executive functioning, or any other aspect of their development, please contact NESCA for guidance. Comprehensive evaluation and targeted strategies can make a meaningful difference in your child’s educational journey and overall well-being.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of a student taking a test and quote from Dr. Hernandez Medellin

What English Language Learners Really Need: A Parent’s Guide

By | NESCA Notes 2026

Image of a student taking a test and quote from Dr. Hernandez MedellinBy Luisa Hernandez Medellin, Psy.D., PMH-C
Bilingual Pediatric Neuropsychologist; PSYPACT-authorized

If your child is learning English at school while also using another language at home, you are not alone. Millions of children in the U.S. are English Language Learners (ELLs). These students bring rich language skills, culture, and life experiences into their classrooms, but they also face unique challenges that schools don’t always understand well.

As a parent, understanding what your child truly needs can help you advocate more effectively and feel more confident working with schools.

English Learners Are Not All the Same

One of the biggest misunderstandings about English learners is the idea that they are all similar. In reality, ELL students come from many different backgrounds. Some were born in the United States, while others arrived recently. Some had strong schooling in their home country, and others experienced interruptions due to migration, poverty, or trauma.

Children may speak one language, two languages, or several. Some can speak well but struggle to read or write. Others understand more than they can say. All of this matters when teachers and specialists try to figure out how a child is doing in school.

Speaking English Isn’t the Same as Doing Schoolwork in English

Many parents hear, “Your child speaks English just fine,” and assume that means they should also be doing well academically. But everyday conversation and school language are very different.

Children often learn social English (chatting with friends, answering simple questions) within a few years. Academic English, the language needed for reading stories, writing essays, solving math word problems, and taking tests, takes much longer to develop. This means a child can sound fluent but still may struggle with schoolwork, and that struggle may be completely normal.

When a Child Is Struggling, What Should Happen?

Teachers are usually the first to notice when a child is having a hard time. The key is figuring out why.

Is the child still learning English? Is the instruction matched to the child’s language level? Has the child had access to consistent schooling? Or is there something more, like a learning or language disorder?

Schools should never rush to label a child with a disability just because they are learning English. At the same time, children who truly have learning challenges should not be ignored because “they just need more time.”

The goal is to understand the whole child, not just test scores.

Parents Must Be Part of the Process

Families play a critical role in helping schools understand a child’s strengths and challenges. However, many parents feel left out because of language barriers or unfamiliarity with the school system.

Schools are responsible for making sure parents understand what’s happening. This includes:

  • Providing interpreters and translated documents
  • Explaining processes step by step
  • Avoiding educational jargon
  • Checking for understanding, not just agreement

Parents should never be expected to rely on their child to translate important information.

Evaluations Should Be Fair and Culturally Sensitive

When a child needs testing (for learning difficulties, speech and language, or attention concerns), the evaluation must match the child’s language and background. Testing a child only in English when they are stronger in another language can give misleading results.

Good evaluations consider:

  • Which language the child is strongest in
  • How long the child has been learning English
  • The language used at home and at school
  • Cultural differences that may affect test performance

Sometimes, no formal diagnosis is given, and that’s okay. Evaluations can still identify areas of need and lead to helpful supports and accommodations.

Understanding Results and Moving Forward

Test results should be explained in plain language. Parents deserve to understand what the findings mean, how English learning affects their child’s performance, and what steps can help next.

Recommendations should be realistic and respectful of family values, beliefs, and resources. The most important part of the process is collaboration – parents, teachers, and specialists working together for the child’s success.

The Bottom Line

Children who are learning English are capable, resilient, and full of potential. What they need most is time, appropriate instruction, fair assessment, and adults who understand the difference between language learning and learning problems.

When schools take a whole‑child approach – one that respects language, culture, and family – English learners don’t just catch up. They thrive.

If you ever feel unsure, ask questions. Your voice matters, and you are your child’s strongest advocate.

 

Headshot of NESCA Pediatric Neuropsychologist Dr. Luisa Hernandez MedellinAbout the Author

As a bilingual pediatric neuropsychologist, Dr. Hernandez Medellin conducts comprehensive and culturally sensitive neurodevelopmental and neuropsychological assessments, comprehensive diagnostic evaluations, and effective care plans, providing appropriate recommendations for the client’s school, home, and the community. She specializes in the identification and assessment of neurodevelopmental disorders such as Autism Spectrum Disorders, ADHD, developmental and learning disorders, and their co-occurrence with anxiety and mood disorders. She also works with children and young adults with acquired brain injuries, epilepsy, brain tumors, strokes, general medical conditions, and genetic disorders affecting the nervous system. She is a native Spanish-speaker, passionate about serving the eclectic and vibrant South Florida community, as well as international patients looking for high-quality and compassionate care.

To book evaluation services at NESCA in Coral Gables, Florida, complete NESCA’s online intake form. 

To book a neuropsychological evaluation or other services at NESCA’s New England offices, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of student walking into middle school with a quote from Dr. Madeline Manning

Navigating the Transition from Elementary to Middle School with ADHD

By | NESCA Notes 2026

Image of student walking into middle school with a quote from Dr. Madeline ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

The transition from elementary to middle school is a significant developmental milestone, bringing new academic demands, shifting social dynamics, and greater expectations for independence. For students with attention-deficit/hyperactivity disorder (ADHD), who often experience executive function (EF) vulnerabilities, this period can be particularly challenging. Understanding and proactively addressing the academic, social-emotional, and behavioral needs of these students is essential to support their adaptation and long-term success.

Academic Demands and Executive Function

Middle school introduces a significantly more dynamic, fast-paced academic environment, characterized by multiple teachers, changing classrooms, and a heavier workload. Students must manage assignments from various instructors, each with different expectations and communication methods. This environment requires cognitive flexibility and other advanced EF skills, including organization, time management, task initiation, and prioritization. For students with ADHD, these demands can quickly overwhelm existing coping strategies, leading to forgotten assignments, missed deadlines, and difficulty transitioning between classes. This, in turn, can contribute to a reduced sense of self-efficacy as a learner.

Notably, many students have not yet been explicitly taught the EF skills needed for this new level of independence. Evidence shows that many students with ADHD require direct instruction, repetition, clear structure, frequent feedback, and opportunities to practice these skills in real contexts. Early identification of EF difficulties and targeted supports, such as executive function coaching, visual organizers, structured routines, and regular teacher check-ins, can ease the transition and build confidence (Giannakopoulos, 2025).

Social Dynamics and Emotional Development

Middle school is also marked by greater complexity in peer interactions. Friendships shift from more convenience-based connections, often formed through proximity and shared activities in elementary school, to deeper emotional bonds, and students face heightened peer pressure and the formation of social cliques. The onset of puberty, elevated emotional sensitivity, emerging interest in romantic relationships, and the influence of social media can further complicate peer dynamics during this developmental stage.

Students with ADHD are already at increased risk of experiencing challenges with impulse control, emotional regulation, and social problem-solving. The reduced adult scaffolding in middle school means students are expected to navigate social situations with more independence, which can be both empowering and challenging. Difficulties in these areas can negatively affect self-esteem and lead to anxiety or withdrawal.

Fostering resilience involves teaching prosocial coping strategies and promoting self-advocacy. This includes encouraging students to seek support from trusted adults when needed and to practice assertive communication skills. Guidance on managing peer pressure, conflict resolution strategies, and building and maintaining healthy friendships is critical for positive social development and emotional well-being in middle school and beyond.

The Adolescent Brain: Developmental Realities

During early adolescence, the brain undergoes significant changes. The prefrontal cortex (responsible for planning, decision-making, and self-control) is still maturing, while the limbic system (a complex set of brain structures governing emotions and reward systems) develops far earlier. This developmental mismatch means that adolescents are more likely to exhibit heightened emotional responses, increased impulsivity, and a greater sensitivity to rewards and peer influence, often before they have fully developed the cognitive skills necessary for effective self-regulation and long-term planning.

These neurodevelopmental factors mean that even typically developing students may struggle with EF tasks and social functioning during middle school. For those with ADHD, whose brains are already wired for greater difficulty with attention and self-regulation, the challenges can be far more pronounced.

Supporting Skill Development

To help students with ADHD navigate this transition, families and educators can collaborate to provide:

  • Explicit instruction in organizational and planning skills
  • Consistent routines and predictable expectations
  • Visual supports (e.g., checklists, planners)
  • Regular feedback and positive reinforcement
  • Opportunities for guided practice and reflection

These supports help students gradually build independence, resilience, and the executive function skills necessary to meet new demands.

A Critical Window for Evaluation and Intervention

The transition from elementary to middle school is a pivotal time to address concerns around academic, social-emotional, and/or behavioral functioning. A comprehensive neuropsychological evaluation can clarify your child’s unique strengths and challenges, guide targeted interventions, and support the development of formal education plans (e.g., IEPs or 504 Plans) to ensure they are receiving the services they require. Early identification and collaboration between home and school are essential for maintaining self-esteem, fostering self-efficacy, and ensuring access to appropriate supports.

If you have questions or concerns regarding your child’s transition to a new school, executive functioning, or any other aspect of their development, please contact NESCA for guidance. Comprehensive evaluation and targeted strategies can make a meaningful difference in your child’s educational journey and overall well-being.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

NESCA is a pediatric neuropsychology and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and Coral Gables, Florida, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Image of an adult looking at a tablet with a child and a quote from Dr. Hernandez Medellin

Looking for the Best Holiday Gift?

By | NESCA Notes 2025

Image of an adult looking at a tablet with a child and a quote from Dr. Hernandez MedellinBy Luisa Hernandez Medellin, Psy.D., PMH-C
Pediatric Neuropsychologist, NESCA

I have three children, ages 7, 13, and 20. I have seen most consoles from the past two decades, from the Wii U to the PS5, including a couple of Nintendo DS versions and X-Boxes. I have purchased Minecraft swords, mini kitchens, baby dolls, Little People, tablets, costumes, skateboards, Rubik’s Cubes, bikes, Pokémon cards, Ninja Turtles, makeup sets, Robux, Battle passes, and phones. And every year, I get the same mixed feelings about the value of gifts, their meaning, and their purpose, especially when it comes to electronics.

As a pediatric neuropsychologist, I want my children to get toys and games that are fun and instill curiosity and creativity. I want their gifts to encourage them to learn new skills, go outside, and play with other kids, but I also understand that some of the skills they learn now will be different from the ones we learned as we grew up.

Online group games can teach kids how to play as a team, communicate with others, assign and/or accept roles, strategize, and reach a common goal. Supervised and monitored by adults, video games can also teach them discipline, limits, and boundaries. How? Because even if they are teenagers, our kids need to learn that using electronics is a privilege, not a right. They need to be monitored regarding the content of their games, their online conversations, and the impact of their actions in the digital world. To use their devices, parental controls must be enabled, and their game’s rating must be appropriate for their age. Their Discord account – if allowed one – must be accessible to the parents for them to check it as needed. The older they get, the “spicier” the conversations. But that also opens the door to having more thoughtful and meaningful conversations with them about cyberbullying, racism, discrimination, sexting, and pornography, as well as where you stand regarding family values, ethics, morals, and life in general.

The same is true of phone use and social media. Research says that having access to social media before the age of 16 has a major negative impact on self-esteem, body image, and mental health – especially in girls – as unfortunately, the algorithms feed them negative ideas and unrealistic expectations about their bodies, as well as relationships, making them more prone to depression and anxiety. While the emotional effects on boys are typically not as severe, the free access to the virtual world tends to expose them to sex, pornography, drugs, and aggressive content earlier, if social media is not supervised.

Therefore, if you ask me, and all the other concerned parents and social scientists, I would not recommend giving kids a smartphone until they are 12-13, depending on their level of maturity and the level of honest communication with each other. And once they have one, the apps downloaded to their phones must be approved by their parents (both iPhones and Androids let you create that set-up). Likewise, their access to YouTube, Instagram, Snapchat, etc., must continue to be monitored by parents until they are adults. The misuse of devices and social media should have consequences and must not be taken lightly. If, as a parent or caregiver, you would not allow certain behavior or vocabulary in person, it should not be allowed in the virtual world either.

Here are other factors to consider when deciding when your child is ready for a smartphone:

  • Child’s maturity: Assess your child’s responsibility, self-control, and ability to handle the device’s features and potential social pressures.
  • Need for communication: Consider if the child needs a phone for safety and communication due to independence (e.g., biking to school, after-school activities).
  • Alternatives to a smartphone: Before getting a smartphone, consider alternatives like a basic phone or a smartwatch with tracking and communication features but without internet access.
  • Wait Until 8th pledge: A movement called “Wait Until 8th” encourages parents to delay giving children smartphones until at least eighth grade, with the support of other families to reduce peer pressure.

Now, for the younger ones, I also have a word of caution for the use of tablets and other devices. Research shows that children under two should not be “plugged” into a tablet, as it reduces socialization time and may affect language development. With supervision, including limiting the time of use, after age four, children could use it for specific educational games and to watch videos for short periods. All tablets allow you to set up parental controls as to what they can do/watch, and for how long, so parents… learn to use them. And please, make sure you do not set up an Apple account/number with free texting or FaceTime on your child’s tablet, as it would pretty much work the same way as giving them a smartphone.

I once read that the best holiday gift a child can get is the one that comes accompanied by a caring adult – and I think that is still true for all electronics. The world we grew up in no longer exists, and this era requires involved parents who are willing to learn, guide, set limits, and model responsibility and integrity while having fun with the new technologies at hand.

 

Headshot of NESCA Pediatric Neuropsychologist Dr. Luisa Hernandez MedellinAbout the Author

As a bilingual pediatric neuropsychologist, Dr. Hernandez Medellin conducts comprehensive and culturally sensitive neurodevelopmental and neuropsychological assessments, comprehensive diagnostic evaluations, and effective care plans, providing appropriate recommendations for the client’s school, home, and the community. She specializes in the identification and assessment of neurodevelopmental disorders such as Autism Spectrum Disorders, ADHD, developmental and learning disorders, and their co-occurrence with anxiety and mood disorders. She also works with children and young adults with acquired brain injuries, epilepsy, brain tumors, strokes, general medical conditions, and genetic disorders affecting the nervous system. She is a native Spanish-speaker, passionate about serving the eclectic and vibrant South Florida community, as well as international patients looking for high-quality and compassionate care.

To book evaluation services at NESCA in Coral Gables, Florida, complete NESCA’s online intake form. 

To book a neuropsychological evaluation or other services at NESCA’s New England offices, complete NESCA’s online intake form. 

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

Image of kids helping to cook in the kitchen and a quote from Dr. Yvonne Asher

Kids in the Kitchen

By | NESCA Notes 2025

Image of kids helping to cook in the kitchen and a quote from Dr. Yvonne AsherBy: Yvonne Asher, Ph.D.
NESCA Pediatric Neuropsychologist

Cooking Thanksgiving dinner usually takes me about 8 hours by myself. With help, it’s closer to 12. But my kids LOVE to help. They always want to mix and pour and measure and dump ingredients hour after hour, standing beside me on a wobbly kitchen chair. I’ll leave the question of safety – you know your child best in that respect – except to say that the heavily marketed “Montessori style” kitchen tools are pretty great. Instead, I want to talk about the neurocognitive benefits of helping with cooking. There are other, wonderful benefits – bonding, sharing memories and family stories, creating traditions – but those probably do not require a neuropsychologist to opine on.

First and foremost, cooking is science and math. Actually, a ton of math. Addition, subtraction, multiplication, division, fractions, and more. Having company? We probably need to double our usual brownie recipe. Only Aunt Sue and Jimmy like cranberry sauce? Let’s halve that one. We need one and a half cups of flour for this pie crust, but only the one-quarter cup measure is clean. How many quarter-cups will we need? For science, we have states of matter, heat transfer, and chemical reactions. Why do carrots turn green in carrot cake? How do baking soda and vinegar get a chocolate cake to rise? What makes those dinner rolls so fluffy? The age of your child is (almost) irrelevant – younger children are intrigued by more basic concepts, and older ones can understand more complex and nuanced ideas. When I was a preschool teacher (long before my current career), I can still remember the wide eyes of my barely 3-year-old pupils when watching heavy cream turn into butter, yeasted dough turn into bread, and disparate ingredients turn into delicious cookies.

There is also a tremendous amount of executive functioning in cooking and food preparation. As anyone who has hosted a meal or, frankly, just tried to get dinner on the table before 9pm, will know, planning is crucial. Holding information in mind (working memory), organizing, setting smaller goals in the service of larger ones, tracking progress through multiple tasks, and checking one’s work are all vital to ending up with a special meal (did you remember to put the butter in the mashed potatoes???). If anyone in your crowd has particular eating requirements (babies learning solids, allergies, vegan/gluten-free diets, etc.), the executive functioning demands are ratcheted up by a lot. And, if you are the kind of person who sets an elaborate table with décor and such (my kids are lucky if I remember to grab a tablecloth), you have even more planning, organizing, and task management to do.

Last, but most certainly not least, learning to plan menus, shop, prepare food, cook, and bake are phenomenal life skills. Life skills are vital for everyone, but especially for individuals with developmental disabilities. Strong, confident mastery of life skills is critical for adolescents and young adults to achieve independence. I’m still patiently awaiting the day that one of my kids can cook dinner all by themselves, but I will be immeasurably pleased and proud when they do.

It is a commitment to have kids help in the kitchen. They make unbelievable messes (I never knew how many places powdered sugar could end up), ruin dishes with expensive ingredients, and most certainly introduce germs into food (even with the best of handwashing practices and “DON’T TOUCH YOUR FACE” admonishments). But this is the space between ideal and real that we can inhabit in service of teaching. Yes, it will take longer. Yes, things you envisioned may absolutely not happen (or not happen the way you hoped). Yes, it will be a crazy amount of work for you. Yes, you may need an extra grown up to actually help while your child “helps.” (You can, of course, designate certain dishes or elements of dishes as appropriate for “help” and others “just for grownups.”) But this is an incredible opportunity to help your kids learn math, science, executive functioning, and life skills in ways that are meaningful, filled with love, and built in to the fabric of their lives.

 

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 and related services practice with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; Coral Gables, Florida; and staff in the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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.

 

Image of a child appreciating nature around them along with a quote from Dr. Manning

Growing Grateful Kids

By | NESCA Notes 2025

Image of a child appreciating nature around them along with a quote from Dr. ManningBy Madeline Manning, Ph.D.
Pediatric Neuropsychologist, NESCA Hingham

Growing Grateful Kids: Tips for Fostering Resilience Through Gratitude

Gratitude, or the quality of being thankful and the readiness to appreciate the good in life, is especially important for youth today. It helps promote resilience, emotional well-being, and positive relationships in an increasingly complex and fast-paced world. By fostering gratitude, young people can develop a stronger sense of self-worth and perspective, empowering them to navigate challenges with optimism and empathy. Parents and caregivers play a vital role in helping children and teens develop the practice of gratitude. Research in resilience and positive psychology consistently shows that practicing gratitude helps individuals overcome adversity, enhances everyday well-being, improves mood, and strengthens interpersonal relationships. Cultivating gratitude can also enhance emotional regulation, social skills, and academic performance.

Why Gratitude Matters for Resilience

Our brains adapt and change in response to what we consistently notice and value in our environments. Encouraging youth to attend to and emphasize positive experiences helps strengthen neural pathways that make it easier for them to recognize the positives and protective factors in their lives. This supports well-being and contributes to better mental and physical health (improved immune function, better sleep, reduced cortisol levels).

Studies show that children and teens who practice gratitude regularly experience increased happiness, life satisfaction, and positive emotions. They also report fewer negative emotions and lower rates of depression and anxiety. By focusing on what is present and positive, rather than what is missing, gratitude helps youth cope with challenges and stress in healthier ways.

How Gratitude Builds Resilience and Well-being

  • Emotional regulation: Practicing gratitude engages brain regions involved in emotional processing, helping children manage difficult feelings and recover from disappointment more efficiently.
  • Social connection: Gratitude strengthens empathy and prosocial behavior, making it easier for children to form and maintain relationships with others.
  • Coping skills: Focusing on positive aspects of situations, particularly during tough times, helps children find meaning and hope, buffering against stress and adversity.

Evidence-Based Ways to Build Gratitude in Daily Life

Incorporating gratitude practices into everyday life does not need to require a major time commitment or dramatic changes to your schedule. Gratitude can be woven into everyday routines through simple, meaningful shifts in daily practices:

  • Mealtime gratitude: During meals, take turns sharing one thing each family member is grateful for, big or small. Regular sharing of gratitude strengthens family bonds and increases positive emotions.
  • Finding silver linings: During challenges or setbacks, gently help children identify a lesson learned, a person who helped, or a small comfort. This reframing fosters adaptive coping.
  • Mindful moments in nature: Encourage children to pause and notice something pleasant in their environment, such as a flower in bloom or a bird chirping. Bringing attention to the present moment and combining mindfulness with gratitude can help reduce anxiety and improve mood.
  • Expressing thanks: Encourage thank-you notes, drawings, or messages to teachers, friends, or relatives. Expressing appreciation and being thoughtful of others builds empathy and fosters deeper social connection.
  • Bedtime reflections: End the day by naming three good things that happened. This simple habit can improve sleep quality and increase optimism.

Modeling Gratitude: The Parent’s Role

Children learn gratitude best by observing adults around them. Consistently expressing appreciation and integrating these or similar practices into the daily routine helps make gratitude a family value.

Research-backed strategies include:

  • Verbalizing appreciation: Let children hear adults thank others and explain why their actions mattered to them.
  • Acknowledging effort: Thank children for their hard work, kindness, or cooperation, not just when positive outcomes have been attained.
  • Sharing personal gratitude: Reflect openly on moments from the day that inspire thankfulness.

These small acts show children that gratitude is an everyday mindset, not something reserved for special occasions or major achievements.

Tools to Record and Share Gratitude

Making gratitude tangible can help children and teens integrate it into their lives. A few examples of simple ways to record what we are grateful for include:

  • Gratitude journals: Writing down daily reflections has been linked to increased happiness and decreased depressive symptoms in youth.
  • Digital apps: Online apps like Grateful or Happyfeed can make it easy for teens to track positive moments throughout the day and reflect back on moments of gratitude over time.
  • Gratitude jars: Fill a jar with notes of things that went well, things you appreciate, or things you are looking forward to. Read them together as a family at the end of the week or month.
  • Photo projects: Encourage older kids (and help younger kids) to capture one photo a day of something they appreciate.
  • Family gratitude boards: Post sticky notes with moments of thanks for everyone to see.

Planting Seeds of Resilience for the Future

Much like strengthening a muscle, gratitude is a skill that grows stronger with practice. Creating opportunities to notice and name what is good and supportive builds happier, healthier children and nurtures resilient, thoughtful young adults who can find meaning and hope even in difficult times.

Gratitude does not mean ignoring life’s challenges. Rather, it is about recognizing the positive, fostering connection, and building the emotional strength to navigate whatever comes their way.

Integrating gratitude practices into daily life gives children a lifelong gift: the ability to find joy, connection, and resilience, no matter what the world may bring.

 

References:

Basit, A., Ali, R., Rahman, S., & Shah, A. A. (2024). Exploring how the practice of gratitude can strengthen interpersonal relationships, enhance mental well-being, foster emotional resilience, and promote greater social connectedness and cooperation. Review of Education, Administration & Law, 7(4), 427-441.

Bohlmeijer, E. T., Kraiss, J. T., Watkins, P., & Schotanus-Dijkstra, M. (2021). Promoting gratitude as a resource for sustainable mental health: Results of a 3-armed randomized controlled trial up to 6 months follow-up. Journal of happiness studies, 22(3), 1011-1032.

Klibert, J., Rochani, H., Samawi, H., Leleux-LaBarge, K., & Ryan, R. (2019). The impact of an integrated gratitude intervention on positive affect and coping resources. International Journal of Applied Positive Psychology, 3(1), 23-41.

Kurian, R. M., & Thomas, S. (2023). Gratitude as a path to human prosperity during adverse circumstances: a narrative review. British Journal of Guidance & Counselling, 51(5), 739-752.

Zainoodin, N. N., Hutasuhut, I. J., & Bakar, M. A. A. (2021). Gratitude and its relationship to resilience and academic performance among university students. Journal of Cognitive Sciences and Human Development. Vol, 7, 2.

 

About Dr. Madeline Manning

Dr. Madeline Manning is committed to providing comprehensive, collaborative evaluations that helpMadeline Manning, PhD Headshot families better understand their child’s unique neurocognitive, developmental, learning, and social-emotional profiles. She specializes in the assessment of toddlers, school-aged children, adolescents, and young adults. Her expertise involves working with youth exhibiting a diverse range of clinical presentations, including neurodevelopmental disorders, such as autism spectrum disorder, attention and executive functioning deficits, learning disabilities, developmental delays, intellectual disabilities, and associated emotional challenges. Dr. Manning is also trained in the assessment of children with medical complexities, recognizing how health conditions can impact a child’s development and functioning. She partners closely with families to develop practical, personalized recommendations that support each individual’s success and growth at home, in school, and within the community.

To book a neuropsychological evaluation at NESCA, complete NESCA’s online intake form. 

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

school student frustrated over the work

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

By | NESCA Notes 2025

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 be getting worse instead of better
  • Not appearing to “get it” even after review and repetition
  • Difficulty studying/holding information in memory
  • Dysfluent reading or not understanding 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 running 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, adolescents, and young adults 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 Coral Gables/Miami, Florida, 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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