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

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pediatric neuropsychologist

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

By | NESCA Notes 2024

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

About the Author

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

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

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

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

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

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

 

Sibling Stress: How to Support the Siblings of a Child with Emotional Needs

By | NESCA Notes 2024

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

A child with significant mental health or developmental needs impacts the whole family system. The impact is multifaceted – from the way that a child interacts in the home environment to the challenging logistics of coordinating outpatient care and appointments. Families have to make sacrifices with their time, attention, and financial resources to address the mental health needs of one (and sometimes more than one) child. Families may also arrange schedules, including planning vacations or social events, for the family in order to accommodate treatment. It can add more stress when parents stop to consider: how is this impacting the other kids in the family?

To buffer siblings against negative impacts from being in the home with someone struggling with mental health:

  • Create an environment of safety and predictability. Talk in a family meeting about basic safety needs for the household – things like being safe with your body, being safe with property, and maintaining basic travel safety (e.g., staying buckled in the car). It is important that all siblings hear the rules and the consequences for violating the rules. If there is an episode of dysregulation, it can be very helpful to return to this conversation again.
  • Create a plan for when there is dysregulation. Remind your child/children without mental health concerns that the job of the parent is to re-establish safety, and where your other child/children should go while you address a problem. This can be their bedroom, basement playroom, or other identified place in the home. Take a moment to identify Plan B for where the safe place is if the dysregulation is happening in a common space. Talk to your child about what activities may distract and distance them from the commotion.
  • Remind your child what adults are available for them. If you are in a two-parent household, one parent can address dysregulation, and the other can stay with the sibling(s). If you are in a one-parent household (or a partner is not home), remind your child that they can call the other parent, aunt, uncle, grandparent, or identified friend or neighbor if they need some reassurance.
  • Put on your “oxygen mask” first. After an incident of dysregulation, check in with yourself as a parent to regulate emotionally before approaching your other child/children. Take a few moments for deep breaths or progressive muscle relaxation to calm your own nervous system. Once you are re-regulated, your message that safety has been re-established will be more soothing and believable.
  • Set aside time in each day to connect with each child. The focus can often be on positive connection with the child struggling. But, all children need the positive connection, praise, and child-driven interactions. This can help ensure that all children receive the attention they need to thrive.
  • Hold the frame. It can be easy to relax the rules with a sibling whose struggles and behavior may seem mild by comparison. It’s important to establish standards that work for each child’s unique skills and needs. It’s worth a candid conversation with each child about what the expectations are and why.
  • Use the village. Establishing a support system is critical to buffer the entire family from the overwhelming stress that can accompany emotional health issues. Enlist the support of other family members, neighbors, teammates’ families, or school personnel. If you feel that your support system is small, start with your child’s pediatrician or school to connect to community resources.
  • Reach out for help. It’s important to closely monitor siblings for signs of increased anxiety, stress response, low mood, or atypical behaviors. If you see classic signs of anxiety (fight/flight/freeze), reach out to your child’s school or pediatrician to evaluate symptoms and initiate treatment.

Additional resources to support siblings:

 

About the Author

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

 

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

 

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

Why Do So Many Girls Get Diagnosed with ASD Later in Life?

By | NESCA Notes 2024

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

In the 15 years that I have been doing neuropsychological evaluations, I have made countless diagnoses of Autism Spectrum Disorder (ASD) in females who are already in high school or even in college. Many times, the diagnosis comes as a surprise to the girls and the families alike, because no one has ever suggested it previously and/or their perceptions are colored by the stereotypes created in the media about autistic individuals. However, a discussion about what ASD is and how it manifests in females as opposed to males usually helps my clients and their families understand the nuanced and comprehensive nature of the ASD diagnosis. They often pivot to feelings of relief and gratitude for having a label for what they have been struggling with for a long time. Many of my clients learn to embrace this new diagnosis and use it as a framework for celebrating their strengths and looking for supports to address their vulnerabilities. They often say, “It totally makes sense!”

Autism Spectrum Disorder is a developmental disorder that manifests in challenges with social communication and interaction, and in the presence of repetitive, restricted behaviors that significantly impact functioning. When autism was first introduced by Dr. Leo Kanner in 1943, he described children (boys) who showed little interest in other people, insisted on routines, and displayed unusual body movements, like rocking back-and-forth and flapping their hands. Many of the children could talk but they rarely used their speech to communicate with others, and they had a variety of pervasive learning difficulties. For the most part, this continues to be the image that is conjured when people mention autism. However, with advances in research, especially within the last few decades, we have come to recognize the various manifestations of autism in children and adolescents who are higher functioning, have better communication skills, and have fewer learning issues. Thus, the newer conceptualization of autism as a spectrum with a wide range of capabilities and communication skills. More recently, researchers have also discovered that the presentation of autism varies in boys versus girls. This has made the diagnosis of ASD in girls difficult.

In their book Girls Growing Up on the Autism Spectrum, ASD researchers Shana Nichols, Ph.D., Gina Moravcik, MA, CCC-SLP, and Samara Pulver Tetenbaum, MA, outlined some preliminary findings of differences between males and females on the spectrum. They reported that:

  • The play of boys with ASDs is more restricted in range and more repetitive when compared to girls with ASDs who have stronger pretend-play skills.
  • Girls have stronger communication skills.
  • Sex-related social difficulties emerge over time – boys have more impairments early on (thus leading to earlier diagnoses), whereas for girls, the difficulties appear more in early adolescence.
  • Boys are more easily distracted when compared to girls.
  • Girls with mild difficulties may not be included in research samples.

They added that these differences could impact the assessment and diagnosis of ASD. They wondered if girls with ASD are being missed or overlooked during an evaluation because their presentation does not fit how professionals currently characterize ASD based on a male prototype. Other researchers have suggested that girls with ASD may be better able to compensate for symptoms despite having persistent core deficits associated with ASD, which might contribute to greater social “camouflage” or what is called “masking” (an individual hides or suppresses symptoms, behaviors, or difficulties). Indeed, as I have been learning more and working with girls diagnosed with ASD, I have been keeping in mind these potential sex differences. For example, I often compare my client’s social and communicative abilities to what is considered normative for girls their age and cognitive ability. I have been avoiding comparing my female clients with what has been the prototypical profile of autism in males. I also think about other manifestations of repetitive behaviors and interests in girls with ASD that are more socially acceptable, for example, an obsession on reading or running as opposed to preferred topics of males on the spectrum (e.g., trains, schedules, calendars, etc.).

Researchers have speculated that these differences in the manifestation of ASD in girls versus boys stem from how girls are socialized at an early age to pay attention to social cues/actions as opposed to boys. There is also research that suggests that girls are more able to follow social actions by delayed imitation. They observe and copy other children more effectively than do boys. This could lead to the phenomenon of masking and to milder presentations when compared to boys.

Sources:

Evans, S., et. al. (2019). Sex/gender differences in screening for autism spectrum disorder: Implications for evidence-based assessment. Journal of Clinical Child Adolescent Psychology, 48 (6), 840-854.

Nichols, S., Moravcik, G. & Tetenbaum, S. P. (2009). Girls growing up on the autism spectrum. London: Jessica Kingsley Publishers.

Ozonoff, S., Dawson, G. & McPartland, J. (2002). A parent’s guide to asperger syndrome and high functioning autism. New York: Guilford Press.

 

About the Author

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

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

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

 

Falling through the Cracks

By | Nesca Notes 2023

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

“You’re going to have a tough conversation on your hands,” I said. The parent sighed and nodded in response. “That’s what her ABA provider said, too,” she responded.

This conversation would not be difficult because her child was acting out, engaging in challenging behaviors, or taking up a great deal of adult time. In fact, she was exactly the opposite. Quiet, calm, gentle, and well-regulated were some of the words I used during our feedback session. And this, we discussed, is a huge part of the problem.

Despite their best efforts, teachers simply cannot be with every child that needs help, each time they need help. School providers do not have infinite caseloads, time, or capacity. There are real-world limitations to providing support and services for children at school. And yet, the children who suffer from these very real constraints are so often the quietest and least disruptive. This is extremely unfortunate when the child has real, diagnosed, observable deficits that absolutely require special attention and intervention at school.

Our brains often develop schema in order to reduce the brain’s workload (these occur entirely outside of our conscious awareness). Many social psychology studies have characterized the harm that schema can do. One such harm often comes to children for whom teachers have either strong positive or strong negative schema about. The effects of negative schema are likely obvious, but the positive schema can be just as challenging to manage. When teachers view a child very positively, they may be more likely to “write off” concerns (e.g., “she was just tired today,” “he really does know, he’s just having a bad day”), over-emphasize the child’s effort and diligence (rather than their actual skill level or mastery), and focus on positive attributes of the child in place of focusing on their weaknesses.

It can be challenging for parents to hear such positive feedback, particularly when it does not correlate with their perception of the child’s difficulties. Although neuropsychology attempts to be a strength-based field as much as possible, fully exploring and adequately characterizing deficits is often an invaluable part of what we do. This can help us to bring objective, data-driven recommendations to school teams for all students, hopefully preventing those quiet, hard-working youngsters from “falling through the cracks.”

 

About the Author

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

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

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

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

 

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

 

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

 

Going South: NESCA Announces New Hingham, MA Location

By | Nesca Notes 2023

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to announce that it is opening a Hingham location to serve clients on the South Shore of Massachusetts. NESCA is currently booking appointments now for Neuropsychological and Psychological Evaluation Services commencing on November 1, 2023. Learn more about what is being offered by our Hingham-based staff from my interview with Hingham Director; Pediatric Neuropsychologist Moira Creedon, Ph.D.

What prompted NESCA’s expansion to the South Shore or Massachusetts, and how can clients benefit from our Hingham location’s services?
NESCA is expanding our in-person services to Hingham on the South Shore to widen the breadth of neuropsychological and educational evaluation and consulting services offered within the state. We know that families have options as they partner with neuropsychologists, and we want to be in close proximity to communities we hope to serve. This is an exciting opportunity to support students in elementary, middle, and high school as well as young adults, as they navigate the complexities of their daily lives. It is our priority to continue providing detailed, client-centered, thorough evaluations that highlight a client’s areas of strength and vulnerability. I am also excited to strengthen relationships with local care providers and schools, and to build new relationships as a new clinician within the South Shore community.

What services do you offer?
At this time, NESCA’s South Shore-based practice will offer Neuropsychological Evaluations and Projective Assessments. The goal of these services is to build a complete picture of a client’s functioning, including their intellectual, academic, and social-emotional profile. Team members are also available to participate in team meetings at school (IEP meetings), conduct school observations, and offer consultation to parents and team members. Sometimes, a child has already participated in evaluations in other settings (schools, hospitals), and a family needs help to review these documents and make meaning of the findings.

What types of clients will NESCA serve in its South Shore location?
NESCA’s South Shore-based practice is similar to our other locations and will serve children, teens, and young adults with a range of presenting issues. The focus is in working with students in elementary, middle, and high school as well as young adults. I can see clients with diagnostic questions, including Autism Spectrum Disorder (ASD), Learning Disorders (e.g., dyslexia, dysgraphia), Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety, depression, and complex psychiatric diagnoses.

A specialty we have at NESCA – including in Hingham – is working with clients who have multiple diagnoses or who don’t fit neatly into a singular diagnostic box. I also see clients who are high functioning and curious about their learning style, how to improve their study skills, and how to plan for their academic future based on their unique profile.

Where are you on the South Shore? Are services in-person or remote?
We are practicing in person in an office at 99 Derby Street, Suite 200, in Hingham, MA. Hingham is uniquely positioned to serve the South Shore/Southcoast, and the Cape and Islands. For those traveling for appointments, most clients schedule testing in two longer (2.5 hour) blocks of time so the commute is reduced for families. I am also available to participate in IEP team meetings and conduct student observations in person on the South Shore, which is an exciting way to collaborate and build strong relationships with families, schools, and organizations.

What is different about what NESCA offers on the South Shore compared to other organizations or services available locally?
NESCA is highly respected in the community for providing detailed, comprehensive evaluations of students that speak to their strengths as well as their needs. Compared to some practices, your child or teen will be assessed directly by a neuropsychologist rather than a technician. You can depend on your neuropsychologist to bring their own expertise as well as the “village” of NESCA, as I am always collaborating with NESCA’s team of innovative neuropsychologists, transition specialists, educational consultants, speech and language pathologists, occupational therapists, and therapists. We work routinely with special education attorneys, advocates, therapists, and school personnel in collaborative relationships to support children and teens. At NESCA, we live our core values everyday: being creative problem solvers, being collaborative and building lasting relationships, and caring deeply for students, their families, and the community.

Does insurance cover your services in Hingham?
Several NESCA providers take both Blue Cross Blue Shield and private pay for services. I am paneled with BCBS. Some families are able to obtain some coverage or reimbursement through other insurance agencies, and we can provide those families with brief billing information to submit to their insurance company. We can never guarantee insurance reimbursement, so it is important that families check with their insurance plan regarding covered services.

What if I am unsure if I should refer my child or client for an evaluation?
Give us a call! Our administrative team is happy to support you in navigating this process. We are also planning some community events to provide information to our community about a variety of topics, including who we are and how to recognize signs that a child or teen may need additional support. There is also a ton of information on our website.

How do people get more information about NESCA’s South Shore services?
You can fill out our online intake form, call 617-658-9800 to speak with an intake coordinator, or reach Hingham-based Pediatric Neuropsychologist Dr. Moira Creedon directly at mcreedon@nesca-newton.com.

 

About the Author

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

 

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

 

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

Shouldn’t We All Get Neuropsychological Evaluations, Then?

By | Nesca Notes 2023

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

One frequent question I have been asked by parents following a neuropsychological evaluation is, “Wouldn’t this process be helpful for everyone?” This tends to come up around the issue of disclosing results of an evaluation to children and teenagers and helping them better understand “how their brain works.” Many families with whom I have had the privilege of working come back months or years later with siblings of an initial client, noting that the process was so valuable the first time, they are hoping for a similar experience for their other child or children.

So, should we all get neuropsychological evaluations? Largely, I think this question is motivated by parents who are eager to help their children understand their own strengths and weaknesses. This is a wonderful goal, as self-understanding is one of the most valuable and lifelong gifts we can give our children.

In my experience, many people come to this kind of self-understanding naturally, over time, through experiences in adolescence and young adulthood. In particular, experiences that involve more independence in living and learning promote this kind of understanding. During childhood, we may learn our relative skill among family members (“I’m good at soccer, and my sibling is good at piano”), but these relative differences may not hold once we leave our family of origin. Many people venture out into the world and find that, compared to their peers, they are actually quite skilled at getting groups of friends together, doing everyday math, putting their thoughts down in writing, or staying organized. These real-world strengths often reflect the strengths that could be found through formal evaluation. As we gain self-understanding, we may be prompted to enter certain professions, take on particular hobbies, or pursue friends and partners with specific traits.

A neuropsychological evaluation can “speed up” the process of self-understanding, giving some young people a head start on the identity formation process that naturally occurs during adolescence. For some, this head start is vital – their brains are structured in ways that present clear, observable differences between them and their peers. This may be the case with diagnoses like autism spectrum disorder, a learning disability, or ADHD. For these individuals, the feedback from a neuropsychological evaluation can (under the best of circumstances) stave off feelings of inadequacy, negative self-esteem, and shame, helping a young person to recognize the deeply important strengths that are present alongside their more observable challenges. In these cases, a neuropsychological evaluation is not only for self-understanding, but also for self-compassion. Our goal as neuropsychologists in these cases is not just to help the child or teen understand themselves, but also to be gentle and kind with how they view their difficulties. Our hope is that, when these individuals venture out of their families and into the broader world, they are able to show resiliency in the face of the obstacles that will almost certainly be present.

 

About the Author

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

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

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

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

 

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

 

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

 

Signs and Symptoms of Common Eating Disorders

By | Nesca Notes 2023

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

In today’s world with the toxicity and normalization of diet culture, it can be difficult to identify possible signs and symptoms of a more serious problem such as an eating disorder. At what point does counting calories cross over into anorexia? When does binge eating meet criteria for bulimia? Listed below are the criteria for several eating disorders, possible warning signs, as well as information on how to seek help if you believe your child needs further help/treatment.

Anorexia nervosa is an eating disorder characterized by the restriction of food intake and is characterized by two subtypes: restrictive and binge-purging.

For both presentations, criteria for anorexia nervosa include:

  1. Restriction of food intake leading to a significantly low body weight for age, sex, and developmental trajectory
  2. Intense fear of gaining weight that interferes with one’s ability to gain weight
  3. Feeling disturbed by one’s weight or shape, reduced self-worth second to weight/body shape, or a lack of recognition of the seriousness of their low bodyweight

Criteria for the restricting type include not having recurrent binge eating or purging within the last 3 months

Criteria for the binge eating/purging type include recurrent episodes of binge eating or purging within the last 3 months

Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating that include the following:

  1. Eating a “definitively” larger amount of food in a 2-hour period than what most other individuals would eat in similar circumstances
  2. Feeling as though one cannot stop eating or control how much they are eating
  3. Recurrent and inappropriate behaviors aimed at preventing weight gain (e.g., self-induced vomiting, misusing laxatives, fasting, excessive exercise) that occur, on average, at least once a week for 3 months
  4. Self-evaluation being dependent on body shape/weight
  5. Symptoms not occurring exclusively during episodes of anorexia nervosa

Bulimia nervosa is also characterized by two subtypes: purging type and nonpurging type.

To meet criteria for the purging type, one must have regularly engaged in self-induced vomiting, the misuse of laxatives, diuretics, or enemas.

To meet criteria for the nonpurging type, one must have used inappropriate behaviors, such as fasting or excessive exercise without self-induced vomiting, the misuse of laxatives, diuretics, or enemas.

Binge eating disorder and avoidant restrictive food intake disorder (ARFID) are also eating disorders recognized in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5).

Binge eating disorder is characterized by:

  1. Recurrent episodes of binge eating (defined by eating an amount of food in a 2-hour period larger than what most people would eat in a similar period of time under similar circumstances as well as feeling a lack of control during the binge eating episode)
  2. Three or more of the following: eating more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone due to embarrassment over the amount of food being consumed, feeling disgusted, depressed, or guilty after overeating.
  3. Distress regarding binge eating
  4. Binge eating occurring on average at least 1 day a week for 3 months
  5. Binge eating not associated with the regular use of inappropriate compensatory behaviors, such as purging, fasting, and/or excessive exercise, and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa

Avoidant restrictive food intake disorder (ARFID) is characterized by:

  1. A lack of interest in eating or food, avoidance of food based on sensory characteristics, and/or concern about consequences of eating that lead to one or more of the following:
    1. Significant weight loss or failure to achieve expected weight gain
    2. Dependence on enteral feeding or oral nutritional supplements
    3. Interference with psychosocial functioning
  2. The eating challenges should not be attributable to a medical condition or better explained by another mental health diagnosis. If there is another mental health diagnosis, the severity of the eating disturbance must exceed what is routinely associated with the mental health condition
  3. The eating challenges should not be better explained by a lack of available food or associated with cultural practices
  4. The eating challenges should not occur exclusively during the course of anorexia nervosa or bulimia nervosa

What are warning signs of an eating disorder that I should be looking out for?

  • A preoccupation with weight loss, dieting, exercise, and/or controlling food consumption
  • Refusing to eat certain foods, such as carbohydrates or fats
  • Not being comfortable eating around others, skipping meals, or eating smaller portions
  • Withdrawing from friend groups and/or typical activities
  • Noticeable fluctuations in weight
  • Stomach complaints/digestive concerns
  • Menstrual irregularities
  • Difficulties concentrating
  • Sleep challenges
  • An increase in dental problems

If you suspect your child has an eating disorder, begin by talking to a medical or mental health professional. You can also contact the National Eating Disorders Association (NEDA) Helpline at 1-800-931-2237 or by texting NEDA to 741-741. The Multi-Service Eating Disorders Association (MEDA) is another source of information with support groups and resources. More information can be found at https://www.medainc.org/.

 

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Warning signs and symptoms. National Eating Disorders Association. (2021, July 14) https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

 

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.​

 

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

 

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

 

How Can a Neuropsychological Evaluation Help?

By | Nesca Notes 2023

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

Recently I met with a family seeking a neuropsychological evaluation for their daughter. After talking about their reasons for pursuing testing, the parents asked me, “So…do you think this will help? Is this type of testing what our child needs?” It’s an important question and one I’m sure many families wonder about but don’t always ask. A comprehensive neuropsychological evaluation can be of tremendous value, but the process requires time and energy as well as a financial investment, so it makes sense to consider this question carefully.

Though it may be surprising to hear this coming from a neuropsychologist, the answer to the question of whether to have a child evaluated is not always clear-cut. For instance, parents sometimes wonder if there is practical benefit to seeking testing when a child or adolescent already has a diagnosis but there are questions about its accuracy. Consider the following scenario as an example. A child with issues regulating attention and with weaknesses in social skills has a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Her therapist has raised the question of whether a diagnosis of Autism Spectrum Disorder (ASD) might better explain the issues the child is facing. Inattention can be present in both ADHD and ASD, and both conditions can result in social difficulties. Especially if a child is already receiving appropriate services, does the diagnostic label matter, and is it worth pursuing formal assessment?

There are valid arguments to be made in favor of seeking an evaluation in this type of situation and valid arguments to support choosing not to invest in an assessment.  In such a scenario, I would encourage a family to consider the following questions:

  • Will diagnostic clarification address unanswered questions that previous diagnoses have not fully addressed?

Sometimes an established diagnosis partially explains a child’s issues but there are lingering questions about other aspects of a child’s presentation. If a different or additional diagnosis could fill in the gaps, it may be worth assessing.

  • Could testing help identify your child’s unique pattern of strengths and weaknesses?

Especially when an existing diagnosis has been made without testing (for instance by a therapist or physician), there may be important aspects of a child’s neuropsychological profile that have not yet been identified. For instance, individuals with Autism Spectrum Disorder share certain key features, but they also differ in significant ways. A diagnosis alone cannot capture the nuances of an individual child’s strengths and weaknesses, while a full neuropsychological evaluation can more fully describe a child on an individual level.

  • Will understanding the root of the problem help guide recommendations?

NESCA’s clinic director compares a child’s observable difficulties to the “tip of an iceberg.” There are inevitably hidden underlying factors, and discerning these can be important in determining how to address the issues that are visible on the surface. For example, problems with social interactions can arise from deficits in social communication (e.g., difficulty interpreting facial expressions), as seen in Autism. Alternatively, a child with ADHD may encounter social challenges because they have trouble paying attention to relevant social cues or because impulsivity leads them to behave inappropriately. Someone with social phobia may have few relationships because their anxiety drives them to avoid social interactions. Effective intervention in each of these cases requires a nuanced approach that targets not just the surface issue but the factors underlying it.

  • Will establishing a particular diagnosis open up opportunities for additional support and resources that may be important?

In some cases, there are specific resources that are available to individuals with particular diagnoses. For instance, in Massachusetts, individuals with a diagnosis of Autism Spectrum Disorder or Intellectual Disability may be eligible to receive services through the Department of Developmental Services. If qualifying for such services could be beneficial, diagnostic clarification may be important.

More broadly, the internet and social media have allowed people with shared diagnoses to connect in new ways. The opportunity to connect with others experiencing similar difficulties can be invaluable, and online communities can provide a sense of support, educational information, and practical resources for children and parents alike.

The answers to these questions and to the bigger question of whether to seek neuropsychological evaluation will be different for different families. There are many factors to weigh in making the decision to seek testing. If you are considering an assessment for your child and need additional information to make an informed decision, answers to frequently asked questions about neuropsychological evaluation can be found on NESCA’s website.

 

About the Author

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

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

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

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

 

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

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

What Is Projective Testing and Why Might My Child Need It?

By | NESCA Notes 2022

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

There can be a great deal of confusion about what kind of testing you want for your child. No wonder when we have so many options – neuropsychological testing, psychoeducational testing, speech and language testing, occupational therapy testing, personality testing, and psychological testing. The part that can be incredibly challenging is that these labels often involve overlapping test measures, meaning that the assessor may choose the same specific tasks that might fall into most or all of these categories. Take cognitive assessment using IQ tests which can be used by a psychologist conducting psychological, neuropsychological, or psychoeducational testing. Another layer of confusion is added for parents when one considers that many professionals in schools or medical practices are also confused and interchangeably use these labels. In an effort to demystify the process, I want to tackle a common question: what is projective testing and why might my child need it?

Projective testing provides psychologists with very specific and unique insight about a person’s thinking habits and processing. Unlike cognitive or academic tests, projective tests do not have a “right answer.” So, projective testing is not going to ask a child to solve a math problem or define a word. It is not going to test how quickly they can name vegetables or see how skilled they are at shifting between sets of the rules. The overall goal of projective testing is to figure out how a child, teen, or adult responds to an ambiguous situation. This means, we ask people to project their brain habits (thinking style, way of interpreting the world, way of processing emotions, way of viewing self and others) onto a situation when it is not clear that there is a “right” or “wrong” answer. A person must use their problem-solving and emotion regulation skills in action. Examples of projective tests include the Rorschach inkblot test, story-telling tasks (e.g., the Thematic Apperception Test or the Roberts Apperception Test), drawings, and incomplete sentences. Projective tests take additional time to administer and usually longer to score, so they are scheduled as separate visits at NESCA.

Why might you use a projective test? There are some situations where projective testing is incredibly useful, such as when a diagnosis of a thought disorder (e.g., psychosis) is in question. It is also very useful for questions of trauma, attachment, anxiety, or mood disorder. Projective testing is also incredibly useful when psychiatric symptoms are confusing. Take the example of someone who is a perfectionistic or very guarded about their symptoms. A person with this profile is very likely to read a question that says, “I am very anxious,” and answer no. However, projective testing can see if there are themes of anxiety by considering how a person responds to an ambiguous situation. Take another example of someone who leans in the other direction and reports many symptoms that overlap with many diagnoses. In this case, many symptoms are endorsed as “yes.” Projective testing can help to provide clarity to narrow down the list, especially without an obvious answer. In both of these cases, it is helpful to access a person’s unconscious brain habits as a key to understanding a person’s functioning.

When would you not use projective testing? I do not use projective testing when my referral question does not need it. For example, a question of a learning disability or ADHD does not require projective testing. Using projective measures would be inappropriate, time consuming, and potentially stressful for a person when it is not needed. Similarly, projective testing is not often used in individuals with Autism Spectrum Disorder as there is little research about how neurodivergent populations respond to the ambiguous stimuli. I also do not use projective testing if neuropsychological testing suggests that a person has an intellectual disability or struggles in their visual processing skills (e.g., NVLD) since many of the projective measures (e.g., Rorschach, story-telling, drawings) use a visual stimulus card. In those cases, it would be inappropriate to assume that a response reflects a person’s emotional processing when it would really be about their visual processing.

Projective testing is incredibly informative and, like other neuropsychological tools, should only be utilized by professionals who are trained to administer and interpret these tests. Since it is not as simple as a correct single answer on an answer key, it is critical that these procedures are administered by psychologists with the advanced training to use and interpret the information. And, like all of our measures, the results gathered using projective measures are data points that are combined with other data points. The performance on one test or demand does not dictate the entire conclusion. A strong and comprehensive assessment will use projective test data as part of a larger understanding of your child. Information gathered in projective testing can highlight important strengths for your child and contribute helpful information to drive treatment.

NESCA has several clinicians who are highly trained and skilled at administering projective testing. If you have questions about projective testing and whether your child needs it, let us know by filling out our online Intake Form.

 

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.

How Do I Know If My Child Needs Early Intervention?

By | NESCA Notes 2022

By Miranda Milana, Psy.D.
Pediatric Neuropsychologist

During the first few years of life, parents and caregivers are often tracking baby’s exciting first milestones, such as their first steps or first words. Routine well-child visits at the pediatrician’s office will often include the doctor asking what new skills you have noticed since baby’s last visit—Are they sitting unsupported yet? Crawling? Saying Mama or Dada? It can be stressful when your child is not yet meeting their milestones. It can be especially challenging when you notice they may be behind their peers at childcare or when around same-aged children at family functions.

The Centers for Disease Control and Prevention is a great resource to utilize as reference for what is expected of children by age. You can access more information here: https://www.cdc.gov/ncbddd/actearly/milestones/index.html or through their developmental milestone checklist.

What are age-appropriate milestones?

At a glance, several notable milestones listed by the CDC are as follows:

6 months:

  • Recognize familiar caregivers
  • Reach for toys/objects of interest
  • Roll from their belly to their back

9 months:

  • Respond when you call their name
  • Smile/laugh in response to interactive games, such as peek-a-boo
  • Babble (mama or dada)
  • Bang objects together
  • Sit on their on

1 year:

  • Call their parent by name (e.g., mama or dada)
  • Pull themselves up to stand
  • Walk while holding on to furniture

18 months:

  • Point to show you something interesting
  • Following one-step directions
  • Imitating your actions (e.g., putting on makeup, vacuuming, hammering)
  • Walking unassisted
  • Climbing on and off couches and chairs without support

2 years:

  • Look to you for your reactions in new situations
  • Putting two words together, such as “more milk”
  • Using gestures like nodding/shaking their head
  • Running
  • Eating with a spoon

Should you have any concerns regarding your child’s development, talk to their pediatrician! Your baby may qualify for a referral to Early Intervention (EI), which can help them to gain the appropriate skills in a way that supports you, your child, and your family.

What is EI?

EI is a federal grant program that was established in order to identify children at risk for developmental delays and to help families meet their children’s needs and maximize their potential. EI serves children ages 0-3 and provides a multitude of services depending on a child’s needs. Referrals for EI can be made by caregivers and/or providers for children who are exhibiting delays in their developmental milestones OR for children who have a medical condition that places them at risk for a developmental delay. EI referrals can be made as early as birth for medical conditions, such as prematurity, low birth weight, and Down syndrome. Many children receive referrals for EI from their parents, pediatricians, and/or childcare providers when there are observable delays in meeting speech milestones, motor milestones, speech milestones, and/or social milestones.

Who qualifies for EI?

Once referred to EI, your child will likely undergo a developmental evaluation. They will qualify for services if they have a diagnosed medical condition with a risk for developmental delays OR a delay in one or more areas of development of at least 30% OR a delay in one or more areas at least 1.5 standard deviations below the norm OR there is a questionable quality of skills based on the informed clinical opinion of the multidisciplinary team. Children can also meet criteria if there is a risk for delays due to four or more child or family risk factors (e.g., NICU stay, feeding challenges, chronic illness of a caregiver, lack of social supports for the caregiver).

At the end of the day, you know your child best. If you have concerns, reach out to their pediatrician. You can also reach out to a local EI provider on your own. In MA: https://www.mass.gov/info-details/ei-program-contact-information. In NH: https://www.dhhs.nh.gov/family-centered-early-supports-services.

 

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.