Tag

pediatric neuropsychology

When the Homeymoon Period Is Over: Signs of School Refusal

By | NESCA Notes 2021

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

As we reach the end of our second 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.”

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 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.

Meet NESCA Pediatric Neuropsychologist Miranda Milana, Psy.D.

By | NESCA Notes 2021

By: Jane Hauser
Director of Marketing & Outreach

This September, NESCA welcomed a new neuropsychologist to its team. Learn more about Pediatric Neuropsychologist Miranda Milana, Psy.D., in my interview with her below.

Where did your interest in neuropsychology come from?

I knew from an early age that I wanted to work with children. I initially thought I would work with children in the medical field, but I ended up being fascinated by child psychology, which led to my focus on the clinical aspect of therapy with kids and families.

I then started to notice the importance of neuropsychological reports in schools, treatment planning, formulating diagnoses and determining the tools needed to help kids be successful. I knew I wanted to do that! I saw my fair share of unhelpful reports and wanted to take the opportunity to write truly beneficial ones.

What is your focus area in working with kids?

I really enjoy working with all kids, but have a particular intertest in early elementary-aged kids – toddlers through early elementary schoolers. I love to get to know kids whose parents, caregivers or educators are questioning whether they may have an autism spectrum disorder (ASD) or some kind of learning challenge. It’s exciting to start to work with a child as they are entering school and continue to watch them progress throughout their education.

Tell me about your clinical experience prior to joining NESCA.

Before coming to NESCA, I was a post-doctoral fellow at Boston Children’s Hospital, which provided me with great exposure to a wide variety of kids and the challenges they were experiencing. My case load there exposed me to a vast range of educational and developmental concerns and presentations. Working with children aged 2 through 17 who showed a wide-ranging array of presentations really helped me to become a flexible thinker.

It was a great opportunity to work with all types of clinicians, families and children. Also, having such a diverse case load afforded me the opportunity to become part of so many teams within the hospital, including the Down Syndrome, Adoption and Teenager teams, among others. It was rewarding to be able to learn from each one of them.

What drew you to NESCA?

I wanted to continue to work in a collaborative environment, where it wasn’t just me contributing to a child’s evaluation and plan. I really wanted to learn and collaborate with a team of psychologists and other providers in a group practice, outside of the hospital setting. Being part of a child’s trajectory in school is exciting, and NESCA allows me to do just that!

What are some of the more rewarding experiences you’ve had as a pediatric neuropsychologist?

Getting kids who are closed off to share their experiences with me is very rewarding. With these kids, we have to be creative in how we approach them, get them to share and play. Having anxious, resistant children feel comfortable opening up to me in conversation or who allow themselves to be vulnerable by sharing personal information, is such a rewarding part of what I do. To know you have built that kind of trust with a child is so fulfilling.

What’s your secret sauce in building that trust with a child who is anxious or resistant?

I am kind of a kid at heart, so I use that in testing children to engage them and create a more fun environment. I take pride in getting to know a child beyond the test scores and collected data. Finding common ground and relating to them is so important. I also like to make sure they know I am part of their team that will support them as they move forward in school and in life. It’s a personal challenge to me to get the most resistant kids to engage and maybe even crack a smile during the evaluation!

 

About Miranda Milana, Psy.D.

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 evaluation with Pediatric Neuropsychologist Dr. Milana or one of our many other expert neuropsychologists or therapists, complete NESCA’s online intake form

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

Vocational Assessment and Transition Planning

By | NESCA Notes 2021

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

Transition planning is a complex process centered around helping students, typically who receive special education services, to set goals for their postsecondary adult lives and to engage in learning, services, and experiences that will help them to ultimately reach those goals. Assessment is a critical aspect of this process, both as a means for collecting baseline information about the student and measuring progress throughout the planning process. While transition planning focuses on outcomes in several key areas (e.g., further education and training, employment, independent living, community engagement, adult service involvement), many families who seek transition assessment and planning help are specifically concerned about employment. What can my child do? What career path is best for my daughter? Will my son be able to support himself? For these families, vocational assessment is a critical piece of the transition planning process. Yet, many families do not have a good understanding of what a vocational evaluation includes and the types of results and recommendations that can come from such evaluation.

Vocational assessment has a relatively simple definition. It is the process of gathering information about a student’s interests, abilities, and aptitudes as they relate to the student’s work potential.[i] However, there is not one universal test or process used to collect this information. In fact, any of the following types of tests might be part of vocational assessment:

  • Record review
  • Informal interview with the student
  • Informal interview with parents, teachers, or other professionals who know the student well
  • Observation of student in current familiar environments
  • Interest inventories (informal or formal)
  • Learning style inventories
  • Self-reported skill, ability and achievement inventories
  • Work preference and motivation assessments
  • Work-related behavior inventories
  • Employability/Life skills assessment
  • Formal aptitude assessment
  • Situational assessment of a student in a controlled work environment
  • Work samples
  • Functional assessment of simulated or real job tasks

Importantly, most students do not need to participate in all of the above types of assessments. In fact, a lot of the best information comes from the first few informal steps of the process, record review (which often includes rich data about a student’s cognitive skills, sensory and motor skills, perceptual skills, and learning style) and interviews with the student and adults familiar with the student. Ultimately, the purpose of vocational assessment is to develop a profile of the student’s interests, skills, and aptitudes and formulate measurable short- and long-term career goals. However, it is important to remember that participation in vocational assessment typically does not, and should not, result in identification of one specific career to pursue. That’s not how any of the tests, or the overall process, is designed. Instead, results of vocational assessment will suggest a variety of careers or career families that a student may be interested in exploring more in depth. It is an important starting point of career exploration, especially for students who are unsure about their career goals. Results can also be helpful for identifying where there is alignment in a student’s aptitudes and interests or where more exposure and instruction may be needed to support a student’s career development. The information that comes out of vocational assessment is an invaluable part of comprehensive transition assessment and planning for students with and without disabilities.

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

Also, stay tuned for more blogs about vocational assessment this fall as my colleague Tabitha Monahan and I will be specifically breaking down some of the above types of testing in greater detail.

[i] Instructional Materials Laboratory. (1998).  Vocational assessment for students with special needs. Columbia, MO: Author.

 

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

 

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

When Gaming Is No Longer A Game

By | NESCA Notes 2021

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist and Therapist

Many parents are wrestling with how much time their children are engaging with screens, and finding themselves wondering how much is too much. Children who experience difficulty related to symptoms of ADHD are especially drawn to the stimulation of screens. And children with ADHD tend to require frequent and immediate rewards, making them especially drawn to screen-time activities. While a specific cause for ADHD has not been identified, there is some consensus that a shortage of dopamine could be to blame. Dopamine not only plays a role in how we feel pleasure, it is also significant in the uniquely human ability to think and plan.

Part of the allure of gaming – and social media – is that each new level reached and each new “like,” instantly releases a small dose of dopamine directly into the brain’s reward center. If you have ever had to fight with your child to get off technology, this is likely why. A deficit in dopamine is easily fed by screen-time activities, leading children to want more. This has led to a demand for content, resulting in tens of millions of dollars having been made by YouTubers whose entire platform is gaming, and children love watching them. They are entertaining, and kids learn tips for improving their own gaming.

Children worship gaming YouTubers, and many strive to be one someday. It is challenging for parents to keep up with the content their children are accessing largely because YouTube has created an algorithm in the system that suggests what to watch next based on frequent views or recent searches. YouTube’s recommendation system is specifically engineered to maximize watch time and often “up next” videos play automatically. In fact, this feature is responsible for more than 70 percent of all time spent on the site, indicating that children, and others, are consistently and reliably exploring recommended “up next” content. It is important for parents to do their research and know who their children are watching and following on YouTube, as they may be drawn into content that could be highly influential and contrary to family values. While many YouTubers are harmless, there are those who include brief, perhaps undetectable messages (e.g., PewDiePie) that influence what shows up next. Children are curious, and YouTube’s goal is to keep them engaged, which can turn into the perfect storm.

YouTube consists of a business model that rewards provocative videos with large sums of money. They strive to attract viewers by leading them down paths meant to keep people engaged. While much of the content may seem innocuous, there are reasons to be cautious as things aren’t always as innocent as they seem. Provocative content creates intrigue. It piques interest and may be especially attractive to older children and adolescents. As individuals strive to create the next viral video, putting forth extreme beliefs and violent content may be their pathway to becoming a celebrity. For these reasons, and as technology becomes increasingly embedded in children’s lives, it is important for parents to do their research and stay informed.

Some helpful resources include:

https://www.pewresearch.org/internet/2020/07/28/parenting-children-in-the-age-of-screens/

https://chadd.org/wp-content/uploads/2018/06/ATTN_06_15_TooMuchScreenTime.pdf

https://childmind.org/article/healthy-limits-on-video-games/

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete 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.

 

The Path Back to Fitness

By | NESCA Notes 2021

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

One of the well-known impacts of the pandemic has been the loss of physical fitness in children and adolescents because of the loss of opportunities to play sports and generally move around. In addition, many children and adolescents have gained weight during this time. Maintaining a healthy weight and being physically fit offer many benefits for social-emotional development as well as academic performance. Numerous research studies link physical exercise to significant improvements in the regulation of mood and anxiety as well as attention and executive functioning.

Parents are often at a loss for how to help their child get back into good habits to lose weight, exercise regularly, or get back into a sport. Common parenting approaches, such as offering “helpful suggestions,” encouraging, nagging and bribing usually don’t work for long term—or even short term—positive change. Instead, these approaches often “back fire,” making the child feel even more ashamed or powerless—emotions that are not likely to fuel motivation to change habits.

So how do we support children and adolescents in developing the positive habits that are necessary for maintaining health and fitness? The key lies in empowering the child to determine his or her own goals and establishing their “why” through discussion of why they would like to reach this goal, what they will get by achieving the goal, and, perhaps most important, how they will feel when they reach this goal. This type of motivational interviewing builds internal motivation, which beats external motivators every time in terms of creating long term change.

Once the child or adolescent is clear on what they would like to achieve and why, the next step is determining the behavior changes that will help the child achieve their outlined goal and working with the child to figure out what’s manageable so that success can be ensured. For example, one adolescent might easily commit to a 30-minute daily bike ride, whereas another might want to start with a daily 10-minute walk. Success breeds success, so it is important to set goals that are challenging but also achievable. Throughout this process, the focus is on creating a positive mindset and positive emotional state of empowerment, hopefulness, optimism, and pride.

Some children may be open to this type of process with their parents; however, most adolescents will likely not want to be involved at this level with a parent. NESCA offers health and life coaching, aimed at helping adolescents and young adults with this process. Coaching offers a structured approach to helping an adolescent or young adult define his/her own goals and motivations as well as understanding the obstacles that they have encountered in reaching those goals, which are usually limiting beliefs (e.g., “I can never stick to things.”) or faulty self-identities (e.g., “I’m not athletic.”). The coaching process works through a combination of structured activities as well as a highly supportive personal relationship. To learn more, please join us for a webinar on Thursday, September 23 at 1:00 PM ET, view a previous webinar on this topic on our website or contact Health & Life Coach Billy Demiri for a free 30-minute consultation to determine if health coaching might be helpful for your child.

 

About the Author

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

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

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

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

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

Helping Students Transition Back to School

By | NESCA Notes 2021

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

Back in June, I wrote a blog about dealing with uncertainty at the end of the school year. Now, two months later, families are focused on the transition back to school, and a level of uncertainty still remains. Many children are re-entering full in-person learning for the first time in over a year and a half. We are also facing the reality that our overall community health is not as improved as we hoped it would be by now. There is debate about how to appropriately re-enter school, and this stress is likely palpable for many children and teens. As a community, we are grieving the continued loss of “normalcy,” with no clear idea of when that will be recovered.

How do we help children, and their adults, transition back to school during such a time? Some of the basic strategies are similar to those that we do to help them cope with the end of the school year. This includes watching for signs that your child may be struggling (e.g., difficulty sleeping) and talking about their feelings related to starting school in an open and validating manner. In addition, here are some strategies for helping to ease the upcoming transition to school:

  • Start to work into your schoolyear daily routine within the last week or two of summer. This includes bedtimes and wakeup times.
  • Create a morning and evening routine checklist or schedule. Use visual prompts for young children. For example, a morning checklist may include: Wake Up, Get Dressed, Eat Breakfast, Brush Teeth, Pack Bag (listing words or pictures of what to pack), and Departure Time. Practice this checklist for a couple days ahead of school starting to help you child get into the routine and understand how long each task will take.
  • Preview your child’s schoolyear to the extent possible. This may include reviewing their class schedule, looking at their teacher’s profile or picture on the school website, going to a back-to-school event at their school, etc.
  • Help your child set some goals for the upcoming year, trying to create intrinsic goals (e.g., build confidence with reading; make a new friend; ask questions more; etc.), rather than extrinsic (e.g., get straight As).
  • For children who were full remote last year and whose schools have mask mandate, practice wearing a mask at home for increasing durations of time.
  • Avoid scheduling extra activities during the first two weeks of school, such as weekend trips or appointments, allowing for a more relaxed transition.
  • Particularly for elementary age children, email your child’s teacher ahead of the year starting in order to briefly introduce yourself and your child. If you child has specialized needs, concisely highlight key things that the teacher should be aware of heading into the year.
  • For children who will be using a locker for the first time, have them practice opening a combination lock at home before the year starts.
  • For families feeling dissatisfaction regarding your school’s COVID-related mandates or plan, work to keep this conflict or stress away from your child.

Understood.org has a range of tools to help children transition back to school, including a Back to School Update for teachers, Backpack Checklists, Back-to-School Worksheet, Introduction Letter templates, and a Self-Awareness Worksheet, among others. Consider the above tips and resources and determine which are most appropriate for your child and their current skill set and feelings regarding the return to school. With the right tools in place, children and families can feel more confident entering the school year.

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Student Involvement in IEPs: Ten Tips to Help Middle School Students Get Started – Part 2

By | NESCA Notes 2021

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

As discussed in my previous blog, federal law requires that students with Individual Education Programs (IEPs) be invited to attend their transition IEP meetings. In Massachusetts, this means that students approaching the age of 14, often 8th graders, should be invited to attend their IEP meetings to start the process of transition planning if this has not already begun. However, many students are not invited to their team meetings until high school, if at all. Additionally, research has indicated that when students do attend team meetings, they have the lowest level of satisfaction about their IEP meeting of any team member and they feel the least comfortable sharing their thoughts and suggestions in the meeting.[i] Nevertheless, studies across the country have shown that students can learn skills to actively participate in their IEP meetings, especially when they are directly taught terminology, roles, and how to participate, and when team members expect student participation.[ii] In the first part of this blog series, I provided five tips for helping students to become involved in their IEP process: Explicitly learn about the IEP document and process; Talk about strengths; Talk about challenges; Complete interest and preference inventories; and, Talk about the student’s goals for after high school. Today, I am adding five more tips aimed at truly helping the student to be an instrumental part of their team meeting. After all, the student’s voice and their vision are the most important aspects of transition planning and special education.

  1. If testing is being discussed, make sure that an adult talks about the testing with the student BEFORE the IEP meeting—The ability to use assessment information to develop goals is one of the most important skills a student needs in order to be an active participant in their transition planning process. This means that students need to have access to, and an understanding of, assessment information just like every other member of the team. Professionals and parents all have the right to access evaluation results ahead of a team meeting and traditionally come to the meeting having read the evaluations, often more than once. Moreover, they have typically seen the same tests or similar tests beforehand and usually already have some sense of the student’s learning profile, strengths, and challenges. When the student has undergone evaluations that will inform IEP development, it is critical for the evaluator or another adult who understands the testing well to sit with the student and explain the findings and recommendations from the evaluations in a developmentally appropriate manner. The student needs to know what areas were evaluated, and to have a general sense of the strengths, challenges, interests, and preferences that were highlighted within the testing, in order to be able to participate in a meaningful discussion about their short- and long-term goals and the services that they need. Moreover, they need to have time to process this information, with support, before they are expected to participate in a discussion about what to do with the information.
  2. Give the student options as to how they would like to participate—Just like any other activity, an IEP meeting can be broken down through a task analysis process, and participation in the IEP meeting can be scaffolded, rather than taking an all or nothing approach. There are many actions and “micro-actions” that a student can take to be involved in their team meeting in a way that feels comfortable and satisfying to the student. Certainly, there are the preparatory activities described in my previous blog (e.g., participating in assessment, learning about the IEP, completing a one-pager, etc.). But there are also administrative tasks that the student can participate in, like photocopying materials or sending out invitations or reminders to participants. Students may also want to prepare a script, PowerPoint, video, work portfolio or other materials they can share with the team during the meeting. Also, they may want to share their experience at the meeting with peers afterward or present highlights of the meeting to a staff member or family member who could not attend. There are many examples of ways to participate before, during, and after the team meeting in this great brochure from the I’m Determined project (https://www.imdetermined.org/wp-content/uploads/2017/10/iep_participation_brochure.pdf). Some students may choose to take a more passive role, but it is important that the student has the opportunity to prepare and to make an informed choice regarding their participation. Over time, students should be building their skills for IEP participation so that they can ultimately lead one or more of their transition IEP meetings (http://www.ciclt.net/ul/mgresa/2.HowtoHelpStudentsLeadIEP.pdf).
  3. Practice!—This tip may seem obvious, but I am taking time to state it because it is often something that is forgotten. Participating in an IEP meeting, especially as the student, is not a normal activity. Sitting in tight quarters with your parents, general educators, special educators, therapists, counselors, and any number of other professionals, who are all talking about you and your challenges is inherently uncomfortable—especially if you have difficulties with language, social cues, anxiety, etc. One way to make the experience “less weird” is to practice. Generally, students will be asked questions about their concerns, strengths, accomplishments, challenges, and goals for the future. It helps to practice answering questions about these areas outside of the IEP meeting and to not be answering these types of questions for the first time in the meeting. An even more useful practice activity is to have a mock IEP meeting. There are plenty of scripts online that follow the typical format of an IEP meeting, such as introductions and attendance, questions and concerns, reports of current performance, transition planning, and IEP development. It is particularly important for the student to be aware of times in the meeting when they will be specifically asked for their contribution (e.g., introductions, student concerns, vision statement, etc.).
  4. Invite preferred staff—Scheduling team meetings is a logistical puzzle, and often not all staff can be present for the whole meeting, if at all. Ask the student who they feel knows them best and who they really want on their team. If you know which teachers are the most motivating for the student, make sure that they are invited. Moreover, when there is a choice related to staff participation, prioritize having the meeting at a time when staff who the student likes and feels comfortable with can be part of the meeting. For student’s who have 1:1 paraprofessional support, it is really important for the paraprofessional to be at the meeting so that the student can have the same level of assistance (and feel the same sense of safety and support) that they do throughout their school day. The student is the most important member of their IEP team, and they will feel most included if they look around the room and see familiar faces of people they know are on their side.
  5. Expect the student to participate!—The  most important thing that adults can do to assist students in participating in their IEP meetings is to make the time and space for the student to participate in the meeting. This may mean requesting a longer meeting than usual so that adults in the meeting can slow down or rephrase language in terms that are accessible for the student and so that the student has time to formulate their thoughts and language in order to participate in the meeting. Whatever accommodations a student needs to participate actively in a classroom discussion should be considered and put in place if they are needed for a student to participate actively in the team meeting discussion. Adults need to be respectful of the student’s voice and to not speak for the student, interrupt the student, talk over the student, or disregard the student’s input. The student’s participation needs to be expected, empowered, and applauded, because, after all, it is their IEP meeting, their education, and their life.

[i] http://www2.ku.edu/~tccop/files/Martins_Perspective.pdf

[ii] http://www2.ku.edu/~tccop/files/Martins_Perspective.pdf

 

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

 

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

Growing in a Fog: The Impact of Sleep Loss on Children’s Development

By | NESCA Notes 2020

By: Angela Currie, Ph.D.
Pediatric Neuropsychologist, NESCA
Director of Training and New Hampshire Operations

A recent study conducted at the University of Warwick, in the United Kingdom, supported the long-held belief that reduced sleep in children has a significant negative effect on their cognitive and emotional functioning. Findings were recently published in the journal Molecular Psychiatry, in an article, titled “Sleep duration, brain structure, and psychiatric and cognitive problems in children.”

When examining children ages nine to 11, reduced sleep was associated with higher levels of depression, anxiety and impulsive behavior, as well as poorer cognitive performance. Findings showed that, on average, behavior problems were 53% higher in children who got less than seven hours of sleep, compared to those who got nine to 11 hours. Additionally, on average, total cognitive scores were 7.8% lower in the children with reduced sleep.

Negative effects of sleep loss were not only observed through children’s behavior and task performance, but there were table differences within brain structure as well. Shorter sleep duration was related to lower volume in brain structures that are responsible for decision making, learning, emotion regulation, memory, executive function, sensory regulation, language function and spatial perception, among other skills. Because sleep is a highly active process, during which children’s brain circuitry reorganizes, it is thought that sleep loss can interfere with actual physical brain maturation, not just emotional, behavioral and cognitive functioning.

This study conducted by the University of Warwick is not the first to demonstrate how a lack of sleep negatively impacts children’s and adolescent’s functioning. In addition to better emotional and cognitive health, adequate sleep is also related to better physical health, including reduced injuries, heart disease and obesity (www.aap.org).

The American Academy of Pediatrics recommends that preschoolers get 10 to 13 hours of sleep per day; grade school children get 9 to 12 hours of sleep; and teenagers get eight to 10 hours of sleep. While this is so, children are often chronically sleep deprived due to excessive school, social and extracurricular demands. Increasing screen time and access to social media is also problematic, not only because these distract children and teens from sleeping, but technology use interferes with the release of melatonin, reduces REM sleep and activates the wake center of the brain. It is thus not surprising that a 2015 analysis of data from the Youth Risk Behavior Surveys found that approximately 57.8% of middle schoolers and 72.7% percent of high schoolers are not getting enough sleep. In spite of this, school start times remain early, expectations for extracurricular involvement remain high, and blue-light-filled technology is increasingly necessary for the completion of late-night homework assignments. This occurs alongside a steady rise of stress and anxiety within pediatric populations, pointing to the importance of re-evaluating the demands and conditions under which our children are expected to grow and learn.

Sleep is a foundational necessity on which cognition, emotion regulation, attention and learning build. The negative effects of sleep loss can be felt at any age, but they are particularly concerning in childhood, a time when the brain is rapidly developing. The American Academy of Pediatrics has provided some tips on how to support healthy sleep in a child of any age. These can be accessed at www.healthychildren.org, at the below link.

References

University of Warwick. (2020, February 4). Children’s mental health is affected by sleep duration. Retrieved on February 24, 2020 from www.sciencedaily.com/releases/2020/02/200204094726.htm

Wheaton AG, Jones SE, Cooper AC, Croft JB 2018, ‘Short Sleep Duration Among Middle School and High School Students — United States, 2015’, MMWR Morb Mortal Wkly Rep., vol. 67, pp. 85–90.

American Academy of Pediatrics (2016). American Academy of Pediatrics Supports Childhood Sleep Guidelines, June 13, 2016. Retrieved on February 24, 2020 from https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Supports-Childhood-Sleep-Guidelines.aspx

American Academy of Pediatrics (2018). Healthy Sleep Habits: How Many Hours Does Your Child Need? Retrieved on February 24, 2020 from https://www.healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx

 

About the Author:

Dr. Angela Currie is a pediatric neuropsychologist at NESCA. She conducts neuropsychological and psychological evaluations out of our Londonderry, NH office. She specializes in the evaluation of anxious children and teens, working to tease apart the various factors lending to their stress, such as underlying learning, attentional, or emotional challenges. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Londonderry, NH, Plainville, MA, and Newton, MA serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call (603) 818-8526.

Does Scatter Matter? How to Understand Your Child Better

By | NESCA Notes 2021

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

Families often come to testing with questions like these: My child is so smart, why is reading so hard for them? If she can remember the smallest conversation from three years ago, why can’t she remember the two things I sent her upstairs to get? If he can do all of the calculations, why can’t my son solve a word problem? The answer can show itself in the scatter.

Assessment measures are based on statistical conversions, where the number of points a child or teen earns is “translated” into a scaled or standard score. This helps us to understand how your child performs compared to other children their same age. Tests are largely based on the idea that scores should “hang together” – meaning that if your child is average for his or her age on one task (e.g., visual-spatial skills) then they should be average on another (e.g., verbal knowledge). And while this may be true for many people, it certainly it not true for all people. Many people have “scatter,” meaning that there is a statistical difference between their scores.

I will spare you the controversy about scatter in our field, about whether a certain degree of scatter or difference between scores means that you cannot calculate certain other scores. There is also specific knowledge of scatter needed to diagnose specific learning disabilities (e.g., if your child has high average verbal skills, how far apart do their reading scores need to be in order to fit the diagnostic criteria). While those topics are incredibly important to the field, my focus today is to build a little empathy for how scatter can matter.

There are times when this scatter can lead us to a diagnostic decision. For example, a relatively common pattern that I see is that of a very bright teenager whose cognitive and problem-solving are at least above average, while their basic focus and attention is below average. With other evidence that corroborates it, this can mean ADHD. A big difference between a child’s verbal knowledge/language skills and their ability to use their language for social purposes can suggest an Autism Spectrum Disorder. In these instances, the scatter absolutely matters. But, scatter can be meaningful to a child’s daily experience even if it’s not statistically “big enough” to warrant diagnosis.

Imagine being your child for a moment. Perhaps your child has a knack for building complex Lego sets and can spend hours assembling structures that are intricate, detailed, and involve more small pieces that my adult fingers could tolerate (let alone our feet as we step on them!). Perhaps your child’s visual-spatial skills are incredible, scoring in the high average range compared to their friends. Then you place a book in their hands and ask them to read a page aloud, where they struggle to sound out words, track their eyes smoothly across the page, or understand the meaning of anything they are saying. While you are left scratching your head as a parent, imagine the frustration and disappointment your child must feel wondering: why can I work with Legos better than anyone I know, but decoding words is torture?

In my mind, scatter can mean frustration. To feel exceptionally strong and confident in one skill domain and then barely hang on in another can leave your child disappointed, angry, and self-critical. Imagine having a vocabulary and encyclopedia of facts in your mind and your hand simply cannot keep up with your thoughts as you try to take notes or write down ideas for an essay. For an adult, it can be a bit like sitting in front of your computer with too many browser windows open and programs running at once, slowing down the entire operating system to the point that you growl in frustration (anyone else?).

While it can be easy to get lost in the controversy over the technical and statistical nature of scatter, it is important that we all have some empathy for what this must feel like for your child or teen. Empathy for this experience is a critical part of building the roadmap forward: where we can use those strong skills to build up the weaker ones, to grow new and stronger neural connections, and to give ourselves a little grace and patience when those weaker muscles get challenged.

 

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.

Student Involvement in IEPs: Ten Tips to Help Middle School Students Get Started – Part 1

By | NESCA Notes 2021

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

Federal law requires that students with Individual Education Programs (IEPs) be invited to attend their transition IEP meetings. In Massachusetts, this means that students approaching the age of 14, often 8th graders, should be invited to attend their IEP meetings to start the process of transition planning if this has not already begun. For many, the idea of a middle school student attending an IEP meeting, an activity that can often be intimidating and upsetting for parents, can initially be overwhelming. And historically research has indicated that when students do attend team meetings, they have the lowest level of satisfaction about their IEP meeting of any team member and they feel the least comfortable sharing their thoughts and suggestions in the meeting.[i] However, research across the country has also shown that students can learn skills to actively participate in their IEP meetings, especially when they are directly taught terminology, roles, and how to participate, and when team members expect student participation.[ii] Student participation in IEPs is not only important because it is federally mandated, it is also essential because the IEP is supposed to be based on the student’s strengths, interests, preferences, and needs as well as the student’s post-high school goals—and because it’s the student’s life! For those reasons, I am choosing to focus this blog (and some future blogs) on tips for helping middle school students to become involved in their IEP processes.

  1. Explicitly learn about the IEP document and process—There are clear rules and vocabulary used to govern the IEP process. However, these are wholly unfamiliar and strange to anyone who has not participated in the process before (and even perplexing for those of us who have a lot of experience at team meetings). Therefore, one of the most critical ways to prepare a student to attend transition IEP meetings and to be a self-directed member of their IEP team is to equip them with knowledge of the vocabulary and rules that govern the process. One organization that has created useful materials for helping to teach students about the IEP process is imdetermined.org which has documents designed to assist students in understanding the IEP (https://imdetermined.org/resource/understanding-my-iep-differentiated/) and preparing for the IEP (https://imdetermined.org/resource/understanding-my-iep-differentiated/), but it may also be important to reference and simplify certain sections of the IEP Process Guide (https://www.doe.mass.edu/sped/iep/proguide.pdf). If students are not ready to review their entire IEP (which many students are not), it may be helpful just to think about the present levels of performance, strengths, or accommodations.
  2. Talk about strengths—While it’s critical that students be able to talk about their strengths and challenges, sometimes it’s easiest to start with strengths. People can have all kinds of strengths, such as character strengths, social strengths, language strengths, academic strengths, technical strengths, extracurricular strengths, and more. For kids who have a hard time with open-ended questions, there are checklists that can be found or completed online, such as character strengths inventories, transferable skills checklists, and strengths worksheets. There are also activities that can be useful for documenting strengths over time, such as this Strengths Chain activity (https://www.understood.org/articles/en/strengths-chain-for-kids), keeping a running list or journal of strengths and accomplishments, or building a deck of strength cards. All students need help learning to describe their strengths, especially the first time. Some students may have a hard time identifying the strengths they see in themselves, but may have an easy time sharing what other people say about them or compliment them on. Talking about strengths is not a one-time activity. Make sure that you are talking about and referring to the student’s strengths often while also highlighting how various members of the household or students in the class have different strengths and skills.
  3. Talk about challenges!—While transition planning is a strengths-based process, an IEP is based on a student needing specialized instruction and related services because the student has a disability and would struggle to make effective progress in school or the general education curriculum without special education. If we are going to ask students to be actively involved in a process of goal-setting based principally on their having a disability and related challenges, it is critical that the student has the opportunity to talk about what is hard for them and what they want to get better at… in their own words. At the same time, it is important to normalize the fact that all people have challenges, learn different information at different rates, and need help (and tools) to function successfully. Ultimately, being able to use a diagnostic label and understand the impact of a diagnosis on functioning is important, but what is more important is being able to describe what is hard on a daily basis and what makes those difficult activities easier. For some students, it is helpful to read a book or watch a television show or movie with characters who face similar struggles and to label similarities between the youth and the character. Some of the same checklists mentioned for documenting strengths can be helpful for identifying areas of challenge or undeveloped skills. It may also be helpful to start filling in a worksheet similar to this one-pager (https://imdetermined.org/resource/one-pager/) or this self-awareness worksheet (https://www.understood.org/articles/en/download-self-awareness-worksheet-for-kids). Just as with strengths, it is important to talk about and refer to specific challenges that each person in the household or class faces.
  4.  Complete interest and preference inventories—Learning to engage in self-assessments and talk about those self-assessments is an important part of transition planning and IEP participation. There are so many fun interest and personality quizzes online that can be taken in minutes. Some examples include these personality tests from National Geographic Kids (https://kids.nationalgeographic.com/games/personality-quizzes), this free personality type explorer (https://www.16personalities.com/free-personality-test), or even the O*Net Career Interest Profiler (https://www.mynextmove.org/explore/ip). Have the student take the test—and take these tests yourself—and talk about how your results are similar or different and how well the student thinks the results of the assessment capture them. Think about whether there are strengths or challenges to add to their running lists or worksheets based on their experience taking these inventories.
  5. Talk about the student’s goals for after high school—Students have the right to input as much as possible into their postsecondary vision statement, no matter how realistic or unrealistic their input is. The only way that they can be prepared to provide input at a team meeting is if they have spent some time thinking and talking about their post-high school goals and learning about their choices and options. Just recently, my colleague Becki Lauzon wrote a blog with important discussion points for talking about post-high school goals with students, which can be found here. A robust transition planning process should include helping a student to have detailed goals for their future education or training, employment, independent living, and community engagement; however, initial discussions might just include ruling in or out things like obtaining a high school diploma, continuing learning after high school, having a paid job, driving a car, and living with other people. In middle school, the goal of talking with a student about their postsecondary vision is just to help the student learn to comfortably engage in those discussions and to find out where future work needs to be done in order to help the student build a more complete picture of their adult postsecondary life.

Every student is different and is able to engage in the process in different ways and at different times, but I hope that there is at least one tip in these blogs that is useful for you. Next month, I will be writing a second blog with more tips for engaging middle school students in the IEP process.

If you are interested in having your child work with Kelley Challen or another NESCA transition specialist to plan and prepare to be part of their IEP meeting, please fill out an intake for our transition consultation and planning services or our student coaching services today!

[i] http://www2.ku.edu/~tccop/files/Martins_Perspective.pdf

[ii] http://www2.ku.edu/~tccop/files/Martins_Perspective.pdf

 

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

 

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