pediatric neuropsychology Archives - Page 3 of 19

Image of a child refusing to go to school and quote by Rebecca Dautoff, Psy.D., NESCA

Helping Your Child Overcome School Refusal: A Place for Parents to Start

By | NESCA Notes 2025

By: Rebecca Dautoff, Psy.D.
Pediatric Neuropsychologist, NESCA

As a parent, it is excruciatingly difficult and painful to watch your child struggle with school refusal. School refusal often doesn’t involve a simple dislike of school; it can be a complex emotional challenge that affects your child’s mental health and academic progress, as well as the day to day logistics of parents and families. It can feel overwhelming to know where to begin and how to help.

Understanding the root causes of school refusal and applying a well-structured, therapeutic approach is key to helping your child reintegrate into the school environment and regain their confidence. While it is different for every child, a stepwise, therapeutic re-entry approach, such as the example below, can help provide practical ways to support your child.

Why a Gradual Return to School Matters

For children who have a long-standing pattern of school refusal, a sudden return to a typical school day may feel daunting and unmanageable. It’s essential to remember that the emotional and psychological barriers that prevent your child from attending school take time to address. As hard as it is to have a child out of school, rushing the process can lead to increased anxiety and reinforcement of avoidance behaviors.

Research shows that a gradual re-introduction to the school environment is the most effective approach. This method helps reduce the anxiety that comes with school refusal while promoting the confidence necessary for longer school days. Best practices suggest starting with just one hour of school attendance per day, then increasing the duration by one hour each week.

This “stepwise” method—beginning slowly and building gradually—has been shown to be successful and should be applied whenever your child transitions back into a school setting, whether at their current school or a new placement. The gradual re-entry helps to normalize the school experience, minimizing feelings of overwhelm.

A Collaborative Approach

School refusal places stressors on all parents and siblings alike, causing the anxiety and frustration emanating from the child to radiate throughout the family system. As a parent, it can be traumatizing to see your child struggle, but the trauma can be compounded by the adverse impact your child’s needs have on other facets of your life. Like the safety guidance offered before taking off in a plane, you must first put on your own oxygen mask before helping others. Parents who are able to be aware of these impacts, or better, seek help and support themselves, are often far more effective at addressing school refusal. Just as children sense the struggles of their parents, they can also draw strength from parents who model constructive behaviors.

Effectively addressing school refusal also calls for close collaboration between parents, teachers, and administrators. Developing a cohesive plan, tactics, contingencies, and even language, can help create consistency from which the child can draw a sense of safety and security. No one can plan for every contingency, and sometimes the best laid plans fall victim to an intransigent overwhelmed child, but consistency and coordination has been shown to dramatically increase the success of treating school refusal.

Key Components of a Successful Reintegration Plan

A successful reintegration plan for school refusal should involve more than just a slow return to the classroom. It’s important to address both the emotional and cognitive aspects of school refusal, as well as provide consistent, structured support. Below are the key components of a comprehensive plan to support reintegration and ensure that they are able to make a successful transition back to school:

1. Gradual Re-entry to Academic Demands: A plan should include a gradual re-entry to academic tasks, starting with smaller, manageable increments of time and progressively increasing in duration. This approach reduces the pressure of immediate academic demands, helping to prevent feelings of overwhelm. Begin by introducing your child to their preferred subjects—those they feel more comfortable with or enjoy the most. This positive reinforcement can help build confidence and reduce resistance to returning to school.

2. Addressing Distorted Thinking: Children with school refusal often experience distorted thinking about school. These cognitive distortions may include beliefs such as, “I’m not good enough,” “teachers and peers will judge me,” or “I won’t be able to keep up with my classmates.” Your child requires specific support in restructuring these distorted thoughts. It’s crucial that they work with a therapist or counselor to challenge these negative beliefs and replace them with more accurate and adaptive thoughts.

Role-playing and practice routines throughout the day can also help your child develop healthier perspectives on school and school-related social interactions. These exercises can prepare your child to cope with real-life situations and increase their readiness to face challenging scenarios in the classroom.

3. Prompt Response to School Refusal: One of the most important factors in overcoming school refusal is acting quickly when a refusal occurs. Research shows that the longer a child stays away from school, the harder it becomes to break the cycle of avoidance. Therefore, it’s critical that your child’s team (including you, their school staff, and any therapists involved) respond immediately when a refusal occurs. Ideally, you want to limit the number of school refusal days to one or two at most before implementing a formalized plan to address attendance.

If your child does refuse school, the plan should prioritize early intervention. This may include additional support, communication with the school to reduce missed work, and mental health check-ins to ensure your child feels supported emotionally. By acting swiftly, you reduce the risk of a prolonged period of school avoidance, which can become harder to reverse over time.

4. Managing Homework and Academic Workload: One of the most common sources of stress for children with school refusal is the idea of falling behind in schoolwork. Your child may feel overwhelmed by the accumulation of missed assignments, which can further fuel avoidance behaviors. To prevent this, it’s essential that a plan be put in place to manage missed work. This could include prioritizing essential assignments or offering extensions on deadlines to help your child feel less pressured.

By reducing the academic burden during the reintegration process, your child can focus on gradually adjusting to the school environment without being overwhelmed by the expectations of their coursework.

Concluding Thoughts

School refusal is not a simple issue to resolve, but with a thoughtful, stepwise approach, your child can successfully transition back into school. A gradual reintegration into the academic environment, support for restructuring negative thoughts, and quick intervention at the first sign of refusal are key to helping your child overcome this challenge.

Parents and caregivers play a vital role in this process. Your understanding, patience, and advocacy are essential to your child’s success. With the right support, your child—and other children facing school refusal—can regain confidence, rebuild their academic skills, and develop the resilience needed to thrive in school and beyond.

If your child is experiencing school refusal, don’t hesitate to reach out to your child’s school or a mental health professional to create a tailored plan that best meets their needs. Neuropsychological testing can also be useful in determining underlying causes of the school refusal and planning a re-entry to their current school or another program that sets your child up for a positive educational experience.

If you would like to learn more about NESCA’s neuropsychological evaluation services, please complete our online Intake Form.

About the Author

Dr. Rebecca Dautoff provides comprehensive neuropsychological and psychological (projective) evaluation services for children, adolescents, Headshot of Rebecca Dautoff, Psy.D. and young adults who have complex presentations with a wide range of concerns, including attention deficit disorders, psychiatric disorders, intellectual disabilities, and autism spectrum disorders (ASD). She also values collaboration with families and outside providers to facilitate supports and services that are tailored to each child’s specific needs.

If you are interested in booking an appointment for an evaluation with Dr. Dautoff or another NESCA neuropsychologist/clinician, 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, 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.

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

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

By | NESCA Notes 2024

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

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

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

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

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

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

About the Author

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

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

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

Approaching Cultural Knowledge and Sensitivity as More Than Just Buzzwords: A Neuropsychologist’s Perspective

By | NESCA Notes 2024

By Pediatric Neuropsychologist, NESCA

In recent years, the conversation around cultural knowledge and sensitivity has gained significant traction across many fields, including education, healthcare, and psychology. Yet, despite the increasing prevalence of these terms, we must ask ourselves: Are we truly embodying cultural sensitivity, or are we merely paying lip service to it?

As a neuropsychologist, originally from the former Soviet Union (what is now Ukraine), I believe that cultural competence is not just a set of buzzwords we throw around to make ourselves sound aware; it’s a crucial, ongoing practice that demands attention, empathy, and, above all, genuine understanding. Now more than ever, as we witness global conflicts and societal shifts, it’s essential to engage deeply with the cultural and psychological needs of children who are affected by these events. The horrific events of October 7, 2023, in Israel, the subsequent rise in incidents involving anti-Jewish sentiments, and other crises around the world have had a profound impact on vulnerable children. How can we, as mental health professionals, approach these children in a way that truly honors their cultural identities while understanding the potential toll of trauma?

Children who experience trauma often find themselves at the intersection of multiple identities—cultural, familial, national, and personal. In the Jewish community, for example, the devastating events of October 7, 2023, marked a profound moment of collective grief and fear. For some Jewish children, the emotional impact of these events may be compounded by historical trauma, including awareness of past experiences of antisemitism and persecution. These children may be processing not only the immediacy of their own situation but also an ancestral history of violence and oppression. Similarly, Ukrainian children displaced by the ongoing conflict face a complex mix of trauma. These children might not only be mourning the loss of their homes, but also grappling with the disintegration of their sense of safety and national identity. The trauma of war is not just physical; it disrupts the very fabric of who these children are and how they see the world. Their cultural identity, bound up in language, traditions, and the shared history of their people, may suddenly feel threatened or fragmented.

It’s essential to recognize that cultural knowledge is not simply about understanding “facts” about a group’s history or customs. It’s about recognizing the psychological and emotional realities of that culture in the present moment, particularly when faced with trauma. When working with children from these communities, it’s important to begin by listening. Listen not only to their words, but also to the silence in between, to their body language, and to the nuances of how they express their grief and fear. Children from these communities may not always have the language to articulate their feelings, particularly when these feelings are wrapped up in both current trauma and long-standing cultural narratives. For instance, a Jewish child might not immediately say, “I’m scared because of antisemitism.” Instead, they may exhibit anxiety in social settings, avoidance of certain situations, or a sense of hypervigilance. It’s essential to recognize these subtler expressions of distress. Furthermore, cultural sensitivity means appreciating how culture influences coping mechanisms. For Jewish children, faith, community rituals, and family structures often play a significant role in both day-to-day life and in how they process adversity. These rituals, whether it’s a prayer or a specific practice for remembering the dead, can provide crucial emotional support, and understanding their importance can help guide effective interventions. Similarly, Ukrainian children may draw strength from their deep cultural connection to the land and their national identity. Understanding these cultural touchstones allows us to better support their emotional recovery.

To effectively support children affected by trauma, it is important to approach care from a framework that integrates both cultural sensitivity and trauma-informed practice. Children need to feel understood, and this means recognizing their cultural identity as an integral part of their experience. Safe spaces where children can express themselves without fear of judgment are paramount. It is important for clinicians not only to appreciate the current crisis but also the cumulative effect of historical events that have shaped the children’s cultures. As a clinician, this means being aware of the historical context and acknowledging the weight of collective memory. This helps to build trust and validates the child’s emotional experience. Working with families and community leaders helps ensure that interventions are not only culturally relevant but also supported by the broader social structure. This collaborative approach fosters resilience and provides ongoing emotional support.

Cultural competence is not a static goal, but rather a lifelong learning process. As clinicians, we must constantly engage with the evolving cultural, social, and political landscapes to ensure our approach remains relevant and respectful. This includes continuing education and being open to adjusting our practices based on new insights. Ultimately, cultural sensitivity is not about checking off a list of “do’s and don’ts.” It’s about recognizing and understanding that culture shapes how children experience and process the world. This empathetic approach allows us to meet children where they are—emotionally, psychologically, and culturally—and to support them as needed. As we move forward, let us take cultural sensitivity beyond a buzzword and make it a true cornerstone of our practice. In times of crisis, the need for empathy, understanding, and culturally informed care has never been greater.

NESCA has a long-standing commitment to working with internationally based clients, families, and schools through neuropsychological evaluation, consultation, coaching, and transition services. For more information on NESCA’s international work, visit: https://nesca-newton.com/international/.

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

NESCA Welcomes Julie Weieneth, Ph.D., to its Team

By | NESCA Notes 2025

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to welcome Pediatric Neuropsychologist Julie Weieneth, Ph.D., to its Newton, Massachusetts location! Read more about Dr. Weieneth’s past experience, areas of specialization, and what brought her to NESCA as a pediatric neuropsychologist.

What drew you to neuropsychology?

Part of what interested me is that I’ve always done and have always enjoyed testing. I did my post-doc at the Developmental Medicine Center at Children’s Hospital Boston and did plenty of testing there. Then, with each subsequent role I was in – whether at a therapeutic school or in a group practice – I was conducting evaluations.

Neuropsychology is a really helpful way to integrate school-based evaluations. If we’re looking at diagnostic clarification, which is one of my areas of interest, that’s what a neuropsychological evaluation and subsequent report can do.

What settings have you worked in previously?

A lot of my background has been as a staff psychologist in therapeutic school settings, including the Manville School and New England Academy for many years, including during Covid.

I then moved on to a group neuropsychology practice so I could better balance my work and life schedules. My own kids were transitioning back to in-person school, and I wanted more flexibility in my schedule to support them as well as the students I evaluate.

What are your specialty areas?

My years in the therapeutic school setting gave me a good understanding of the various challenges students have as well as the complex educational needs that come with supporting them through those challenges.

Taking a step back, my dissertation was on the early development of ADHD, so that is an area that I am very familiar with and still really interested in. I also enjoy working with students with complex presentations, helping to provide diagnostic clarification as well as the kind of supports the individual and family will need to foster their education and development. In addition, I’d say I am also a bit of a generalist, able to work with most children and adolescents who are struggling.

What were you looking for in a new environment?

I am really excited about NESCA being a multidisciplinary practice. I’m looking forward to being part of a team made up of providers from different specialty areas. It will be great to refer children and students to people and providers in-house who I trust for executive function coaching, real-life skills coaching, transition planning, therapy, consultation, and more.

What do you find most rewarding as a neuropsychologist who works with children and adolescents?

I find it particularly rewarding when a student who has struggled with school refusal, meaning they are not actively attending school, is fully back in school and thriving. It’s a great feeling to be part of the team that helps figure out what is happening for them, and helps direct them to the right resources so they can get back into school. I recently heard from a parent of a student I evaluated, who was really struggling and not engaging in any aspects of their schooling or life overall. They let me know that their child sought out and stuck to the interventions we recommended, and their child is back in school and doing well. That’s what our job is all about.

What do you think are the benefits of working in a group practice?

Sometimes the children we work with have a really hard time during the evaluation process, and we can’t finish all of the testing in the first session. I like having the ability to be flexible with them and bring them back in for another session if necessary. If we rush or force the testing, we will not get accurate results. Being in a group practice – rather than a hospital setting where the flexibility in schedules just isn’t there – allows me, as a neuropsychologist, to meet kids where they are at and get the best data and observations that I can.

Working as part of a group practice allows us to share insights, perspectives, connections, and experiences of the entire team. The cases that we all see are complicated, and sometimes, it’s really helpful to take all the information we have available and consult with those around us. To me, it’s a best practice to consult on cases with others. You gain the perspectives and experiences of others in the practice, and it also helps to develop solid recommendations with specific referrals from other experts in the practice to help a family move forward.

As neuropsychologists, we’ve all had different training and previous work experiences, and this is particularly important when cases are complicated. I’m open to hearing information and feedback from others, especially if I think it’s going to help the family move forward. When you work with a team of experts, it makes our reports so much more meaningful for the families we serve.

What are some of the strategies you employ when you are evaluating a child or adolescent who is struggling during the assessment?

Oh, there are so many. Sometimes, I will use Collaborative Problem Solving techniques. I’ve also had sessions where I have waited children out, offered them rewards, provided lots of nurturing and praise – again just meeting them where they are at. I also involve the parent or caregiver in the sessions if the child needs that support.

I’ve learned through the years how to be comfortable in most situations or settings, and I’m not easily thrown by emotional intensity. I always try to end on a positive note, whether the evaluation was smooth or challenging. If they struggled and needed an extra session, I involve the child in the decision to come back the next day and praise them for everything they accomplished in the initial session. They worked hard and should be positively reinforced for that.

Parents and caregivers come to NESCA for answers. How do you help guide parents and caregivers through the evaluation process?

Just like with children and adolescents, I meet the parents and caregivers where they’re at. And everyone is so different in their own experience when they are exploring or seeking out a neuropsychological evaluation. It may be their first time, and they are afraid, or it could be the sixth neuropsychological evaluation their child has had, and they know the drill. No matter where they are at, you do your best to explain what the process is and inform them about what to expect. I let them know that the whole process is designed to understand an individual’s learning strengths and challenges. I let them know that when I develop the report, I will write highly personalized recommendations that build on their child’s strengths and how they can help to understand and work through their challenges.

People often say that I have a “matter of fact” way about me. I approach things practically, and I like to share input, feedback, and guidance with parents, caregivers, and students in that way. While I am practical, I am also empathetic and understanding of everyone’s stories.

How important do you think observation of the individual being evaluated is? What can you tell from the observations?

I was trained to pay attention to the observations. What’s behind the numbers is super important. I would never write a report without a lot of behavioral observations and interpretations around what things mean, because that is so critical.

Behavioral observations can provide insight into what comes easy to the students. And even if they have an average score in a particular area, it’s critical to look at how they approached that task. This can be really meaningful in an evaluation and in providing recommendations.

When you are working with students who are complicated, their struggles emerge in many ways beyond what the typical data show. If you just looked at the numbers, you might not see any struggle. Because the tasks are administered in a 1:1 setting, you see how they approach a task, how they complete it, or whether they can complete it. It informs us about things like their working memory and processing speed, and how that may impact them in real-life or educational settings. Children with high variability in their scores can “fall through the cracks” in school. They may appear like they are doing just fine from their grades and other test scores, but they are often dealing with an internal struggle or an uneven profile. The risk in saying they are doing fine is that, as they progress through their education, the struggle often just gets worse.

What have you noticed in the students you’ve evaluated since Covid?

I see a lot more school refusal among students, meaning the students who are not able to attend school or those who may be in school but need to arrive late or leave early on a consistent basis.

In addition, there has been a lot of anxiety, depression, isolation, and those sorts of things. Everything seems to be far more complex than it had been before Covid. And that’s a lot, considering it was already getting more complex before, with social media other stressors.

I’ve also noticed that there’s a lot of anxiety among adults. The parents and caregivers seem to have a heightened sense of anxiety and uncertainty.

How did you work through Covid?

It certainly was challenging, but there were two important silver linings that emerged from that experience. I learned to meditate and get more interested in mindfulness throughout that time. It has been really helpful to me.

Professionally, Covid actually helped me grow and transition from the therapeutic school setting to a group neuropsychology practice. While I loved my roles within schools, I was looking to delve deeper into diagnostic assessment. Doing so also provided me with more flexibility to balance things between my professional and personal lives. So, there were at least two positives that came out of the experience.

About the Author

Dr. Weieneth is a licensed clinical psychologist who has worked with children and families with complex diagnostic and treatment needs for the last twenty years. Her areas of specialty include ADHD, autism spectrum disorders, anxiety, mood disorders, learning disabilities, executive functioning, and school-related challenges. That being said, Dr. Weieneth also understands that not all individuals fit cleanly into diagnostic groups or labels. Her goals for each evaluation are to help families feel comfortable with the process, use all the tools available to best understand each individual’s unique strengths and needs, and to write a clear and comprehensive report that will guide educational and treatment planning.

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

Welcome 2025 banner with quote from Dr. Ann Helmus

NESCA Welcomes 2025!

By | NESCA Notes 2024

By Ann Helmus, Ph.D.
Founder and Director, NESCA

At NESCA, we are thrilled to share how 2025 has gotten off to an incredible start! During the very first week of the year, we had the pleasure of welcoming three new neuropsychologists to the NESCA team. These talented clinicians started their NESCA careers with an intensive week-long training, during which many of our seasoned NESCA clinicians presented on their areas of specialization. This immersive onboarding experience underscored our commitment to professional growth and ensuring that every team member has the tools to provide the highest level of care to our clients.

Adding to the richness of the week, we were joined by a neuropsychologist from Florida, who is considering relocating to Boston to become part of our team. Her perspectives on regional differences in neuropsychological practice, including bilingual evaluations, added a valuable dimension to our discussions, enhancing the exchange of ideas. All of our new neuropsychologists are mid-career professionals, and the week was characterized by vibrant discussions where everyone learned from each other. This mutual sharing of knowledge exemplifies the collaborative and collegial spirit that makes NESCA a leader in the field of pediatric neuropsychology.

We also had the honor of hosting a special evening for pediatric neuropsychology postdoctoral fellows and interns, aimed at supporting them in their career exploration. Over dinner, these early-career clinicians heard from a panel of four experienced pediatric neuropsychologists working in diverse settings, including hospital-based roles, solo practices, and group practices like NESCA. The panelists shared insights on what drives career satisfaction, how to achieve work-family balance, and considerations around compensation. The discussions were lively and thought-provoking, providing invaluable guidance to those embarking on their careers in pediatric neuropsychology.

At NESCA, our mission goes beyond delivering exceptional neuropsychological evaluations. We are deeply committed to fostering an environment of learning, professional development, and collaboration. Whether it’s through welcoming new team members, creating opportunities for knowledge-sharing, or helping early-career clinicians chart their career paths, we strive to build a professional community that embodies support and excellence.

What I saw unfold and experienced during our training week – from both NESCA’s seasoned clinical staff and our newest additions – gives me immense job satisfaction and gets me out of bed in the morning. While I am no longer seeing clients myself, I am now inspired by creating opportunities for people to learn from each other and exchange ideas; watching people meet and collaborate; and working closely with NESCA’s leadership team to continuously improve NESCA. All these things drive me personally, but, more importantly, lead to better client care.

Here’s to a 2025 filled with growth, connection, and continued dedication to our mission of helping children and families thrive. We look forward to the year ahead and all that we will accomplish together!

About the Author

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 30 years. In 1996, Ann Helmus headshot she jointly founded the Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost 10 years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

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

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

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

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

Neuropsychologist observing the behavior of a child being evaluated

The Importance of Behavioral Observations in Neuropsychological Evaluations

By | NESCA Notes 2024

By: Alison Burns, Ph.D.
Pediatric Neuropsychologist, NESCA

Neuropsychological evaluations integrate information collected from multiple sources: (1) history and presenting concerns obtained during clinical interviews with a parent/guardian and the patient, (2) information from a review of records (e.g., past testing reports, school plans, such as IEPs or 504 plans, medical documentation), and (3) neuropsychological and psychological test findings. While these sources of information are important components of an evaluation, behavioral observations are essential to truly understanding a child’s strengths and weaknesses.

Behavioral observations are the qualitative observations made by a clinician that help to understand the child’s unique set of strengths and weaknesses. This includes overall impressions of the child throughout the evaluation process, such as their cooperation level and general attentiveness, their mood/affect and interpersonal skills, any nuances noted in their expressive or receptive language skills, and their fine motor abilities. This provides a “big picture” context to help the interpretation of more specific test findings. For example, if a child appears depressed and, as a result, thinks and completes tasks slowly, this can provide context for test scores which indicate processing speed deficits. In addition, these “big picture” behavioral observations can highlight the daily life impact that results from a weakness. For example, a child may be observed having difficulty opening a food container during a snack break which relates to the fine motor weaknesses seen during direct testing. Lastly, observations during unstructured times (e.g., waiting room behavior, separation from parents, social chit chat in between tasks) can often contribute invaluable information that would otherwise not be elicited from structured standardized testing.

Behavioral observation during testing tasks is necessary to look for any factors that may help elucidate the specific strengths or challenges a child may be experiencing. For example, a child may receive a Low Average score on a “Block Design” task in which they are asked to use blocks to recreate a visual-spatial design within a time limit. However, this Low Average performance could occur for many reasons. First, it could be due to a child having a hard time perceiving the correct angles and shapes within the design, suggesting a visual-spatial deficit. Second, a child may answer all items correctly but had done so after the time limit, suggesting a processing speed weakness. Third, a child may make an error as they rush through each item, suggesting difficulties with attention to detail or impulsivity.

Behavioral observations allow the clinician to identify a child’s unique profile of strengths and weaknesses to a greater specificity, which, in turn, allows for more tailored treatment recommendations. For example, knowing a child has a fine motor weakness that results in difficulty opening food containers could suggest a more specific and targeted treatment goal for a school-based intervention plan or private occupational therapy than simply knowing the child scored below age expectations on a fine motor task. In addition, three children who performed similarly on a block design task would require very different treatment approaches (e.g., visual-spatial accommodations, extended time, attention/impulsivity accommodations). As such, good behavioral observations are the key to a comprehensive evaluation that can provide the most tailored treatment recommendations.

About the Author

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

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

Introducing Pediatric Neuropsychologist Sean Hyde O’Brien, Psy.D., ABPdN

By | NESCA Notes 2024

By: Jane Hauser
Director of Marketing & Outreach, NESCA

NESCA is excited to welcome Sean Hyde O’Brien, Psy.D., ABPdN, to our team, conducting evaluations in the Newton, Massachusetts office! My interview with Dr. O’Brien offers an opportunity for readers to get to know him, his professional background, experiences and expertise, and his approach to working with children, adolescents, and young adults as a pediatric neuropsychologist.

You covered a broad swath of academic, emotional, and developmental challenges in your career as a pediatric neuropsychologist. Tell us more about that.

I think I’m a good generalist as far as pediatric neuropsychology goes, covering a lot of the high-incidence disorders, like ADHD, autism spectrum disorder, and learning disorders, but there are a couple groups that I really like working with.

What are the groups of children or students you find the most interesting?

I really like kids that are on the high functioning end of the autism spectrum, so I did one of my post-doctoral years at McLean at the Center for Neurointegrative Services, which is a DOE-approved special education school for kids who used to have what was called Asperger’s Disorder, which is now part of the ASD diagnosis. I got to spend a lot of time honing my assessment skills, but also spending quality time getting to know this group of students. They have a special place in my heart.

Another area I enjoy is working with children who came from other countries and may have moved because of war, famine, or simply for better opportunities for their families. They often come to this new country, perhaps not with the best English skills, and a lot of complex developmental and psychiatric challenges. Teasing all of those components apart and helping them acclimate to a new school, culture, and world has been interesting to me.

It takes a lot of thinking on your feet from an assessment standpoint to work with this population. For example, when you evaluate a child who speaks Russian and has only been learning English for six months, you’re not going to be able to do your standard battery of tests to figure out what their cognitive functioning is like. You have to think creatively and find ways to work slightly outside the domain of standard evaluation procedures. I’ve learned so much being with them, watching, and observing them in different settings, and, of course, getting the information from multiple sources, like teachers and parents. Those kids along with those who come from other countries through adoption are the most challenging, but also probably the most rewarding to me.

My wife and I were both adopted, so I come from a family of people who know and are part of the adoption community. I did a lot of research and clinical work involving international adoption. I love working with children who are coming from China, India, Korea, or domestically and their adoptive parents who are trying to figure out how to best support them with the range of strengths and weaknesses that they might have. These are also some of the kids who stick out to me.

Why did you come to NESCA?

I was looking for a change. I’ve been a partner in a private practice that we built from scratch for about 15 years, handling all of the many aspects of running a small business and evaluating students. I felt that the operational and clinical duties became too time-consuming to have a healthy work-life balance. I decided that it was time for a recalibration that would allow me to continue to evaluate children, but not have to stress over all of the other time-consuming operational details.

Throughout my career, I’ve had many NESCA reports come across my desk. They were very well done, and the practice has an incredible reputation. I met with NESCA’s founder and I knew it was the right place. She values the same things that I value – collegiality, warmth, and child-centric care. I was looking for a place where I could do good work and do it in a way that feels good at the end of the day. I found that in NESCA.

What do you feel you can contribute to NESCA families and staff?

The feedback I received over the years is that my ability to connect with children makes me an ally to them, especially those who may be a little resistant to the process. Some kids come in and are scared or angry that they have to be there for an evaluation. I always find a way to let them know this is in their best interest. I will explain what an evaluation will do for them in the end and that I want to work with them to figure out their “operating system” to make life work better for them. Families feel that I’m warm, approachable, and just a nice guy. I make sure that the individuals I evaluate don’t see me as Dr. O’Brien – I’m just Sean, and I’m a “learning detective,” of sorts, who helps figure out what’s going on with them.

I’ve had a number of students who I’ve seen three or so times over the course of the past 15 years. They may have come to me as a struggling six- or seven-year-old and are now in college. It’s the long-term relationships and knowing that the work I did, or that we did together, changed their developmental trajectory and helped them start to feel better about themselves as a learner and/or a person. That’s the piece that keeps me loving the work that I do and feeling young, fresh, and energized. I couldn’t ask for a better job.

What are your thoughts on the field of neuropsychology overall?

We’re a field that is a mixture of art and science. We are students of the brain; not experts, and we are all still learning about how the brain works. That is continuously being questioned, refuted, and remodeled. Since I first started studying neuroanatomy, we have come so far and yet we still know so little.

We can’t become rigid or complacent in the evaluation of children, adolescents, or adults, because that will be the biggest disservice we can give to our clients. We have to always be learning and evolving. Using antiquated models, not being open to new tests or new ways of thinking about things will not help anyone. I have the feeling I will learn a lot of new, creative, proven approaches while I am at NESCA, and that is very exciting to me.

I don’t think you get that kind of ongoing learning and exposure to innovative ways of doing things in many places. Often, neuropsychologists have to go outside of their practices to get that kind of knowledge from colleagues. Having that built in here at NESCA is something I am excited about.

About the Author

Dr. Sean Hyde O’Brien has been providing comprehensive neuropsychological evaluations in the Greater Boston area since 2006. He specializes in the assessment of children and adolescents who present with a wide range of developmental conditions, such as Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder (reading, writing, math), Intellectual Disability, and Autism Spectrum Disorder; as well as children whose cognitive functioning has been impacted by medical, psychiatric, and genetic conditions. He also has extensive experience working with children who were adopted both domestically and internationally.

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

dictionary entry with the word ready and its definition

Is Your Teen Ready for College? Key Skills for a Smooth Transition

By | NESCA Notes 2024

dictionary entry with the word ready and its definition By: Kristen Simon, M.Ed, Ed.S
Transition Specialist; Psychoeducational Counselor

As the school year picks up momentum, many parents of 12^th-grade students find themselves wondering if their students will be truly ready to take the plunge into college life. Parents of younger students may also be noticing academic or social challenges and wondering how to ensure their teens are on the right path to college readiness. These are normal concerns, and they often require a closer look.

Transitioning from high school to higher education is a significant step, and it’s essential to gauge your child’s readiness to determine whether college is the right next step or if additional supports will be needed during the transition. While academic abilities that match the rigor of college are essential, there are many practical, non-academic skills that are just as vital for college success.

Below are some important academic and non-academic skills necessary for a smooth transition to higher education. Focusing on these abilities can help you assess whether a student is prepared for this new chapter.

Academic Preparedness

Engagement with coursework: Ability to read high volumes of text, think critically about the content and produce organized written work
Study habits: Prepare for assessments effectively and in a timely manner
Note-taking: Ability to take effective notes during class
Executive functioning: Track and manage assignments and grades, plan for future goals, break down long-term assignments and meet deadlines, absorb and follow multiple syllabi, manage significant free time, follow their individualized schedule

Independent Living skills

Getting up: Wake up at a designated time without parent support
Managing medications: Taking them at the appropriate time, managing refills, and tracking side effects
Self-care: An independent hygiene routine (showers, haircuts, brushing teeth) they can follow on their own
Health: Ability to treat a cold or minor illness; Can the student identify when an ailment is something more serious? Can they head to the health center independently?
Maintain a living space: Room organization, keeping up with laundry, vacuuming, taking out the trash
Maintain a basic healthy lifestyle: Nutrition choices, sleep hygiene, regular movement or exercise, coping skills

Self-determination

Disclosure: Describe their disability or diagnosis and the accommodations they require
Asking for Help: Recognize when they need help and ask for it
Self-advocacy: Advocate for accommodations with their college professor
Goal setting: Is your adolescent able to make, set, and attain realistic goals?
Self-awareness: Identify clear interests, preferences and strengths
Career Awareness: Explored career paths based on preferences and strengths; Linked potential careers to college degrees or areas of study

Social/Emotional skills

Conflict resolution: Manage social conflict
Community engagement: Find a community of peers
Self-regulation: Regulate emotions under increased stress
Teamwork: Work in a group effectively

Determining if your 12th grader is ready for college involves more than just evaluating their academic skills. Readiness looks different for every student, and knowing which of these areas your 12^th grader has not yet mastered allows for skill building prior to college as well as setting them up with some supports to bolster this area as they transition.

Resources:

Landmark College: A guide to assessing college readiness for Parents of College Bound Children with Learning disabilities or ADHD.

College Freshman and Executive Function: The Often Unexpected Demands by Dr. Sophie Bellenis.

If you are interested in taking a deeper dive into the questions and concerns around college readiness and have the opportunity to ask questions in a live Q&A to NESCA’s Transition Services experts, register today for our upcoming free webinar on November 6, 2024 at 11:00 AM ET.

Register here: https://nesca-newton.zoom.us/webinar/register/WN_VVXHZBSESCaHAksfl_5oKg

NESCA offers many services designed to help students bridge the transition from high school to college, including executive function coaching, pre-college coaching, transition planning, and neuropsychological evaluation. To learn more specifically about our coaching services, visit: https://nesca-newton.com/coaching-services/ . To schedule an appointment with one of our expert clinicians or coaches, please complete our intake at: https://nesca-newton.com/intake/ .

About the Author

Kristen Simon, M.Ed, Ed.S, has worked with transition-aged youth as a licensed School Psychologist for more than a decade. She has extensive experience working with children and adolescents with a range of learning and social/emotional abilities. Kristen’s strengths lie in her communication and advocacy skills as well as her strengths-based approach. She is passionate about developing students’ self-awareness, goal-setting abilities, and vision through student-centered counseling, psychoeducation, social skills instruction, and executive functioning coaching. Mrs. Simon has particular interests working with children and adolescents on the Autism spectrum as well as individuals working to manage stress or anxiety-related challenges.

Mrs. Simon is an expert evaluator and observer who has extensive working knowledge of the special education process and school-based special education services, particularly in Massachusetts. She has been an integral part of hundreds of IEP teams and has helped to coordinate care, develop goals, and guide students and their families through the transition planning process. Mrs. Simon further has special expertise helping students to learn about their diagnoses and testing and the IEP process in general. She enjoys assisting students, families, and educators in understanding a student’s disability-related needs as well as the strategies that can help the student to be successful in both academic and nonacademic settings. Mrs. Simon has often been a part of teams in the years when students are initially participating in transition services, and she has helped countless students to build the skills necessary to be part of their first team meetings. She is committed to teaching students—as well as parents and educators—how to participate in student-centered team meetings and the IEP processes.

At NESCA, Mrs. Simon works as a transition specialist and psychoeducational counselor. She works with adolescents, their families, and their school communities to identify and build the skills necessary to achieve their postsecondary goals. Mrs. Simon provides transition assessment (including testing, functional evaluations, and observations), program observations and evaluations, case management and consultation, and individualized counseling and skills coaching.

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

Individualized Education program written on blocks, IEP Symbol

Guide to Transition Planning and the New Massachusetts IEP

By | NESCA Notes 2024

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

Transition planning has long been a critical component of special education, mandated by the Individuals with Disabilities Education Act of 2004 (IDEA 2004). Its purpose is to prepare students for life beyond high school in the areas of postsecondary education and/or training, employment, and independent living. While federal law requires transition services to begin at age 16, Massachusetts has gone a step further, requiring that postsecondary goals and transition services be included in a student’s individualized education program (IEP) by age 14.

However, the previous Massachusetts IEP format made it difficult to effectively integrate transition planning. Even with the introduction of a Transition Planning Form (TPF) to facilitate discussions, there was no consistent practice for embedding contents of the TPF into the IEP itself. As a result, much of the transition planning that was included ended up in the “additional information” section, limiting its visibility and coherence within the broader IEP process.

After over a decade of development, the Massachusetts Department of Elementary and Secondary Education (DESE) released a new IEP document last school year, which all districts are required to adopt during the 2024-2025 academic year. One of the most promising features of this new IEP is its heightened emphasis on transition planning, now driven more clearly by the student’s vision and voice. Notably, the new format embeds transition planning directly into the structure of the IEP, making transition assessments a more visible and integral part of the process. While the legal requirements for transition planning remain unchanged, the new IEP format makes it easier to document these critical steps, ensuring that important aspects of transition planning are not overlooked.

So, what’s important to know about transition planning in the New MA IEP?

Student Voice and Vision are Up Front
One of the most significant improvements in the new IEP is its emphasis on the student’s voice and future vision. The “concerns” section is clearly labeled Student and Parent Concerns, empowering students to express what they want out of their IEP process. This is immediately followed by the Student and Team Vision, placing the student’s aspirations firmly at the center of the IEP process. Students ages 3-13 are encouraged to participate in visioning, fostering earlier goal setting, and encouraging teams to think explicitly about the student’s goals at younger ages. For students who will be ages 14-22, the IEP now more explicitly asks for the student’s postsecondary goals in key planning areas: education and/or training, employment, and independent living. This focus ensures that the IEP reflects the student’s ambitions and drives a more outcome-oriented process for postsecondary success.

Disability Categories are Transparent
The new IEP introduces a more transparent Student Profile section, where teams no longer need to select one “primary” disability category, making a student’s full profile more visible to all team members. While students can participate in the IEP process without fully understanding their disabilities, they can be more fully engaged if they know that they have one or more disabilities as defined by IDEA. Learning to disclose their disability and understand how it affects their learning, work, and daily life is a critical component of the transition process, empowering students to self-advocate and seek the supports they need. The transparency in the new IEP can help students gain a clearer understanding of the connection between their disabilities, their disability-related needs, and the accommodations and services they receive. Although transition-aged students are not required to participate in all aspects of their IEP, they must be invited when transition planning is discussed. Research shows that students who learn to lead their team meetings and self-advocate regarding their disabilities experience more success when transitioning to adulthood. This revision to the IEP offers a more balanced view of how multiple disabilities shape a student’s overall profile and enhances transparency in disability disclosure.

Assistive Technology as a Critical Component of the Student Profile
Assistive technology (AT) plays a vital role in helping students build independence and reduce reliance on prompting and support from adults or paid providers. The new IEP appropriately increases the visibility of assistive technology within the Student Profile. Whether used to support communication, mobility, learning, daily living skills, or work-related tasks, assistive technology empowers students to succeed both in school and in adulthood. The updated IEP format requires teams to specify whether these needs will be addressed through accommodations/modifications, goals/objectives, the service delivery grid, or another method, as documented in the Additional Information section. By thoroughly considering and documenting a student’s assistive technology needs, the IEP ensures students have access to the tools they need for greater independence and long-term success—a critical step in transition planning.

Life Skills and Self-Determination Can Be Explicitly Included at Early Ages
The new IEP organizes a student’s present levels of performance into four main areas—Academics, Behavior/Social/Emotional, Communication, and Additional Areas, including “activities of daily living.” Even before age 14, teams now have more explicit opportunities to describe strengths and needs in a broad range of areas that impact transition planning. Many students with disabilities require earlier planning and support to build independence in areas like personal care, home living, and community integration. When skill development takes longer, being thoughtful about life skills instruction, parent training, referrals to community resources, and assistive technology is crucial at earlier ages. While not explicitly in the document, the new format also provides an opportunity for teams to evaluate self-determination skills at younger ages. Self-determination—encompassing self-awareness, self-advocacy, self-efficacy, choice-making, decision-making, goal setting, and self-regulation—is one of the strongest predictors of successful transition to adulthood. Current performance with these skills can be addressed across various categories (Academics, Social, Communication) or as a key “Additional Area.”

Current Performance Levels for Transition Services are Built-in
A major improvement in the new IEP is the explicit integration of transition assessment data and transition services within the IEP itself. For students turning 14 to 22, the IEP now includes a dedicated postsecondary transition planning section, which can also be used earlier if the team determines transition planning should start sooner. This section starts with documentation of the student’s current performance, strengths, preferences, interests, and disability-related needs in each postsecondary planning area—education/training, employment, and community experiences/postschool independent living. All of this documentation is informed by transition assessment data. Teams will also specify whether accommodations/modifications, goals/objectives, services, or other activities—documented in Additional Information—are needed to support the student’s transition planning. This ensures that all team members know exactly where to find details on how transition services will be implemented. As a caveat, all skills developed through special education support transition planning; thus, all general content in the IEP is relevant. Teams can confidently reference other parts of the IEP when completing the Postsecondary Transition Planning section to avoid unnecessary duplication of content.

Course of Study and Projected Graduation/Exit Date are Centrally Documented
Federal law has always required teams to identify a “course of study” that aligns with the student’s postsecondary goals, but there was no obvious place to include this in the old IEP. The course of study—a semester-by-semester plan of the classes the student will take—is a critical part of transition planning. For instance, a student aspiring to become a doctor will likely need lab science and advanced mathematics in high school. The new IEP provides places for teams to document the student’s course of study, the anticipated type of completion document (diploma, certificate of attainment, etc.), the student’s expected graduation date, and the student’s progress toward meeting exit requirements. This information is essential for monitoring and informing transition planning and creates a clearer link between the student’s transcript and progress toward their individualized postsecondary goals.

Transfer of Rights and Decision-Making
Adult decision-making is a significant milestone, and the new IEP emphasizes discussing the Transfer of Rights at least a year before the student turns 18. The IEP now includes designated space to document when both the student and family have been provided notice of this transfer and a copy of procedural safeguards. In addition, the new IEP encourages teams to discuss and document the student’s Decision-Making Options for adulthood. Although this is a requirement once the student turns 18, its more visible presence in the IEP encourages earlier conversations. This is crucial, because preparing for adulthood may require putting legal, educational, medical, and financial decision-making frameworks in place—processes that can take time to complete.

Community and Interagency Connections
Transition planning takes a village, and a central part of effective planning is to build a supportive network that extends beyond the protections of special education. The new IEP includes a dedicated section for community and interagency connections, ensuring that teams discuss and document connections to community partners (such as independent living centers, job centers, pre-employment transition service providers, etc.) that are supporting the student. Additionally, the IEP incorporates prompts to ensure timely referrals to adult service agencies well before the student’s exit. In Massachusetts, Chapter 688 Referrals—referrals to adult human services to engage in transition planning for students who will need continued support—must be completed at least two years before the student’s expected exit from special education. The new IEP provides even more guidance to ensure that teams can make and document these referrals on time.

Final Thoughts

The new Massachusetts DESE IEP represents a significant advancement in integrating transition planning into the IEP process. As teams implement the new IEP, prioritizing adequate transition assessments will be crucial, as effective transition planning relies on thorough assessment processes that reflect each student’s strengths, needs, and aspirations for the future. The law requires the use of age-appropriate assessments to identify the student’s strengths, interests, preferences, disability-related needs, and, most of all, their postsecondary goals. Involving diverse voices, such as guidance counselors, is also essential for ensuring a seamless connection between a student’s course of study and postsecondary goals. While the law has not changed, the new IEP makes transition planning more transparent. More importantly, it places the student’s vision and voice at the forefront of the process.

Additional Resources

Download Massachusetts IEP Form and Related Resources including the Transition Planning with the New IEP Quick Reference Guide and Discussion Questions to Get Ready for My Yearly IEP Meeting at https://www.doe.mass.edu/sped/improveiep/
Learn more about the specific language in the IDEA regulations that relate to important transition topics at https://www.pacer.org/transition/learning-center/laws/idea.asp
Explore NESCA Video Resources including webinars on transition planning, postsecondary learning and training options, fostering self-awareness and self-advocacy and more at https://nesca-newton.com/video-resources/
Learn about NESCA Transition Service offerings for students, schools, and families at https://nesca-newton.com/transition/

To download a PDF-Version of this Guide, visit https://nesca-newton.com/wp-content/uploads/2024/10/Guide-to-Transition-Planning-and-the-New-MA-IEP.pdf

About the Author
Kelley Challen, Ed.M., CAS, is an expert transition specialist and national speaker with over 20 years of experience supporting youth and Kelley Challen headshot young adults with diverse developmental and learning abilities. Since 2013, she has served as Director of Transition Services at NESCA, offering individualized transition assessments, planning, consultation, coaching, and program development. She specializes in working with students with complex profiles who may not engage with traditional testing tools or programs. Ms. Challen holds a BA in Psychology and a Minor in Hispanic Studies from The College of William and Mary, along with a Master’s and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard Graduate School of Education. She is a member of CEC, DCDT, and COPAA, believing it’s vital for all IEP participants to have accurate information about transition planning. Ms. Challen has also been actively involved in the MA DESE IEP Improvement Project, mentored candidates in UMass Boston’s Transition Leadership Program, and co-authored a chapter in Technology Tools for Students with Autism.

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

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; the greater Burlington, Vermont region; and Brooklyn, NY (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.

an image of a child thinking about how different each side of his brain is, used to describe the difference in functioning between both sides when nonverbal learning disability is present

What is a Nonverbal Learning Disability?

By | NESCA Notes 2024

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; Londonderry, NH Director, NESCA

At August’s Democratic National Convention, Gus Walz, the teenage son of Democratic Vice Presidential nominee Tim Walz and his wife Gwen, melted hearts throughout the country with his outward show of emotions upon his father’s nomination. He exhibited deep love and pride for his dad in that moment. His tearful cheers evoked a sense of tenderness among many, confusion for others, and, sadly, public mockery, as well. At that time, many people were unaware that Gus carries the diagnosis of Nonverbal Learning Disability (NLD or NVLD) – a cognitive processing profile that often impacts emotion regulation and social cognition; however, his family’s openness about his condition has brought new attention to this profile.

There is often lack of awareness or confusion about what a NLD is. While NLD has been long-discussed in the neuropsychological and educational world, it has not been formally recognized by the medical field due to variability within individual profiles and lack of clarity on its causal factors. While this is so, there is a very clear pattern that is noted through the neuropsychological evaluation process. And most importantly, there is a breadth of interventions and supports to address NLD-related challenges, highlighting the importance of identifying and understanding this profile in children.

By definition, NLD is a relative strength in left-brain skills, which are largely verbal, and weakness in right-brain nonverbal skills. As such, to understand NLD, it is important to understand the right hemisphere of the brain.

The right side of the brain is responsible for the collection and integration of multiple sources of information, particularly sensory information, lending to an organized “big picture” understanding of events or information. The right brain is thus not only important for basic visual processing and reasoning, but it is also responsible for the organization and coordination of information and skills across a wide range of domains, including learning, motor coordination, self-regulation (e.g. sensory regulation and attention), social thinking, and task management. As such, the word learning within the “Nonverbal Learning Disability” title is somewhat of a misnomer, as NLD can impact functioning across most any domain.

It is important to understand that NLD is a relative deficit, meaning that it is a personal weakness. Some individuals with NLD may have nonverbal skills that are all technically “average or better,” but they are still discrepant from that person’s strong verbal skills, causing variability within the profile.

Because many students with NLD have strong verbal reasoning, processing, and memory skills, they are often able to compensate and fly under the radar for some time. However, their over-reliance on verbal skills and rote learning tend to become less effective once they are tasked with the abstract demands of middle and high school. As such, while some individuals with NLD may be identified at a young age, others may not be flagged until much later.

As already stated, although NLD profiles can vary significantly, there are fairly predictable patterns that allow for its accurate identification, namely within the following areas:

Visual Reasoning – On structured intellectual assessment, individuals with NLD demonstrate a significant difference between their verbal and visually-based reasoning, with verbal being better. The Wechsler Intelligence Scale for Children, which is currently in its fifth edition and is the most commonly used intellectual test for children, contains two domains of visually-based reasoning. One is the Visual Spatial index, which contains more concrete puzzle-like tasks, and the Fluid Reasoning index, which assesses abstract pattern recognition. At times individuals with NLD struggle with both domains, while other times they may only demonstrate impairment within one. Because there are many factors that can contribute to challenges within either one of these visual domains, a proper NLD diagnosis can only be made through collection of a thorough history, direction observation, and the assessment of other associated challenges, detailed below.

Visual Processing and Perception – In spite of having perfectly fine vision, individuals with NLD have difficulty managing visual input. This may include problems with tracking lines while reading, difficulty discerning visual details (e.g. differentiating math or letter symbols, recognizing errors when editing their writing, misreading graphs and charts, etc.), or difficulty creating mental imagery (i.e. “seeing” and holding information in one’s head).

Motor Integration – Individuals with NLD demonstrate some level of motor integration or coordination difficulties. This may involve fine motor skills (e.g. poor handwriting and spacing on the page, difficulty tying shoes and using utensils, etc.), gross motor skills (e.g. clumsiness, awkwardness when running, poor hand-eye coordination, etc.), or both. Most often, individuals with NLD have appropriate motor strength, but they struggle to appropriately integrate and manage their movements within space and present demands. This may also correspond to difficulties with directionality and finding their way around, causing them to get lost easily.

Social Skills – Individuals with NLD most often meet early social milestones without any concern. In fact, some individuals with NLD may demonstrate early verbal precociousness that gives the appearance of advanced social engagement, which is aided by the fact that individuals with NLD generally possess appropriate foundational pragmatic skills, particularly when one-on-one or with adults. However, as these children grow older, they continue to over-rely on verbal language and miss out on nonverbal language (e.g. body signals) and context clues. As such, children with NLD may misperceive or misinterpret situations or interactions, or they may become overwhelmed by the complexity of typical peer interactions, causing them to withdraw. Often times, individuals with NLD know what they “should do” socially, but they struggle to actually generalize those skills to interactions.

Executive Functioning – Executive functioning refers to a complex set of skills that are responsible for an individual’s ability to engage in goal-directed behavior. This includes skills necessary for self-regulation, such as impulse control, attentional management, and emotional control, as well as skills for task management and cognitive regulation, such as organizing materials, creating a plan, starting a task and sustaining effort, prioritizing and organizing ideas, holding information in memory, etc. Individuals with NLD likely have some executive function strengths, particularly when they can rely on their verbal strengths; however, they are likely to demonstrate significant challenges with the executive function skills that rely on “big picture awareness,” such as organization, integration, planning, prioritizing, time management, and self-monitoring. Individuals with NLD are detail-focused – they often miss the forest for the trees. For some, they compensate by redoing work and over-exerting their efforts, eventually achieving a semblance of desired outcomes at the cost of time and energy; others may produce work that misses the main point of the task or demonstrates a lack of understanding; and others may just become overwhelmed and give up, appearing to lack “motivation.”

Learning – With the above profile, individuals with NLD tend to rely on rote learning, as they do well with concrete repetition of verbal information. However, they may have difficulty flexibly applying this knowledge, and they are likely to struggle with tasks that require more abstract, “big picture” thinking. Parents and teachers of individuals with NLD often report frustration because problems with information retrieval, pattern recognition, and generalization of skills can result in these individuals making the same mistakes over and over again, not seeming to learn from their errors.

Due to the above learning challenges, children with NLD often struggle with math reasoning, doing best with rote calculations than application of knowledge. Challenges with reading comprehension and written expression are also common, as they not only struggle to see the main idea and integrate information, but they also struggle to “see” the images or story in their head. For younger children with NLD, problems with mental imagery may be mistaken for a reading disability, such as dyslexia, due to difficulties holding, appreciating, and learning letters, numbers, and sight words.

Other Associated Challenges – Because the right hemisphere of the brain coordinates and manages sensory input and complexity, individuals with NLD are at higher risk for challenges with self-regulation. This may include sensory sensitivities, variable attention, or difficulties with emotion regulation. As such, those with NLD may demonstrate heightened anxiety or emotional reactivity that is only further-challenged by the complexity of their learning profile. Because of this, individuals with NLD often rely on a rigid, predictable routine. There is a high rate of comorbid, or co-occurring, diagnoses in individuals with NLD, including things such as ADHD, anxiety disorders, specific learning disabilities, and potentially autism spectrum disorder. Because of this, it is important to have a comprehensive understanding of each individual’s profile before devising their intervention plan.

What do we do to support individuals with NLD?

The supports set into place can be widely variable depending on the individual child’s profile. Some of the most common recommendations include social skills interventions that target “higher level” skills, such as social perspective taking and problem solving; executive function instruction that aims to teach task management skills, develop “big picture” thinking, and generalize skills across tasks and settings; academic remediation for any specific domain of impairment, potentially including math reasoning, reading comprehension, or written expression; and occupational therapy services to develop skills, such as handwriting and/or keyboarding, visual processing, and motor coordination.

It is important to understand that individuals with NLD struggle with abstraction, so concrete, explicit instruction, with frequent repetition, is often key. This not only applies to academic instruction, but also therapy or instruction in daily living skills at home. Things need to be rehearsed “in real time,” as there needs to be a plan for how to ensure skills translate to life.

Self-advocacy most often needs to be directly taught by first increasing self-awareness, as it may be difficult for individuals with NLD to recognize the patterns within their challenges or self-monitor when support may be needed.

There are many useful resources for further understanding ways to support individuals with NLD. One comprehensive resource is the NVLD Project (https://nvld.org/), a nonprofit organization that conducts research, offers educational workshops and community outreach, and has an extensive list of NLD-related resources for parents, clients, and schools.

Because NLD profiles can be variable, complex, and clouded by co-occurring challenges, a thorough neuropsychological evaluation can be a critical step toward fully understanding an individual child’s needs and thinking about how they will be best supported not just in school, but also in their day to day life. Should you require support in navigating such needs for a child, teen, or young adult in your life, more information about NESCA’s neuropsychological evaluations and team of evaluators is available at www.nesca-newton.com.

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. 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.

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

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