Tag

psychological testing

Understanding Empathy

By | NESCA Notes 2020

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Our children are growing up in a social environment that is too often flavored by fear; fear of inexplicable violence, fear of people who look different than us, whose politics are contrary to what we hold dear, people who seem to despise us as much as we discount them. At the same time, we are realizing that in order to help our children learn, we must pay attention to their emotional and social states as well as their intellectual development.

In the context of these paradoxes, the concept of empathy has become a topic of considerable interest. The fact of the matter is that empathy may be at play in the divisiveness of our communities as well as in the efforts to include all children in our schools. Empathy is critical in forming close and supportive relationships, but at the same time, it is also responsible for a built-in bias toward people with whom one feels a connection. Further, being empathetic towards others does not ensure that one will follow that feeling of concern with acts of kindness. Finally, too much empathy for those in pain is very painful and can cause the empathizer to pull back or avoid the situation or person  in order to protect themselves. The research of the past 15 years has deepened our understanding of empathy and has helped to explain some of these contradictions. In an article in the Scientific American (December 13, 2017), Science Writer Lydia Denworth summarized the general consensus of the scientific community to describe three different but interactive aspects of empathy:

  • Emotional empathy refers to the experience of sharing one’s feelings and matching that person’s behavioral states; for example, feeling afraid when watching a movie in which someone is being attacked by a lion. This form of empathy is a biological response that is seen in a variety of animals as well as children as young as one year old.
  • Cognitive empathy is the capacity to think about and understand other people’s feelings. It is often referred to as perspective taking or theory of mind. While aspects of this ability can be seen in very young children, it is not fully developed until adulthood.
  • Empathetic concern, or compassion is the feeling of concern that motivates one to help in some way. This capacity can also be seen in young children.

True empathy requires the engagement of all three capacities. Consider, for instance, the experience of many people on the Autism Spectrum. They may be fully capable of feeling emotional empathy; in fact, they are often overwhelmed by the sharing of pain. However, they struggle with the cognitive task of  perspective taking, or appreciating that the other person may not see things in the same way that they do. On the other hand, people with antisocial tendencies may be very good at understanding how someone feels, but do not have any interest in helping them. Finally, it is extremely difficult for people who live in a homogeneous cultural area to be able to extend the same kind of care and consideration to others who look and sound different and whose views may run counter to their own.

Gwen DeWar is a biological anthropologist who edits the Parenting Science website. In one of her articles, she describes 10 steps parents can take to encourage the development of empathy in their children. These include tasks such as, providing the support needed to develop strong self-regulation skills, the modeling of empathic behavior, the avoidance of reward or punishment in favor of thinking through the impact of one’s actions on others, the fostering of cognitive empathy through literature and role-playing, and the education of children to avoid the “empathy gap” that occurs when people forget what it is like to be in the grip of pain, discomfort or fear. It is worth reading.

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

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

When No One Looks Like Me

By | NESCA Notes 2020

By:  Stephanie Monaghan-Blout, Psy.D.

Coordinator of Therapy Services; Trauma-informed Therapist; Pediatric Neuropsychologist

We form our sense of identity by “trying on” aspects of other people to see how their ideas, tastes and values “fit,” keeping those things that seem to resonate and discarding those that don’t. We find those models for identification in our families, schools and community. We also find those sources in the books we read, the news we catch and the movies we see – the larger community in which we live. This larger community offers many models who may offer something that resonates with us.

This process of identification is complicated in adoptive children whose connection to their families is through relation and not genes. The challenges are even more torturous when those issues are coupled with the “othering” that occurs when a child does not fit into the American standard of being white. In my neuropsychological practice assessing adoptive children, my own little bubble of white privilege has been pricked many times by a child saying, sometimes to me or sometimes through their parent, that “no one looks like me.” The loneliness of this statement is palpable, but the cost goes beyond to indicate impediments to the healthy development of identity, which includes that of racial identity.

In an article for Time Magazine written by the parent of a transracially adopted child and with the help of adoptees and their parents, the following four “comforting but dangerous” myths about race and difference were identified:

Myth 1: Color doesn’t matter. Oh, but it does; just ask the child who has been called the “N” word or the one who is assumed to be a math whiz because they are Asian. Adopted children who are raised by a Caucasian family and in a Caucasian community will tend to think of themselves as white – sort of – until they hit the wall of the way others perceive them. People have expectations about others based on race and ethnicity and insisting that people “should” be colorblind is ignoring reality. It leaves no room for the child to ask questions about what makes them the person that they are and prevents the parent from giving them what they most need – a caring listener when they are hurt or confused.

Myth 2: If I talk to my kids about race, I’m just creating an issue. As parents, we cannot protect our children from the verbal and physical assaults of others, but we can prepare them for how to handle it if it happens. One adoptee and current adoption advocate asks parents if they would not teach their children how to safely cross a street because they may become frightened of being hit by a car. This includes having “the talk” with our African American boys about how to handle themselves with police officers and other authority figures.

Myth 3: No matter what, a “good” school is best for my child. This is the source of the “No one looks like me” plaint of many of my clients but it is the toughest of all myths to unpack for most white parents to whom education has been touted as pretty much the solution for everything. A “good school” may be the one with high test scores and good real estate value, but it is unlikely to be the school with a diverse student and teacher population that could provide a non-white child with a rich source of role models and narratives to use in the development of their own identity. Other sources of identification include churches, community groups and cultural organizations, such as language schools and adoptive family groups. Lacking these sources, the child’s options for racial identity are determined by those who know nothing about their culture.

Myth 4: You are the hero of your child’s story. As someone who has heard many terrible and tragic origin stories and stood in awe of the efforts adoptive parents have made to help their children, I have often been guilty of encouraging this kind of thinking without considering the consequence to the child who has been rescued. The burden of “forced gratitude” is emotionally crippling and prevents the child from asking questions about their biological parents or fantasizing (in the way that all children do) about what it would have been like to be in a different family. Conversely, the concept of “saving” a child feeds into the parental fantasy that if we just love our child enough and do all the right things, we can protect them from being hurt by the loss of adoption and the ugly reality of racism. This is also an ultimately futile effort. As Martha Crawford, psychotherapist and mother of two transracially adopted children, stated, “An adoptive parent’s job is to be a sturdy scaffold for kids to do their own work, not to tell them how to construct their own identities.”

 

About the Author:

Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. She specializes in the neuropsychological and psychological assessment of children and adolescents with complex learning and emotional issues and enjoys consulting to schools on these issues. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing therapeutic services, providing therapy and psychoeducational counseling and, in the time of the COVID-19 crisis, providing teletherapy to parents and teens.

In her early career as an adolescent and family therapist, Dr. Monaghan-Blout became very interested in the needs of those contending with traumatic experiences. She brought that interest to her work as a pediatric neuropsychologist and continues to be passionate about treating this population. She has developed an expertise in working with adoptive children and others who have experienced early trauma. She is a longtime member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic and presents nationally and regionally on assessment and treatment of children with complex/developmental trauma.

Dr. Monaghan-Blout graduated from Bowdoin College and received a Master’s Degree in Counselor Education from Boston University. She obtained her Doctorate in Clinical Psychology from Antioch New England Graduate School with a dissertation entitled, “A Different Kind of Parent; Resisting the Intergenerational Legacy of Maltreatment.” She completed an internship in pediatric neuropsychology and child psychology at North Shore University Hospital in New York, and a postdoctoral fellowship at HealthSouth/Braintree Rehabilitation Hospital.

She joined Dr. Ann Helmus at Children’s Evaluation Center in 2003, and again at NESCA in 2007. A member of the Massachusetts Neuropsychological Society Board of Directors from 2010 – 2013 and from 2014-2017, Dr. Monaghan-Blout served in many capacities, including as President. Dr. Monaghan-Blout is the mother and stepmother of four children and the grandmother of six. She is also an avid ice hockey player, cook, gardener and devotee of urban fantasy.

 

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

Let’s Stop Trash-talking Stress and Anxiety-Part 1

By | NESCA Notes 2020

By:  Stephanie Monaghan-Blout, Psy.D.

Coordinator of Therapy Services; Trauma-informed Therapist

Stress and anxiety have gotten a really bad name in our society. Just ask kids – it is a question we sometimes pose to our clients during testing, and the answers we get usually run along the lines of, “Are you kidding? There’s nothing good about stress!”. So, let’s talk about the purpose of stress, how it functions, and what we can do to manage it.

From a scientific viewpoint, stress is a challenge or stimulus to DO SOMETHING when certain circumstances arise – specifically, when danger is detected. Let’s make this easy – what would your body need to do if a tiger showed up? Let’s start with upping your heart rate and breathing faster to get oxygen into your blood so that you are able to move quickly, and then let’s send some fuel (glucose) to your muscles for strength. This is the process that happens when some kind of danger is sensed – the brain sends down orders to the body that diverts resources to the systems that help us escape from the tiger (fight, flight or freeze) while diverting resources from systems that are less important at that time (rest, digest and think). When the danger is over, the focus changes; our fear response is dampened, our heart rate and breathing slow down and those other systems come back online to get our bodies back to normal.

The feedback between these two systems of getting us prepared for danger (activation of the sympathetic nervous system) and calming down after the event has passed (activation of the parasympathetic nervous system) remain important, even when tigers are no longer a concern. Remember that stress is a stimulus to do something in the face of fear or danger. A little stress in our daily lives helps us get things done, like studying for that big test. It is also adaptive to be anxious at a time like now, when our whole world is under the threat of the COVID-19 virus. There’s lots to be worried about, and this stress can help us remember to take precautions like staying home and keeping physical distance. We’ll get back to this.

But what happens if the threat is more immediate, the danger sensor is too sensitive and/or the body never gets a chance to calm down? In this situation, the person remains activated, looking for danger and ready to respond, even when it is not appropriate or even against their best interests. Remember, during these times of perceived danger, the child does not have access to higher-level cognitive processes, like thinking flexibly, problem solving or even access to language. At these times of high stress, they are not available for learning. Asking a child to “talk about it” or even tell you what the problem is can be beyond their capacity at the time and will only add to their stress. This is the situation in school encountered by many children with learning issues, emotional concerns, autism or other neurodevelopmental disorders. They may find the academic, organizational and social demands of school to be so threatening that their danger alert is set off and only gets the chance to reset when school is finished.

So, what does the overly stressed child look like and how can we help? This is going to be the challenging part, because you are going to be asked to look at common behaviors in a different way. Let’s go back to the Fight-Flight-Freeze responses. Most of us tend to prefer one of these, though we will use all three depending on the situation.

Fight – This version of the response involves active resistance to the threat, but in the classroom or the dinner table, it more likely takes the shape of being argumentative, noncompliant and defiant (“You can’t make me!”).

Flight – This version is characterized by avoidance or getting away from the threat. This could mean needing to go the bathroom, see the school nurse or suddenly remembering that very important pen in their cubby that they absolutely have to have at that moment. However, it could also mean leaving mentally (“spacing out”).

Freeze – This version involves immobilization strategies, like wild animals who “freeze” so as not to attract the attention of a predator. In children, these behaviors are more subtle; they manifest as problems with getting started, switching from one thing to another and/or stopping. Oftentimes these kids are described as “shutting down,” but it is more accurate to describe them as “stuck.”

How do we help our kids get out of this stress response?

Remember, stress is a response to the perception of danger, and anxiety is the feeling of being helpless and out of control.

What “turns off” the threat alert and allows us to feel more capable and ready to try? The perception of being safe. When children feel safe, they can focus and concentrate on the task at hand. They can think and problem solve. And, they are more aware of others and what they are saying and doing.

How do we help our children feel safe and capable of tackling a challenge? Say a child doesn’t like math and does everything to avoid doing their homework. Which of these three approaches would make them feel more safe and ready to give it a try?

  • “Stop acting like a baby and just get that math done. It’s only 10 problems! Don’t even think of playing any video games tonight.”
  • “You poor thing. I know you are bad at math and it’s mean that your teacher is making     you work so hard. I’m going to write to her and tell her you can’t do that much.”
  • “Wow, you really don’t like to do your math homework, do you? That’s hard! Tell you what, I’ll help you with the first two and when you are done with the rest, we’ll play a game together!”

Notice that in the last example, the parent started with validating the child’s feelings, or just recognizing what the child’s emotional experience is like at the moment – not the same as agreeing with him or her. The second thing s/he did was to offer some help, and the third was to offer a fun activity to help the child feel calmer and more connected.

What if the child is really upset and can’t switch gears to start working? Just change the order of the events. Validate feelings, offer a calming and connecting activity and offer some help to get back to work. The calming/connecting activity doesn’t have to be a game – it just needs to be something they makes the child feel cared for and gives them something else to think about, like a cup of tea or a special cookie.

But what if the stress and anxiety is related to something that is bigger than math homework and can’t be easily fixed with a cup of tea and some extra help with those fractions? What if it is something that is out of the parent’s control, like the COVID pandemic? Again, the way to “turn off” the threat alert in our children’s brains is to help them feel safe and to have some control over what is happening to them. How do we do that? Validate their feelings makes them feel heard. Answering their questions (but sticking to their concerns) will tell you what they are really worried about and allow you to correct misperceptions and reassure them. Calming and connecting activities are still really important. Finally, helping them feel more in control by being able to do something to help. Utilize a child’s skills and interests in finding ways for them to help. If your child likes to draw, have them make pictures for family, friends and neighbors. Do you have a budding computer whiz? Help them make a zoom video of their classmates saying hi to their teacher. Is your child someone who loves people and isn’t shy? Have them call grandparents and older neighbors who may not be able to leave their houses. Equally importantly, remind them that they can help others by following the guidelines of washing their hands, keeping physical distance and, as hard as it is, staying home.

In a follow-on blog, we’ll discuss how to build resilience in children.

 

About the Author:

Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. She specializes in the neuropsychological and psychological assessment of children and adolescents with complex learning and emotional issues and enjoys consulting to schools on these issues. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing therapeutic services, providing therapy and psychoeducational counseling and, in the time of the COVID-19 crisis, providing teletherapy to parents and teens.

In her early career as an adolescent and family therapist, Dr. Monaghan-Blout became very interested in the needs of those contending with traumatic experiences. She brought that interest to her work as a pediatric neuropsychologist and continues to be passionate about treating this population. She has developed an expertise in working with adoptive children and others who have experienced early trauma. She is a longtime member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic and presents nationally and regionally on assessment and treatment of children with complex/developmental trauma.

Dr. Monaghan-Blout graduated from Bowdoin College and received a Master’s Degree in Counselor Education from Boston University. She obtained her Doctorate in Clinical Psychology from Antioch New England Graduate School with a dissertation entitled, “A Different Kind of Parent; Resisting the Intergenerational Legacy of Maltreatment.” She completed an internship in pediatric neuropsychology and child psychology at North Shore University Hospital in New York, and a postdoctoral fellowship at HealthSouth/Braintree Rehabilitation Hospital.

She joined Dr. Ann Helmus at Children’s Evaluation Center in 2003, and again at NESCA in 2007. A member of the Massachusetts Neuropsychological Society Board of Directors from 2010 – 2013 and from 2014-2017, Dr. Monaghan-Blout served in many capacities, including as President. Dr. Monaghan-Blout is the mother and stepmother of four children and the grandmother of six. She is also an avid ice hockey player, cook, gardener and devotee of urban fantasy.

 

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

Understanding Empathy

By | NESCA Notes 2019

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Our children are growing up in a social environment that is too often flavored by fear; fear of inexplicable violence, fear of people who look different than us, whose politics are contrary to what we hold dear, people who seem to despise us as much as we discount them. At the same time, we are realizing that in order to help our children learn, we must pay attention to their emotional and social states as well as their intellectual development.

In the context of these paradoxes, the concept of empathy has become a topic of considerable interest. The fact of the matter is that empathy may be at play in the divisiveness of our communities as well as in the efforts to include all children in our schools. Empathy is critical in forming close and supportive relationships, but at the same time, it is also responsible for a built-in bias toward people with whom one feels a connection. Further, being empathetic towards others does not ensure that one will follow that feeling of concern with acts of kindness. Finally, too much empathy for those in pain is very painful and can cause the empathizer to pull back or avoid the situation or person  in order to protect themselves. The research of the past 15 years has deepened our understanding of empathy and has helped to explain some of these contradictions. In an article in the Scientific American (December 13, 2017), Science Writer Lydia Denworth summarized the general consensus of the scientific community to describe three different but interactive aspects of empathy:

  • Emotional empathy refers to the experience of sharing one’s feelings and matching that person’s behavioral states; for example, feeling afraid when watching a movie in which someone is being attacked by a lion. This form of empathy is a biological response that is seen in a variety of animals as well as children as young as one year old.
  • Cognitive empathy is the capacity to think about and understand other people’s feelings. It is often referred to as perspective taking or theory of mind. While aspects of this ability can be seen in very young children, it is not fully developed until adulthood.
  • Empathetic concern, or compassion is the feeling of concern that motivates one to help in some way. This capacity can also be seen in young children.

True empathy requires the engagement of all three capacities. Consider, for instance, the experience of many people on the Autism Spectrum. They may be fully capable of feeling emotional empathy; in fact, they are often overwhelmed by the sharing of pain. However, they struggle with the cognitive task of  perspective taking, or appreciating that the other person may not see things in the same way that they do. On the other hand, people with antisocial tendencies may be very good at understanding how someone feels, but do not have any interest in helping them. Finally, it is extremely difficult for people who live in a homogeneous cultural area to be able to extend the same kind of care and consideration to others who look and sound different and whose views may run counter to their own.

Gwen DeWar is a biological anthropologist who edits the Parenting Science website. In one of her articles, she describes 10 steps parents can take to encourage the development of empathy in their children. These include tasks such as, providing the support needed to develop strong self-regulation skills, the modeling of empathic behavior, the avoidance of reward or punishment in favor of thinking through the impact of one’s actions on others, the fostering of cognitive empathy through literature and role-playing, and the education of children to avoid the “empathy gap” that occurs when people forget what it is like to be in the grip of pain, discomfort or fear. It is worth reading.

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

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

Epigenetics—Redefining Nature and Nurture

By | NESCA Notes 2019

 

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

Parents often wonder why their children are contending with learning problems or attentional issues, or suffer from emotional difficulties, and if they could have done something different in their parenting to have spared their child. Alternatively, they assume their own genes are condemning their child to these difficulties and challenges. This is the nature-nurture debate, but beyond contributing to parental sleepless nights, this either-or construction is overly simplistic—and overly deterministic. A  better way to think about this problem is provided by the study of epigenetics, or the  interaction between genetics and environment (genetics x environment).

The word “epigenetic” refers to  any process that alters gene activity (“turning on“ or “turning off” genes) without changing the underlying DNA sequence. These changes are sometimes referred to as “mutations.”  Some of these mutations will be “reset” in the next generation, but some continue to influence gene expression for several generations. Nessa Carey, author of “Epigenetics Revolution,”  uses the analogy of a movie to help understand this process. If a person’s life were a movie, their DNA would be the script, and certain blocks of the DNA sequence (genes) would instruct key actions or events to take place. The concept of genetics could be compared to screen writing, while epigenetics  would be like directing. The script may stay the same, but the director can choose to eliminate or accentuate certain scenes or dialogues, thus changing the course of the story.

Epigenetic effects may occur anytime throughout the life span, from within the womb to old age. Epigenetic influences include what you eat, how you sleep, who you interact with and whether you exercise. They also include environmental factors, such as the quality of the air you breathe and how safe you feel in your home and in your community. For instance, children whose pregnancies occurred during the Dutch famine of 1944-45 have been found to have increased rates of coronary heart disease, obesity and schizophrenia in comparison to the children of mothers who were not exposed to famine.  Other research has shown that children who had experienced stressful events during the pregnancy or during childhood were more likely to experience depression if they have mutations on a small number of genes, including those affecting neurotransmitter serotonin.

The really exciting element of the new research on epigenetics involves the  possibility that lifestyle factors can reverse or mitigate the negative elements of gene mutations. For instance, there is intense interest in the impact of diet on ADHD symptoms. At this point, the findings from the analysis of a large number of studies indicate that Omega-3 (fish oil) can have a small but measurable effect in reducing symptoms, and food additives and allergens can cause or worsen  symptoms in children who are sensitive to these triggers. Exercise has been proven to improve cognition and brain plasticity, the effects of which can be felt for a long time. We are just at the beginning of these investigations, with more exciting findings to come.

References and Resources:

Neurosci Biobehav Rev. Author manuscript; available in PMC 2018 Sep 1.

Published in final edited form as: Neurosci Biobehav Rev. 2017 Sep; 80: 443–456. Published online 2017 Jun 27. doi: 10.1016/j.neubiorev.2017.06

Weinhold, Bob. Epigenetices: The Science of Change. Environmental Perspectives 2006 Mar: 114 (3): 160-167

A Super Brief and Basic Explanation of Epigenetics for Total Beginner: Epigenetics Simplified. https://www.whatis epigenetics.com/what-is-epigenetics

Epigenetics: Fundamentals: Epigenetics Simplified. https://www.whatis epigenetics.com/what-is-epigenetics

Nigg, Joel (2017) Getting Ahead of ADHD. New York. Guilford Press

 

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

 

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

 

Why does my neuropsychologist need that? What do the tests measure and why is previous testing important?

By | NESCA Notes 2019

 

By:  Stephanie Monaghan-Blout, Psy.D.
Pediatric Neuropsychologist

When a family books an intake for neuropsychological evaluation, they are typically asked to complete a few pieces of paperwork and to bring previous testing and other educational documents such as an Individualized Education Program (IEP) for their intake appointment. Despite this request, many parents will come to the intake session with empty hands. Understanding that parents have an enormous number of tasks on their plate, one could expect that paperwork was left at home due to timing or organization difficulties. However, when I ask parents about the missing paperwork decision, the reasons for leaving it behind generally fall into two groups: (1) lack of knowledge about the purpose of testing; and (2) concerns about creating some form of bias in the examiner’s mind. Some parents don’t share prior testing with me because they don’t have a clear idea of what the testing is and how it is going to be used for my evaluation. This is very common with families who are new to the special education or mental health process. Some parents are reluctant to share past testing because they want a “fresh view” and are concerned that looking at someone else’s work may create a bias. This often comes up when there is disagreement between parents and their school or past provider as to the nature of the child’s difficulties. Sometimes the parents and child have had a bad previous experience with testing and/or with the examiner, and they do not feel that the test results accurately (or at least empathetically) describe their child. In any of these situations, I find that parents feel more comfortable if they know more about how the tests we use are developed and why we find it helpful to view previous testing.

Purpose of Testing: The purpose of neuropsychological testing is to find out if a child (or adolescent or adult) is developing skills at a rate and capacity commensurate with their age and ability level. In order to do this in an efficient, equitable, and consistent manner, test developers identify skills they think are important in learning, devise a task that appears to quantifiably measure that skill, give that task to children in different age groups and then transform the raw scores attained by the children into a common scale. This allows them to compare different children within an age group, and this also allows them to compare the same child at different ages. Some common measurement scales are standard scores, scaled scores, Z scores, T-scores and percentiles. All of these formats are based on a normal distribution (remember the bell curve?) in which the majority of scores fall within a certain area with increasingly fewer scores falling at either end. The “bump” where most scores fall is described as average (between 25th and 75th%ile) with the tails receiving an above or below average description. While these descriptions do not begin to capture the whole child, they do convey information about how a child is performing relative to developmental expectations based on what we know about children of the same age. They can also tell us if the child is making age expected progress according to their unique learning curve. Furthermore, most people are good at some things and not so good at others, and the pattern of their scores can often give us valuable information about their learning profile.

Question of Bias: The concern about bias is important, given that neuropsychological tests are often used to classify people and make decisions about providing or denying services. There are a number of ways in which we try to control for bias, starting with trying to make sure that the group of people that are used as test subjects when developing norms are representative of the population at large. Test makers are getting better at this, but we have a long way to go, which means that it is important that evaluators know how each test has been developed and normed. Test selection is also extremely important; some tests are not appropriate for some groups. Think about giving a Calculus test to someone who has not completed Algebra 1; this kind of mismatch is going to result in a spuriously low score on math ability.

The main way that neuropsychologists and psychologists try to control for bias is through what is referred to as standardized administration—giving the test in the same way to each child. A good deal of the training of graduate students, interns, and post-doctoral fellows involves learning and practicing these skills so that the test is given to every child in the same way, regardless of who gives it. At the same time, children are children, and sometimes they need something different. It is up to the evaluator to decide when to engage in “non-standardized administrative procedures.” One example of non-standard administration could be starting a child who has trouble catching on to novel tasks at a lower age starting point in order to help them master the task demands. Another example would be stopping a task before a ceiling of errors is reached because the child is very anxious and is having a hard time staying with the activity. It is important to make note of that break in protocol in the report; while it may somewhat reduce the validity of the scores, it also tells us something very valuable about the child’s learning style and tolerance.

Value of Having Previous Testing: Having the opportunity to review all previous testing is extremely valuable to neuropsychologists because it gives up some insight as to a child’s developmental trajectory. Scores that are higher than in previous testing may suggest improvement in a skill set. Scores that are consistent with previous testing indicate that a child is making age-expected progress along their unique learning curve. However, they may be falling farther and farther behind their same-age peers or progressing more quickly. Scores that are significantly weaker than in previous testing need to be closely examined. This could be a result of an imbalance between the environmental demands and the child’s internal resources. For instance, smart kids with executive function deficits are often not prepared for the organizational challenges of middle and high school. Significantly lower scores could also indicate stalled development due to ineffective educational interventions. It could also be a sign of emotional distress that is interfering with a child’s functioning. Rarely, it could be a sign of a medical or neurological problem. There are also some times when a change in average scores reflects a change in the exact tests or subtests used for the child. For example, when a teenager turns 16, it is common to begin administering adult intelligence scales and these tests may place higher value on slightly different skills (e.g., mental math). Without reviewing previous testing, a current evaluator may be able to provide a snapshot of a child’s current functioning, but might miss a critical developmental pattern important for understanding if/how the child is learning, what is needed to enhance their performance, and what can reasonably be expected over time for the child.

 

About the Author:

Formerly an adolescent and family therapist, Dr. Stephanie Monaghan-Blout is a senior clinician who joined NESCA at its inception in 2007. Dr. Monaghan-Blout specializes in the assessment of clients with complex learning and emotional issues. She is proficient in the administration of psychological (projective) tests, as well as in neuropsychological testing. Her responsibilities at NESCA also include acting as Clinical Coordinator, overseeing psycho-educational and therapeutic services. She has a particular interest in working with adopted children and their families, as well as those impacted by traumatic experiences. he is a member of the Trauma and Learning Policy Initiative (TLPI) associated with Massachusetts Advocates for Children and the Harvard Law Clinic, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations.

 

 

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

 

Encourage Your Children to Read

By | NESCA Notes 2018

By: Alissa Talamo, PhD
Clinical Neuropsychologist, NESCA

According to Sally Shaywitz M.D., (Audrey G. Ratner Professor of Pediatrics-Neurology; Co-Director, Yale Center for Dyslexia & Creativity), dyslexia is highly prevalent, affecting one in five people, and it represents over 80% of all learning disabilities.

Even when a child does not meet the criteria for dyslexia, they may be a reluctant reader. Children who do not practice reading perform poorly on reading tests relative to children who do read on a regular basis. In addition, reduced reading time results in exposure to fewer words. In general, people use limited vocabulary during conversation compared to the language one is exposed to while reading. As such, a reluctant reader is at risk to have poorly developed vocabulary knowledge compared to same-age peers. They are also less likely to improve their reading skills over time. In her book, Overcoming Dyslexia (2003), Dr. Shaywitz shared the following information:

Through reading, a child is introduced to new concepts and information. In addition, the more a child is exposed to literature, the more likely reading will become an integral part of their daily life. However, how does a parent encourage a reluctant reader?  Here are some ideas:

1.  Read a story to your child. Then ask them to talk about their favorite parts of the story.

2. Be ready to read or listen to books over and over again – this is how children learn. FYI- Did you know you can listen to the audio version of Mrs. Piggle-Wiggle (a series of children’s books by Betty MacDonald originally published in 1947)  four times in a row on a drive from Boston to Maryland and four times in a row on the way back?  I did this with my daughter when she was 4-years-old (she is now 16) and I do believe that, to this day, I can still quote parts of the book!

3.  Surround your children with reading material – this can be comprised of books, graphic novels, or magazines, anything that is of interest to your child.

4.  Let your child take out their own library card and go with you to the library to pick out their own reading material. Allowing a child to read for pleasure is the best way to create a more engaged reader. However, it is also important to make sure the child is choosing an age-appropriate book. A librarian can be very helpful in providing recommendations based on a child’s age and areas of interest.

 5.  Have your children practice reading whenever possible. Baking a cake? Ask them to help you read the instructions (perhaps your hands are too messy to turn the page!). At a restaurant? Let them read the menu aloud to a younger sibling.

6. Use technology to your advantage. For example, I worked with a 14-year old boy with dyslexia who was intimidated by the size of the first Harry Potter book. However, I mentioned to him that, on the I-pad, the book is no bigger than the I-pad itself. He was more willing to carry an I-pad around and read at his own pace. Another advantage is that with an e-reader the child can place as much or as little text on a page as they wish, another way to reduce reading stress.

 7. Take advantage of audiobooks. This technology is a huge benefit for students who struggle to access books that are written for children their age but beyond their current independent reading level. The child can simply listen along, or they can hold the book and follow along with the text while listening. There are several ways to access audiobooks, including downloading them from your library for free!

8. Finally, model good reading habits. If your child never sees you reading, but you insist that they read, they will see reading as a chore rather than a pleasure. If you are not a strong reader, that is ok, you too can listen to audiobooks!

While these recommendations will hopefully help your child experience increased reading pleasure and exposure to literature, it is still important to find out the reason why your child is struggling to read. If your child has not had a thorough reading evaluation, you can ask your child’s school to complete such an assessment. In addition, you may wish to have your child evaluated by an independent evaluator.

To book a consultation with Dr. Talamo or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate “Consultation” and your preferred clinician in the referral line.

About the Author:

With NESCA since its inception in 2007,  Dr. Talamo had previously practiced for many years as a child and adolescent clinical psychologist before completing postdoctoral re-training in pediatric neuropsychology at the Children’s Evaluation Center.

After receiving her undergraduate degree from Columbia University, Dr. Talamo earned her doctorate in clinical health psychology from Ferkauf Graduate School of Psychology and the Albert Einstein College of Medicine at Yeshiva University.

Dr. Talamo specializes in working with children and adolescents with language-based learning disabilities including dyslexia, attentional disorders and emotional issues. She is also interested in working with highly gifted children.

 

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, 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.