Tag

worry

When the Worry Bug Makes You Mad: Understanding the Importance of Positive Behavior Plans for Anxious Kids

By | NESCA Notes 2021

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

“Don’t Feed the Worry Bug,” by Andi Green is a wonderful book for children who are anxious or experience a lot of worrisome thoughts. The story is about a monster who constantly feeds his WorryBug, only to find that as he worries more and more, the WorryBug continues to grow until the monster is totally overwhelmed by the emotion. Eventually, he learns to control it. In my practice, I evaluate a number of children with lots of worries…but they don’t actually look worried. Instead, children may appear defiant, hyperactive and aggressive. Why do children overwhelmed with anxiety sometimes become frustrated and angry or have poor behavioral control at home and in the classroom?

Children with anxiety “on the surface” may appear angry, oppositional and defiant to adults. However, these behaviors oftentimes reflect secondary responses to an underlying cause: anxiety. Responses to anxiety can be categorized as “fight, flight or freeze.” As a classic example, if you run into a grizzly bear on a hike, your body’s natural physiological response is to fight, flee or freeze. Your anxiety about the demands of a situation send your body and brain into a state of “threat alert.” Similarly, when a child is worrying about something, is socially anxious, or is feeling nervous about their ability to handle a task, this “threat alert” system is activated and the child’s ability to make well-thought out decisions is impaired. The child may be labeled a “behavior problem” because of the impulsivity, defiance, disruptiveness or aggression (fight mode). Or the child may appear distractible, silly and immature, or avoidant of challenging tasks (flight mode). An anxious child may also show difficulties shifting gears/transitioning, problems letting go of events, or seem unmotivated or apathetic (freeze mode). It is also not uncommon for children with anxiety to have challenges demonstrating appropriate social skills, such as problems with insight into how their behaviors may affect others. They may also experience challenges reading the nonverbal and verbal cues in their environment because their brain is “soaked” with high arousal, immobilizing their capacity to apply logic to everyday situations. How do we help children manage their anxiety and the resulting behavioral challenges from that anxiety?

A neuropsychological evaluation can provide insights into your child’s behavioral challenges to determine if there may be an “underlying cause,” such as anxiety, (or other causes such as learning disabilities, depression or poor information processing) which are driving weak emotional and behavior control. Once identified, a neuropsychologist can provide guidance on the most effective interventions for a child at school and at home.

In my experience, one of the most important interventions for a child who experiences anxiety and secondary behavioral challenges is the development of a Positive Behavior Plan at school, which can then be included in a child’s IEP. However, many children with anxiety do not respond well to traditional behavioral reward systems that solely focus on increasing or decreasing behaviors (e.g. follow directions, sit calmly, keep your body safe, etc.), as these systems do not teach the child the self-regulation skills necessary for controlling emotional and behavioral responses. Instead, an effective Positive Behavior Plan for a child with anxiety includes behavioral targets or “goals” that focus on the attempt at coping strategy application. Importantly, a child with anxiety should be rewarded for trying to use a coping strategy, as it will take time, practice and reinforcement before a child develops the capacity to apply coping strategies consistently and successfully.

Sample coping strategies that a child should be taught by a special educator, counselor or other specialist include “taking deep breaths, jumping jacks, taking a break, using words to say how I feel,” or other self-regulation tools. When the goals of a Positive Behavior Plan focus on using a coping strategy before or during moments of distress rather than a plan that is tied to increasing or decreasing specific behaviors after they occur, a child builds independent capacity to appraise and react appropriately to physical and emotional responses in the classroom and the community. Children learn the signs (e.g. in their body, mind and in their environment) that the WorryBug is approaching, and feel better equipped, confident and more in control of their emotions and behaviors. For more information on how to appropriately develop Positive Behavior Plans for children with anxiety, “The Behavior Code” by Jessica Minahan and Nancy Rappaport is an excellent resource for parents and educators.

When the “WorryBug” or anxiety makes kids mad, mean and aggressive, a comprehensive and thorough neuropsychological evaluation can determine how to best tackle the anxiety “beneath the surface” through therapeutic and educational interventions. A neuropsychological evaluation can also direct the development of strategic Positive Behavior Plans that are individualized and appropriate for the child’s home and school environment.

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

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

 

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

 

We’re All “Perfection Pending”

By | NESCA Notes 2019

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

I recently came across a raw and powerful blog post on Perfection Pending by Meredith Ethington. It’s a worry-filled, heartfelt and all-too-familiar account of a mother dropping her child off at school in tears, questioning her parenting skills after a tough, embattled morning with her struggling child. We can all relate to her fears, questioning and self-doubt.

At NESCA, I often meet with parents, just like the mom in the blog post, who question the decisions they’ve made as well as the indecision they’ve allowed on behalf of their children. They blame themselves for the challenges their child has at home and/or in school and frequently ask themselves and me what they could have done better. Many times, the answer is nothing. These are normal emotions for any parent, but when there are special needs present, these emotions are intensified.

Recently, our staff across NESCA’s three offices met as a team to get to know new staff  better, discuss what’s going on in the field of pediatric neuropsychology and hone in on what makes NESCA different. After lots of insightful discussions throughout the day, we were struck by the consistent theme that emerged—when families come to NESCA, they don’t just get a cookie cutter neuropsychological report about their child’s learning style, diagnosis and rote recommendations. At NESCA, not only do families get a thorough, individualized report with an accurate diagnosis and highly customized, realistic recommendations, but they get—sometimes even more importantly—an entire team of experts in their field all contributing ideas and resources to support families in the quest help their child.

Our expert neuropsychologists and providers don’t arrive at the label of “expert” solely by their degrees, years of experience and broad networks of resources who may help the children and young adults we see. Many of our clinicians and providers also have children or relatives they care for—a large number with their own identified challenges and special needs. We see things from both sides, can relate to the ongoing struggles and are there alongside the parents and caregivers during the testing process and over the long haul. We work side by side with parents, families, schools and children throughout a person’s development, not just the hours or days of testing and observation. Our jobs are not done when we deliver that final report to families. We serve as teammates throughout your journeys.

So, to the parents and caregivers crying tears of worry, doubt and blame, we hear you and we support you.

Additional reading:

Perfection Pending by Meredith Ethington

Mom Life: Perfection Pending

 

About the Author: 

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

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

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

 

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

 

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

 

 

We’re All “Perfection Pending”

By | NESCA Notes 2019

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

The final months of the school year always feel intense at NESCA as the clinical staff works diligently to get reports out on shorter timelines, squeeze in extra meetings and school observations, and ride the waves of joy and disappointment with parents who are seeking different educational placements for their child in the fall.  And somehow, every year, it all gets done, and then I can feel everyone let their breath out.  The halls of NESCA are a bit quieter now with staff taking well-deserved time off to be with their families and friends, relaxing and renewing in their favorite places.  I’ve just come back from a week of hiking in Norway, feeling rejuvenated by the time in nature and physical challenge—something we all need.

Even with the quieter summer months upon us, we continue to improve and expand NESCA’s services to meet the needs of the children and families we serve.

  • NESCA is very fortunate to have Dot Lucci, M.Ed., CAGS, join us as the Director of Consultation and Psychoeducational Services. I have worked with Dot many times over the last 30 years and am thrilled to have her as part of our team. She now brings her vast experience with the meaningful inclusion of children with special needs and her exceptional ability to work with school systems effectively to our NESCA families.
  • We also recently welcomed a new pediatric neuropsychologist, Dr. Yvonne Asher, who is splitting her time between the Newton and Londonderry offices. While she sees a wide range of children, Dr. Asher specializes in the evaluation of preschoolers and children with Autism Spectrum Disorder.
  • We are sad to be saying farewell to Holly Pelletier, our acupuncturist, who will be practicing full time in Maine, but welcome Meghan Meade, who will be taking her place starting today, today, July 15.
  • In September, Dr. Sophie Bellenis, OTD, OTR/L, will be joining us full time as a member of the Transition Planning Team under the leadership of Kelley Challen, Ed.M., CAS.

I hope you and your children enjoy the different pace and energy of the summer months and that this is a time of growth as well as reflection for all of you.

 

About the Author: 

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

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

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

 

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

 

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

 

 

Taking parents to SPACE! A groundbreaking treatment for parents of children with anxiety

By | NESCA Notes 2019

By: Ryan Ruth Conway, PsyD
Clinical Psychologist

As a child and adolescent psychologist who specializes in treating anxiety, it is very rare that I work solely with the individual. More commonly, in working with anxious youth, I engage the caregivers in treatment as well, as they serve a unique role in helping children better manage their symptoms. Sometimes I even meet with parents without ever seeing their anxious child, usually in situations where children are either very young or having difficulty participating in treatment.

Anxiety is a universal emotion that we all experience, and it can be quite helpful in alerting us to danger. However, some people experience heightened anxiety related to things or situations that do not actually pose a real threat, even though it truly feels that way. There are three parts of anxiety that impact each other – 1) cognitions (worrisome thoughts), 2) feelings (emotions and physiological sensations e.g., racing heart, stomachaches), and 3) behaviors (fight/flight/freeze response e.g., having tantrums, avoidance of anxiety-provoking stimuli).

Children will go to great lengths to find relief from anxiety. One of the typical ways they do so is by avoiding things they find scary. For instance, a child with separation anxiety may decline invitations for sleepovers and/or refuse to go to school. As their “go to” for support, children oftentimes manage anxiety by eliciting their parents to make them feel better. For a child with social anxiety, parents might step in and speak for the child when confronting strangers. When a teenager is facing persistent and obsessive thoughts about germs and cleanliness, parents might wash and re-wash the child’s clothing. For the individual who worries about a bunch of different things, parents might find themselves providing reassurance by answering a lot of their child’s questions or responding to repeated text messages ensuring the parents’ safety.

Anxiety has an interesting way of entangling family members into its “worry web,” and families fall victim to its demands to maintain peace in the household, largely without even realizing they are doing so! We call this parent accommodation, or any actions caregivers take or deliberately do not take because of their child’s anxiety. Accommodation is incredibly common and understandable. Parents will do anything and everything to protect their children and make them feel better. While accommodation might alleviate anxiety symptoms quickly and reduce anxiety in the short-term, unfortunately it is unhelpful in the long-term. Anxiety is tricky – the more parents accommodate, the more the worry web continues to grow, and children end up relying on their parents to bring relief as opposed to learning to manage anxiety on their own.

Last month I had the pleasure of attending a training for the SPACE (Supportive Parenting for Anxious Childhood Emotions) program, an innovative, short-term intervention developed at Yale University’s Child Study Center under the leadership of Dr. Eli Lebowitz, a prominent child therapist, researcher and author. As an empirically-supported treatment, SPACE has been well researched and, in a recent study, shown to be just as effective as individual cognitive-behavioral therapy (CBT) in treating child and adolescent anxiety (Click here).

SPACE is unique in that the treatment is delivered only to parents. In considering the interpersonal nature of anxiety and different reactions parents can have to their child’s symptoms, it brings caregivers together to send consistent, supportive messages. The aim of SPACE is two-fold. One goal is to help parents respond effectively to their child, in a way that both validates the child’s experience of anxiety and also shows confidence in the child’s ability to tolerate discomfort. Parents also work collaboratively with the therapist to develop a clear plan to take small, gradual steps in reducing accommodations. In addition, parents receive guidance on how to respond to their child’s reactions to these changes. Parents are not viewed as the problem, but rather as part of the solution. The result is a child or teen who can better self-regulate and cope with anxiety independently.

The interested reader can access additional articles about the SPACE program here:

https://www.jaacap.org/article/S0890-8567(19)30173-X/pdf

https://www.sciencedirect.com/science/article/pii/S1077722913000977?via%3Dihub

Dr. Conway offers SPACE to parents at NESCA’s Newton location. For caregivers who would like to participate in this treatment or have any questions, feel free to contact Dr. Conway at rconway@nesca-newton.com or 617-658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT) and Exposure with Response Prevention (ERP). Dr. Conway conducts therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

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