24 Goose Lane, Tolland, CT 06084 & 112 Spencer Street, Manchester CT 06040
Advanced Psychological Services, LLC
Advanced Psychological Services, LLC
Neuropsychological evaluations specializing in:
Autism Spectrum Disorders, trauma, Post Traumatic Stress Disorder (PTSD), dyslexia / reading issues, dyscalculia (math issues), dysgraphia (writing issues), and attentional disorders (ADHD)
Please note:
-- In order to accept a referral for an evaluation, we require a Referral Information Form (below). If you are a physician, clinician, or other provider referring a client/child (client may fill out the form), we request that parent/client contact us directly afterward to confirm the referral.
-- We don't do psychotherapy or counseling, we only do assessments / evaluations , although we provide a list of potential therapists in our reports , based on the issues identified.
— Presently we are scheduling evaluations about 3 months out.
---We are not able to become involved in sending evaluation reports to Social Security (but you are welcome to do, so if needed).
---We are conducting evaluations in-office / in-person only.
Eneida M. Silva, PHD
Neuropsychologist / Licensed Clinical Psychologist
Advanced Psychological Services LLC
Contact: dreneidasilva@gmail.com
24 Goose Lane, Tolland CT 06084
112 Spencer Street, Manchester CT 06040
Phone: (860)- 926-4544 Fax: (866-607-3956)
We evaluate all ages - except children under 4 & older adolescents ages 17-18
Insurances Accepted:
Anthem (Connecticut only) - adults and children (age 4 and up)
HUSKY A (we accept HUSKY A, but not B) we take HUSKY A for children/adolescents ages 4 to 20
Medicare: Please note we do not participate in Medicare
I’ve seen Dr. Silva’s work because of working at Community Child Guidance Clinic and her evaluations are very thorough and understandable—they’ve been a great resource for when I have to advocate for kiddos! My clients have really liked her and her team as well.” Erica Mott, Licensed Professional Counselor - Community Child Guidance Clinic, Manchester CT.
To initiate a referral for an evaluation and download our Referral Information Form above to request an evaluation at our practice, please click on a button above. You may self-refer.
Please note: we are following all recommended CDC protocols, including medical grade air purifiers, in order to keep all of our patients safe and healthy.
“...because every child has the potential to succeed and flourish”
Office
24 Goose Lane, Tolland CT 06084
Insurances Accepted:
Anthem of Connecticut only - children and adults
HUSKY A only (we don't accept HUSKY B)- we take HUSKY only for children/adolescents
Our Practice in Tolland, CT
Established in 1991, Dr. Silva's practice utilizes a neuropsychological functional medicine approach to conduct autism and neuropsychological assessments of children, adolescents, and adults. A functional medicine approach aims to discover underlying causes of issues. Dr. Silva's compassionate approach combined with the most advanced neuropsychological and psychological assessment techniques are unique elements of her practice.
Dr. Silva has expertise in conducting Autism / Autism Spectrum Disorder assessments, neuropsychological evaluations, child and adult trauma, ADHD, Post Traumatic Stress Disorder (PTSD), Dyslexia, learning disabilities, and reactive attachment disorder assessments.
What issues do our neuropsychological evaluations assess?
- Memory
- Reading issues / learning disabilities / dyslexia /dysgraphia / dyscalculia
- Nonverbal Learning Disorder (NVLD)
- ADHD (attentional challenges)
- Dyspraxia and Dysgraphia
- Trauma based issues and Post Traumatic Stress Disorder
- Autism Spectrum Disorders and social functioning skills
- Reactive attachment
- Academic challenges
- Anxiety and depression
- Executive functioning issues
Autism and Autism Spectrum Disorder Evaluations
Autism Spectrum Disorder (ASD) is characterized by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. ASD may be associated with problems with motor coordination, attention, and physical health issues, such as sleep and gastrointestinal difficulties. Autism seems to originate during the very early stages of brain development, with the most apparent signs of autism tending to appear between 2 and 3 years of age. One of these signs is the child having acquired language, only to lose it several months later.
Girls often exhibit less frequent repetitive behaviors than boys, among other differences. Strikingly, recent studies have found that girls with autism have different patterns of neuronal connectivity than boys in brain areas associated with language, motor functioning, and visuospatial attention. Dr. Silva is mindful of these gender differences so that all children can be accurately diagnosed.
Differences between boys and girls with Autism Spectrum Disorder:
An important issue in the diagnosis of autism is that girls often differ substantially from boys in their presentation of autism, and may get missed in being diagnosed. It’s possible this may be because another condition is easier to recognize, or because autism appears different in girls and women. Conditions that often co-occur are:
* mood disorders such as depression
* ADHD
* anxiety disorders
* conduct disorder
* eating disorders
* sleep disorders
* intellectual disability
* obsessive-compulsive disorder
Additionally, compensatory behaviors can shape the diagnostic process and add to autism in girls often being missed. People generally adapt their behavior to different social situations. For people with Autism Spectrum Disorder, the practice of camoufloging autistic traits and mirroring neurotypical behaviors takes a huge amount of energy. Moreover, when compensatory strategies are skillful, they may interfere with a correct diagnosis. They can also make it appear that girls are less impaired than they really are.
There’s some evidence that girls with autism may be more likely than boys to use compensatory behaviors. For example, girls in one study used many gestures during an autism assessment. Using fewer gestures, especially gestures to signal joint attention, is considered an autistic trait, and autism assessments generally measure gesture use. For this reason, there is a concern that girls’ emphatic use of gestures could lead to a lower score in this area and in less likelihood of an accurate diagnosis.
There is also evidence that girls and women exhibit less repetitive behaviors which may lead to being less frequently diagnosed, since this is one of the criteria for Autism Spectrum Disorder.
We try to be cognizant of these factors because early identification and support are critical for the long-term success, health and well-being of girls and women with autism.
Our evaluation approach to Autism Spectrum Disorder:
Dr. Silva assesses Autism and Autism Spectrum Disorder using the most advanced evaluation measures to accurately assess this increasingly prevalent syndrome. This allows children to enter into treatment as early as possible since early intervention is crucial. Dr. Silva utilizes a functional medicine approach in the comprehensive assessment of Autism and Autism Spectrum Disorders with the goal of getting to the root causes, in order to provide the very best chances for improvement, while delineating highly specific strategies and recommendations.
Neuropsychological Evaluations
Neuropsychological assessments aim to discover how different areas of the brain work together. Difficulties with concentration, memory, verbal expression and comprehension, organizational skills, planning, visual perception, and personality or mood changes may all be a result of neuropsychological issues. Based on extensive new research, the brain is believed to be highly malleable and receptive to new learning and information. This is an exciting and hopeful time for neuropsychological issues and traumatic brain injury, making real improvement now possible.
For individuals with difficulties with memory, concentration, or in completing daily tasks, a neuropsychological evaluation can be helpful to delineate areas of difficulty and to establish a diagnosis.
A neuropsychological assessment provides insight into whether a person's issues are a result of brain based deficits and provides specific strategies for improvement. Specific areas assessed include:
- Memory - visual, auditory, immediate, and long term
- Language
- Information processing style
- Attention and concentration
- Organizational and planning ability
- Visual motor functioning
- Processing speed
- Emotional intelligence
- Academic skills
Dyslexia and Reading Evaluations
Dyslexia / Reading Evaluations: Our neuropsychologically based evaluations for dyslexia and reading issues are comprised of comprehensive assessments encompassing specific areas, such as: phonemic awareness, processing speed, spelling, processing of sounds, vocabulary knowledge, word sound discrimination, reading comprehension, word retrieval, and visual spatial ability. Judith Weiner, MS, a specialist in reading evaluations and dyslexia (more about Judith Weiner in the About Us and Directions tab) has extensive experience in this area. Children and adults who have dyslexia or a significant reading disability often exhibit the following:
- Difficulty with letter sound discrimination (for example: ban, bin)
- Weakness in retrieving words
- Difficulty sounding out new or unfamiliar words
- Issues with understanding isolated words when they are not in context
- Weakness in distinguishing similarities and differences in words (for example: pal vs. lap)
- Low reading comprehension
- Inability to enjoy reading
- Poor spelling
- Early issues with rhyming activities
- Commonly substituting similar words for each other (for example kitty for cat)
- Disliking and avoidance of reading aloud
- Confusing left from right while reading and writing
- Trouble summarizing and recalling details from a story
Along with core tests to assess dyslexia, our reading/dyslexia evaluations also include neuropsychological testing (executive functioning, processing speed, attention and concentration, visual tracking, etc.) to provide a greater understanding of one's individual learning challenges and optimal learning styles.
(Credit: Susan Barton, M.A. (Dyslexia Expert))
How We Learn to Read:
How We Learn to Read:
(Credit: Arkansas Department of Education)
Dyslexia Evaluations with Intellectually Bright/Gifted Children:
Dyslexia can involve more than just reading problems. It may be associated with difficulties in these areas as well: handwriting, oral language, math, motor planning and coordination, organization, sequencing, orientation to time, focus and attention, right-left orientation, spatial perception, auditory and visual processing, eye movement control, and/or memory. Reading difficulties are just one of the many neurologically-based manifestations of dyslexia. Children can struggle academically due to difficulties that are clearly dyslexia-related, yet show age-appropriate – and in many cases even superior – reading skills. Because of their apparently strong reading skills, most of these children are not identified as dyslexic and/or as having a learning disability, or given the help they need to overcome their academic difficulties. This problem is especially common among intellectually gifted children. The reason is that these children are able to use strong higher-order language skills to compensate for the low-level deficits in auditory and visual processing that cause the reading problems in dyslexia. As a result, they may be able to read with relatively good comprehension.
Intellectually gifted children with dyslexia may have: difficulties with written output and word processing, findings on neuropsychological testing consistent with auditory, visual, language, and motor processing deficits characteristic of dyslexia, and reading skills that appear to fall within the normal or even superior range for children their age.
The most academically disabling difficulty affecting intellectually bright children with dyslexia is almost always dysgraphia, or difficulty writing by hand. Several factors often contribute to their difficulties with written output. First, they typically have the characteristic dyslexic difficulty: turning words in their heads into signals that cause the motor system to form the letters needed to make words. Some reasons for their difficulty may be: they lack the kinds of visual templates that can be used to form words, they are unable to translate auditory word images into the kinds of signals the motor system needs to form letters, they may have spatial or sequential processing difficulties that make it difficult for them to do the following: remember how to form individual letters (resulting in oddly formed letters, reversals, inversions, and irregular spacing), and remember the sequence of letters or even sounds in a word.
These children are often especially hard for parents and teachers to understand because they may have verbal IQs in the intellectually bright/gifted range and show every sign of verbal precocity. Yet, these same children may have very significant difficulty with writing tasks. Dyslexic children may have difficulties with sensory-motor dyspraxia or motor coordination problems. These problems, common in dyslexia, may cause difficulties with the manual aspects of handwriting, even for children who are trying to copy directly from examples of printed words. Often, these children experience the extreme frustration of knowing what words they want to write, while being unable to get their fingers to make the proper motions. Dyslexic children may also have visual processing difficulties. These problems can contribute to poor hand-eye coordination, or difficulty using visual feedback to guide their writing.
The severe handwriting impairment associated with these deficits produces one of intellectually bright children with dyslexia’s most noticeable manifestations: the characteristically large gap between oral and written expression. The psychological trauma and anxiety that can result from this gap between aptitude and output can be very significant. Another clue to the presence of dyslexia in these children is spelling errors in children’s written output that are far out of character with their general language, working memory, or attention skills. While they are sometimes able to score within age norms on multiple-choice tests of spelling recognition, or even on weekly tests of spelling words that they study carefully for, these children essentially always show substantial deficits when they try to spell words from memory.
The dyslexic deficits in handwriting and spelling tend to be more persistent and resistant to treatment than the reading deficits. Therefore, it is important that children with dyslexic dysgraphia be identified as early as possible so that they can be given appropriate handwriting interventions, in order to begin as early as possible to develop proficiency in typing/keyboarding. Keyboarding should probably become their primary means of written expression for all schoolwork.
In addition to difficulties with written expression and spelling, intellectually bright children with dyslexia often show persistent, yet subtle, issues with reading. Despite the appearance of age-appropriate reading comprehension on classroom assignments or standardized tests, careful examination of oral reading skills usually shows difficulties with word-for-word reading, which can result in word substitutions or skipping words and they can result in significant performance difficulties, particularly on exams and quizzes. Seemingly paradoxically, they may do better on longer reading passages than on shorter passages because when reading longer passages, they can often use their excellent higher-order language skills to fill in or correct errors in word reading, often using contextual cues that are usually present in longer passages. Briefer passages contain fewer contextual cues and less redundant content, thus the likelihood of errors increases for shorter reading passages.
Intellectually bright children with dyslexia may be able to compensate enough to avoid failure, especially during the early elementary years, and because of this, they may not be identified as having dyslexia or any other learning challenge, and may not receive the needed interventions for their issue. Typically, intellectually bright children with dyslexia struggle through elementary school, performing well below their potential and often making great efforts just to keep up. However, when they meet the heavier writing demands (as well as more complicated reading assignments) in middle and high school, they often find themselves unable to keep up, resulting in failure and psychological distress. Early intervention, therefore, is crucial.
Social pragmatic communication disorder:
Social pragmatic communication disorder (SPCD) refers to marked challenges with both nonverbal and verbal communication skills used in social settings. Social-communication difficulties may be associated with other communication disorders. However, as of 2013, SPCD is now considered its own category as defined by the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).SPCD is also considered separate from certain neurodevelopmental disorders that may also affect communication skills, including Autism Spectrum Disorder (ASD), even though there is continuing debate about this.
Recently added to the DSM-5’s Communication Disorders section, SPCD refers to a primary deficit in verbal and nonverbal communication used in social situations.
Difficulties may include:
* inadequate communication in certain social contexts
* Issues with using language to socialize
* not knowing how to use and understand both verbal and nonverbal cues
* a lack of understanding with respect to nonliteral language
Symptoms:
SPCD symptoms may vary in type and intensity between individuals. Below are some of the signs of SPCD:
* difficulties with adapting communication skills to different social contexts, such as greetings and initiating conversation
* inability to switch between formal and informal language
* problems with taking turns during conversations
* difficulties with using nonverbal communication techniques during social interactions, such as eye contact and hand gestures
* difficulty understanding nonliteral language, such as inferences, sarcasm, metaphors, and idioms made during conversation
* making and/or keeping friends
Having one or more of these symptoms doesn’t automatically mean you have SPCD. To be diagnosed with this communication disorder, the symptoms must significantly interfere with:
* work
* school
* relationships
* socialization
How is social pragmatic communication disorder different from autism?
As of the DSM-5, SPCD is considered a separate condition from ASD. However, as mentioned previously, there has been continuing debate about this. It is important to note that some of the symptoms of SPCD may seem to overlap with those associated with ASD, including what is formerly known as Asperger’s. SPCD may not seem completely different from ASD, and may include traits in common. However, at the present time, the DSM-5 has placed SPCD in its own category as those that are not caused by any other underlying developmental disorder or medical condition. Communication difficulties that may be noted in ASD include:
* seeming “lack of attention” in social interactions
* difficulty engaging with back and forth conversations
* talking with others without giving them a chance to respond
How is social pragmatic communication disorder different from ADHD?
SPCD may at times be diagnosed in conjunction with attention-deficit hyperactivity disorder (ADHD). While ADHD may lead to some communication difficulties, the causes and impacts aren’t the same as SPCD.
Communication difficulties that may be seen in ADHD include:
* inability to concentrate on someone talking with you
* excessive talking
* having trouble waiting for your turn to talk
* interfering with others’ conversations
* interrupting others who may be talking with you
These may or may not be present in someone with Social (Pragmatic) Communication Disorder.
How is social pragmatic communication disorder treated?
Treatment for SCPD focuses on speech and language therapy usually given by a speech-language pathologist (SLP). SLP services are available for children in schools who qualify, and you may also obtain speech therapy in private practices.
While individual, one-on-one sessions are essential, group therapy can also help improve social pragmatic skills. Group therapies are also used in school settings. Some private practices may also offer group social skills classes. With these treatment approaches, SCPD is expected over time to significantly improve.
Nonverbal Learning Disorder
Nonverbal learning disorder (NVLD), or nonverbal learning disability, is a neurological condition which affects about 1 in 100 children and is characterized by a series of academic and social difficulties often experienced by children of average or above average intellectual ability. NVLD may include difficulty writing, drawing, manipulating visual spatial information, and even telling time using an analog clock. Additionally, activities that require motor coordination, such as tying shoes, may also be a problem. NVLD can also include problems with executive functioning and higher-order or abstract information processing, social skills, as well as with math, especially as math becomes more abstract.
Even though each of these skills appear quite different, each emanates from the right hemisphere of the brain. It is also important to note that only one or two skill sets may be impaired in NVLD. The signs and symptoms of a nonverbal learning disability can be difficult to discern, since many deficits potentially fall under this umbrella term, and most children do not manifest all issues. Typically, even though there may be a large vocabulary, strong verbal, memory and language processing skills, the child has issues with reading comprehension and higher forms of math, especially mathematics word problems. Difficulty with handwriting, using scissors and tools, riding a bicycle or participating in sports can stem from deficits in gross or fine motor skills and are another area that can be impacted.
Behaviorally, resistance to change, lack of common sense, anxiety over new situations, concrete and literal thinking while missing the bigger picture, and problems with social situations can all be characteristics associated with a nonverbal learning disorder. Anxiety related to new situations may make it hard to meet new people and make friends.
Children with a nonverbal learning disorder rely significantly on oral language as their main social tool. Because of this, the result may be that the child is seen by others as someone who talks too much. Some children are unable to perceive subtle environmental cues or learn non-verbal social skills by simply observing others. Children with a nonverbal learning disorder have difficulty interpreting nonverbal forms of communication, like facial expressions, body language, non-verbal gestures, or the idea of personal space.
With respect to the evaluation of nonverbal learning disorder, it is not always easy to differentiate between autism, ADHD and nonverbal learning disorder. Our practice has expertise in differentially diagnosing between these disorders. Evaluating early in the child’s life is important so that he or she can have ample opportunity to improve both socially and academically.
Attention Deficit Disorders - ADD and ADHD:
A person with an attentional disorder is frequently described as having a short attention span and as being distractible. However, in fact, distractibility and inattentiveness are not synonymous. Distractibility refers to how quickly one can be pulled off-task. Attention, on the other hand, consists of several different processes. Some of the most important ones are: selecting that to which to pay attention at a specific moment in time, sustaining or paying attention for an extended period of time, resisting or avoiding things that remove one's attention from where it needs to be, and shifting attention to something else when needed. Children and adults with ADD or ADHD can have difficulty with just one or more attentional processes.
Our attentional disorder evaluations utilize the most advanced measures, questionnaires, and computer based assessments to evaluate all the different processes that encompass attention and provide very specific recommendations to improve each area.
More on these processes is described below.
Sustained attention: Although It’s relatively easy to catch anyone’s attention, it is more challenging to sustain or keep it for a considerable amount of time. Sustained attention is the ability to keep that focus or concentration for long periods of time even if one is exposed to the repetitive action or activity. This is the kind of attention that is usually needed for the majority of learning and work activities like listening to a lecture for an entire hour, reading books and studying for several hours for a test, for completing a long project, or for working on a repetitive activity.
Selective attention: Selective attention is the ability to select from many factors or stimuli and pay attention to only one that you or your brain chooses. Almost everyone uses this cognitive ability most of the time. Every day, people are exposed to a number of environmental factors at home, at work, or at school, for example, but their brains respond by focusing only on specific factors that matter most or those that people choose to focus on.
Alternating attention: The next type of attention is alternating attention. This is the ability to shift or quickly transfer your focus or concentration from one thing to another. A healthy brain can adapt even if the succeeding activity requires a different level or type of knowledge. Similar to selective attention, alternating attention is an ability that is used quite frequently. Sudden changes in activity or action can require attention to shift.
Divided attention: The last kind of attention is divided attention, which is the ability of an individual to focus or concentrate on two or more environmental factors, stimuli, or activities simultaneously, also commonly known as the ability to multi-task.
Trauma based and Post Traumatic Stress (PTSD) evaluations:
Dr. Silva conducts trauma based and PTSD evaluations resulting from sexual abuse, physical abuse, neglect, loss, and other trauma. The most advanced and culturally sensitive tests and interview techniques are used, combined with a caring and compassionate approach, to evaluate children and families who are referred for trauma-based assessments.
Achievement, learning disabilities, and career/aptitude
Achievement, learning disabilities, and career/aptitude testing is another area of specialty in our practice. We assess whether children and adolescents experiencing learning challenges have a learning disability, attentional disorder, or other factors that may be interfering with their ability to perform their best in school. Dr. Silva has a strong educational background of over 20 years assessing children with learning disabilities. Additionally, evaluating a person's strongest work-related interests and aptitudes can help someone decide what kinds of careers to explore and at what type of job or career he or she would likely be most successful.
Reactive Attachment Disorder Evaluations
Reactive attachment disorder is a rare but serious condition in which a young child cannot engage in healthy attachments with a caregiver or parent. Reactive attachment disorder may develop if the child's basic needs for nurturing and affection are not met and thus a stable and caring attachment with others is not established. Treatments for reactive attachment disorder include providing the opportunity for interactions between the child and caregiver, a nurturing and stable environment, and psychological counseling. Providing caregivers with education about Reactive Attachment Disorder has also been found to be quite beneficial. Dr. Silva conducts assessments to differentially diagnose between Reactive Attachment Disorder, Post Traumatic Disorder, and other disorders/issues.
How much experience does Dr. Silva have?
Dr. Silva has over 25 years of experience assessing children and adults in multiple settings -- medical centers, hospital and university based clinics, school based, and private practice. Comprehensive assessment of a child's neuropsychological, cognitive, academic, psychological, or life situation difficulties has far-reaching implications for the type of treatment and support the child or family will subsequently need. Accurate assessment of issues, whether they are related to life/environmental circumstances, emotional adjustment, intellectual difficulties, or neuropsychological issues, provides a strong foundation from which to work toward the formulation of solid and effective treatment strategies.
Why are cultural factors important?
Cultural factors and background are important considerations for both psychological assessment and neuropsychological assessment. A person's issues are most accurately assessed when the approach takes into account one's culture. A true understanding of a person’s psychological world is optimally achieved when cultural context is an integral part of the evaluation.
What geographical areas does our practice serve?
Dr. Silva's practice provides services to the Manchester, Glastonbury, Hebron, Hartford, Wethersfield, East Windsor, Willimantic, New Britain, Tolland, Vernon, Mansfield, Norwich, Stafford Springs, Enfield, and central-northeastern and southeastern parts of CT.
