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Aug 19th, 2009 Expert Chat Archived Transcript
| firwin | 20:53:03 | Hi Dr. Kurtz..thanks for doing this |
| smgexpert | 20:54:10 | Sure. Fire away. |
| emvcostello | 20:56:11 | Can you suggest approaches that the teacher can take to make our son more comfortable in his new surroundings? He'll be a fourth grader in a new school in town. |
| smgexpert | 20:58:39 | General approaches would include several visits to the setting, i.e., the class, the buildling, the playground, to encourage his sense of surity there and to get him communicating in that setting. We GRADUALLY bring in others, as the child's progess tells us they are ready, e.g, lunch date with sister or friend, then more than one peer, or teacher in background pretending not to be direclty involved with the child and then taing your cues to approach more closely. We pair their talking with praise for brave talking or pair their communicating with praise for brave communicating and this often works quite well. thanks for the question. |
| firwin | 20:59:18 | Hi, I have a SM daughter entering first grade..can you comment on importance of class placement and the need to have a SM child placed with at least a few kids whom they have an established spelaing relationship--how critical is this? |
| smgexpert | 21:00:59 | It's actually more complex than you might realize. Friends with whom they HAVE been talking before is a definite positive to be grouped with. On the other hand, friends that they are not talking to I would have reservations about. I hope everyone will also understand that the advice in this context has to be understood in teh context that the Expert has relatively little information. :) |
| smgexpert | 21:01:30 | Great questions. Keep em' coming! |
| sarahpavek | 21:01:39 | How do you address or undue the rule that children have regarding I can't talk at school. |
| mstolen | 21:01:54 | My daughter was recently assessed for speech therapy and needs |
| smgexpert | 21:02:19 | I'll take in the order given. So give me a minute to formulate response to sarahpavek. |
| mstolen | 21:03:14 | Sorry, my daughter needs speech therapy and has SM issues. How do we insure that she gets speech therapy without making her too worried about how her voice sounds. I don;t want this to backfire. Thanks |
| crisaugusto | 21:03:35 | my daughter is going to 4 grade what can i do? the school is the same and so far no progress should i take new ideas and what? |
| smgexpert | 21:04:42 | We don't argue with kids or try to debate their "rule." We find the literal and figurative point where the child is talking to their parent, fade ourselves in as listener then communcation partner to that dyad, then slowly fade the parent out, then slowly fade toward the school environment. All the while, we are praising kids for Brave Talking, using copious activity rewards for their bravery and this has worked effectively. For those not ready for the talking part, for whom using a white board, for example, would be their first step (like the 8yo I evaluated this morning), we reward that instead - brave playing, brave writing, etc. |
| juddanti | 21:05:59 | Hi, I have a SM son entering first grade. We have setup a meeting with his teacher . How do we prepare him for this meeting ? |
| mayraborcea | 21:06:47 | My 4 yr old daughter has SM issues and it looks like her brother, who is two years old, has been acting the same way.How can we tell if he is solely copying her behavior or if he really carries this condition? |
| smgexpert | 21:07:44 | the next question pertained to speech therapy and SM and how to ensure the focus on speech doesn't backfire. Great question: We don't advise speech therapy, per se, until teh child is comfortable in that relationship talking in whatever whey they usually do. We don't care if this is the speech therapist, the school psychologist, the OT, the teacher, etc. We just focus first on their comfort with communciating verbally (after establishing that they are already comfortable nonverbally) adn then, and only then, would we endorse proceeding with speech therapy per se, i.e., how they pronounce things or the many other areads that qualified SLPs work on. |
| sgreisberg | 21:08:06 | I am wondering if you find it useful to speak openly with children about the fact that they have anxiety, rather than using purely behavioral methods, such as shaping. At what point would you speak to the child about the fact that certain situations make them apprehensive and that it's good to push themselves, essentially do psychoed? |
| smgexpert | 21:08:20 | RE setting up 1st grade son for meeting with teacher for first time. |
| smgexpert | 21:12:20 | sorry I hit enter to fast...for that meeting we have SPECIFICALLY told teachers in those meeting to NOT ASK THE KIDS ANY QUESTIONS AT ALL, and we have prepped the teachers ahead of time what TO DO: play with the child, following their lead in teh play, i.e., describinhg what the child is doing like a sportscaster, praising "regular" behaviors, and if the child is talking reflecting their words back. These are skills we have adapted from Parent Child Interaction Therapy (PCIT) - which is focused on oppositinoal children but we use in COMPLETELY DIFFERENT CONTEXT, adaped for our SM kiddos, and NOT assuming oppositinality. But these techniques are associated IN RESEARCH with increading attachment, vocalizaitons by the chidlren and allow a non threatening interaction. I presented DATA at teh annual SMG Conference in Ahaheim in July showing that when a teacher on this first visit gave only forced choice quesitions AND waited 5 seconds for child to reply , the child's verbal repsonse rate MORE THAN DOUBLED!!! Poweful data and you can use these techniques. |
| smgexpert | 21:13:24 | regarding psychoed of SM with chidlren with SM: we routinely do some of that and specifically do NOT do some of that. Let me clarify... |
| smgexpert | 21:17:36 | We talk to the children about things that scare us all or make us all uncomfortable and talk with them about Bravery as doing some that makes you nervous, but it is an Okay/right thing to do and you get yourself to do it anyway - that's what Brave is. These kids TYPICALLY do NOT have "insight," typically do not talk about or identify what they fear, specfically, and the talk about talking is unproductive per se. The behavioral shaping methods with children and adults, with a WIDE variety of anxiety concerns, is the heart and soul of contemporary evidence based treatment. With OCD for example their is fairly universal accpetance of Exposure (and Response Prevention) as the key active ingredient. I had a (recovered 13yo (former SM patient) last year lead a Q&A session with other parents of SM kids. The parent asked him, "so why didn't you speak?" He said, "I don't know - it was just hard." that is the typical young child's pre-abstract reaSONING viewpoint. |
| sgreisberg | 21:18:08 | Thanks, i feel like it could help to give them an explanation for what's going on but don't want to increase self-consciousness either |
| lrichardson | 21:18:10 | Thank you for speaking with us. I have a daughter who just started 2nd grade yesterday. She did very well in 1st grade with non-verbal communication but has yet to speak in class or to any teacher. She knows her 2nd grade teacher outside of school and has talked to her outside of school. I feel she has somewhat mastered her non-verbal skills at school and is responding extremely well to encouragement talking outside of school...how do you suggest the encouragement at school when there is no one except the teacher to help? I feel she needs someone there to help "push" her to master some behaviors but there is no one to help at school. Thank you. |
| smgexpert | 21:18:31 | Great quesions and glad to see so many of you participating. |
| smgexpert | 21:19:18 | re your now, new 2nd grader who has talking relationship with the teacher out of school: |
| smgexpert | 21:19:21 | continuing |
| mayraborcea | 21:19:59 | My 4 yr old daughter has SM issues and it looks like her brother, who is two years old, has been acting the same way.How can we tell if he is solely copying her behavior or if he really carries this condition? |
| evanmichael | 21:21:12 | My son is entering first grade. He had a difficult and very stressful year in kindergarten. In addition to the selective mutism, he has sensory processing disorder. He started the kindergarten year off playing nonverbally with the other kids and even raising his hand if he knew the answer to a question the teacher was asking. Things progressively worsened and at the end of the year he was sitting outside the story circle, not participating even nonverbally. It did not help that many times other children pointed out that Evan did not talk or even called him a baby. He has had a much better summer and has made small but wonderful gains. We want to make sure the first grade starts out better. Do you have any suggestions? |
| smgexpert | 21:23:48 | she does not need to be PUSHED, but she does not graduated opportunities to continue buidling on her successes. So if she is talking with teacher outside of school there are lots of creative (and some of these are even research tested and supported) techniques to try. It feels a bit weird to me to be recommending techniques, when treatment is an entire package that starts with assessment and invovles an entire treatment PLAN, but if some benefit form the specifcs, great....We often videotape using procedure known in SM literature as VIDEO FEEDFOWARD, where the children answer questions on video and we SPLICE IN the other folks they want to or need to communicate with, such taht it looks like the other person is actually asking the qeustions. You could do this iwth the teacher she talks with. We've had GREAT SUCCESS then bringing these tapes, spliced or not, into teh classroom so other kids get to see our SM kiddos speadking. (Yes, we always get the child's OK first - we NEVER spring it on them) and we gradually fade in the kids answering their peers questions about their tapes. For example, a child did a video quiz on birds of prey, which his class was studying. He could then clarify answer about the questions. |
| Adrianna | 21:23:59 | We have a 5-year-old son who had been mute for a year and a half, until we put him on medication this summer. Now he talks to everyone he meets, completely normally. He's done well on playdates, at birthday parties, at church, in public, etc. As we approach the beginning of school, can we assume he will be verbal at school too, and see how it goes before we make special plans with the teacher to help with his SM? Our son progressed so much, so suddenly, that we almost don't know what to do! Also, his 3-year-old brother seems to be walking the same path, but with him we've been using the methods we learned with our firstborn. He's not on medication. He'll be starting preschool at the same school as his brother. How should we proceed with him, other than letting him visit the classroom before school starts? |
| juddanti | 21:25:18 | Hi, How do you prepare a SM child on his first day of joining back to school. |
| emvcostello | 21:26:09 | Could you please comment on your experiences in using SSRIs in the treatment of kids with SM? How useful has the treatment proven? What are the timeframes for seeing results? What are the signs of improvement (other than verbalization)? Any information you could provide would be helpful. |
| smgexpert | 21:26:40 | re 4yo bona fide SM child iwht younger sib looking like same...tough to differntiate because as you think about it..they share same gene pool but also younger kids look up to older sibs. So on the surface we can't say 100% one way or other. We can say this though: we can minimize undo attetnion to the SM beahvior, we can praise and give attention to both/all for beahviorsl they are working on. Our therapists are required to share with kids issues they are trying to change as COPING ROLE MODELS. There is a vast literature on this type of modeling. (We've had 8 pairs of twins in our Center, and have seen ALL variatons - both have it, younger only, boy only , etc. |
| crisaugusto | 21:30:28 | if the child loves the school she is ready every morning and happy BUT sm for the fifth year, am i wrong in not starting my 9 year old daughter in medecine? |
| smgexpert | 21:32:08 | Several related questions. RE prep for first days, please refer to my earlier answers. Re Meds: first, let me remind everyone that my colleague and fellow SMG Board Member is hosting med related chat quite soon. The SSRIs, which prescribed and followed by a child psychiatrist especially are quite safe and generally effective. Doses are MUCH lower than same meds used to treat other conditions. We almost always combine with behavioral approaches. The smartest answer I ever heard about how long to keep kids on meds for anxiety was from Dr. McCracken from CA, who said he liked to see kids stay on for one year's life cycle of events - ther return to school, the next birthday party, the next Chanukah/Xmas/Qwanza celebration, the next family gathering etc. We have NEVER had a child stay on for years and years and ahve ALWAYS been able to taper without ill effects and this disorder is RARELY associated with relapse. |
| smgexpert | 21:32:30 | Who we suggest meds to is a dfferent question |
| debbiefischer | 21:33:32 | We saw my 5 year old's doctor today. I asked him if he knew of good doctors in the area for my son. He told me he had never had a patient with SM and would set me up with a neurologist. Is this the right step? We have an appointment on the 25th. Should I cancel and see an expert in SM in the area? |
| firwin | 21:33:33 | Dr., picking back up on your great suggestion on how a teacher first interacts with a SM child, how about "fading in" the new teacher? It seems like it could be a bit tricky. Assuming we can only schedule a few interactions with the new teacher before first day of school (likely during class setup time), how is this best done? Arriving to school 10-15 minutes before the bell? Lunch time? Other ideas? Seems so important but potentially very difficult logistically to arrange. |
| sarahpavek | 21:33:50 | What do you recommend for class placement for twins entering kindergarden, same or seperate classroom? |
| will1207 | 21:35:15 | our son is on meds just this summer, very low dosage, 10 mg per day, we are seeing great results over the summer, speaking to people that he would have never spoken to in the past, little or no side effects, we used meds as the last resort and we have seen great results |
| smgexpert | 21:35:36 | We have a nice slide we use in presentations (one I included in the 5hr talk at this year's SM Conference in July) showing who we are likely to recommend medication to. Here's the essentials: a young child, who has never had a course of behavioral therapy, who does go willingly and happily to school and other events, should certainly ahve a trial of behavior therapy first before considering medication. On the other hand, the older child, like 4th adn 5th grade and up, who has struggled for years, despite reasonably evidence based approaches, with strong family history, who is becoming perhaps deomorlized and certain things won't chagne, in our opinion, DESERVES the added benefit medicine can bring. |
| juddanti | 21:37:05 | Hi, My son is showing signs of stuttering. Could this make him conscious and lead to SM behaviour ? We have not yet visited any speech therapists. Can both be treated simultaneously ? |
| imag8tor93 | 21:38:41 | what accomodations would you recommend for a 504 plan, besides the obvious of not grading down for nonverbal with our 3rd grader? |
| smgexpert | 21:39:25 | re referral of 5yo to neurologist: I would be hard pressed to think how that would be the appropriate recommendation. We have one, and only one, pediatric neurologist at our medical Center who I would even consider this with and frankly she would have her staff tell them to come see someone else first with lots of experience with SM. An expert in SM has to be a better choice. The SMG website has some profedssionals active in the SM field and if you tell me where you are, I'd be happy to try to identify someone close. |
| evanmichael | 21:40:23 | We are trying to get an IEP for my son entering the first grade, as he was graded below grade level in 14 areas on his kindergarten report card. Part of the reason there were so many below grade level marks is that socialization is a huge part of kindergarten, and also if a child does not speak in school, it is near impossible to assess their reading, etc. We are getting a lot of resistance from the school regarding this. Also, can you give us some examples of goals for an IEP of an SM child? |
| will1207 | 21:40:34 | just went through the 504 plan/IEP process with our 9 year old entering 4th grade: |
| smgexpert | 21:41:21 | Firwin: the devil is in the detals on this. We have a hard enough time even when granted ehough time, but you HAVE TO BE your child's advocate and teh literature supports GRADUAL FADE IN. Please pring out this chat when we are done, please buy some of the excellent material in SMG store, please go to www.AboutOurKids.org and download our pdf on working iwth SM kids in school and set up best possible plan. |
| debbiefischer | 21:41:47 | Regarding the doctor .. Thank you my thoughts exactly. What are some good doctors in Brevard County? Melbourne, Even Orlando. |
| smgexpert | 21:42:19 | ARe the twins both affected by SM? In general, when we work with twins, or best friends, or older sibs, we need to teach the friend/sib/twin how to NOT answer for their SM person in their life. |
| imag8tor93 | 21:42:42 | We need a referral in Orlando as well |
| sarahpavek | 21:42:45 | both girls have sm |
| will1207 | 21:43:04 | Agreed, the school will not be your child's advocate, you have to be there pushing the school to get things done |
| crystal | 21:44:48 | We have an 8 yr old girl with SM who just entered third grade. So far we have had no progress as far as her talking at school and in other social environments. The therapists we have seen around here know little or nothing about SM and have given us bad info. What's the best way to find someone who can help in Nashville TN? |
| smgexpert | 21:45:07 | re stuttering: technically, stuttering is a communication disorder (aside from when it is age appropriate and short lived) and therefore rules out SM. ADmittedly, if people approach the stuttering incorrectly, it can indeed make the child very anxious about talking which would be a shame. If done right, the treatment for stuttering (if indeed the SLP deems it indicated) would LOWER anxiety, not RAISE it. (My 21 yr old looks back on her speech sessions at school (not for stuttering) with great fondness - it was game oriented and gave her a great relatinship with a caring adult! |
| smgexpert | 21:45:38 | so many great questions...I hope I am taking them in order and not missing anyone :) |
| will1207 | 21:46:30 | Would you suggest a meeting with the school at the beginning of the school year to go over summer results and to review IEP plan goals and to go over SM information with new school year teacher? |
| smgexpert | 21:46:36 | DEbbie: I'll have to reserach the FL referral for you offline, tomorrow. Is Melbourne in FL or Australia ??? |
| debbiefischer | 21:46:47 | Florida |
| firwin | 21:47:07 | Dr. any SM conferences in the NY/tri-state area coming up that you are aware of? Would like to try and get my daughter's new first grade teacher to attend one (with us)to get up to speed on SM |
| juddanti | 21:49:32 | Hi, We have been trying to look for SM specialists in our area ( Dallas, TX ) but unfortunately could not find one. Can we approach any other professional with no SM experience and what should we be looking for ? |
| smgexpert | 21:49:42 | re IEPs and 504s: that should be separate chat in and of itself. Let me try to make a couple of points here: first, I konw that our SMG bookstore has some EXCELLENT materials specifically on 504s and IEPs. Go shopping (after the chat :)... a child with SM should NEER be discriminated aginst for their difficulties communicating. We fight hard with parents for services and accommodations, including at least 5 Districts near us that pay for us to do Inservice training each year AND to provide MONTHLY consultation in a few Districts to staff working iwth our patients (even thought the parents pay for our treament services separately) |
| sarahpavek | 21:51:33 | would you ever recommend a child changing schools? |
| kellycody | 21:53:53 | kelly |
| smgexpert | 21:54:34 | re What to look for in a therapist. I konw my fellow Board Member, Dr Kristen Eastman, wrote a piece that is on this website, that identifies characteristics to look for. ADmittedly, SMG has moved in the direction of trying to promote and advance evidence based treatments, but there is still a long ways to go in identifying "slam dunk" treatments. But an SM therapist, in my opinion, should be able to describe to you their training, background, and specific experienc with SM. (They shoudl not feel threatend by your questions.) They should be able to tell you exactly what sessions would look like, how you will konw if the child is progressing, what your involvement will and will not be, whehter they ROUTINELY do school based or communicty based visits. The research so far gives the greatest support for beavhior therapy approaches with and without adjunctive medication. |
| firwin | 21:56:00 | Dr. my 6 yo daughter is in a social skills/pragmatics group with 3-4 other kids..goes once a week and seems to realy enjoy and we have seen som nice results. After school begins again, we'd like to continue these sessions but would also like the school to conduct a similar group. How importatn is it that the "outside" and in school efforts be well coordinated (i.e. use similar techniques, perhaps similar topics, etc)? I don't want to unnecessarily complicate things but do want to make sure we are optimizing our services |
| mayraborcea | 21:56:48 | My daughter is in pre-k 4 this year. When would be the best time to ask for an IEP--now or when she starts Kindergarden? She goes to a private school..are we still entitled to have an IEP? |
| smgexpert | 21:56:50 | I'm having trouble keeping up...for referrals please know that I wil print out the chat but need your emails to reply with a referral question. Send to selective.mutism@AboutOurKids.org and I will reply. (We are staring our first SM day camp-like prgram called Brave Buddies in only a few days, so my turn aroudn time will either be before Monday if possible or a week later when our program is over) but I'll do my best. Please referral questions only as I can't continue an email chat. |
| sarahpavek | 21:59:02 | I'm working with a family that has their daughter in a french immersion school. The staff there strongly believe it is an injustice for the family to kid their sm child in language immersion program. What is your opinion? |
| smgexpert | 22:02:28 | Changing schools is a SUPER FASCINATING question. Let's see if I can make this simple and I just noticed our time is almost over..how quick! Thanks for the opportunity to chat with you. As I tell parents with SM in their lives..you MUST continue to give your kids a message of optimism and hope. They don't choose this as a way of life and I KNOW how frustrating it can be. That said..here's some interesting data we have about changing schools...When we had kids change schools - WHO HAD SOME REASONABLE AMOUNT OF TREATMENT BEHIND THEM ALREADY - not kids who have had no treatment, like three kids who moved, and one who changed on scedule from nursery to Kg, and another from lower to middle school, they LEAP FROGGED forward in their gains, meaning made huge gains simply on the swithch. We have conceptualized this as they went from "contaminated" sites, i.e., where they had histories of not talking to new "uncontamintated" sites, where they had no hx of not talking and could bring their new skills with them. Fascinating, eh? We have never suggested swtich for this reason, only obsereved what happend when they did switch. Speaking of switches, the people who set these chats up apparently pull the plug so I must sign off but am grateful to have this opportjnity. Good night. |
| emvcostello | 22:04:34 | Thanks so much. |
| juddanti | 22:04:52 | Thank you very much. |
| mayraborcea | 22:04:56 | thank you so much |
| mayraborcea | 22:05:06 | thank you for your time |
| evanmichael | 22:11:03 | Thank you very much for your time |