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Expert Chat, May 2011
Expert Chat Session with Dr. Kearney on May 18, 2011
| verajoffephd | 20:50:56 | Expert Chat: May 18th, at 9 pm Eastern TimeWelcome to our Expert Chat this evening. This is Dr. Vera Joffe, psychologist in Florida, and National Board Member, Coordinator of the Expert Chats. I will be monitoring the Expert Chat with the goal of allowing us to enjoy and learn from our Expert in the most efficient, helpful, and enjoyable way. I am much honored to have Dr. Kearney as the Expert in the Chat tonight. Before I introduce Dr. Kearney, I would like to remind all participants that the rules for the chat room are posted on our website. To save time, I will not post all of them here tonight… just a couple of reminders:Be respectful; let the expert type in an answer to a question before asking another. Please do not advertise your business here without prior permission. In addition, we want you to know that although Dr. Kearney may answer questions from parents, teachers, professionals, and others, he will not make specific recommendations for a child given the fact that he does not have a professional/therapeutic relationship with the people attending this meeting. Thus, when asking questions, remember that Dr. Kearney will be able to answer your questions in a more general manner, and he may direct you to discussing strategies and tools with other professionals, when indicated. Now, to the technical details of having an “Expert Chat” that is actually a “Written Chat”: One of the tools we have used in previous chats was to have some “signs” to help people start a question, and to tell others when they are done asking the question. Here are the signs that we can use to help people ask one question at a time, and to give the Expert time (and space) to answer the question: ( to start) to finishAt times, the monitor may have to say something, and this is the sign for that clue: !I wish you all a very informative and helpful Chat. Now, we are ready to start: Our Expert is Dr. Kearney, Distinguished Professor of Psychology at UNLV. He is the Director of the UNLV Child School Refusal and Anxiety Disorders Clinic, and he is the Director of Clinical Training. Dr. Kearney has written extensively in the area of Childhood Anxiety, School Refusal, and he published a book on Selective Mutism last year. Dr. Kearney will certainly be a great Expert and Speaker, with his very rich background in academic, research as well as clinical experience. Please, join us in this very fruitful and informative activity that is a benefit to the members of the SMG. org. Vera Joffe, Ph.D.We can now start the questions. |
| verajoffephd | 20:52:43 | Welcome Lisa and Cyndi. We will start at 9 pm. Please, review my text above. We are looking forward to having Dr. Kearney speak. |
| verajoffephd | 20:55:54 | Welcome "ananario" and "Chimborazo", we are waiting to start. |
| verajoffephd | 20:56:53 | Welcome Dr. Kearney, We have a few people already on the Chat. Please, participants, you are welcome to ask questions after you read the guidelines. |
| smgexpert | 20:57:30 | Hello everyone. |
| verajoffephd | 20:57:54 | Hello, Dr. Kearney |
| Lmkoll | 20:57:58 | Hello, Dr. Kearney. Thank you for being with us tonight! |
| smgexpert | 20:58:48 | You are welcome, glad to be here! |
| cyndigermack | 20:58:51 | My daughter is 5 is diagnosed with a mild case of SM. She began to whisper to her teachers in preschool this year she will be attending kindergarten this fall, what are some things I should do to get her prepared? I am looking into a 504 plan |
| smgexpert | 21:00:35 | It might be a little early for that. Many kids are naturally shy and reticent about speaking at that age, and we do not even see kids in our Clinic until they are at least age 5 years. |
| smgexpert | 21:01:29 | I do recommend getting her involved in play dates and social activities and to gently encourage her to speak in public situations, such as ordering food at a restaurant or ice cream place. |
| cyndigermack | 21:02:20 | She did not talk for three years in preschool and the teachers recommended for her to see a therapist, the therapist is working with us on strategies to get her more vocal in the classroom, she is fine in the "real world" just mute in the classroom. |
| Phillipssa | 21:02:38 | I have a 15 yr old son with sm. He still does not speak in class but will do oral reports with teacher only. Next year do you have any suggestions how to handle - should we act as though he does not have a problem, It seems to be a learned trait he has formed over years b/c he says he doesnt have sm. |
| smgexpert | 21:02:40 | Another thing to do is establish a good working relationship with the kindergarten teacher and guidance counselor and share your concerns and talk to them about how they can help her speak a little louder. |
| smgexpert | 21:04:06 | It might be a good idea to expand a little on what your son already does. If he is willing to do an oral presentation to the teacher, the next step would be to add another 1-2 people in the room as he does so and gradually increase the amount of people with time. |
| smgexpert | 21:05:03 | In both cases, I would also check to see whether the child speaks to friends or classmates. The more they do so, the better the long-term outlook. |
| cyndigermack | 21:06:53 | My daughter speaks to her classmates outside of the classroom and friends but in a group of her peers more then 5 such as kid parties she is silent. Just in school or larger social gatherings she does not talk much. |
| smgexpert | 21:07:05 | In the adolescent situation, I would also speak to him about what he is thinking as he speaks, as some kids worry about the negative consequences of speaking, such as people laughing at their voice. |
| Phillipssa | 21:07:15 | Using his manners has been a big problem - like saying thank you should i do anything when he doesn't as least thank people |
| smgexpert | 21:08:34 | For the younger child, that is a good sign, that she is willing to speak to others outside the classroom. That means she is not far away from speaking in the classroom, just needs some practice. One thing I might do is have her speak to 1-2 of her friends first in an empty classroom with no one around and gradually build from there. |
| smgexpert | 21:09:40 | For the older child, it is always a good idea to prompt manners (believe me, I have to do this all the time with my own kids!). That helps build his social skill and his speaking ability at the same time. Feel free to have him repeat the phrase if others cannot hear him. |
| cyndigermack | 21:09:56 | We are putting that in the plan for next year with small groups.. |
| ananario | 21:10:12 | my son is now 9 yrs. old he was dx with sm since he was in kinder and we decided to try medication prozac when he as in 3rd grade he now talks normal in the playground and with his team mates but whispering to his teachers. do you think it's time to slowly try to cut down the medication |
| verajoffephd | 21:10:26 | With a child who has not spoken for three years, Dr. Kearney, is it possibly a good idea to approach the child's S.M. with a little more intense approach to help with prevention for next school year? |
| smgexpert | 21:10:42 | That is a good idea, regarding the 5-year-old. Remember also that it is tough for young kids to speak in a big group. |
| cyndigermack | 21:11:32 | What is your recommendation to pursue a 504 or an IEP to help with the becoming more comfortable in the classroom? |
| smgexpert | 21:11:45 | Yes, Dr. Joffe, I would agree with that. Likely a good idea to engage in an intense program of social skills training and speaking ability. The good news is that the adolescents can absorb more therapeutic information and can progress quickly if motivated. |
| smgexpert | 21:12:55 | A 504 plan is not a bad idea, but we usually reserve this for kids who do not speak at all outside the home. But it is a good tool in the toolbox. I don't think you need an IEP just yet, especially because we want to see how much of her behavior is developmentally normal. |
| smgexpert | 21:14:17 | To ananario: You didn't say what the dosage was, but I am biased in favor of lowering medication when possible. A compromise might be to have the child speak more to the teachers first and then discuss medication change. |
| Phillipssa | 21:16:01 | my son is here now and says its just hard to speak to his peers but he is comfortable around adults and doesnt know why.. i would love to find a social skills training class for him maybe that would help |
| verajoffephd | 21:16:52 | Dear Participants: I would like to ask you to please not ask Dr. Kearney questions regarding medication since he is not a psychiatrist, nor a physician. His wonderful book on S.M. and School Refusal addresses treatment and school approaches and help from a team approach to SM. |
| smgexpert | 21:17:32 | A social skills training class is often available at school (check with the guidance counselor) or via therapists or other community agencies, so I would check around. It's not unusual for kids to have more trouble speaking with peers than adults, or even vice versa. |
| smgexpert | 21:18:35 | Dr. Joffe is correct, I am a clinical child psychologist, not a psychiatrist or pediatrician. All medication issues should always be discussed with a physician first. |
| Chimborazo | 21:19:21 | yes that is the case with my daughter (vice versa). she speaks to peers in and out of the classroom but not to teachers. |
| Phillipssa | 21:20:30 | when my child is prompted with a question from another person should i just wait for his response - when it could seem like forever or eventually speak up for him |
| smgexpert | 21:20:40 | That is also not unusual. But, for everyone, it is a REALLY good sign that the kids are willing to speak to someone outside the home. Many of the kids we see will not speak to anyone outside the home, peers or adults, so I want to emphasize that that is a good thing. |
| smgexpert | 21:22:35 | I always let the child try to answer first without rescuing him or her, but after a few seconds it is okay to provide a prompt such as "What do you say?" or "Say 'hello'" or something like that. If the child remains quiet, then afterward it is okay to have a conversation about what he/she could have said in that situation. But a little awkward silence never hurt anyone, so feel free to give the child a chance to speak. |
| ananario | 21:23:12 | it's 3/4 tsp. and he still go to his therapy we started every 3 weeks now that he talks to his therapist and really meeting his goal (therapist always communicate with my son's teacher to check his progress) from no talking at all to whispering to talking in a soft voice to adult in school and participating in social activities in school |
| smgexpert | 21:24:32 | That sounds like excellent progress; keep pushing the envelope until you get to where you want to go. Our end goal is usually that the child can speak audibly to others in the classroom and read a story or give an oral presentation out loud so everyone can hear. |
| sani | 21:25:13 | MY DAUGHTER will be 6 in Nov 2011 , joining K this Fall.We have been getting play therapy for her for over a yr without much visible benefit.We met a child psychiatrist last week and she recommended Prozac for her .Recommended dose--1.25 ml /day.She has been on medication for a week now.She seems to be more active, more verbal at home but I am not sure if this is a god idea to keep her on med when she is so young. |
| smgexpert | 21:26:46 | Well, again, I will defer on the medication question, but a better treatment would be a behavioral approach that focuses on practice and social skills training. Also, if she has never been in school, then it is normal to have some difficulty speaking to others at that age. |
| smgexpert | 21:27:48 | For the younger kids, exposing them to social situations, even if the child does not speak, is important. Play dates, birthday parties, get-togethers, family reunions, and such should be encouraged. |
| sani | 21:28:09 | Other than play therapy, what other behavior approach we could try for her? Is cognitive behavior therapy effective for kids this age.I have been getting mixed opinions on this.Pl advise. |
| Phillipssa | 21:29:44 | should we push them into some type of school activity such as the clubs they have at school even if they don't want to do it. The key club is always good i think for everyone |
| smgexpert | 21:29:50 | Cognitive approaches won't work well because she is too young. A behavioral approach focuses on simple practice in everyday situations. So, for example, bringing the child to an ice cream parlor and asking her to say one word (e.g., chocolate) to get the ice cream (the reward). Always a good idea to encourage speech in any normal situation and then to arrange social situations where the child can model appropriate speaking by others. |
| jaytea2 | 21:30:33 | If a 12 yo firl with SM is comorbid with a language processing disorder and ADD, how to you explain why she is now getting an IEP and required to go to speech therapy in school. She hates to be seen as different and has begged me not to involve the school. Yet, she doens't capture much of what the teacher says if not reinforced. The anxiety over looking different to her peers my cripple my two years of hard won efforts. Can you suggest what to expalin to her that leaves her self esteem intact and won't devestate her. |
| sani | 21:30:37 | Her non verbalness at school and with people outside of home(except a few) has persisted for 3 yrs now and so the psychiatrist suggested that its time to try medication. |
| smgexpert | 21:31:26 | It's always a tough call about extracurricular activities, but what we tell our clients is that they can choose 1-2 activities from a large list. The expectation is that they will participate in at least one activity, but can choose something within their comfort level. Also, think outside of school - church groups, neighborhood activities, or sporting activities are good. |
| verajoffephd | 21:31:46 | I would like to second our Expert that Behavioral approaches would be helpful. "Play Therapy" is a very broad term, and unless it has clear objective goals of how your child will get closer and closer to feeling comfortable in speaking in social situations, it does not work. Therapy should have clear goals, and not be happening for "ever" without slow, but constant gains towards goals. |
| sani | 21:32:06 | I agree with you.We have been trying playdates and more social exposure. My daughter has started saying a few words to a few kids that she meets with for playdates. |
| verajoffephd | 21:32:50 | Dr. Kearney and our Organization are her to help participants learn about empirically-based therapy for children with SM and with other anxiety disorders. It is good that you asked the question. |
| smgexpert | 21:33:12 | Regarding the child with the language processing disorder, try to work with the school to reduce whatever stigma might be attached to any special services she receives there. Because she is 12, she is very sensitive to others' judgments of her. But I would also tell her that it is an expectation that she will engage in all aspects of education and therapy that can best fit her educational goals. |
| ananario | 21:33:46 | i am so worried about the side effect of the prozac now he will be in 5th grade next school year. We only agree to put him on medication because for 4 yrs. of play therapy did not really help. he still in iep for speech only and to make him comfortable in the classroom he as given an teacher's aide to be with him since he was in 3rd grade up to now in 4th grade only for 4 hrs. and does help him. |
| sani | 21:33:46 | She seems to be making slow but consistent progress.Is it advisable for us (parents)to meet with a CBT so we can get some ideas as to how to encourage her to talk or such things? |
| jaytea2 | 21:34:31 | 12 yo girl: Would you say the school requires this speech therapy evenif it were inititaed by a parent? |
| smgexpert | 21:34:41 | I would encourage you to have a frank discussion with the physician about the medication and your concern about the side effects. |
| smgexpert | 21:35:10 | To sani: yes, I would encourage you to contact a therapist skilled in CBT in this area. |
| smgexpert | 21:35:41 | To jaytea2: I am not sure I understand what you mean. |
| Lmkoll | 21:37:49 | What advice would you have for my situation: My daugther, diganosed with SM and she is 6, has trouble generalizing and talking freely. She is able to answer yes, no questions, and answers in short answer from--which she has been doing about a year. Will it come? Or do I need to be actively working on expanding her language? |
| smgexpert | 21:38:13 | Is she in kindergarten or first grade? |
| Lmkoll | 21:39:08 | Her teacher does not see it as a problem, but I don't see it generalizing any further. |
| smgexpert | 21:39:35 | That is good. The fact that she is willing to speak at least at that level is a good sign. But I would be very active this upcoming summer about encouraging speech in greater detail and preparing her for first grade, which will be more demanding socially and academically. |
| sani | 21:39:57 | Another question I had is regarding Play Therapy.I am not sure how much benefit we are getting from play therapy.My daughter does not talk to her play therapist even after one yr of play therapy.The play therapist has recommended twice a week therapy instead of weekly sessions that we have been doing so far.I am not sure whetehr we should continue or not. |
| sani | 21:40:08 | Any advise would be helpful. |
| Lmkoll | 21:40:48 | Dr. Kearney, I read that play therpay is not effective with these kids, is that true? |
| Lmkoll | 21:41:14 | As a parent, I can sincerely understand your frustartion, Sani. I would be switching if I were you. |
| sani | 21:41:35 | Do you mean i should go to anothe rplay therapist? |
| smgexpert | 21:41:36 | The issue with play therapy is that there are many different kinds of play therapy. Some play therapy is very active, and we do a lot of play therapy early in our process to prepare for the speaking exposures. Other play therapy is more passive, trying to get the child to "come out of her shell" more naturally. The latter approach, in my opinion, is less helpful than the first approach. |
| jaytea2 | 21:42:03 | Can you offer wording to 12 yo girl to expalin why she will be pulled out 2-3 times a week to meet with speech thearapist when it will take her out of a dance class she loves. Been over it from every angle and I can't find the words that I feel she will understand and come to accept. |
| sani | 21:42:07 | We have been using the later approach so far. |
| sani | 21:42:40 | Hta's exactly what our PT said--it would bring her out of her shell and allow her to overcome anxiety. |
| smgexpert | 21:42:46 | For children with selective mutism or reluctance to speak, a more active therapy approach is suggested, at least from my standpoint. |
| Lmkoll | 21:42:54 | I personally would not go to another play therapist. As a fellow parent, I would not want more of the same stuff that is not working. |
| sani | 21:43:41 | yes I am thinking along the same lines. |
| smgexpert | 21:43:56 | Again, we do some play at the beginning of our process because the kids won't speak to us at first, but we begin "pushing the envelope" a bit once the child is accustomed to us and this works well. |
| jaytea2 | 21:44:42 | For those who have young children with SM, I urge you to do behavior therapy. It is so much easier and quicker at this age and will save a lot of heartache. We did it all and are now in behavior therapy and getting slow and steady results in a short time. |
| sani | 21:44:42 | This question for the expert--would it be advisable in my situation to look for a PT who is expert in using a more active play therapy approach. |
| smgexpert | 21:44:44 | To jaytea2: I would work with the school officials to see if some kind of compromise could be made regarding the dance class. Your daughter may have a legitimate point! |
| smgexpert | 21:45:42 | I recommend more so a behavioral therapist who is familiar with the treatment of SM or reluctance to speak. A good resource for finding such a therapist is www.abct.org. |
| verajoffephd | 21:46:52 | Sani, you can also contact visit this website to find a state coordinator of our organization. www.selectivemutism.org |
| sani | 21:47:09 | i did some courses in filial therapy(offered for the parents to do with their kids) from a university .I have been doing it once a week for 30 mins at home with my daughter and she seems to love it.But would it be advisable to stop PT an djust stick with Filial Therapy at home? |
| smgexpert | 21:47:36 | Not sure what filial therapy is. |
| sani | 21:49:21 | It is for parents .The way it differs from Play Thearpy is taht PT is done by a professional with a child while Filial Therapy is done by a parent for her/his child.It is very similar to play therapy. |
| ananario | 21:49:29 | I agree with going to another therapist with my son before I find the right we have been to six and asking questions which I learned from attending the SM conference in California really helped us alot in finding the right therapist. during that selective mutism conference the experts share what question to ask. i recommend for parents especialyy with younger kids with sm to attend the conference it's really very informative thanks to this organization |
| smgexpert | 21:50:45 | I would definitely encourage everyone to continue to learn more about SM and interact with other parents and professionals. The literature in this area remains in development but a behavioral therapy approach has generally been found to work better than non-behavioral approaches. |
| campbellsix | 21:50:54 | I have an 8 year old son w/ SM. Speaks only to family members and one peer. It is very difficult to speak with him about his SM, therefor difficult to work on it with him. Any suggestions? |
| sani | 21:51:13 | It is letting the child take the lead in play, showing "more be with" attitude, more affirmation and allowing the child to express herself in a place where she feels safe (in this situation, home). |
| smgexpert | 21:51:34 | If the 8-year-old will only speak to one peer outside the home and to no one else, then I would recommend a therapy approach. |
| campbellsix | 21:52:19 | Can you please give more insight? |
| smgexpert | 21:52:26 | The problem with that, sani, is that many of these kids are not natural leaders, they tend to be more reticent and withdrawn and often need an active, structured approach from others. |
| smgexpert | 21:53:47 | Regarding the 8-year-old, I think an active therapeutic approach might be warranted, especially since he may be entering 3rd or 4th grade and where the expectations for academic work and testing are much greater than before. |
| sani | 21:54:40 | So do you mean play therapy for her should be continued.I feel it is too late to change therapist as she has been going to the present on efor one yr now.But again, this does not seem to have helped my daughter much. |
| smgexpert | 21:55:23 | If it has not helped, then, yes, I would switch. Again, a more active behavioral approach has been shown to be best for this group. |
| sani | 21:55:54 | ok thank you.What is therapeutic approach and how is it different from CBT? |
| verajoffephd | 21:56:00 | We are almost in the end of our discussion. Please, for participants who have not asked questions, I hope you have a chance to do it now. |
| smgexpert | 21:56:40 | I do mean CBT, except without the "C" part because that refers to cognitive and many of these kids are too young for the cognitive approach. |
| srf2moms | 21:56:42 | I'm sorry, I just joined. My son is 10. He is making progress slowly |
| Lmkoll | 21:56:50 | How are children with SM who are gifted manage, and what can be the testing implications? |
| srf2moms | 21:57:22 | He speaks to his peers and a few teachers but it difficult |
| smgexpert | 21:57:31 | Many kids with SM with high intelligence do well in school until the expectations for speaking in an academic sense come up, and then problems arise. |
| sani | 21:57:43 | How do I find a play therapist or a CBT who has experienc ewith SM? |
| smgexpert | 21:58:05 | Regarding the 10-year-old, that is good that he speaks to some people, continue to encourage speech. |
| smgexpert | 21:58:15 | On this site or www.abct.org |
| smgexpert | 21:58:37 | Again, I don't think you want a play therapist. |
| sani | 21:58:40 | Thank you. |
| PattiSullivan10 | 21:58:47 | I have a 10 year old who is making progress. She was in therapy last summer and hated every minute of it. She talks w/ friends but has a harder time in school or groups where she doesn't know people. Should I take her to counseling against her wishes, or try to do the behavorial approach on my own. |
| srf2moms | 21:58:56 | Our therapist is trying to get him to explain to people why he doesn't talk. Make a card to give people |
| sani | 21:59:22 | yES i DO NOT WANT pt ANYMORE.I dont know how to find a BT WITH sm. |
| sani | 21:59:41 | I mean they do not tell honestly whether they have Sm exp or not. |
| srf2moms | 21:59:43 | to make him responsible to communicate with people |
| smgexpert | 21:59:49 | To Patti - you might want to look into social skills groups offered at a school or community agency. Less stigma and perhaps she'll be more receptive. |
| verajoffephd | 21:59:59 | We are almost in the end of our Expert Chat discussion. I would like to thank Dr. Kearney for his time, expertise, and wonderful contribution to our group tonight. We would like to ask you to please send us an email with feedback about this talk, and also to let us know about possible topics you would like to be covered in our next Expert Chat. We will have one Expert Chat in the June/July time, and we would love to hear from you of themes and topics of interest. Please, let us know as we want to serve the needs of our members, as we thank you for being part of this very important organization. Please, email the website with attention to Dr. Vera Joffe so that I can receive your feedback and plan the next Expert Chats. Sincerely, Vera Joffe, Ph.D. |
| Phillipssa | 22:00:15 | THANKS FOR YOUR TIME ITS BEEN VERY HELPFUL! I LOOK FORWARD TO ANOTHER ON LINE CHAT |
| smgexpert | 22:00:18 | Thank you, everyone. |
| sani | 22:00:27 | Thanks so much! |
| verajoffephd | 22:01:27 | Dear participants: please, visit our website for more information, we have a Annual Conference coming up in October, and please, contact your state coordinator for help in looking for therapists and people in your state who can help. And please, send us emails with questions for next Expert Chats. |
| verajoffephd | 22:02:09 | Also, make sure that you read the Newsletter. |
| verajoffephd | 22:02:36 | Any suggestions for other topics for the upcoming Expert Chat that anyone would like to mention now> |
| verajoffephd | 22:03:18 | This would help us provide you with Chats that can help you in the next few months. Dr. Kearney had so much to say, in such a short time. Hopefully we will have him back again. |
| cyndigermack | 22:03:40 | Preparing your SM child for full day school and preparing the school officials who will be working with your child to make it successful for both of them |
| ananario | 22:03:41 | thank you very much. |
| verajoffephd | 22:04:19 | Cyndigermack: this is a great topic. WE will certainly take your suggestion into account. Thank you all, we will end our chat now. |
| verajoffephd | 22:04:56 | Thank you, Dr. Kearney: for your time and help. We appreciate your contribution very much. |