How to Help Children and their Families Impacted by Selective Mutism to Transition Back into School

verajoffephd
2011/08/17 20:56:42 Welcome 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. Esther Hess to answer questions and to share her knowledge, expertise, and clinical experience in the area of Selective Mutism as well as in other areas. Before I introduce Dr. Hess, 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. Hess may answer questions from parents, teachers, professionals, and others, she 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. Hess will be able to answer your questions in a more general manner, and she 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: Dr. Esther Hess is a developmental psychologist and executive director of a multidisciplinary treatment facility in West Los Angeles, CA, Center for the Developing Mind. Dr. Hess's specialty is the assessment, diagnosis and treatment of children and adolescents with regulatory concerns like Selective Mutism. We are very grateful that Dr. Hess has volunteered to be in the Expert Chat tonight, and she is also a Member of the National Board of SMG. We can now start the questions.

Drhess
2011/08/17 20:58:23 It's a pleasure to be with you tonight Vera

verajoffephd
2011/08/17 20:59:14 It is almost 9 pm. We can start asking Dr. Hess questions now.

verajoffephd
2011/08/17 21:00:13 In the meantime, let me inform all of you that Dr. Hess wrote a wonderful article in the upcoming Newsletter in this website about the topic of "Going back to School". Do not miss her article and other ones in the Newsletter.

Drhess
2011/08/17 21:00:19 I'm looking forward to answering.

verajoffephd
2011/08/17 21:01:36 Dr Hess, in the meantime, while we wait for more people to join us, will you please go over some of the steps to help children with S.M. when they go back to school?

OlgaLuci
2011/08/17 21:02:12 HI Dr Hess, I have a daughter (13 years, her name is Michelle.

renaud
2011/08/17 21:03:05 Marie-France Renaud present !

cjgls5
2011/08/17 21:03:51 Hi My daughter is 8 yrs old and resistant to help - she is a very sweet child and acts perfectly normal at home talking away - but whispers to only a few friends. She is entering 3rd grade in a new school and I am petrified about the whole bullying/girls being caddy thing. What can I do to help.

Drhess
2011/08/17 21:04:35 Certainly. I think the main issues are how to make your child impact with SM feel more comfortable when he/she returns to school. The first thought is how to get the teacher 'on board' before school starts. I oftern suggest that the child and teacher meet before the beginning of school. Often the occassion is a couple of days before the opening day, but I have had parents also arrange for the teacher and child to meet at an ice cream store near the school to demystify the process of the first day.

SJLM9331
2011/08/17 21:06:47 Hello. We have a 4 year old daughter who is beginning Pre-K in a couple of weeks. She has been going to pre-school part time the past 6 months and has progressed quite a long way. But as the summer has drawn to a close, more children are coming into the class and she has become more apprehensive & nervous. What can we do to alleviate some of that apprehension?

Lmkoll
2011/08/17 21:08:29 Dr. Hess and Dr. Joffe, are you still here?

Drhess
2011/08/17 21:08:31 Let me welcome the parents that have joined us. Specifically, in regards to bullying, I would do two things. First, I would alert the teacher to your concerns and see if she/he could keep an extra eye out for your child, perhaps give her a 'buddy' on the yard, that could both help her 'hang out' and also minimize the chances of being a victim (bullys like children to be alone). Secondly, I would role play with your child what to do if they were approached by bullies and how to ask for help initially nonp0verbally. Parent and child, for example, could write a note for the teacher asking for help ahead of the needed situation.

verajoffephd
2011/08/17 21:10:36 Dr. Hess: We had a parent of a teenager introduce herself. Maybe you would like to talk a little about S.M. and teenagers, and the importance of intervention for them as well.

Drhess
2011/08/17 21:13:14 In regards to your 4 year old daughter starting Pre-K. My first question is does she have a special friend in class? Is is possible to organize playdates with some of the friends that she already has in class after school, at home, where I imagine she is feeling more secure? If so, I might also get a list from the teacher of one or two of the new children who are entering the class and based on the teacher's recommendations as to which child would be the most supportive, creat multiple opportunities for play dates so that the socialization can be practiced and the subsequent anxiety reduced.

cjgls5
2011/08/17 21:14:40 My Cassie is going to have a brand new teacher (prior was a long term sub) for 3rd grade who seems very nice and wants to help her. I met with the principal and new teacher and she will too before the beginning of the year. Cassie will have 2-3 friends in her class who she whispers to. What type of goals should we set up with the teacher? I feel like my child is so resistant to me trying to help her. Ex- she talks to some cousins but not others and when I asked her how she feels about it -she always gets goofy or changes the subject.

Drhess
2011/08/17 21:14:56 My apologies, I seem to be one step behind in my typing. In regards to adolescent issues. Being a teenager is tough, a teenager with SM is tougher. My first question to the parent is how long has your child been impacted and has intervention being successful to some degreee? renaud
2011/08/17 21:17:06 Dr Hess, as a parent of a 5 year old 90 % re-covered SM child, I would be curious to know , to your knowledge, even with a recovered child, can i as a parent be positive for her future as i would like to be?

Drhess
2011/08/17 21:19:22 This is for Cassie's mom; my goals for the teacher would be to try and create a relationship with your child, that focuses on the ability to attend and stay interested in the school work and not be so focused on the ability to speak out loud. Your daughter feels resistant to your questions, probably because she doesn't know the answer as to how she is feeling about only speaking to her cousins. I would try and reduce your own anxiety and focus on creating deeper friendships with the 2-3 girls that she does talk to. It also sounds like the teacher and the principal are on board, which is a great advantage.

verajoffephd
2011/08/17 21:21:02 Dr. Hess: While you are answering other questions, I thought that the note that "renaud" sent brings an interesting point: What does it mean to be 90% recovered, renaud? And what does it mean to you to "be positive for your child's future". If your child is, at this point, 90% recovered, what is left to be worked on? I would love Dr. Hess' comment on this as it is a common question parents have.

Drhess
2011/08/17 21:22:52 I think the fact that your 5 year old is 90% recovered from SM is wonderful news. What I would be looking out for in the future is how he/she approaches new situations, new people, new obstacles. I am not clear about the specific treatment used to help your child be so successful. But in my own practice, it is not unusual for me to see a child 6 months post graduation to see how they are maintaining. I would not hesitate to be positive for your child's future. I would only tell you to remain vigilant, if you see problems navigating new circumstances.

Drhess
2011/08/17 21:23:40 Vera,

verajoffephd
2011/08/17 21:23:46 yes

verajoffephd
2011/08/17 21:23:59 I am here, Dr. Hess, and reading your wonderful, complete, and very informative answers.

verajoffephd
2011/08/17 21:24:41 Your answers help not only the one who is asking but other parents as well.

Lmkoll
2011/08/17 21:25:23 Renaud, how long was your 5 year old in therapy? did he/she do behavior therapy?

Hutton
2011/08/17 21:25:28 I have a 7 year old daughter who doesn't talk or whisper to any kids at school, but will whisper to me, her Mom. I've read about a verbal intermediary. Do you recommend verbal intermediaries?

renaud
2011/08/17 21:25:47 Well, she isn't frozen anymore.. much more relaxed, speaks in her class to the teacher and friends. Spoke in front of strangers at our last family gathering. The only time she doesn't answer is when ordering at a restaurant ( although she did it 2 times).. its really day and night.. what i wonder, is if kids with SM that are recovering well, when they hit a crisis period lets say for example teenage years, do they regress to their initial state of mutism. ( are there any serious studies on that ?) Thank you !

Drhess
2011/08/17 21:27:10 I agree with your quesition. I believe that the child with SM has a regulation issue that prevents him/her from correctly interpreting environmental stimulus. They become overwhelmed for whatever reason and shut down verbally. Even though a child has recovered, again whatever that means to the child and the parent, I would still be concerned that the child is now able to navigate when faced with challenges and not shut down prematurely, as they have done in the past.

Drhess
2011/08/17 21:28:19 I am not familiar with any studies about regression in adolescence. Vera, how about you?

renaud
2011/08/17 21:28:23 to answer lmkoll if you permit for the time of the therapy was quite short !

verajoffephd
2011/08/17 21:29:09 Unfortunately, there aren't many studies at all in S.M. in general, let alone longitudinal studies.

cjgls5
2011/08/17 21:29:09 Can I ask you what treatment approach you use? I am in the process of looking for a good counselor or psychologist in the South Jersey area. Do you know where I can go to find out who has experience with treating kids with SM?

verajoffephd
2011/08/17 21:29:40 However, we do know that the earlier intervention starts, the better response we get. Also, the later the intervention, the more chronic anxiety appears.

OlgaLuci
2011/08/17 21:29:42 Michelle is starting her 8th grade next week. And her situation is very complicated because of custody issues. She hasn't had any type of therapy since 2008 because her therapist graduated and moved. She has not spoken to anyone else (outside of mother, father and siblings) in that time. She was put on prozac at the insistence of her father but received no cognitive therapy during this time. Since last October she has refused to take the medication.Her father, who has custody, has not pursued therapy because he wants to move out of state and does not want the entanglement of her having a relationship with a therapist. She doesn't communicate at school, does not turn homework assignments in (she does them, she just won't turn them in) and does not eat. She is embarrassed by any parental participation in her schooling. She will not eat in public so she does not eat during the school day, between about 7:30 and 3PM.A life-long churchgoer she has now stopped attending. Sometimes she dresses but won’t leave the house.Her father attempted to move her last summer without court permission and was ordered to return. She has regressed severely since then.I need suggestions for a therapy plan so that I can make arrangements and present a plan to her father for action (he has custody)\

Drhess
2011/08/17 21:30:20 What I would contineu to do, is to take out your child into the community and create more positive emotional experiences that will actually create new neural connections that will help her take the risks necessary for new learning opportunities.

renaud
2011/08/17 21:30:21 sorry .. she started occupationnal therapy in september of last year and started to scale up the communication scale in a matter of weeks. She has both SM and Sensory Processing Disorder and the really amazing method that worked for her is MNRI Masgutova Method verajoffephd
2011/08/17 21:31:27 For a child who has treatment early, if she/he receives treatment that also teaches coping skills for new situations (such as cognitive behavior treatment), then they are likely to use their skills for the future. However, it a parent notices new stressors, such as high school, getting a period, having a negative social experience, of any signs of other type of anxiety, it would not hurt to have a "check up" with the treating doctor, just like we do with pediatricians.

campbellsix
2011/08/17 21:32:17 Hi, We have a third grader - will be 9 in a couple weeks. He only speaks with my husband, me (mom) and his 3 siblings. 2 other friends...but rarely sees them. No one in his class this year that he will speak to. Just wondering if you have any suggestions on how help us open him up a little, in helping him figure out why he feels the "fear" of speaking. We've tried to help him w/this anxiety, but he's not interested in understanding it. Maybe this would be the first step for him? Thanks for any suggestions.

Lmkoll
2011/08/17 21:32:43 CJGls5, we have a state coordinator in NJ. Please contact her and hopefully she will be able to direct you to some local resources. Here is her contact information: Annette Ristoro (Burlington, NJ) agjr20@comcast.net If you do not copy and paste it from here, you can find it on our website.

Drhess
2011/08/17 21:33:29 This is for the mom who is a verbal intermediary for her child. It's not my favorite position for a mom to be in. I teach parents to participate in their child's therapy and have mom playfully 'play dumb' in session. Often the first major step towards verbal communication is for the child to talk in front of me in session, to her mom who might be frustrating the child by not talking for her.

cjgls5
2011/08/17 21:33:40 Thank you!!!!

cyndigermack
2011/08/17 21:34:58 My daughter 5 yrs diagnosed with a slight case of SM, is starting kindergarten this fall new school new peers and new teachers, I have been really unsuccessful with getting the school to accomondate the need of having her meet with the teacher in advance. She starts in less then two weeks, and they have still not assigned the kids teachers. How can I express the sense of urgency to get the school to allow us in advance to have my daughter meet her teacher rather then waiting for orientation when the rest of the students are meeting the teacher.

crystaltobin06
2011/08/17 21:36:46 Dr. Hess, we have a 10 year old with SM in the 5th grade. She has yet to speak to a teacher or anyone in the school setting. The one friend she had in her class was moved to another class and the school is very apprehesive to our help although we approach them with our issue. We have a meeting with the school psycologist, teacher, asst. principle, and guidance couns. tomorrow. Are there any questions you suggest we ask or any suggestions we should make?

verajoffephd
2011/08/17 21:36:55 While Dr. Hess is answering questions, I would like to remind all of you that the Newsletter will be in the website at any time now. You can print the copy of the newsletter and take it to the school where your daughter will go (Cyndigermack) because there is good information in the Newsletter, including accommodations, the law, and preventive measures to take before school starts.

Drhess
2011/08/17 21:37:54 The answer is the parent in South Jersey. I utilize a developmental/relational approach to children with SM called DIR/Floor Time. I would find a therapist for your child in a couple of ways. If you are intersted in DIR/Floor Time as an approach, contact the parent organization ICDL and see who is a treating clinician in your area. You are also welcome to see the treating professional listing on the SMG web site and finally, you might want to contact your local chapter of the American Psychological Association or the New Jersey Psychological Association and ask for a good child clinician who specializes in anxiety and preferably SM.

Lmkoll
2011/08/17 21:39:54 cjgls5, we also have 4 treating professionals in NJ listed on our website. Go to 'Find Help', then Treating Professional profiles, you will find 4 listed under NJ.

verajoffephd
2011/08/17 21:40:35 If I may, let me inform you all that S.M. is a disability, as it is a social-anxiety communication disorder. Thus, under the IDEA, children with a disability have the right to receive accommodations to help them learn and feel comfortable in regular education despite their disability

Drhess
2011/08/17 21:41:16 I am addressing the mother who has a ocmplicated custodial arrangement with her daughter's dad. You cannot treat your child until you work out the legal conerns with her father. If you have concerns that your child's physical and mental health issues are hot be addressed, then I suggst that you contact an attorney and see if these issues could be addressed in front of a judge.

OlgaLuci
2011/08/17 21:42:49 I have retained an attorney and he has told me to assemble an affirmative plan and present it to my ex husband.

crystaltobin06
2011/08/17 21:45:46 What are your recommendations for getting an IEP although our daughter makes straight A's in class.

renaud
2011/08/17 21:45:59 Is there any neurological new research that was been published recently specifically for kids with SM ?

Drhess
2011/08/17 21:46:41 This is for the mom who has a third grader who speaks primarily to parents and sibs. You are asking him something that is 'way too hard' for him to answer. Most children let alone a child with SM know why they feel fearing when speaking. I would not let this be an issue. Instead of being so complext, I would suggest playing with your son, at his developmental level (which might be a bit younger than 9) compliment him on what he can do well, and build on his strengths while supporting his challenges. If he speaks with sibs, perhaps have a sib along on a playdate with one of the children who he occationally sees and with whom he does speak with.

cyndigermack
2011/08/17 21:47:36 Do have a date when that article will be available in the newsletter and also is there a way to sign up to recieve it on email?

cjgls5
2011/08/17 21:48:43 Have you found great success with the DIR/Floor time approach. I don't know anything about it and am planning to look it up.

Drhess
2011/08/17 21:48:57 I have writen professional letters for parents to the school making the request for both an early introduction to teacher and student body to help with the transition to school. I have rarely met resistance from the school when the request is in the form of a clinical recommendation.

verajoffephd
2011/08/17 21:49:05 If you are all members, you will receive in the email within the coming week.

cyndigermack
2011/08/17 21:52:07 I am working with a treating professional who is composing a recommendation for an IEP, I plan on submitting the documents tomorrow I am hoping that will get the ball rolling with the school becoming more accomondating. Thanks

Drhess
2011/08/17 21:52:23 This is for the parents of the 10 year old who are having a meeting with the staff tomorrow. The first thing that I would do, is have the parents make a request to see if their child could be moved to the class where her friend is.

crystaltobin06
2011/08/17 21:55:52 Dr. Hess, we asked our child if she wanted to change classes and she does not. She is comfortable in the class that she is in, but we know not having someone in there that she is known to speak to is a setback. Should we let our child make that decision or make it for her?

Hutton
2011/08/17 21:56:50 My daughter who is 7 tells me that she wants to talk at school but says everybody in her class already knows that she doesn't talk. Any suggestions on changing her feelings towards that?

Drhess
2011/08/17 21:58:02 This is for the parent who's child is getting straight A's but is still impacted by SM. The issue with the IEP, is that the school is going to say that your daughter is able to access her curriculum and will be unwilling (likely) to provide services. The first question, I would ask yourself, is what services would you like your child to have from the school. Your child, depending on the state that you live in, is likely eligible for services through the criteria of 'other health impaired'. I might ask for a social skills group and accomodations for test taking and evaluations.

Drhess
2011/08/17 21:59:56 The newsletter with all of the articles on transitioning back to school (including information re: IEP updates) is coming out in the next couple of days. You can access the newsletter once you become members of SMG.

cjgls5
2011/08/17 22:00:47 My daughter has a 504 plan and does very well academically - does she need an IEP?

verajoffephd
2011/08/17 22:01:54 Dear Participants: Time goes so fast! In a few minutes, as soon as Dr. Hess answers the questions up until the last one, we will start the end of our expert chat

Drhess
2011/08/17 22:01:59 I don't know your child's sensitivities, but if her one social connection is in the next classroom, I would help my child make the decision to move.

Drhess
2011/08/17 22:03:41 My quesition to you is whether the 504 plan fits your child's needs. If she needs more extensive support, then I would consider an IEP and again, elible under the category of 'other health impaired.

verajoffephd
2011/08/17 22:05:00 Dr. Hess: You are welcome to answer the last questions. I will just put the last words from the Expert Group out, and as soon as you are finished, please, let us know. I am very grateful for your participation, and the questions and answers were very helpful to all of us.

verajoffephd
2011/08/17 22:05:28 We are almost in the end of our Expert Chat discussion. I would like to thank Dr. Hess for her 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 Fall, 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, or you can email Dr. Joffe directly at verajoffephd@gmail.com . Sincerely, Vera Joffe, Ph.D.

Drhess
2011/08/17 22:06:22 I am reviewing that last couple of questions, my aplogies for not getting to everyone. I would suggest a socail skills group for your 7 year old who says that everyone knows that she doesn't talk. Adress the thought that here are kids who don't know her concerns and let her practice being social in a safe place with professionla guidance.

Drhess
2011/08/17 22:07:41 Vera, thank you for giving me the opportunity to chat with all of these wonderful, caring families. All the best, Estie Hess, Ph.D.

verajoffephd
2011/08/17 22:08:32 Thank you, Dr. Hess. This was a very very rich Expert Chat. Vera. Thank you all.

Lmkoll
2011/08/17 22:10:01 Thank you for the wonderful information!!!

cjgls5
2011/08/17 22:10:13 Thank you!

Lmkoll
2011/08/17 22:10:20 We really appreciate your time and expertise!

Drhess
2011/08/17 22:11:57 You are most welcome. If you would like to continue a discussion with me, you are most welcome to contact me directly at Drhess@centerforthedevelopingmind.com. All the best.

OlgaLuci
2011/08/17 22:17:41 thank you.