| roviesk |
20:50:32 |
Welcome to our Expert Chat "Long-Range Treatment Planning" Our expert for this evening is Dr. Richard Gallagher.Dr. Gallagher is a psychologist who currently works for NYU Child Study Center. Along with his experience with kids who have SM, Dr. Gallagher also has expertise in working with kids who have ADHD and other disorders. 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. Thank you, Dr. Gallagher, for being our "expert" this evening. I am sure some of the attendees would like to know more about long-range treatment planning for youngsters with selective mutism.
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| roviesk |
20:52:09 |
Hello to all: I am your moderator, Dr. Steven Kurtz. I am an SMG Board Member and will be moderating this chat with my colleague, Dr. Richard Gallagher. We look forward to your questions.
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| smgexpert |
20:56:29 |
I am here. I hope that the information that I provide is helpful.
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| roviesk |
20:57:46 |
Feel free to pose your questions to Dr Gallagher :)
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| smgexpert |
20:59:30 |
Perhaps I can start with some ideas. Our work at the NYU Child Study Center for over 12 years and even work before that has led me to meet children and adolescents afflicted with SM in many different forms.
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| smgexpert |
21:00:15 |
With treatment, many of the children have become highly effective treatment in a short time. Others required a concerted effort for 18 months or more.
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| mstolen |
21:00:33 |
My daughter is now in kindergarten and doing very well. Many of her teachers tell us that they don't really see any issues with her having SM. I am wondering how I can know when to stop worrying, know that she is "better" and what the chances of a relapse might be for someone her age.
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| smgexpert |
21:01:42 |
Our experience has been that children do not relapse in the same way as their original response to social situations.
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| ananario |
21:01:57 |
my son finally feel very comfortable with his new therapist, whci he have been seing for 2 sessions now how long is long term treatment?
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| smgexpert |
21:02:17 |
If they have a long course of comfortable communication, they generally find that enjoyable and rewarding.
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| smgexpert |
21:03:04 |
Sometimes kids relapse when they encounter a new setting, but usually only for a brief period of time. This can happen when going to camp.
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| smgexpert |
21:03:23 |
With regard to the second question, it is a good sign when a chid talks with a therapist.
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| smgexpert |
21:03:52 |
We believe that the next step is for the therapist to encourage and provide supportive coaching for the child to talk to more people.
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| azolfghr |
21:04:24 |
Hello, my son has been treated for a year and a half now and the longer it goes on the more I worry. He is talking to his teacher but only when he is alone with her after school.
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| smgexpert |
21:04:29 |
When this form of exposure work is done with the therapist as the guide we have found treatment progresses well in a few months.
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| JodiMiller |
21:05:28 |
Since SM occurs in different settings under different circumstances, does one ever fully recover?
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| smgexpert |
21:06:00 |
For the third question (azolghr), it can be important to develop a plan to have your child be heard by more people. This can be done with tapes or others in the vicinity. To make these advances, it is best to have the steps guided by a behavior therapist.
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| azolfghr |
21:06:00 |
My therapist is not aloud to come to school and I feel this is prolonging treatment. Should I worry?
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| azolfghr |
21:06:11 |
I meant my son's therapist...
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| smgexpert |
21:06:44 |
For Jodi, full recovery has been observed by us many times and has been reported by others.
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| azolfghr |
21:07:00 |
sorry, I meant allowed
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| roviesk |
21:08:05 |
(smgexpert is typing..please wait)
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| allycat |
21:08:41 |
Hi, my daughter is in 4th grade now and still deals with SM. She still will not talk to any adult on campus. My wife and I have spent the last 3 years fightin a nuclear war with the school district: We won and have had untold services provided to us over the past two years. She still will only talk "through" a few trusted friends at school BUT, her social life at home has blossemed. We have read every book...talked to the the psychologist down in San Diego. And, continue trying different things. We still hope and pray and are indeed worried. The problem is though time is going by and school is getting hard. The teachers are becoming less willing. I need to start planning for the upper grades!?
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| smgexpert |
21:08:45 |
Azolfghr, it is important to discuss your son's situaiton with the director of special services if he is enrolled in public school. Social anxiety in school hinders children's achievement. If a school is blocking work to help your son, it is blocking his achievement. If the school is not able to provide an alternative expert, it should not be allowed to restrict the therapist from establishing an approach in the building by going to the building.
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| roviesk |
21:09:45 |
(please note there are some GREAT books on advocacy for SM in the SMG bookstore)
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| smgexpert |
21:09:50 |
Allycat, sorry for your struggles.
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| azolfghr |
21:10:00 |
He does have an IEP and is working with the social worker and special ed teacher but I feel he is not progressing that much since they don't know that much about SM and my son...
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| smgexpert |
21:10:38 |
If treatment has gone on for awhile, it is often helpful to consider additional treatments to alleviate associated anxiety. A consultation for medication is sometimes warranted.
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| smgexpert |
21:11:01 |
That last idea was for allycat.
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| mstolen |
21:11:17 |
Again, about my daughter who is in kindergarten. Her teachers tell us that she is talking in class to teachers and to other students but she now seems the most inhibited to speak when she is with me, her mom. I have read a lot about SM and have yet to come across an example when that is happening? Is it because she is used to me speaking for her all this time? This is a strange reversal for us to understand.
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| roviesk |
21:11:49 |
(I will suggest we host a CHAT just on advocacy in the near future for everyone's benefit)
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| smgexpert |
21:11:50 |
Mstolen, I have seen that pattern before.
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| smgexpert |
21:13:04 |
Please be patient mstolen, your daughter may be used to you providing her with more support than she now needs. Using the therapeutic resources that you have available, I would suggest developing a specific plan for "brave talking" in front of you.
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| allycat |
21:13:34 |
roviesk: I am the expert on IEP's/advocacy if any one ever needs help
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| azolfghr |
21:14:00 |
What is the longest you have seen treatment take place before recovery?
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| azolfghr |
21:14:28 |
I would need help allycat
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| smgexpert |
21:14:35 |
Unfortunately, we have encountered some children that do not improve greatly.
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| smgexpert |
21:15:12 |
This siuation has been rarely seen, but found when children seem to be highly anxious in all social contact away from home.
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| smgexpert |
21:16:01 |
Some children that we have met (a rare small number) seem to find playing with other children or engaging in activities away from home highly anxiety arousing, so their interactions are very constricted.
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| smgexpert |
21:16:56 |
When we see this pattern, we are often very concerned that the child may not do well with behavior therapy alone. Sometimes, medication may be required in order to reduce the substantial amount of anxiety that is present.
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| smgexpert |
21:17:22 |
Most children, however, do make gradual progress.
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| ananario |
21:17:23 |
my son have music class every monday, and teacher is giving him a ticket(punishment) for not doing the hand action or just openning his mouth like pretending to sing. She know's my son has SM, do you think giving him a negative consiquences will benifit him in the long run?
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| smgexpert |
21:18:38 |
Ananario, it is not likely that such a consequence will be effective. We have found negative consequences to be only useful in a carefully designed package of incentives.
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| beba |
21:18:48 |
My daughter has had SM since the age of 4 and now she is 13 and she still struggles with it. It's important to be patient with your child for. In our experience as parents, she continues to make progress as each year passes by. Would cognitive therapy help her reach her goal of speaking by the time she reaches 9th grade next year?
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| azolfghr |
21:19:07 |
My son is still sociable in his way, he participates, smiles, acts, he just doesn't talk. What I find difficult is to know how much to askof him depending on the situation...
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| smgexpert |
21:19:27 |
Cognitive therapy could be useful for an older child as she is likely to understand the purposes of the work.
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| smgexpert |
21:20:05 |
An effort that has been developed based on the work with general social anxiety for your daughter beba may be helpful.
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| roviesk |
21:20:58 |
Moderator's prerogative :) Given the topic of long range planning, how do you suggest parents work with their children and schools when changes of schools, such as lower to middle school, is coming up?
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| smgexpert |
21:21:00 |
Azolfghr, it is hard to answer such specific questions without knowing your child directly. You should set the goals for gradual change based on a consultation with his therapist.
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| smgexpert |
21:21:50 |
For moving from one school setting to another, it is important to expand on the usual methods used for helping all children feel comfortable.
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| smgexpert |
21:22:11 |
First, introduce the child to the new setting early on, even earlier than other children.
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| smgexpert |
21:22:37 |
Second, get to know the important support personnel and teachers in the new setting.
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| ananario |
21:22:58 |
after 7 therapist with no success my son is 8 yrs. old our new therapist ask my son to draw faces on the level of his anxiety(from 1-5) & asked him to write examples of what trigers his anxiety,do you think we find the right one for him? My son looks forward seing her and says she miss her
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| smgexpert |
21:23:49 |
Third, determine who is a point person in the school for establishing any treatment program that may need to be established in the setting.
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| allycat |
21:24:23 |
I too question what type of planning needs to go on from lower into middle school. The teachers are less willing to accommodate! RSP teachers are overloaded...there is less support
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| smgexpert |
21:24:26 |
Finally, have your child introduced to all of the important people ahead of time and find out how likely your child is to communicate with those people.
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| smgexpert |
21:25:30 |
Once you have an understanding of the communication needs in each class setting, it can be helpful to establish treatment goals for those settings, having the child move from one level of communication to the next one.
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| azolfghr |
21:25:41 |
When should you tar planning for the upcoming year?
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| azolfghr |
21:26:07 |
tar meaning start
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| smgexpert |
21:26:29 |
I think that planning from one school setting to the next (from elementary to middle) should start in February at the latest.
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| smgexpert |
21:27:03 |
You need time to find out who will be available to help and, in reality, who will be most helpful.
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| smgexpert |
21:27:21 |
Then,you need time to find out what resources are present in the school.
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| smgexpert |
21:27:35 |
It all takes time.
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| smgexpert |
21:28:11 |
For movement from one school year to the next in the same setting, I would suggest planning should start in April.
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| allycat |
21:28:20 |
In Ca. you can request an IEP / 504over the summer and it will be held with in 30 days of the start of school
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| allycat |
21:29:17 |
We can't come close to finding out who is willing to participate and help until we are all seated at the table
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| beba |
21:29:49 |
My daughter and I believe that the planning should reflect the goals of the child. Shouldn't children be given an opportunity to set goals as well?
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| smgexpert |
21:30:11 |
Getting back to ananario: It is really not possible to answer your question as a good answer would require thorough knowledge of your child and the therapists involved.
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| azolfghr |
21:30:54 |
allycat, how can I get your help for IEP\advocacy?
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| smgexpert |
21:31:13 |
Beba, you make a very good point. But, the child's participation should be geared to the child's development. Too much responsibility for making decisions can be a problem if those decisions slow progress.
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| allycat |
21:31:43 |
I am a member of this group: my email skygusty@sbcglobal.net
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| smgexpert |
21:31:56 |
However, beba, setting goals together can result in a very effective collaborative approach.
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| ananario |
21:32:09 |
my son has OT and speech in school, once a week (30 mins.), what should I be expecting from the O.T to do to my son. One time I observed and he is just playing with my son and letting him win.
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| roviesk |
21:32:16 |
Moderator: Please make your back channel requests, like how to contact each other, through the Ask the Doc panel on the left of your screen and I will connect you with each other. Let's leave the chat for Dr. Gallagher.
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| beba |
21:32:32 |
Yes, this is exactly what we have done.
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| smgexpert |
21:33:11 |
Ananario, it is best to discuss this directly with the OT. Playing maybe part of the motor coordination work that is part of the process.
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| azolfghr |
21:33:18 |
What is OT?
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| smgexpert |
21:33:30 |
Occupational therapy
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| ananario |
21:34:10 |
What is cognitive therapy?
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| smgexpert |
21:34:57 |
Cognitive therapy is really a collection of therapies usually conducted by psychologists or mental health therapists with training in cognitive and behavioral therapy.
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| quinnw |
21:35:19 |
Our son has made incremental progress with SM thru effective therapy along with medication for the anxiety. Recently, he has even shown more ability to join social activities
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| allycat |
21:35:37 |
Are there any resources out there for parents on cog.therapy and SM...As my child gets older I and my wife will need to carry this out
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| smgexpert |
21:35:47 |
Cognitive therapy is most often used with children older than 8 or 9 to help them understand what thoughts might be contributing to anxiety and reluctance to speak freely.
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| roviesk |
21:36:03 |
exoert still typing...please wait
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| smgexpert |
21:36:22 |
Quinnw, you make a good point.
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| smgexpert |
21:36:33 |
Combinations are often the key.
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| quinnw |
21:36:33 |
Is the trend toward more social activities usually a leading indicator toward more progress in overcoming sm?
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| smgexpert |
21:37:03 |
I believe that engagement in activities is a good sign for both SM and general social anxiety.
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| JodiMiller |
21:37:42 |
Is Selective Mutism and anxiety directly correlated? If a child recovers from SM, do they usually still have the social anxiety?
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| ananario |
21:37:44 |
Is it true that omega 3 is good for anxiety?
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| smgexpert |
21:37:49 |
Allycat, there has not been alot of development of cogntive therapy for older children with SM.
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| roviesk |
21:38:17 |
please hold up on questions, so Dr G can catch up
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| smgexpert |
21:38:32 |
However, the cognitive therapy work that is being done with social anxiety in people that do not have SM probably has some hints for how to help with SM.
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| smgexpert |
21:38:45 |
The technology still needs to be developed, however.
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| smgexpert |
21:39:18 |
JodiMiller, in most cases that we have seen, SM usually results from anxiety about speaking in social situaitons.
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| allycat |
21:39:27 |
I am just thinking as they get older they can begin to realize and think about it for themselves....which my daughter could not do as a when she was little
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| smgexpert |
21:39:30 |
Anxiety and SM are very strongly associated.
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| smgexpert |
21:39:43 |
You are right allycat.
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| smgexpert |
21:40:01 |
I am just saying that there has not been alot of development in that direcion.
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| smgexpert |
21:40:03 |
direction.
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| JodiMiller |
21:40:07 |
Thank you. Can they fully recover from the anxiety also?
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| smgexpert |
21:40:24 |
Yes, Jodi, that has happened.
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| smgexpert |
21:40:59 |
And, Jodi, some people still experience anxiety, but know how to control it and keep their behavior on track.
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| azolfghr |
21:41:05 |
Are there any food diets or supplements that help with SM?
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| smgexpert |
21:41:39 |
I do not believe that any issues with food or diet has been found to be present.
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| smgexpert |
21:41:50 |
That question, however, is not in my area.
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| mstolen |
21:42:15 |
What is the best source to find published long-term effects/results of different therapy types/treatments for children with SM?
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| smgexpert |
21:42:36 |
Mstolen, there are no long term review articles on the issue.
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| mstolen |
21:43:01 |
That's is frustrating? Why is that?
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| morgangillard |
21:43:07 |
In terms of long-range planning, can you suggest summer activities and ideas to scaffold progress from year-to-year?
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| smgexpert |
21:43:25 |
The condition is relatively rare mstolen, so it is just now getting the needed attention.
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| smgexpert |
21:43:54 |
Yes, morgan, some ideas come to mind and perhaps others can help with their experiences.
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| smgexpert |
21:44:23 |
However, depending on a child's status, supportive camp programs in which counselors will facilitate progress are useful.
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| roviesk |
21:44:55 |
Dr. G: would you clarify that you meant no long term outcome reviews but that searching for reviews of shorter term beahvioral and medicine therapies is a good idea at online libraries such as PubMed???
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| smgexpert |
21:45:06 |
If camp is not an option, establishing as many social contacts as possible in which a child has specific goals for communicating and interacting with others can also be done.
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| allycat |
21:45:31 |
As my daughter gets older it is becoming evident that her "shyness" is not as cute as it was when she was little. At 10 and now going on 11...I am hearing words from teachers like "defiance" and ODD...once again...my wife and I are worried and beginning to prepare for middle school where, I fear, teachers will be more willing to label the SM
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| allycat |
21:45:55 |
I think in the future we need a middle school parent chat :)
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| smgexpert |
21:46:18 |
For getting information on reviews of treatment, here is some elaboration.
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| roviesk |
21:46:20 |
(I'll work on that as I coordinate future topics..good idea)
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| roviesk |
21:46:43 |
expert is typing, please wait
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| smgexpert |
21:47:12 |
Resources such as Google Scholar, PubMed, and this website can provide articles on treatments that show promise in SM treatment.
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| smgexpert |
21:47:46 |
Those treatments include, behavior therapy in a variety of forms, and medications using selective serotonin reuptake inhibitors.
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| smgexpert |
21:48:18 |
Treatments that have no documented impact include play therapy, general family therapy, and other forms of medication.
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| morgangillard |
21:48:23 |
Great! Thanks - and, it seems like a real key with SM is day in, day out, commitment to helping the child have as many opportunities to be engaged socially (or have the chance to be engaged socially), as possible - from paying for items at the store, to waving goodbye to friends.
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| mstolen |
21:49:14 |
Re: summer activities. Our daughter emailed her new teacher all summer (and also attached photos)She also made a scrapbook that she shared with her teacher before school began (one on one). It worked wonders.
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| smgexpert |
21:49:16 |
A good summary of behavior treatments was completed by Kratochwill and coleagues in School Psychology Review or School Psychology Quarterly about 3 years ago.
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| smgexpert |
21:49:34 |
Mstolen that is an excellent idea.
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| smgexpert |
21:49:50 |
it could probably be adapted for the middle school setting.
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| morgangillard |
21:49:54 |
Cool. Great idea.
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| allycat |
21:50:07 |
i will look hat up thanks
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| allycat |
21:50:13 |
that
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| quinnw |
21:50:16 |
We have been working on having our son commit to making good eye contact when others speak to him even is situations where he may not be ready to speak yet. Is eye contact important?
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| smgexpert |
21:50:24 |
However, even better mstolen would be a tape for the next teacher.
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| smgexpert |
21:50:39 |
Eye contact is important.
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| morgangillard |
21:50:47 |
a tape?
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| azolfghr |
21:51:03 |
video tape?
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| smgexpert |
21:51:19 |
Of your child speaking so it could be played for the next teacher. Audio first and video second.
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| azolfghr |
21:51:48 |
Should that be done in the classroom for the students also?
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| smgexpert |
21:51:55 |
Related to these questions, it is often helpful to think of eye contact and verbal contact as separate parts of communication.
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| smgexpert |
21:53:18 |
We have found that children can make progress in one area (visual interaction through eye contact or verbal contact) while avoiding the other area. So, having a child engage in eye contact without verbal interaction is helpful as a step.
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| smgexpert |
21:54:04 |
Then, having the child engage in some form of verbal interaction without eye contact can be another step. We think that the combination of verbal communication and eye contact is the most difficult for many children.
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| ananario |
21:54:15 |
My son was being teased in school for not talking and one time the teacher asked me to video tape my son for his oral presentation in class and when the teacher played it all the kids were suprised that he can talk and stop teasing him.
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| smgexpert |
21:54:40 |
A tape for other students to hear is often very useful along the course of getting your child used to being heard by others.
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| smgexpert |
21:55:01 |
Ananario, we have had similar experiences.
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| morgangillard |
21:55:06 |
Is it important to get the permission/OK of the child before showing the tape?
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| smgexpert |
21:55:10 |
It is often very helpful
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| roviesk |
21:55:27 |
Only a few minutes left folks :(
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| smgexpert |
21:55:32 |
Yes it is important to let the child know.
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| smgexpert |
21:55:53 |
There are many ways to use tapes.
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| mstolen |
21:55:56 |
Re:tapes. It worked for us. We could not have her "formally" evaluated for SM or speech in "person" but a video tape helped with a long distance diagnosis of SM and was 100% effective for getting her speech therapy.
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| smgexpert |
21:56:02 |
They should be planned carefully, however.
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| ananario |
21:56:20 |
I asked my son first if he wanted to show his video tape in class and he was very happy with the result
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| azolfghr |
21:56:47 |
How is speech therapy related to SM?
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| smgexpert |
21:56:58 |
One way we often use tapes is to have one made that is played in the background, not as a big show for the class. We have often had the tape played over and over again in the background.
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| morgangillard |
21:57:05 |
It would be fascinating to see the child with SM's reaction to others seeing him/her talk on video...
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| morgangillard |
21:58:00 |
I don;t understand the repeated background idea. Would you please elaborate?
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| smgexpert |
21:58:21 |
The other kids in the class get used to the SM child speaking. And, the SM child gets very comfortable with having others know that he/she does speak. The SM child also often finds out that the other children accept him/her speaking so that there is much less anxiety.
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| smgexpert |
21:58:53 |
Just have the tape playing in one corner of the room while other actiities are going on. Don't make it a show.
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| smgexpert |
21:59:20 |
This is usually only possible in preschool or primary grade classes (K-2nd grade).
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| azolfghr |
21:59:30 |
Wouldn't it become a show pretty quickly once a child notices it?
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| roviesk |
21:59:51 |
Thank you Dr Gallagher for sharing your time and expertise with us. Thanks also to all our SM family for your thoughtful questions and comments. We look forward to you joining our next Expert Chat in November with NYU neuropsychologist, Dr. Daniela Montalto, on the topic of school testing with children with SM. Until then,Keep positive and keep workin’ the program!-Dr. Steve Kurtz, moderator
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| smgexpert |
22:00:06 |
My pleasure.
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| ananario |
22:00:25 |
thank you dr. kurtz
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| morgangillard |
22:00:30 |
Thanks Dr. Gallagher!!
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| JodiMiller |
22:00:31 |
Thank you Dr. Gallagher
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| azolfghr |
22:00:33 |
thank you!
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| Melli04 |
22:00:35 |
Hallo. I'm new to this chat. I have sm 3 & 7 year old boys and a 4 year old girl and a 6 year old boy, who are doing fine. The 7 year old is in 2nd grade. His teacher in school says he is an excellent student and "talking" to her and some of the classmates... Anyway I was following the chat and it helps me (the mom!) a lot, to know there are more parents around with the same "problem"... Thank you!!! Btw: our son came out of his shell after we showed his tape to the class - but he was watching the class through a window (he didn't want to be in the class.) And he liked that the class did not make a "big deal" out of it but know how he can talk now!!! :)
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| smgexpert |
22:01:20 |
It is good to see you all helping one another. Good night. Thanks for moderating Dr. K.
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| mstolen |
22:01:34 |
Hang in there moms and dads, you are not alone!
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| quinnw |
22:01:41 |
thanks
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| quinnw |
22:01:53 |
Thanks Dr. Gallagher and Dr. Kurtz
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| Melli04 |
22:02:29 |
Good night and THANK YOU again Dr. Gallagher and Dr. Kurtz!!!
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| ananario |
22:02:46 |
thanks dr. gallagher
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| allycat |
22:11:22 |
thank you so much!
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