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Neuropsychology and Children with SM
Expert chat session from November 19, 2009
| roviesk | 20:51:21 | Dr Montalto, are you logged in? |
| roviesk | 20:52:02 | roviesk is our Moderator of tonight's discussion with our Expert, Dr. Daniela Montalto, of the NYU Child Study Center in New York. |
| slevine74 | 20:53:52 | i am here to attend. is this on-line only, or should i be calling in as well? |
| smgexpert | 20:56:07 | Hello, I am present. |
| roviesk | 20:56:57 | roviesk is Dr. Steven Kurtz, a child psychologist at the NYU Child Study Center and an SMG Board Member. Dr. Daniela Montalto is a pediatric neuropsychologist at the NYU Child Study Center who developed our Center's wonderful approach to testing children with SM. Dr. MOntalto, do you want to mention a bit about what you do? |
| roviesk | 20:57:12 | this is online only...not call in :) |
| smgexpert | 20:58:36 | As Dr.Kurtz mentioned, I am a pediatric neuropsychologist and I have been working with our clinical team in developing a sensitive evaluation battery for children with SM |
| smgexpert | 20:59:16 | my background is in learning disabilities, child behavior, and parenting |
| smgexpert | 21:01:55 | ... |
| roviesk | 21:03:04 | Dr. Montalto: How do you advise teachers of let's say 1st or 2nd graders to try to assess kids' skills if they won't talk??? |
| smgexpert | 21:04:14 | great question. |
| smgexpert | 21:06:44 | I would begin by using nonverbal tasks that focus on yes/no questions and/or providing mulitple choice questions to initially engage students and rewarding and praising responses |
| smgexpert | 21:07:25 | nonverbal tasks such as spelling, math, and pictorial choices are also all great ways to start |
| slevine74 | 21:08:08 | can standardized tests be altered for children w/SM so their cognitive skills can be appropriately assessed (ex - kindergarden readiness tests, etc?) |
| smgexpert | 21:08:34 | absolutely |
| ananario | 21:08:36 | what is the best therapy that will work for 8 yrs. child already in medication. |
| smgexpert | 21:08:53 | there are cognitive measures |
| smgexpert | 21:09:02 | that are completely nonverbal |
| smgexpert | 21:09:28 | and yield scores of intellectual functioning... |
| roviesk | 21:09:31 | annario...we'll try to get to your question, but the focus of the Expert Chat tonight is somewhat different..If you don't get answered, send in question to the site and I'll respond |
| slevine74 | 21:10:15 | how would a school system know about this or be convinced to do this for a child? |
| roviesk | 21:10:27 | Dr M, can you mention a few that parents might jott down to mention to schools??? |
| smgexpert | 21:10:40 | the measures are research based on normed |
| ananario | 21:10:44 | can you explain the cognitive behavioraltherapy, my son is totally non-verbal in school and he feels very comfortable with his therapist but he still does not talk to her. |
| roviesk | 21:11:21 | Annario, I am going to have to ask that you let Dr. Montalto restrict her remarks to the topic of the night - testing issues.... |
| smgexpert | 21:11:23 | they yield scores that parallel what would be used on other standardized batteries |
| roviesk | 21:11:40 | we care about your question, but you may want to email me at the website for to answer |
| smgexpert | 21:11:45 | some tests include... |
| smgexpert | 21:12:16 | wechsler nonverbal scale of abilities, |
| smgexpert | 21:13:01 | leiter international performance scale- revised |
| smgexpert | 21:13:35 | wechsler intelligence scale for children-integrated is also |
| smgexpert | 21:13:51 | a measure that uses multiple choice items for the verbal subtests |
| smgexpert | 21:14:14 | what is important to keep in mind- is that there are measures that assess verbal abilites, working memory, attention |
| slevine74 | 21:14:30 | is it reasonable for me to request to a public school system that someone who is a "preferred" person for my son do the testing rather than a stranger? otherwise, he does not perform to his capacity, or for me to be present (his mother). he would not be able to ask for further explanation/clrification, othrewise... |
| smgexpert | 21:14:40 | and even language functioning that do not require a child to verbalize |
| smgexpert | 21:15:47 | it is important that the "preferred person" does not have a personal relationship with your child |
| smgexpert | 21:16:14 | because it can influence the administration and interpretation of the results |
| slevine74 | 21:16:16 | so, not a parent. what about a favorite teacher? no? |
| smgexpert | 21:16:17 | however... |
| smgexpert | 21:16:48 | it is reasonable and customary for a parent to be present during parts of the evaluation and, in rare instances, |
| smgexpert | 21:16:53 | during its entirety |
| ananario | 21:16:58 | are this test only done in school? |
| smgexpert | 21:17:30 | teachers would need to have a background and qualifications |
| smgexpert | 21:17:36 | to administer the tests; if they do.. |
| smgexpert | 21:17:58 | then this would be a very appropriate situation |
| smgexpert | 21:18:18 | no, these tests can be done privately as well |
| smgexpert | 21:18:38 | some schools actually may not be aware of these tests or able to administer them |
| smgexpert | 21:19:06 | getting back to the testing with a "preferred person" |
| smgexpert | 21:19:18 | if a child with SM is being tested |
| smgexpert | 21:19:31 | there needs to be preliminary contact and exposure to the evaluator |
| smgexpert | 21:19:50 | in order for the testing to be done effectively |
| roviesk | 21:20:07 | What a great idea...prior contact where the focus is NOT on testing but rapport building??? |
| smgexpert | 21:20:21 | because this would ease their anxiety, build rapport, and increase the liklihood of them providing verbal responses |
| smgexpert | 21:20:30 | yes |
| smgexpert | 21:20:46 | the rapport building is an integral piece to the testing process |
| slevine74 | 21:20:49 | that makes sense. school system would really need to be committed and educated on the importance of this. so, depending on how my son is doing, it may be necessary down the line to look into other means of cognitive testing. in your opening remarks you mentioned the sensitive evaluation battery. what is the sensitive evaluation battery that you are working on? |
| smgexpert | 21:21:00 | if a child is working with a clinician it is also imortant |
| smgexpert | 21:21:36 | to include the therapist in the testing process |
| smgexpert | 21:21:43 | the battery i am working on |
| smgexpert | 21:22:21 | assess cognitive, language functioning, attention |
| smgexpert | 21:22:36 | and academic abilities |
| smgexpert | 21:22:42 | as well as... |
| slevine74 | 21:22:43 | in kids w/sm? |
| smgexpert | 21:22:53 | learning and memory and motor skills |
| smgexpert | 21:22:56 | yes.. |
| roviesk | 21:23:08 | Do u think parents should request this warming up process (like maybe printing out this expert chat after we archive it and bringing to their schools) ??? |
| smgexpert | 21:23:10 | we have actually been using the battery succesfully |
| smgexpert | 21:23:27 | absolutely |
| smgexpert | 21:23:42 | the warm up process should be required prior to testing |
| smgexpert | 21:24:33 | and documenting in writing is important |
| slevine74 | 21:24:51 | documenting what in writing? |
| smgexpert | 21:25:16 | documenting that the evaluator spends.. |
| smgexpert | 21:25:32 | time before the testing session to play nonverbal games |
| slevine74 | 21:25:52 | ok. i see. sorry. yes documentation to back-up recommendations. schools can hear that. |
| smgexpert | 21:26:15 | exactly |
| roviesk | 21:26:18 | Dr M, do children with SM typically have higher rates of learning problems than other typically developing kids? higher rates of language problems? |
| smgexpert | 21:26:33 | we are finding that children with SM... |
| smgexpert | 21:26:50 | do tend to have higher rates of language weaknesses |
| smgexpert | 21:27:18 | and, in our sample, we have also noticed difficulties with reading readiness |
| ananario | 21:27:22 | how do I find private evaluators? |
| smgexpert | 21:27:40 | which is not surprising because reading is a language based task |
| smgexpert | 21:28:08 | ... |
| smgexpert | 21:28:35 | there is the american board of pediatric neuropsychologists... |
| roviesk | 21:29:03 | Ananario, Great question...start with using the find a doc part of this website, and local SM folks can point u to good evaluators. Also, the tab on the left Ask the Doc can be used to identify local resources as well as our State Coordinators on this website |
| smgexpert | 21:29:07 | at the child study center, we have a host of resources |
| smgexpert | 21:29:20 | thanks steve |
| smgexpert | 21:29:34 | for pointing that out |
| slevine74 | 21:30:23 | what are you seeing in terms of memory, motor development, and sensory integration issues in these kids? |
| roviesk | 21:30:50 | Great question :) |
| smgexpert | 21:31:00 | the findings are mixed |
| ananario | 21:31:04 | my son is in 3rd grade and he is getting good grades in math (A) and language arts but when there's open ended questions he is having difficulty in writing the answers. what do you think I should do |
| slevine74 | 21:31:28 | how about any co-occurring medical issues? |
| smgexpert | 21:31:49 | with writing... |
| smgexpert | 21:31:53 | it could be either motor |
| smgexpert | 21:32:03 | or language-based difficulties that are getting in his way |
| smgexpert | 21:32:27 | as he may be having difficulty "finding the words" he wants to use in his written answers |
| smgexpert | 21:33:13 | regarding co-occuring medical issues...hearing should always be checked |
| smgexpert | 21:33:30 | as auditory processing difficulties can result from hearing impairments |
| slevine74 | 21:33:54 | is 5 too young to test for auditory processing difficulties? |
| smgexpert | 21:34:19 | anxiety often plays a big part in sm |
| smgexpert | 21:34:30 | no, five is not too young |
| smgexpert | 21:35:01 | children as young as 24 months can be tested |
| smgexpert | 21:35:07 | for auditory processing |
| slevine74 | 21:35:55 | my son's teacher mentioned being concerned about that last yr. could that confuse his diagnosis? he was having trouble follwoing multi-step instructions that other kids could easily do, but he is really bright. a picture schedule helped him a lot as well as some individualized attention. should i be getting him tested for this? |
| smgexpert | 21:36:41 | i don't think it can confuse the diagnosis... but rather clarify it |
| smgexpert | 21:36:55 | i like the use of the picture schedule.. |
| smgexpert | 21:37:19 | i also think multi-step directions can be overwhelming |
| roviesk | 21:37:22 | Don't you use that for testing as well to make things more predictable, and less anxiety arousing??? |
| smgexpert | 21:37:32 | i do! |
| roviesk | 21:37:36 | that..meaning a picture schedule??? |
| smgexpert | 21:37:53 | i use a work organizer that is pictoral... |
| smgexpert | 21:38:37 | and I also use a behavioral chart that has three goals shown both in writing and in pictures... for example... |
| smgexpert | 21:38:46 | it might say.. |
| smgexpert | 21:39:18 | stay in seat (picture of child sitting) |
| smgexpert | 21:39:28 | stay on task (picture of child at desk working) |
| smgexpert | 21:40:26 | and try my best... I also include a separate chart for brave talking (picture of child chatting) |
| roviesk | 21:40:26 | Can we scan this in and make available to interested folks??? What a great way to keep kids involved and motivated! |
| smgexpert | 21:40:45 | wonderful idea- i'd be happy to share |
| slevine74 | 21:41:03 | my son would eat that up. he loves his schedule!!! to go back to the multistep directions: so, multi-step directions increase anxiety which is where SM "lives". ok, so learning approaches which are less anxiety provoking would be a faster route to verbalizing? |
| smgexpert | 21:41:21 | yes |
| smgexpert | 21:41:24 | well said |
| slevine74 | 21:41:44 | how do i say that to a teacher w/o them thinking i'm directing them on how to teach? |
| smgexpert | 21:41:51 | the goal is to decrease the anxiety in order to see if there are other difficulties interfering with his learning |
| ananario | 21:42:17 | when my son is having difficulty in his own classroom with 20 kids, his aide will bring him to the resource room with 4th and 5th grades and the special ed teacher and they said he feels very comfortable working with older kids and he sits and do his work without a problem ., why do you think is that? |
| smgexpert | 21:42:39 | you can tell a teacher that your child "responds" best when he is provided with pictoral choices |
| smgexpert | 21:42:56 | steps broken down and accompanied by a visual cue |
| smgexpert | 21:43:14 | and this would not be you telling her/him how to teach |
| smgexpert | 21:43:23 | but how to really get the most out of your child |
| smgexpert | 21:44:11 | it may be that the older kids don't expect as much from him, in terms of verbal responses, as do children his age |
| roviesk | 21:44:21 | My experience with teachers of children with SM is that they LOVE to know what works best with these kids. Do u agree? |
| smgexpert | 21:44:23 | older children may also "fill in" the language |
| smgexpert | 21:45:04 | i do agree- i think teachers are really interested in helping children with SM feel comfortable |
| roviesk | 21:45:12 | Does praising brave talking when it happens turn kids "on" as opposed to increasing anxiety? I ask because there's some talk from some folks that focussing on talking backfires for children with SM. I gather your experience is decidedly different? |
| smgexpert | 21:45:23 | and that they are eager to implement alternative strategies and ideas |
| smgexpert | 21:46:38 | i praise them for sharing their ideas and thank them for giving me answers and this increases... |
| smgexpert | 21:47:02 | their likelihood to respond again |
| smgexpert | 21:47:43 | i base what i put on their chart on their level of verbalizing at the start of the evaluation |
| smgexpert | 21:48:03 | if they are not talking at all, i do not have a brave talking chategory |
| roviesk | 21:48:55 | We sometimes just reinforce |
| slevine74 | 21:48:57 | i have tried to use "brave talking" or "brave playing" w/my son. he responds much more positively when i talk about "brave playing" vs "brave talking". |
| smgexpert | 21:49:03 | i agree that focusing on the talking at the start would increase anxiety; however, once they have began verbalizing and show an increase in comfort- they respond favorably |
| roviesk | 21:49:10 | brave participating, even if non verbal. Do you do that too???? |
| slevine74 | 21:49:24 | good one. i will tomorrow! |
| smgexpert | 21:49:51 | yes- it is important to acknowledge and praise efforts |
| smgexpert | 21:50:24 | i like "brave participating!" |
| roviesk | 21:50:24 | You two parents are lucky to have this almost undivided professional attention :) |
| smgexpert | 21:50:44 | you both have great questions |
| roviesk | 21:50:50 | yes! |
| ananario | 21:50:59 | mmusic class very Monday with 50 3rd graders is really increasing my son's anxiety and I told the teacher but she said music is part of the 3rd grade curriculum. I would really like to talk to the principal to just pull my son out of music do you think this is a good idea? |
| slevine74 | 21:51:55 | it is so hard when the system does not understand. would your son be able to break it down and tell u what is causing him the most stress in there? that's a lot of kids! |
| roviesk | 21:52:00 | I'll throw my 2 cents in...the situation has to be made one where he can succeed and simply telling him to go and participate when he has this condition is unfair... |
| smgexpert | 21:52:01 | is there a way for your son to participate in music without being in such a large group |
| roviesk | 21:52:31 | It's like adaptive PE for kids who can't fully participate in typical gym.. |
| smgexpert | 21:52:33 | i would ask if there is an instrument he could do on his own |
| smgexpert | 21:52:57 | or in a small group; i'm sure there are other children who are feeling overwhelmed as well |
| roviesk | 21:53:05 | you should definitely print this out to give to the school and let them konw Dr. Montalto or I would be HAPPY to talk with them about alternatives. |
| smgexpert | 21:53:32 | yes, i think we could come up with creative solutions |
| slevine74 | 21:53:43 | it is so hard to negotiate all of this in the world. what a great resource we have here. |
| smgexpert | 21:54:03 | it is great that you feel supported- that is what we are here for |
| smgexpert | 21:54:38 | you are your child's voice and we can help you advocate |
| slevine74 | 21:54:58 | i am trying to prepare myself to change my parenting techniques when we start treatement next week. any advice on the best ways to "be there" for my son as we start treatement for something he does not completely want to change? |
| ananario | 21:55:29 | he said he is afraid that he will make mistake and kids will laugh at him. He told us to enroll him in piano and the teacher goes to our house to teach him. |
| smgexpert | 21:57:18 | the best advice i could be is to praise his efforts and nonverbal participation |
| roviesk | 21:58:02 | We think overall that "being there" means being guided by an expert to balance setting up situations for greaduated exposures, expectations of success, lots of positive reinforcement, and no shaming |
| roviesk | 21:58:27 | We focus heavily on decreasing parental mind reading too |
| smgexpert | 21:58:48 | yes, you want to focus on what he is doing and not "fill in" for him |
| roviesk | 21:59:37 | Dr MOntalto: we look forward to your continued input in this important area. I know having watched you engage children that people like you can bring out the best in them and that parents should ask for second opinions if the testing from their Districts way underestimates their childrens abilities. Do u agree? |
| slevine74 | 21:59:43 | ah, yes. he asks me to speak for him much of the time, or he speaks to me when asnwering the questions of others. i am really looking forward to getting this expert help and translating that to the community. |
| smgexpert | 22:00:31 | i agree. it has been a pleasure to participate in tonights session and to help try and make a difference in the lives of children with sm |
| smgexpert | 22:00:54 | it is important if an evaluation does not seem to capture |
| roviesk | 22:01:06 | As it is 10:00, Dr. Montalto's pumpkin carriage has arrived. Many, many thanks for donating your valuable time to our SMG Expert Chat. We bid you all a good night and thank you for your participation. Please join us again next month. |
| smgexpert | 22:01:06 | a child's skills that a second opinion is obtained |
| smgexpert | 22:01:16 | also, if the child is deemed "untestable" |
| slevine74 | 22:01:51 | thank you. |
| ananario | 22:01:51 | thank you very much this organization really helps us alot in making the rightdecision forour children |
| smgexpert | 22:01:55 | it is likely that the evaluator was unable to produce results |
| smgexpert | 22:02:10 | given the measures that they had and process they used |
| verajoffephd | 22:02:33 | Thank you. I enjoyed and learned a lot in this session. |
| smgexpert | 22:03:09 | i'm glad you all found it helpful. hope you all have a happy holiday next week. |
| smgexpert | 22:03:14 | good night |