Social Skills Group

December 16, 2008 Expert Chat Session archived transcript.

kervatt	21:03:19	Hello, lapietra 704. We will start in a few minutes as soon as Dr. Joffe enters the room. I believe we should have about 10 attendees from the RSVPs.
lapietra704	21:03:42	Great!
kervatt	21:04:15	Hello and welcome to tonight’s chat, “Social Skills Groups”. We will be starting in just a moment, but first:
smgexpert	21:04:16	Hello, everyone, This is Dr. Joffe. I am finally connected to the Expert Chat.
kervatt	21:04:45	Please be reminded of the chat room rules, especially these two:
kervatt	21:04:56	First, please allow the “Expert” to answer an attendee’s question before asking or typing in another one.
kervatt	21:05:09	Please try to refrain from any attendee-to-attendee exchanges during the first hour.
kervatt	21:05:19	Thank you for your cooperation so that we keep our chat environment focused on the topic and as a safe and friendly place.
kervatt	21:05:31	Our guest speaker is Dr. Vera Joffe.
kervatt	21:05:41	Vera Joffe was born in Sao Paulo, Brazil. Dr. Joffe finished her Post-Doctoral Residency at Iowa Lutheran Hospital in Des Moines, Iowa and has since been working in South Florida for over 19 years in private practice.
kervatt	21:05:53	Her specialty is in the area of neurodevelopmental disorders, including ADHD, Tourette’s Syndrome, Asperger’s Syndrome, and Selective Mutism, among others.
kervatt	21:06:03	Dr. Joffe works cooperatively with parents, schools, physicians, and other professionals in the area of health.
kervatt	21:06:15	Welcome Dr. Joffe and thank you for being our “expert” for this chat. Perhaps you would first like to explain what is social skills training and how it can be of help to selectively mute children.
smgexpert	21:08:10	Thank you for the introduction. I would like to welcome all that are participating in this chat, and to remind parents, educators, and other participants that S.M. is a condition that is social-communication anxiety. I just came back from AACAP and from APA (where I presented and participated in meetings with people from various parts of the world). S.M. has been connected to other conditions also, and one of the topics we discussed was Social Skills Difficulties in some of the children.
smgexpert	21:08:48	However, BEFORE one would treat that, we would have to address the social anxiety communication part of the picture which affects children so much.
smgexpert	21:09:29	I would like to ask parents, educators, and other professionals to ask me questions regarding their concerns about this topic. This would help me answer questions that are more relevant for the participants.
smgexpert	21:11:03	In the meantime, I can also inform you that when children are afraid to express themselves verbally, they may inhibit more, and have more social anxiety, and more communication anxiety.
smgexpert	21:12:02	Some children perceive a minor (or maybe not so minor) articulation problem, or accent (some children who speak another language at home), and they are afraid to speak up, and they develop more and more anxiety.
smgexpert	21:13:43	Once a child has diffciulty or is afraid to initiate a social interaction, it becomes more and more difficult for that child to participate in social situations, such as during lunch, or other unstructured activities.
kervatt	21:14:10	How do SM parents know if their child is developing social skills and potential for friendship if the child does not spend time with kids as often as other children his/her age?
smgexpert	21:14:50	There are some children who do have social skills difficulties. However, one should not assume that all children with S.M. have social skills deficits because they need to uncover the social anxiety and communication anxiety first before discussing social skills deficits.
lapietra704	21:15:19	Are there certain strategies you could suggest for children who have overcome SM but yet still struggle socially?
smgexpert	21:17:05	Thank you for asking the question: This is a very good point, and it should be part of the treatment plan. So, making the plans to develop "social dates" with friends in a situation that is more secure for the child to begin with would help. For instance, having your child have a play-date at your house first before going to the other child's home. Then, you can observe your child's ability to take turns, to be flexible with the social exchange, and you can notice if your son or daughter has difficulty with other elements of socialization in addition to the verbal communication.
dannamurphy	21:18:35	We have a 7 year old daughter who had extreme difficulty speaking to strangers in pre-school. We had a great school that worked with her a lot and now she is able to speak in school and most settings, however, she is very reluctant to participate in social activities without her older sister. Are there things we can do with her to help her identify activities she is interested in and become less dependent on her sister?
smgexpert	21:18:49	Your question regarding: social skills difficulties even after a child overcomes SM is very good, and it follows the one that I was responding to before. Once the social-communication anxiety is decreased, yes, it's a good time to address the social struggles. But, what do you define as "social struggles"? Is it social deficits? Social anxiety? Please, define for me more so that I can actually address your question better.
smgexpert	21:20:12	So, Danna, you are referring to your child having social anxiety, and feeling safer if she has her sister around her. There are ways to address this issue by helping her slowly and always become more comfortable in a situation that at first involves her sister.
smgexpert	21:21:17	then, you can slowly add another child in that social situation (like a class or activity), and then as you are introducing that child (who you also invite to your house for a play date, and without your other daughter around), you may take your older daughter out of the situation, slowly and always.
chrisvb	21:21:19	our daughter who is 11 will now answer a teacher's question in a whisper voice, but will not initiate a question if she needs help. Any suggestions? Sonia V.
lapietra704	21:22:03	My daughter continues to have difficulty initiating with her peers. When I observe her in larger groups, she is uncomfortable interacting
smgexpert	21:24:08	Yes, your child is now in the stage of responding verbally, and using "whispering" for that. This is a good step. Sometimes, the teacher could play a little "I can't hear you" (without looking at your daughter), "can you say it a little louder?", and slowly and always your daughter may increase the volume of her voice. Remember to know that there are different stages of the communication "bridge" (as Dr. S. Blum calls in her presentations), and we take steps towards the voluntary, initiating verbal communication as being the highest level that she will reach. With time, and with more comfort and with work with all people involved, there are ways to do it.
kervatt	21:26:15	Perhaps, we could address dannamurphy's question about only interacting when a sibling is there?
smgexpert	21:26:36	Depending on the age of the child, it would be helpful for the professional to investigate with the child (and with parents) the sources of fear and anxieties about the bigger group interacting. Then, they could use Cognitive Behavior Therapy approaches to defining the fear, finding out whether it is "irrational", challenging the fear, and having a plan of action. You can refer to Cognitive Behavior Therapy framework, and work with a professional who knows the approach in helping your child.
JodiR	21:28:04	My child, age 5, is so anxious that she does not respond verbally and non verbally to people. How do I teach her to respond or so that people will continue to communicate with her.
smgexpert	21:28:22	I talked about having another child coming into the picture (of the child's age), a friend from school, inviting that friend for a play-date at home (without the presence of the older sister), and then introduce the younger child with the peer more and more in situations where the older sister is present, then slowly "fade away" the older sister from the picture.
kervatt	21:30:43	How can parents help their children socialize rather than just staying by the parents, for example at parties or family gatherings so as to enable both to have fun like everyone else?
smgexpert	21:30:53	Hello, Jodi. Thank you for joining the chat. It appears that your child is experiencing significant and very high levels of social anxiety and communication anxiety around people. So, first and foremost, it is important to recognize that if children are experiencing those feelings and symptoms, that it would not help to "force" them to speak. The most important first step is to understand whether they do have S.M. and your participation in this chat is a good step for you to learn more about this subject (if your child indeed has S.M.). we cannot diagnose children in this chat, so I would recommend you to talk to your pediatrician about this matter, because it sounds that your child is suffering a lot from the anxiety that you described.
smgexpert	21:31:35	You can also look into the literature in the website, and Dr. S. Blum's books and information. I also have a book for parents that explains how children feel, and how to explain to them and to others about their anxieties associated with S.M.
JodiR	21:31:57	She does have SM and social anxiety ?phobia
JodiR	21:32:18	She interacts appropriately with her sisters
JodiR	21:32:32	but is unable to socialize on her own
chrisvb	21:33:34	Now that my daughter is 11, she is aware of her mutism. She thinks that if she goes to a new school for middle school where people "don't know" about the mutism she may have an easier time speaking up. Is this true?
smgexpert	21:33:48	The question regarding "parties and socialization for all the family". Good question, difficult situation. So, before you go to a party, it would be helpful to talk to your child about the choices, the possibilities. It depends on the stage of treatment you are with your child. You cannot "flood" the child with a very hard, difficult, intense social situation if your child is not ready. She/he will freeze, and your will be upset. In addition, it is often common for parties to be very noisy, overstimulating, and many children with S.M. have sensory integration difficulties, such as being very sensitive to noises. Anyone can relate to this?
chrisvb	21:34:50	Yes, when my daughter was younger, we could only have birthday parties with 2-4 other children. This worked well. Now we are up to 6, and she talks.
dannamurphy	21:36:07	The book you mentioned for parents that explains how children feel, is that by Dr. S. Blum or you? Can you tell us the title?
smgexpert	21:36:36	Dear JodiR: Let's say, not that she "unable" to socialize, but she is not yet able to face her anxiety. But she can, with the help of her family, educators, professionals and the support group, be taught to take steps towards it. This is why it is important to work with a professional who knows about S.M., social anxiety, developmental psychology, and language development
kervatt	21:37:14	One very good piece of advice that I have heard about parties and family gatherings is to have the attendees arrive about 15 minutes apart so that not all are converging at the same time. It's less overwhelming.
kervatt	21:37:50	Just to clarify, it's Dr. Elisa Shipon-Blum.
smgexpert	21:38:23	I wrote a book called Sophie's Story, a Guide to Selective Mutism. It's in my website. I do give examples of various steps that one can take towards becoming more comfortable with communicating with others.
bethblair	21:39:50	My six year old is doing great in most social situations within school except in gym class. She still is unable to participate in gym. I understand why, but her classmates cannot. They do not understand why she can talk in the classroom , but not in gym class. The school has suggested talking to the class, without my daughter present, about her special situation. I am fearful that doing that will draw more attention to her anxiety. Any input?
smgexpert	21:40:36	You can think of three basic elements: place, people, and situation. A birthday party is very noisy, has lots of kids, lots of adults, and strangers around. There can be music, noise, visual stimulation (like a C. Cheese restaurant), and sometimes clowns (scary for some children).A much calmer situation is home, around parents, and familiar places. So, the child who only communicates with her older sister around: start inviting another child to a familiar place, to play something that is comfortable, and slowly take the older child away from the picture. So, you would be working with one element at a time.
smgexpert	21:41:41	I would like to find out why your daughter does not participate in that class. You said you know why. Can you tell me?
smgexpert	21:42:59	I use Dr. Shipon-Blum's scale to measure where a child is in the beginning of treatment, and to make plans for helping the child become more comfortable in various situations, with many people, and with many levels of social communication (from nonverbal to verbal, for instance, and from responding to initiating).
bethblair	21:44:12	Her anxiety is very much rooted in social anxiety. Gym is like a social performance. From my research, many children with SM have difficulty in gym. Is that not true?
smgexpert	21:44:26	I would like to hear from bethblair why her child is not participating in Gym class. And can you define "participate"? I do know of a case where the child has difficulty with gross motor skills, and this inhibits him even more when in gym class. He feels he is not fast enough, and would be made fun of for not running as fast of the other boys.
bethblair	21:45:34	She does not have any problem with gross motor skills. She feels so anxious, she freezes and shuts down.
lapietra704	21:46:02	Could you respond to the question of switching schools posed by chrisvb?
smgexpert	21:47:02	It depends on the gym class you are talking about. Many children with SM have other developmental delays. Researchers and clinicians in the area (from US, Europe, Singapore, and other places in the world) have been collecting data from case studies and some initial larger studies, and we are finding out that there are neurodevelopmental basis for S.M. So, one child may have a language difficulty, social difficulty, sensory integration difficulties (especially when younger), gross motor delays, among others.
kervatt	21:49:10	Dr. Joffe, could you explain the process you use in conducting "social skills groups"? I know this is mostly used with SM children who have overcome the mutism and due to lack of verbalization and socialization through the years, they lack those skills. What type of strategies do you use in these groups?
smgexpert	21:51:52	If your daughter is developing this mind-set, I would not go against it. She may have made a decision to think this way. On the other hand, it is important that she knows that you are there to support her in any way when she does start the new school. Whenever children start a new school year, and a new school, it is normal to have anxiety. So, be prepared to support her if she needs. It is very difficult to face a new school year when children have already experienced so much anxiety in the past. This is usually not a condition that switches off suddenly, but I would not try to put down what your daughter is saying to you know. Being supportive, and giving her tools to look for support and help if she needs is important. You also brought a good point: start of the school year is important to do some preventive work before the first day of classes. Help your child get used to the new school, the map of the school, etc.
smgexpert	21:54:53	The social skills group "curriculum" and process would depend on the group of children in the situation. I usually screen children carefully so that I make sure that I introduce children who have various strengths and different ones so that they can learn from each other. Depending on the social skills difficulties, I develop activities, social skills situations, role-play situations, and we also do some planning for "outside" the office situation. I also give homework to the children, such as completing an activity during the week, and they go over in the next group. This needs to be worked in conjunction with parents so that they can facilitate, observe the children during the week, and give the therapist feedback on how well the children are being able to apply what they experience (and role play) in the group situation in real social situations during the week.
dannamurphy	21:55:37	Our daughter also has difficulty verbally expressing the main ideas of events or stories as she often gets caught up in the details. Have you heard of this type of issue being connected to SM?
smgexpert	21:55:51	I also wanted to tell you that it is possible that children do not actually lack the social skills. During the time that they have observed without participating, they may have actually learned even without participating actively.
smgexpert	21:57:49	However, I would be interested in finding out from you, parents, and other professionals, if you have found out that the children with SM did not actually develop social skills. As a matter of fact, children with SM may be very hard on themselves, and self-critical. They are sensitive to social norms, and they think they need to be perfect in social situations before they actually interact. What do you all think of this? I would appreciate your input in this matter because of current cooperative work I am completing with some colleagues in Europe, and in the US. I would like to find out from our leader if people can actually email me the answer to these questions if we do not have time any more tonight.
smgexpert	21:59:01	Parents, you help us, clinicians and researchers, ask more and more questions so that we can help understand S.M. better, and treat it better. I hope that in the future we will know more about S.M., since we are just in the very early stages of developing real empirically based studies. You can help us ask the relevant and important questions.
kervatt	21:59:05	Certainly, they can email you. Please leave your email address.
smgexpert	22:00:10	Danna: Yes, I do see this. It is important to provide the professional working with you with information about your daughter's cognitive skills, organization of thoughts, and verbalizations in situations that are more comfortable. Address this in treatment and with school also.
dannamurphy	22:01:07	thank you
kervatt	22:02:04	We’re out of time so we’ll have to wrap it up for tonight.
smgexpert	22:02:42	Dear parents and professionals: Please, email me at verajoffephd@gmail.com or even better, go to my website at www.verajoffe.com where you can find out more about me, and my credentials (including the book I wrote re. S.M.). I thank you all for being part of this chat. I learned a lot from all of you, and would like you to send me emails re: the social skills, language, and other developmental issues. Also, thanks to your children with their special gifts to teach us more about all this. Finally, I am also thankful to SMG, and also to Dr. Shipon Blum for being a great inspiration for my work on S.M.
lapietra704	22:02:56	I can attest to the fact that my daughter will most definitely be verbal when she knows she is correct or "perfect." She will not take risks.
dannamurphy	22:03:39	I completely agree with lapietra704 regarding my daughter.
kervatt	22:03:40	Dr. Joffe, thank you so much for the information and for taking your time to "chat" with us tonight. You have certainly shown us many ways to begin now to help our children develop age appropriate social skills.
kervatt	22:04:04	Thank you all for joining our Expert Chat. Expert Chats may resume in February.
kervatt	22:04:30	I will no longer be moderating, but want to thank all who have attended. Hopefully, you have gained knowledge and insight into the perplexing world of selective mutism. I wish you all wonderful holiday season!
kervatt	22:04:48	The transcript of tonight’s chat will be posted soon.