Sunday, March 30, 2014

Helping your child with selective mutism

When my son was about 3 we went to the dentist. Knowing his proclivity for anxiety and tantrums, I went to the library and took out every picture book about going to the dentist I could find. (My graduate program included a class that emphasized bibliotheraphy for children, a fact for which I am ever so grateful.) For four weeks we read stories about the dentist every day. There was a wonderful Mr. Rodgers one that had photos of the chair and equipment. There was Dr. Seuss' Tooth Book, H.A. Rey's Curious George Goes to the Dentist and I think a William Steig one, too. He still had to have his first and second visits done while sitting in my lap. There were tears and not a lot of dental work. At the end of the second visit, I brought my camera and we took pictures of him in the chair, waiting room, and on the walk going into the building- no not three pictures, probably about 15 as we went through all the stages of the physical environment. After that, the dentist became no big deal. We looked at the pictures before the visit, read one story and that was enough. Angela E. McHolm, Charles Cunningham, and Melanie K. Vanier's book, Helping Your Child with Selective Mutism: Practice Steps to Overcome a Fear of Speaking, shares that photos are a useful way to help children with selective mutism deal with anxiety related to new places or events as well.

One thing I liked about this book is chapter 11: Factors that may influence progress. They indicate that shy or anxious temperament, duration of the mutism, severity of the mutism, poor peer connections between school and home, challenges related to maintaining momentum, age and developmental level all will influence progress. So my homeschooled teenage student who has not spoken a word in nearly three years, interacts with no peers and has anxiety issues, will be extremely difficult to break out of the mutism cycle. Unfortunately, they do not offer tips on how to deal with a confluence of features that make the disorder difficult to treat.

The point I do think the book offers as a critical take away is the maintenance of a journal for the parents. If parents are the key to getting over mutism, they need their role acknowledged and reinforced. A notebook offers them the opportunity to record progress, set backs and thoughts. It enables them to keep a record of what is going on. This could be especially useful for those dark moments when it seems like the tunnel is a bottomless pit and you are not getting anywhere but the center of the earth. It also allows for a set record of interventions, especially when providers change. The notebook or record file is an essential piece of any parent's special education file, it is doubly true if parents are directing the treatment plan.

Similar to Helping Your Anxious Child, the authors describe creating a ladder of progressively difficult steps for the child to master. These steps must address the people, location and activity involved and only one must be changed at a time. They emphasize the importance of creating achievable challenges in which children are unlikely to fail to communicate because failure is likely to result in  backsliding not perseverance at a difficult skill. I liked the idea of creating situations where a reward can be given, not for speaking, but for a task in which the child speaks. For example, reward for reading out loud not for speaking or play a game of TV tag where the child must say a TV show to be unfrozen. The event includes speaking, but it is not the speaking that receives the reward, but the reading or the game play. Crafting situations that are authentic and are not seen as rewarding communication per say may take some thought, but it can be done. In my math instruction, I am not getting excited about communication, but I do reward pointing to a yes or no icon after a
question is asked with support in solving the problem the child is flummoxed by.

I am increasingly amazed at the complexity of this disorder and the apparent lack of professional medical support available to this family. Actual centers exist for the treatment of selective mutism. Sadly, there is not one here locally.

Sunday, March 16, 2014

Helping your anxious child

Anxiety and autism spectrum disorders go hand in hand as it does selective mutism. Since these are two of my current research areas, when I found Ronald M. Rapee, Ann Wignall, Susan H. Spence, Vanessa Cobham and Heidi Lyneham's book, Helping Your Anxious Child: A Step-by-Step Guide for Parents, Second Edition, I was intrigued with how it might be useful in my practice. The book is aimed at helping parents help their children. For children reluctant to work with service providers, this program could be remarkably helpful.

The book focuses on a couple of strategies:
  • Identifying anxious feelings with words and the strength of them
  • Linking feelings with thoughts and actions
  • Detective thinking to identify unrealistic thinking.
  • Assertiveness and social skills training for children lacking in these skills
  • Step ladders to plan desensitization
  • Relaxation training
Before teaching children how to engage in these activities, the authors propose that the parents engage in them, especially if they have anxiety issues themselves. This gives parents insights to the challenge of resetting behavior and helps them develop skills that they will be teaching their children. Worksheets to supplement the activities are available both in the book and online.

One of the pieces that I thought was particularly helpful was the section on parental reaction to anxious behavior. The authors identify excessive reassurance, being too directive, permitting or encouraging avoidance and becoming impatient as normal but not helpful reactions. They recognize rewarding brave, non-anxious behavior, ignoring unwanted behavior, prompting constructive coping and modeling brave non-anxious behavior as productive reactions. They also caution that consistency, emotional control and distinguishing between anxious and naughty behavior as essential to productive action.

I think the concept of distinguishing between anxious and naughty behavior is perhaps the most challenging. When is my teenage son acting like a typical teenager, pushing limits and resisting parental input and when is he acting like an anxious aspie? I know that I get this wrong sometimes, but I also recognize how critical this is. As a parent I need to set limits and have expectations. I also need to recognize that inappropriate behavior is sometimes caused by his disability. For him, tears are an indicator that this an aspie moment, but I do not want to push him to tears to check what we are dealing with on a consistent basis. Detective work on my part is important to know what typically is a challenge for him because of his disability and what is a challenge for him because of his teenagerness. I suppose one of the key features is to give myself permission to get it wrong sometimes because I will.

Wednesday, March 12, 2014

Why "A" students work for "C" Students

Robert T. Kiyosaki of Rich Dad, Poor Dad fame wrote a book for parents, Why "A" students work for "C" Students and "B" Students Work for the Government. Warning: if you are liberal in your political leaning, you may find many issues with his premise. He believes that schools fail to provide a sound financial education to students because a) they don't know how and b) they are incented to keep students ignorant of financial education so that the government can benefit from their ignorance. He describes this book as a manual for financial education for parents to help them teach their children. Individuals with a sound basic financial education, he proposes, have an unfair advantage over those who do not.

Kiyosaki points out that the top 1% of income earners pay nearly 40% of all income taxes and the bottom 50% pay only about 3% of all income taxes. That leaves the majority of the tax burden (approximately 57%) to fall on the middle class. Both Democrats and Republicans, he asserts, want to save the middle class because they pay the taxes that support the hulking governmental machines that compose these groups.

Kiyosaki divides earnings into four quadrants: E- employees; S- self employed; I- investment; and B- business owners. Taxes are highest in the E and S quadrants. Government need highly capable people to put money into investments and it needs people to start and own those large corporations to hire the other people and house their populace. That is why large business owners do not pay high taxes- the alleged "loop holes" people complain of. They are doing the work that the government wants done, so they are rewarded. The author assert the unfair advantage starts with understanding this concept and going from there.

I listened to the audio version of this book. It is particularly suited to an audio format because the pace is slow, the content not dense and the book includes lots of repetition. It almost seems as if the book was meant to be read out loud rather than read silently.

While you may not agree with many of his theories, the book does offer some thoughts on how to look at financial education and understand that schools do not offer this concept. At our district they instituted a Finance Tech class which appeared to be light on finance and high on tech- how to use Excel, Publisher and Word. (Fortunately we only offer a one semester computers class in middle school to teach the Microsoft suite, so the kids cannot possibly be expected to have learned them.)  They did not teach about insurance or debt, but did make a poster that used a list of Word special features for an activity of interest. If we truly want to avoid another financial meltdown we need to teach kids about debt, assets and liabilities, not how to make pretty posters with curved text, multiple text effects, and pretty pictures.

We need to teach them about college education being something that enhances your lifetime earnings only if you have a skill associated with it. Expensive college degrees in liberal arts can result in significantly lower lifetime earnings than a two year associates degree. All college debt is not created equal. If a child needs to take remedial classes because he did not apply himself in high school or the standards at the school were too low, the courses should not be taken at a four year institution. Parents who carry debt or pay for such things are not helping their kids, they are perpetuating the problem.

Kiyosaki does not see the picture as impossible. He believes that people with the unfair advantage of a financial education can be successful and should be more successful than those who do not have such an advantage. He argues that schools should change, but that the rate of bureaucratic change is slow and teaching your children ahead of the curve will give them the unfair advantage that may enable them to become truly rich. Mostly, he argues, that if we do not begin the path to change, our country will farther and farther away from capitalism and closer and closer to socialism and economic ruin.