just pulled dd from class - need thoughts

[rainbringer]

Dd started her social skills class this morning, her first time there.  They had the kids start with an obstacle course.  Most of the kids loved that.  Dd would have been ok except she was supposed to start by going up the ladder.  She is afraid of ladders.  As soon as she saw the ladder she started screaming.  Once she had calmed down, the leader let her start on the swing, and do the course from there.  The second time around, another teacher came and made her go three steps up the ladder.  Lots of screaming but dd did it.  The third time around, they insisted she go four steps up the ladder.  Screaming.  After that, I just got up and took her out and left.  I told the teacher I was uncomfortable.

I've never pulled her in the middle of a class before so I am feeling bad about handling it that way.  I was so upset about them forcing her to do the ladder over and over.  She's never even met these people before.

What would you have done?

[sbgrace]

Wow.
What does "overcoming a fear of ladders" have to do with social skills anyway?

This wouldn't be the way to deal with anxiety in my mind (first visit, no plan with her, rapid exposure, etc.). I don't get what they were doing at all. I think I would have pulled my son and I'd probably talk with them later to try to figure out what they see as the purpose of the class and what they were trying to accomplish with your daughter. I don't get it.

[rainbringer]

Thanks for the response, sbgrace.  I'm still trying to process and wondering if I was way out of line in reaction.  Glad to know it doesn't make sense to you either!  I do plan to call them on Monday, trying to decide what to say.

[karne]

I think, going forward, that I would want an idea of the "curriculum", and what the activity of the week would look like.  I don't know what's normal for a social skills class as we've not done anything like that, but in general, I like to know not only what the overall plan is for things, but what the steps will look like to get there.

I also think it's incredibly misguided to not establish a connection and sense of trust with a child prior to anything else.

[oceanbluemomma]

Totally would have pulled my child too.  Never doubt your Mommy Intuition - it is the best form of protections:)

I would follow up with a direct note including the head people about the known fear and ways they should have dealt with it appropriately.

Warrior Mom to Nick and 3 more Amazing kids!

[marge234]

You did the right thing.  I'm sure they mean well, but I don't think the people running this class know what they're doing.  I've heard stories about what passes for therapy, particularly around eating but also OT type stuff, and seems like there's a wide variety in the skills, abilities and approaches.  Parents go along in spite of doubts because they think it's will help their child. Good for you for taking care of your LO and I hope you find something that's a better fit.

[rainbringer]

Thanks ladies!  I will talk to them and see.  Dh thinks it would be best to try again, but I am finding it hard to trust their judgment.  I just don't understand if she was having such a hard time with three steps, why make her do four.  I can talk to them about the ladder but what if she gets agitated about something else next time?  Dd wants to go back as long as she doesn't have to climb the whole ladder.

[Emmeline II]

Originally Posted by rainbringer 

Thanks ladies!  I will talk to them and see.  Dh thinks it would be best to try again, but I am finding it hard to trust their judgment.  I just don't understand if she was having such a hard time with three steps, why make her do four.  I can talk to them about the ladder but what if she gets agitated about something else next time?  Dd wants to go back as long as she doesn't have to climb the whole ladder.

Awhile back some one posted about a similar experience with someone coming to their home for EI. After a few visits Mom ended up telling them she didn't want that therapist back, she wanted the other therapist that she had seen with more specialized training. Just because someone has "therapist" on their shingle doesn't mean that they are the right one for you or even good at it. I don't think that making a small child scream is very therapeutic.

[KCMichigan]

I would agree w/ PP about getting ahold of the curriculum, the goals, and the format of the class.

As well as talking to the staff about your DD and getting to know her better and bonding before trying to attempt activities that may intimidate her.

That said, both my DDs had OT/PT- one had some social skills activities and the other feeding therapy. At times, they fussed and cried. (never horribly) Yes, the therapists were asking them to do things they did not want to do (stretch tight muscles, put things in their mouths- oral defensiveness-, push limits, etc), but it was done after a bond had been formed and in small steps. I am positive some of it was not comfortable or pleasant- but the therapists were positive and encouraging, knowing *just* how hard to push. They were in therapy to build skills that were hard for them- they had not mastered them at home or on their own. Also, working with someone that is *not* mom at times led to less battles and helped my DD know that a certain person was to work with her on x, y, or z.

That said- trust your gut. Some therapists and some programs work better for some families. Dont let a particular person turn you off of a type of therapy. Depending on the situation and my DD's distress I may have pulled her as well (or even stopped her to observe or talked to the therapists).

[Linda on the move]

Originally Posted by KCMichigan 

I am positive some of it was not comfortable or pleasant- but the therapists were positive and encouraging, knowing *just* how hard to push. They were in therapy to build skills that were hard for them- they had not mastered them at home or on their own.

yeah, therapy can be difficult because the whole point of it is to work on things that do not come naturally to the child.

But I'm not understanding why they handled the ladder thing they way they did, and would talk to them before going back.

My DD didn't so social skills class until she was older, and there were no ladders!  She doesn't do ladders, either. 

I can see why they have some gross motor/sensory stuff at the start, but I don't see the point of power struggles over it. At my DDs class, they played short board games at the end, which was difficult for the kids at the start, but really great for them in the long run.

[beachcomber]

I think that you have to trust your instincts. Examine what you want her to gain from this class. Look at the curriculum. Discuss your concerns with the people managing the classes. I'm not sure what I'd do in your case, to be honest. My DD works with 2 different interventionists, one is very gentle and the other is very frank. I think that if she hadn't had the few months of easing into the expectations she got from the gentle interventionist, I'd have been way more uncomfortable with the very direct one. She gained her footing, learned some skills that built her confidence before being presented with the more challenging expectations and personality and I think that those months were key. If she hadn't had those, she'd have been way more disturbed and frightened. I'd have not allowed it, I think. But knowing she'd had time to gain confidence, knowing the therapy service better, knowing the reputation of the 2nd person after hearing about her from another parent and staff, i realized she could handle it and after some rocky first sessions, they are now good friends. Plus, it's helped me be sterner about behavior and boundaries at home. I've seen that she can take correction that is very direct and so now I have adopted a more similar style.

[RiverTam]

The therapist is using a form of flooding to break the fear of ladders. It's a legitimate behavioral psychology technique.  The person with the fear is placed in a room with the object until he/she gets over the hysteria. The person is coached to relax while in the presence of the object that  he/she is afraid of.  Example: a person who is abnormally afraid of balloons might be locked in a room with hundreds of balloons and until he/she gets over the irrational fear and realizes that the balloons are harmless. A child who is afraid of cars might be locked in a car and driven around for hours until he/she stops screaming.

Flooding is a very quick intervention, but it's also a very difficult intervention for patients and therapists because it's emotionally exhausting to do.

A slower intervention is systematic desensitization. If you were going to systematically desensitize a patient with a fear of dogs,  you would start the patient with looking at pictures of dogs and then looking at movies of dogs and then looking at dogs through a window at a pet shop and then touching a small dog or puppy while another person held it, then being in a room with a dog while someone else held the leash, then holding the dog on a leash yourself, then walking the dog, then being with the dog off the leash, then meeting dogs in public, etc.

It's a lot less emotionally intense, but it takes a good deal longer.

If you don't want to do the flooding because it's too intense, tell them so and don't do it. It's worse for her to start the process and then be removed from the fearful stimulus, then to not do it at all. Taking her away from the ladder when she is screaming reinforces her fear of ladders and reinforces screaming as a means to get away from ladders. It's not helpful to her.

They should have discussed this technique with you before they started her on it. It's too intense to just spring on a parent and child without warning. Bad therapist!

[Emmeline II]

Originally Posted by RiverTam 

The therapist is using a form of flooding to break the fear of ladders. It's a legitimate behavioral psychology technique. ..

They should have discussed this technique with you before they started her on it. It's too intense to just spring on a parent and child without warning. Bad therapist!

Her dd was not there to get over her fear of ladders and using one is not necessary to learn social skills.

[RiverTam]

Originally Posted by Emmeline II 

Originally Posted by RiverTam 

The therapist is using a form of flooding to break the fear of ladders. It's a legitimate behavioral psychology technique. ..

They should have discussed this technique with you before they started her on it. It's too intense to just spring on a parent and child without warning. Bad therapist!

Her dd was not there to get over her fear of ladders and using one is not necessary to learn social skills.

The inability to use a playground because you can't climb a ladder is a social skill deficit in a kid.

My son did social skills camp/speech camp last summer and they worked on all sorts of activities that are common to kids, including playing games, working on arts and crafts at a common table, and obstacle course type situations. (DS has MERLD with semantic/pragmatic deficits. He's not ASD, but I think he was the only kid in his camp that wasn't ASD.)

Again, as I said ("Bad therapist!") the therapist should have gone over the activities of the camp, therapeutic goals, and their therapeutic approach before putting a kid in a flooding situation. It's too intense to spring on someone.

[karne]

If the intent was "flooding", versus just really poor management and judgment on the therapist's part, I would have even more of a problem with it.  A responsible therapist would never use such a difficult intervention, with the strong possibility of emotional trauma, or re-activated trauma, with an unsuspecting child.  Not to mention the parents, with whom a therapist needs to form a trusting working relationship with as well.  Such an intervention would, or should, never be done without a plan for appropriate support as an adjunct to such therapy.  Even desensitization is handled in this manner.  The child was new to the group, and there for social skills.  It was completely irresponsible in the absence of an articulated plan with the parents.  It doesn't sound as thought the therapists were contracted with to address phobias in this manner.

[Emmeline II]

Originally Posted by RiverTam 

Originally Posted by Emmeline II 

Originally Posted by RiverTam 

The therapist is using a form of flooding to break the fear of ladders. It's a legitimate behavioral psychology technique. ..

They should have discussed this technique with you before they started her on it. It's too intense to just spring on a parent and child without warning. Bad therapist!

Her dd was not there to get over her fear of ladders and using one is not necessary to learn social skills.

The inability to use a playground because you can't climb a ladder is a social skill deficit in a kid.

Not liking ladders is not an inability to use a playground and I can't imagine considering overcoming a fear of ladders so dire that forcing a child to climb one is a priority . My son is in therapy for social skills and if his therapist tried to force him into anything he would do his best imitation of a rock for the entire session.
 

[BetsyNY]

I get the playground thing, I do, but IMO that would be best approached 1:1 with an OT or SEIT, especially if a child is majorly averse to ladders. 

In my son's social skills class, they work on conversation, turn taking, appropriate things to say or do when meeting someone, etc.

[rainbringer]

I appreciate all the feedback.  Dd has been in different therapies and classes for the past four years, and I haven't reacted like this in the past.  (Though I have wanted to a few times!)  I think it is confusing to dd for me to jump in like that - luckily she didn't understand what was going on.  So I am still pondering, was it instinct or an over reaction?  I might not have agreed with it if her OT forced her to do the ladder, but they have been working together for a long time and she knows dd's limits and how far to push.  I would never have intervened in the middle of OT because both dd and I trust the therapist. This was different.  Also the woman's tone of voice and manner was as if she was annoyed with dd and that really rubbed me the wrong way.

[joensally]

Originally Posted by karne 

If the intent was "flooding", versus just really poor management and judgment on the therapist's part, I would have even more of a problem with it.  A responsible therapist would never use such a difficult intervention, with the strong possibility of emotional trauma, or re-activated trauma, with an unsuspecting child.  Not to mention the parents, with whom a therapist needs to form a trusting working relationship with as well.  Such an intervention would, or should, never be done without a plan for appropriate support as an adjunct to such therapy.  Even desensitization is handled in this manner.  The child was new to the group, and there for social skills.  It was completely irresponsible in the absence of an articulated plan with the parents.  It doesn't sound as thought the therapists were contracted with to address phobias in this manner.

 
I totally agree with this.  What they did does not meet any practice standard I can imagine.  Approaching a child, unknown to the clinician, so assertively upon first meeting is ridiculous.  I would not be surprised to learn that these are generically-skilled staff attempting to operate above their skill and training level.  What they did could have harmed the child.

I would ask the program manager, or equivalent:

-what are the goals of the program?

-what are the types of strategies employed?

-what are the qualifications of the staff?

OP, I would have done exactly what you did.  I would be contacting the program manager and being very clear about exactly what occured, the potential risks, and what you would have prefered to have seen done.  If the program manager doesn't immediately get it and address it with staff, I would not go back.  Clinicians/staff need to have the right skills, qualifications and supervision to perform appropriate interventions with children.  I work in the field and have a child with some special needs, and what you describe is non-sensical to me.

[karne]

Originally Posted by joensally 

Originally Posted by karne 

If the intent was "flooding", versus just really poor management and judgment on the therapist's part, I would have even more of a problem with it.  A responsible therapist would never use such a difficult intervention, with the strong possibility of emotional trauma, or re-activated trauma, with an unsuspecting child.  Not to mention the parents, with whom a therapist needs to form a trusting working relationship with as well.  Such an intervention would, or should, never be done without a plan for appropriate support as an adjunct to such therapy.  Even desensitization is handled in this manner.  The child was new to the group, and there for social skills.  It was completely irresponsible in the absence of an articulated plan with the parents.  It doesn't sound as thought the therapists were contracted with to address phobias in this manner.

 
I totally agree with this.  What they did does not meet any practice standard I can imagine.  Approaching a child, unknown to the clinician, so assertively upon first meeting is ridiculous.  I would not be surprised to learn that these are generically-skilled staff attempting to operate above their skill and training level.  What they did could have harmed the child.

I would ask the program manager, or equivalent:

-what are the goals of the program?

-what are the types of strategies employed?

-what are the qualifications of the staff?

OP, I would have done exactly what you did.  I would be contacting the program manager and being very clear about exactly what occured, the potential risks, and what you would have prefered to have seen done.  If the program manager doesn't immediately get it and address it with staff, I would not go back.  Clinicians/staff need to have the right skills, qualifications and supervision to perform appropriate interventions with children.  I work in the field and have a child with some special needs, and what you describe is non-sensical to me.

Cannot get the hang of quoting here, but what I want to say is this type of practice frankly deserves reporting to not only the program manager, but it really is the type of thing that supervisory/licensing boards pay attention to, and for good reason.