[loraxc]

DD has been having a hard time lately (lots of emotional outbursts, negativity, and controlling behavior) and has also been having a few outbursts at school (see previous thread here: <a href="http://www.mothering.com/discussions/showthread.php?t=1221028" target="_blank">http://www.mothering.com/discussions....php?t=1221028</a>). After some thought, I had just about decided to put her in some kind of therapy, just to see if it helped or if a professional might turn up anything we are missing. I have also been toying with getting a gifted assessment (DD has not had one, though she is scheduled to get one through school) and/or a socioemotional evaluation. My gut feeling is that DD is not really diagnosable with anything, but I'd hate to be missing something.<br><br>
I have a friend (acquaintance, really) who is a psychologist who works on child behavior and emotional health (she's a professor, though, and does not practice). She has never met DD, but she did a very compassionate and thorough phone interview with me yesterday about her. After some discussion, she told me that she seriously doubted DD had anything diagnosable, that her behaviors sounded basically within the range of normal for an intense, bright kid, and that she thought therapy would be a waste of time and money. She felt the school was the problem and that our best solution would be to change schools (which is not that possible, unfortunately).<br><br>
Now I don't know what to think. I had really moved to the mindset of "Let's try therapy" and I feel very confused. It is probably worth noting that she said she doesn't really believe in individual therapy for kids this age. She said the research does not support its efficacy. Also, while we can find the money for therapy if we have to, it certainly will be a stretch for us, and my friend does know this.<br><br>
We don't seem to have any play therapists in my city. My friend did give me the name of a child psych she likes if we want to go that route.<br><br>
Thoughts? Has your child had therapy and did it help?

 

[egoldber]

I am the poster from the other thread whose DD sounds similar. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
I really could not disagree more with your friend. We did do a full neuropsych evaluation (including questionnaires for ADHD, anxiety, WISC IV, achievement tests and other stuff I don't remember). We did it for several reasons (one of the main ones being the school's concerns) but I think it was valuable. What we found was that DD was HG with a tendency to anxiety. She is NOT diagnosed with GAD because she does not meet all the critera. But she very definitely exhibits anxious behaviors.<br><br>
Despite not having the technical disgnosis of anxiety, we decided to seek out a therapist's help with the anxiety she does have because it has had an impact on her behavior at school, her social acceptance at school and on her self esteem.<br><br>
We started her in Cognitive Behavioral Therapy when she was 8.5 and my only regret is not doing it sooner. It has been so incredibly helpful to her and to us. It has given her and us concrete tools for helping her learn to cope with her emotions and her reactions (overreactions) to situations. We have a common vocabulary to talk about it with her and ready made tools that we did not have to seek out. The place we are taking her also had social skills classes and we plan on doing that starting in the fall.<br><br>
We are working very explicitly on things that DD has self identified as being things she was very worried about (including things that I did not necessarily even know that she was worried about!). We are spending a lot of time on teaching her how to be less rigid in her thinking and be more "go with the flow". This has been VERY hard for her, but it is what causes her the most trouble at school. She is learning new ways to cope and is actually using the new skills for herself. Not all the time of course and we still have many emotional outbursts, but we can actually see her trying to use the techniques she is learning.<br><br>
The therapist has also been invaluable in advocating for her with the teacher. She has consulted with him on the phone. She has given us tools for DD to take into the classroom to help manage her anxiety there. She helped us get a 504 plan at the school to provide DD with (zero cost) accommodations at the school to help her cope. The 504 plan provides a vehicle for me to ask for what DD needs with her teacher and the teacher cannot say no because it is in her plan.<br><br>
One added bonus is that our therapist is also a school psychologist in our school system (not at our school obviously) so she has an insight into the system that has been very helpful.<br><br>
So I guess my take on it is that while your DD's issues may not be diagnosable, that doesn't mean that they are not real issues and are not causing her distress and pain in school. For us, the therapy has been very helpful at learning to manage these issues, especially in school.<br><br>
Now cost is a real concern. Our neuropsych eval was about $2K and we had to pay OOP because insurance did not cover it. We live in a high COL area but I think this is a pretty standard cost. But we did use FSA money to pay for it, so that helped a little. We have mental health coverage on our insurance, but our therapist is not in network. We do get it covered as an out of network expense and we get reimbursed at 60% after a $150 co-pay. It is $120 per visit though and she goes weekly. We are going to reduce visits over the summer and then start up again before school starts in the fall.<br><br>
I'm not sure how old your DD is and time and maturity do help. But for us, third grade and the increased demands on personal responsibility and a huge step up in homework expectations this year (plus a lousy teacher fit) really pushed us to the point of getting outside help. There is nothing rocket science about the tools and many people try them themselves. There are several really good books about helping kids with anxiety/anxious tendencies. But for us the therapist has been invaluable.<br><br>
Good luck!

 

[quaz]

Thanks, that response was actually helpful for me. <br>
I've considered a full neuro-psych eval as well. Yes, the cost is in that 2k range, and I'm not in Colorado.<br><br>
Good to know that it at least proved useful.<br><br>
Tammy

 

[annettemarie]

My 11-year-old has had his own therapist since he was 6. He has some major anxiety issues, which I think comes from taking in more than he is emotionally prepared to deal with. He also has a disparity in ability-- really smart kid with a small motor skills delay-- which would lead to angry, violent outbursts when his hands and fingers couldn't carry out the vision of the day. He also-- and it took me several years to admit this-- can be very manipulative and plays me like a fiddle.<br><br>
The only diagnosis he ever got was a general anxiety disorder. I was told it was a very basic blanket diagnosis they give so insurance will cover it. We also did a neuropsych eval (IQ test, ADHD, eval by an OT, pediatric ophthalmologist, etc) and never received a definitive diagnosis. His IQ scores were in the 99% on one end and the 4% on the other (coding and I forget what else, it's been a long time), so there's obviously *something* going on, but they were never able to pinpoint it.<br><br>
Anyway, therapy helped a lot. Michael loves Dr. John. I trust Dr. John. He gave Michael so many coping skills that Michael uses every single day. And he hasn't been in his office in over a year now, but he knows that he can go back any time he feels he needs to, and he has actually come to us in the past and said "I'm having a hard time dealing with XYZ and I think I need to see Dr. John."<br><br>
I wanted to encourage you, too, because sometimes we paint this shiny happy picture where all gifted kids are balancing equations in their cribs and never ever have any issues. In reality though, sometimes gifted kids need a little extra help managing their emotions, and that's OK. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">

 

[loraxc]

She did say that she felt therapy becomes more effective in later elementary school.<br><br>
Who does a "full neuropsych evaluation"? Neurologist, psychologist, psychiatrist?<br><br>
I'm not sure why I coulddn't locate this info before, but I did find a list of play therapists in my city, so they are out there.<br><br>
This person has been recommended to me. She is a school psychologist who practices independently. Does this sound like what I am looking for?<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Generally speaking, a gifted evaluation takes 1 to 1½ hours, an evaluation for learning difficulties takes approximately 4 to 6 hours, and an evaluation for social-emotional or attentional difficulties takes approximately 4½ to 7 hours. These estimates are for time spent with your child and do not include evaluation preparations, report writing, or parent meetings.<br><br>
What does an evaluation involve?<br><br>
A psychological evaluation can include many components, depending on your concerns and the needs of your child. The following is a brief description of what your child's evaluation may include.<br><br>
* Intelligence – a measure of learning aptitude/potential. Typically includes abilities such as verbal comprehension, problem solving, reasoning, etc.<br>
* Cognitive Processing – a measure of how your child uses information to learn. May involve areas such as memory, spatial relations, language, visual-motor, auditory processing and/or information processing abilities.<br>
* Achievement – a measure of your child's academic skills in the areas of reading, mathematics, written language, and/or oral language.<br>
* Attention – a combination of measures that explore your child's functioning in the areas of inattention, hyperactivity, and impulsivity.<br>
* Social-Emotional Functioning – a combination of measures that explore your child's personality, temperament, and/or behavior at home and at school.<br>
* Developmental Abilities – a measure of your child's development in the areas of cognitive, motor, communication, social-emotional, and adaptive abilities.</td>
</tr></table></div>
Gifted eval is $225 and socioemotional eval is $675-800 (estimates).

 

[egoldber]

<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">She did say that she felt therapy becomes more effective in later elementary school.</td>
</tr></table></div>
Hmm. I see now that your DD is in K. I had concerns in K, and decided to wait. I don't know that I would wait as long as I did again, but some kids do grow out of (or into depending on your perspective) their emotions. But my kid was always a bit outside the norm for emotionality, even in K. As she got older, her ability to control her emotions got better, but she was still very much out of step with her grade level peers. At this point (age 8) her emotional outbursts are very much outside the norm for a third grade class, whereas I would have said they were only slightly outside the norm in K.<br><br>
Our evals were basically everything on that list. It was about 7 hours of testing plus questionnaires that DH and I and her teacher had to complete. Our testing was done by a licensed psychologist who specializes in testing gifted children and in educational/social emotional evaluations. Her therapist is not the same person who did her evaluation. We had the eval done in second grade because her teacher was concerned about ADHD and we were concerned about anxiety. We did not decide to go the therapy route until she was a third grader. So it's not all or nothing. It can be a process. Maybe you start with an eval. Then see what that says and make decisions from there. Or maybe you decide a full eval isn't necessary and you just want to see a therapist to get some immediate tools and coping mechanisms.<br><br>
But given that your school is concerned and you think they may counsel her out, I would seek help sooner vs later. JMO. You can always call the psychologist and do a phone consult and see what they suggest.

 

[joensally]

I really agree with PPs.<br><br>
I googled "meta analysis child therapy" and found this:<br><a href="http://www.a4pt.org/download.cfm?ID=10935" target="_blank">http://www.a4pt.org/download.cfm?ID=10935</a><br><br>
There is some debate in the mental health field about what modalities are effective for which populations. But many, many clinicians and researchers believe in CBT in particular and various therapies generally as being efficacious for children, including young children. A lot of funding is invested in early interventions including around mental health for a reason - there's demonstration that it works. I included the above link to demonstrate that there isn't consensus as to whether it works with kids or not.<br><br>
Anyway, as I shared in your other thread, both of my kids see a play/art/CBT therapist. They see her intermittently, as they need to. She gives them tools to handle whatever they're struggling with. Neither have been diagnosed with GAD or anything else - but anxiety is a problem for both of them. DS's social emotional inventories show he's "at risk" of depression and anxiety, so we're helping him before he's diagnosable in hopes of avoiding the problem expanding to become diagnosable.<br><br>
Another point is around complexity. It's actually pretty rare that any human has one definitional quality - like having GAD doesn't explain everything about an individual. I think my children, and maybe your DD, are just really complicated and it's the intermingling of all of it that makes it harder. So, while DS's anxieties are problematic in their own right, they're happening within his intense personality and divergent thinking style and are influenced by his high sensitivity and over-active sensory systems. When I look at all that goes on with him, it makes sense to not let it be when he's clearly struggling, and that if we help with the anxiety other issues are also ameliorated.<br><br>
Why not try it? If it doesn't seem to be working, you can stop. There's no commitment that needs to be made and right now you don't know if it's worthwhile or not, trying it will give you more information.<br><br>
The clinician above seems good. What about doing IQ first (my goodness that's cheap!!) and see how you like her. Honestly, the social-emotional inventories kind of confirmed what I knew, and I've never shown them to the kids' art therapists. I knew DS had anxiety issues (sort of a "yup, check"), although it did rule out other issues.<br><br>
ETA: re time and money commitment. My children only see their therapist occasionally. This school year they saw her once or twice each in October, once in December, and DS saw her this month. I think there's a range of what kids need.

 

[joensally]

<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>egoldber</strong> <a href="/community/forum/post/15427399"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Hmm. I see now that your DD is in K. I had concerns in K, and decided to wait. I don't know that I would wait as long as I did again, but some kids do grow out of (or into depending on your perspective) their emotions. But my kid was always a bit outside the norm for emotionality, even in K. As she got older, her ability to control her emotions got better, but she was still very much out of step with her grade level peers. At this point (age 8) her emotional outbursts are very much outside the norm for a third grade class, whereas I would have said they were only slightly outside the norm in K.<br><br>
Our evals were basically everything on that list. It was about 7 hours of testing plus questionnaires that DH and I and her teacher had to complete. Our testing was done by a licensed psychologist who specializes in testing gifted children and in educational/social emotional evaluations. Her therapist is not the same person who did her evaluation. We had the eval done in second grade because her teacher was concerned about ADHD and we were concerned about anxiety. We did not decide to go the therapy route until she was a third grader. So it's not all or nothing. It can be a process. Maybe you start with an eval. Then see what that says and make decisions from there. Or maybe you decide a full eval isn't necessary and you just want to see a therapist to get some immediate tools and coping mechanisms.<br><br>
But given that your school is concerned and you think they may counsel her out, I would seek help sooner vs later. JMO. You can always call the psychologist and do a phone consult and see what they suggest.</div>
</td>
</tr></table></div>
<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/nod.gif" style="border:0px solid;" title="nod"><br><br>
DD had major tummy trouble in kindie (and all through school until this year when she's finally in an appropriate academic setting). She's a major melt down kid, although never at school. I did take her to one session with a useless clinician when she was 5, and my mistake then was to stop rather than to find someone good. We waited until gr4 and I really, really wish we'd helped her sooner.

 

[loraxc]

After some thought, I think we will wait till summer vacation (we only have a few weeks left) and see how DD's behavior changes or not before pursuing therapy. I need to get a better sense of how much of this is coming from school. Thanks for the input--I'm sure I will need more!

 

[Marimami]

I have been struggling with trying to decide whether to have DD evaluated too. She has a lot of anxiety too, but we are managing with the tools we are giving her to work through it. For now, I'm waiting as we continue to see improvements. Many (but not all) of her problems were school related, but I wanted to comment that she has been out of school now for 14 months, and it took a very long time to see real changes.<br><br>
I know from reading your other posts that you seem to feel like this school is the best option for your family. But, I have to admit from this side of the screen it just doesn't seem like a good fit, even if it's theoretically the best school.<br><br>
DD was in the coolest, most awesome holistic, child-directed school in our area. Tons of outdoor exploration. Small class size. Great teachers. Everything I could have hoped for. Yet, it was horrible for her, for so many reasons. It took me a while to really recognize the problems because I was so wrapped up in how perfect this school was. Even when I finally accepted the problems, the school itself really didn't see the problems I did. I finally just had to trust my intuitions, and pulling her out of that perfect school was one of the best parenting decisions I've ever made. We homeschool now.<br><br>
I'm just babbling, but when I read that you wanted to see how much was school related, I just immediately thought about our experience. On one hand, her behavior might not change very much but yet still be very much related to school. It can take a long time for kids to "deschool" and the summer months are often not enough. So, you might erroneously assume that it's not related to school if her behavior doesn't change. Then again, if her behavior does change immediately, how will that impact your schooling decision for her next year? Will you be satisfied with her attending that school if you feel it's been the source of her anxiety and emotional flare-ups?<br><br>
These are all the thoughts that I would have in my head so just sharing them aloud...<br><br>
ETA: My girl is in K this year too so we're dealing with same-age issues. I always forget that I don't have that in my siggie.<br><br>
Holli

 

[egoldber]

FWIW, my DD's issues are very much school related. In looking back, she always has a very hard time at predictable times of year: the first few weeks of the school year, when homework ramps up at the beginning of the second grade period, and returning to school after winter and spring breaks. But it took me several years of this to really see the pattern.<br><br>
So she would have a crisis time and then get better and my resolve to get her help would disappear. The it would be a crisis again and I would debate for awhile about what to do. And by then the crisis would subside.... This is why it took us until third grade to reach the point of therapy. Finally I decided that getting her help even if she was not in a crisis time would help us help her manage the crises better.<br><br>
This year we are anticipating a crisis in the fall. Not only is it the start of the year, but we are changing to a different school. The therapist suggested having a couple meetings over the summer and then in the 3 weeks before school starts ramp up therapy again with a refresher on her coping skills and continue that into the first few weeks of the school year. But by then the therapist thinks that she should have internalized the tools to the extent that she should only need occasional therapy sessions (like a PP mentioned) when she feels the need.<br><br>
So it is worth thinking about meeting someone and getting some ideas from them so that if she does have a hard time again in the fall, you're prepared with a plan in place vs starting from ground zero.<br><br>
Good luck!

 

[carmel23]

I'm going to go back and read everything more carefully, but we are going to start therapy for anxiety, and anger management (which is related to the anxiety). I wish we would have done this a year ago, but it seems to come and go (or at least the appearance of it). Like now that we are going forward, my guy seems so mellow and not anxious. I'm sure there is a connection.<br><br>
One thing that concerned me was when our pediatrician mentioned that treating anxiety (my son has pretty extreme anxiety in certain situations, being around doctors is one of those situations--so he was freaked by the dr. ) it is most successful before adolescence. So I'm really interested in doing this now.<br><br>
I agree to having a plan in place in the fall. That is our strategy now--coordinating with is teacher, therapist, and himself (of course) so that in the fall, he can hit the ground running and have a good school year, knowing how to manage the bumps.<br><br>
I just feel that this will be crucial to his future success (like the difference between succeeding in middle/ high school and beyond and not making it.)

 

[Diane B]

Your post title caught my eye; I can share our experience with our very bright 6 year old (hasn't been tested; probably moderately gifted.) We tried play therapy when she was 4.5. Total waste of time and money - she had a lot of fun in the sessions, but we didn't see any positive changes. At 5.5 years, we tried narrative therapy, which is related to cognitive behavioral therapy. We had to search a bit to find a therapist willing to do this with a 5 year old, but our daughter is incredibly verbal and insightful about her feelings and able to report in detail on her inner world, so it worked great. We saw a lot of improvement in a very short time, and she's doing great now. I don't think a cognitive approach would work very well on a typical 5 year old, but for our kid it was exactly the ticket. I would imagine this would be true for many gifted/very bright young children, especially if they are gifted in language and self-awareness.

 

[Treasuremapper]

Loraxc, your daughter sounds so much like my daughter that I searched for more of your posts after reading your school thread.<br><br>
We recently had her evaluated by a neuropsychologist. We found her IQ was much higher than we had expected, and the neuropsychologist suggested we read the Love and Logic books and that was the end of it. But our daughter goes to OT three days a week for SPD. Her OT works with her regarding what to do with intense emotions.<br><br>
After reading this thread, I am going to ask the neuropsychologist about cognitive behavioral therapy and a 504. We homeschool but I would like to have her in school.<br><br>
I am following your experiences with interest.