We recently had DD8 complete the CDI (a depression inventory) and the MASC (an anxiety inventory) through our ped. She scored within normal limits for anxiety and right on the borderline of diagnosable for depression. Daily issues include rage, tears, inflexibility, low self-esteem, and worry. She likes her school, which is a GT magnet. It is still probably too easy, but a lot closer than her previous school arrangement. She has no behavior issues of note at school. I don't really think school is the issue, though I could be wrong. She has always been a "hard" kid, from birth.

DD's ped, whom I really like and who had GT kids herself, has recommended counseling (based on the screeners) and given me the names of a couple of counselors. She was pretty firm in her opinion that DD does not need meds (I agree) but that intervention of some kind is warranted.

I'm not anti-therapy, but I wonder about its efficacy for a young child. I'd be interested in positive (or negative, I guess) stories about your children's experiences with it.

I will say that we are all frustrated and upset here quite often. I feel a need to do SOMETHING. I have explained the concept of therapy to DD and she is receptive. I have no idea what our insurance coverage would be like.

With the insurance plans we've had they won't cover w/out a diagnosis. Previous ones you could pay out of pocket but it depends on the provider, some won't do that (and it's very expensive, at least where we have lived $125-$150 per hour range.

My first experience with DD when she was in K, the counselor (who was supposed to be really good for gifted kids) was very...casual...saying she needed to code either anxiety (a "lighter" diagnosis to attach to the child's record) or depression. She said she usually recommended depression,even if the child wasn't clinically depressed, because looking down the road, with this on the child's record it was easier to go on disability when the child turned 18.

That didn't set too well with me, a child with obvious problems at school but none at home. It was simply my opinion but it felt too much like throwing in the towel too soon without exploring anything else, a better school fit etc. Anyway I did thanks but no thanks to that.

With homeschooling there weren't any issues.

We explored it this summer after 2nd grade, having been back in school, and some bullying issues but just got some advice which when applied seemed to work wonders, then a great summer vacation. No diagnosis. I'm not looking deeper right now until we do some more educational type testing. My DD is staying afloat besides just being very tired, possibly according to her OT from the amount of compenstations she's doing for 2E type issues. We need more info about that right now it's the priority to get the whole picture/framework to move forward.

So I'd ask outright about how the diagnosis works, and maybe ask about family counseling? Maybe she's really holding it together at school but letting things come out at home where it's more "safe" to do so and you could learn some ways to help and feel more secure about your support to your DD.

It's all a very personal decision but you're right to seek as much info as you can! Anyway good luck.

DS8 has been going to counseling for about a month. I'm not sure how much it's helping yet, but it's certainly not hurting. She focuses on practical things with him - how to calm himself down, breathing exercises, etc. She also talks through issues he's had that day or the previous - and helps him identify the choices he made and if they were good choices, or if not, what the better choice might have been.

There's nothing Social Security Administrative Law Judges like less than a diagnosis that is completely unsupported by clinical notes coupled with a lack of medication.

We have had therapy of different types since DS was in preschool. I was AMAZED at how effective it was. The therapists seem to have a way of talking and playing with our son that encourages him to open up and work out solutions on his own.

Seeing it in action, I have tried to use their techniques, but am not NEARLY as successful as they are. I do not know what the magic trick (ha ha) is, but it has worked very very well for us.

And we do not have any insurance coverage for any of it, but it is well worth the money for us.

(just so you know how serious it was, DS was making suicidal statements when he was 5 and the psychologist worked him through it. She has been our life-line ever since.)

Kate

Thanks JonLaw! I didn't know that but based on my gut feeling about it at the time (and also looking back) I threw it on the giant heap of really bad advice I've gotten for my DD over her young life.

Dd was having trouble in K --social difficulty at school -- she truly didnt know what to do on the playground--and some anxiety. I remember feeling so odd calling to set up a therapy appt for my 5 yr old. The therapist did say that she wanted to see young children--the earlier the intervention/ help the better.i look back on that experience as a fork in the road. It made a huge positive difference for my dd.

Our insurance has mental health benefits. We used a therapist "in network" and paid a small co-pay.

DD7 is in the beginning stages of therapy with a psychologist, though we're not calling it that. We do tell her he's a doctor who specializes in how people think, and that the purpose of going there is to help her deal with some of her negative emotions and help us advocate for her better at school.

She mostly spends her time there socializing and drawing, which suits her just fine. She enjoys going.

We hate our insurance company overall, but after we resolved their usual screw up they're covering this reasonably well, leaving us with a reasonable co-pay.

Re: Kate's "(just so you know how serious it was, DS was making suicidal statements when he was 5 and the psychologist worked him through it. She has been our life-line ever since.)"

That is very scary. I have an aquaintance whose daughter has stopped eating decently because she says she is fat...the child is only 6/1st grade and like a little toothpick (before she stopped wanting to eat).

Hearing these stories just makes me feel very sad for our society, what are we doing wrong...?

I get that school is better than it's ever been, but it may not be helping as much as it could. I would call a meeting with the teacher and let her know the results of the Pedi meeting and ask if you can do some kind of trial of subject acceleration or full grade accel just to see if it improves the observed symptoms of rage, tears, inflexibility, low self-esteem, and worry. They might be shocked to know what is going on at home if she is holding it together in school, and sadly, they might need to hear some same stories of the above behavior to get an idea of the level of importance making an exception might have to your family.

As for her being 'hard' since birth, well, yes, we see this. I love the book "Transforming the Difficult Child Workbook" by Lisa Bravo and will answer any questions about how to apply it. Like an IQ test, the CDI results don't change the child you have in front of you, only label her. She is still the same kid, so it's ok to try a few things, diet, exercize, the book before you try the therapy. I like to write a date on my calandar with a note like - are symptoms 70% improved, if not call (list the numbers)

Best Wishes whatever you try,
Grinity

I wondered about whether she needs a diagnosis for therapy to be covered. The ped didn't mention it. I suspect they can code her as depressed if they need to. She scored a 13, which some people use as the cutoff, whereas others use 19.

I think DD would like therapy. She likes adults, she likes to be taken seriously, and she is open and receptive to discussing her feelings. I also believe that on a gut level she wants to be helped. So all this is good, but then I do wonder about the expense and inconvenience.

Grinity--I have considered asking for harder work. The interesting thing about DD is that she scored just a few points over this school's cutoff (130) but seems to still be pretty much way at the top of her class. Anyway, her numbers would likely not support acceleration, since she is of "average" IQ for this group, I'm sure. Her achievement in school is extremely high, however. She appears interested and engaged, with some occasional complaints about math being too easy.

There is a question about suicidal ideation on the scale. She answered it with the "middle" answer--"I think about it sometimes but I would never do it." She has said "Fine, then I'll just kill myself!" (or "Since you hate me I just want to die", or something) once or twice in the extreme heat of the moment, then later has been remorseful and said she knew that was a very hurtful thing to say. I really don't think she is seriously sucidical, but that does give you a sense of the intensity of her emotions.

I also think we might benefit from family therpay--we might suggest that. And I still wonder if we are missing an Asperger's or ADHD dx. The ped appeared very skeptical that either was at play, but she is just one ped.

Ultra, are you still planning to pursue neuropsych type eval, or are you stopping at this point? I ask because what therapy you choose depends on what you find.

Based on our experience, I am not a huge fan of talk therapy for little kids. DS did a year of that, but the therapist didn't get far with him. She did give us the AS diagnosis and she shipped us off to someone who really could help, so I'm grateful to her, but talking alone wasn't going to solve his particular combination of issues, which included a hefty dose of anxiety.

I am a huge fan of cognitive-behavior therapy. I think even a bright 6 year old can start understanding the principles, and using it to reduce anxiety. Far more effective IMO than most other kinds of therapy.

I agree that if you're that frustrated, it is worth trying something.

HTH,
DeeDee

ETA: for the sake of completeness I should mention that DS has had a hefty dose of ABA therapy (also based on behaviorist principles) and that this too has been very effective for him.

The ped recommended against a neuropsych eval. I didn't feel like pushing it with her, so I'm instead planning to push for further evaluation with the therapist (I guess that means I am planning to call). On the positive side, the therapist she recommended does do CBT.

I think a psych would code either the anxiety or the depression, whatever works better for the insurance. Insurance is highly variable with regard to mental health issues.


I hear you, but I'd still want to make sure a therapist was working on that issue. Even the idea of self-harm is not one to mess around with.


Anything that helps parents cope is good IMO.


I wouldn't trust a ped's judgment on this. My DS has a glaringly obvious, almost stereotypical case of AS, and the ped (who is otherwise superb) thought it was just giftedness.

As you know from our prior conversations, I see red flags for AS in some of her profile. If you can get the eval done, I think it may be helpful for ruling in/out.

DeeDee

The therapist will know more than the ped; time will tell what all she can accomplish. This sounds like a good first step.

DeeDee

I would consider myself conservative on the subject of counseling etc. and diagnosis due to how I was raised, and DH is worse, but when DD was 3 and her preschool music teacher said "don't let that child enter a public school without a diagnosis" and strongly advised, as a friend, sensory processing issues, I listened and learned about it. However DD's ped at the time would not "cooperate" and sign the required script/papers for the eval and sessions, and we muddled through.

Anyway, long story short, we're at age 8 with 4 hard years behind her. She's a lovely kid blessed with a fantastic sense of humor, but it hasn't been fair on her. I haven't given up trying and I believe she knows that but it's hard on the family.

I really respected that ped back then but it was not good advice.

5 years later, she's in OT and it's great and better than not doing it, but it would have been great if she started when littler.

And now we have a neuropsyche appt scheduled for the spring. Her current ped (third one since we moved to new state less than 3 years ago) readily admitted that he is a conservative ped but in some circumstances he is willing to listen, learn, grow, and DD's case is one of them. We spoke on the phone for 30 minutes yesterday evening...he called at home after 7 pm, and he is on board for anything that needs to happen based on her history and getting to the core of some of the reasons for the history.

Anyway I probably went overboard with this post, but I agree with other posters that you can be friends with your ped and respect them for what they are, but you might be right back to the neuropsyche in a few years or so, and that's time wasted for your DD and a huge amount of stress for your family to go through.

Best wishes...

I think therapy is a good idea if it is really needed...
School sounds like it is the problem... because if it isn't school, is it home?

I hope this doesn't sound too hippy-ish, but another thing no one has mentioned is nutrition and diet. I doubt hormones (like thyroid) are a problem at that age, but I know when I had hypothyroidism and was eating only processed food I had horrendous depression. Eating real food, making sure I take enough thyroid hormone and taking Vitamin D (or going in the sun enough) turns me into a completely different and pretty happy / content person. Do not underestimate what eating all whole foods can do for someone's mood and outlook on life. It is not all mental.

Food allergies or intolerances can also affect your mood. If I start slipping on those things I get depressed and I don't even have an actual reason to feel that way.

We discussed the possibility of blood tests, but I doubt there's anything. Ped suggested Omega 3s, which I'm fine with trying but won't expect much from.

DD7 got the idea that she was ugly just by watching an episode of "Victorious," which as a Nickelodeon show tries very hard not to send the wrong messages. A repetitive theme has people remarking on the star character's beautiful cheeks... innocent enough... except that people with prominent cheeks are usually gaunt, just like the actress is. My DD decided she didn't have pretty cheeks, and therefore was ugly.

The wrong message about girls and their appearance is so pervasive that it's just that easy for our kids to receive it.

As a parent, I took it upon myself to immediately invalidate that message. We explained how everything she sees on TV and magazines is fake.

Don't forget regular exercise. Regular exercise (in kids and adults) can help prevent depression. Regular exercise can also help prevent Alzheimers long-term.
In today's world, so many kids get very little exercise- they sit in front of the TV or play video games.

I am reading "Cinderella Ate My Daughter" by Peggy Orenstein. Along this subject line, Dude.

We don't have cable but when there is some image etc like that on a netflix DVD(or when she watches cable in a hotel) DH has a running commentary to counteract. It's a little over-the-top sometimes, but DD thinks it's hysterical and I think you need to go overboard sometimes due to the bombardment of messages they are sending. The culture is quite pervasive as you said.

Since my DD loves science so much it comes up alot. She even went to a LEGO workshop one time where you had to pre-register. They had waiting for her a screaming pink lego set. Anyway we've since found another group that doesn't "discriminate" as they say, where she is more comfortable.

We're always analyzing stuff. Sometimes we even discuss the messages to attract/retain girls in science beacause, though I respect the efforts, it's almost like people are afraid that if something's not pink or flowery or chemistry about perfume it's not acceptable to girls. Again, I respect the effort but sometimes it appears to be an either-or situation...either pink or not in. Anyway I'd better quit now!

She gets a lot of exercise, eats a varied diet (and like a horse--but she is 40th% for BMI), plays outside a ton, and sleeps well. Very little screentime; maybe an hour or two a week. Her only activites outside school are a couple of low-key afterschool clubs, with no commitments outside the hour or so a week she spends there. The one thing that I wish could change is the amount of homework she gets (too much), but there we are.

Plenty of sleep, too--we shoot for 11 hours. No sleep disturbances. She is often very enthusiastic, outgoing, and cheerful and does not seem at all withdrawn or "sad." But she also has a major temper, is argumentative and combative, and is perfectionist and low in self-esteem.

The more I think about this, the more I conclude that she still needs "more." She does better if kept mentally active. She really wants to take piano, but I've held off since the homework load is so heavy and she already expresses frustration about her limited afternoon playtime. I may try to do lessons this summer. Summer will be a good time to asses some other stuff, too.

I don't think this is the MAIN issue. I suspect she is wired this way to a large extent. While I think we are not parenting optimally, I don't blame us exactly--she really is TOUGH and we try really hard. The irony is that her actual behavior is really pretty good. It's the anger, attitude, rudeness, and stubbornnness that wear us down.

ETA that we are both poorer parents to DD than to my son, which is a hard thing to admit, but which clarifies things a little, IMO. I mostly feel that I am a good parent to my son, who has an easier temperament (though he is not "easy"). I screw up occasionally, of course, but to me it seems like it's totally within normal limits, and I do not get down on myself about my parenting when it comes to him. I--we--screw up much more with DD. The patterns we've developed are problematic. It's not that I think we are inclined to be bad parents generally, but she is challenging and we run out of strategies and just get burned out.

I hear you.

At one point I took a parenting class because I really thought that DS's behavior was somehow a result of my bad parenting. Nothing in the class worked at all: over the 10 weeks it became clear to me that normal strategies were not working, which also clarified that we needed something else. Of course, it was a class for parenting typical kids, and DS's neurology was working against us, but I didn't know that yet.

Extraordinary kids require parenting off the map. I don't think you should feel badly about being burned out, or about not being able to give enough. You'll do all you can, I'm sure.

DeeDee

We've had two of our kids go through therapy at relatively young ages, and we've actually tried a total of three times for our ds. I think whether or not therapy will be successful with young children depends on two things: I think the biggest issue is - is the therapy you're seeking targeted to the actual issue at the root of whatever challenges your child is having (I'll explain this relative to my own children's experience), and second, the personality of the child. I really think the personality of your child is secondary to the first thing though - understanding what exactly it is that you're trying to get help with and having a reasonable goal related to it.

My ds first had counseling when he was 6 years old, for suspected anxiety (he'd been suffering from stomach pain for months and been through every physical test under the sun before his ped referred him for counseling. He had a counselor that just didn't seem to get him at all - she talked to him as if he was a little kid, when he was used to talking to us and us responding to a much older-intellect kid (he's our EG kiddo). He went for several sessions, didn't seem to get anywhere, then his dad stopped *traveling* for work and voila, no more stomachaches... so we thought we were through, never went back and lived happily... for another few months or so lol. The next year he was back into full-on anxiety and that's when he had his first neuropsych eval and we learned he was 2e.

Soooo... his neuropsych recommended counseling for him to help learn how to deal with frustrating situations, since he was bound to run into them on his journey through the world of 2e. She recommended a male counselor that she had a lot of great feedback on from other clients of young children. DS was 8 at the time. The counselor wanted to meet with ds alone so ds could talk openly about feelings, and that freaked ds out - he didn't want to be alone with him and didn't really want to be there at all, so it didn't work and we gave up on it after a few sessions. At the same time, we were making accommodations and changes at school and ds' anxiety disappeared - especially when school let out for the summer, so we didn't pursue any further counseling. Later on we realized that part of the challenge with talking to the counselors had been that ds has an expressive language disorder that no one was aware of at the time. So then - a few years later, when he was 10 and on the verge of middle school plus having a tough time with accepting that he needed to use accommodations at school we sought out a counselor again, and had a much better success - I think partly because we had a clear goal in counseling and we understood what was going on with him. A few years worth of maturity also undoubtedly helped.

So that was our ds - counseling didn't work at all for him until we really understood what was causing his anxieties. Once we had that, it worked - a bit. He's still not a kid who responds well to counseling - he prefers to talk it out and figure things out with his parents, and for the most part, that works ok.

Our second experience has been with our dd7. She's a kid who is all about accomplishing accomplishing accomplishing - very driven. She's also all about control and began going through some very severe temper tantrums around 5-6 years old. They got to the point that we had to have some kind of help, and our ped recommended counseling before neuropsych, which we thought was the right way to go (at the time). She has just started counseling recently and it's going relatively well - because she is so keyed into being in control, it's been much more effective to have a third party adult who has is in a position of "authority" make suggestions re how to cope with her feelings than having the same type of advice come from a parent. She's also put in a position where she can perform for this person to a certain extent, ie, the counselor gives her techniques to practice during the week, then we go back and I and she both have a chance to tell the counselor how it went - kinda like a report card for a kid who is all about getting straight As. I don't know if it will work for the long run, but it's been *very* helpful in helping her feel calm, and to identify and own her feelings - and she's clearly coping much better with far fewer tantrums than she was before counseling. So - for her, it seems to be working. The irony is - we're kinda in a relatively small town.... and the counselor she's seeing... is the counselor who our ds saw at 6 and just seemed to be such a poor match.

So that's our very limited experience, fwiw.

polarbear

That's consistent with my impression that one of the more important aspects of therapy is just being a good "match" with the therapist because therapy is more personal and less mechanical that standard medical diagnosis and treatment.

[quote]She has just started counseling recently and it's going relatively well - because she is so keyed into being in control, it's been much more effective to have a third party adult who has is in a position of "authority" make suggestions re how to cope with her feelings than having the same type of advice come from a parent. She's also put in a position where she can perform for this person to a certain extent, ie, the counselor gives her techniques to practice during the week, then we go back and I and she both have a chance to tell the counselor how it went - kinda like a report card for a kid who is all about getting straight As. I[/quot]

This sounds a LOT like my kid. I hope we have a positive experience as well.

Yes, it has been incredibly helpful for our family. Life changing really. It sounds like what you are saying is that her disposition heads toward anxious. If that's the case those traits are not usually outgrown, but instead they need to learn to be managed. The earlier - the better. She can learn habits of the mind that will last her into adult life. So, if later she resurfaces in adult life with more anxiety, she will have a foundation for dealing with it.

The key is getting a good match with a therapist. I would encourage you to interview therapists and be choosy if you can. You want someone you both can feel comfortable with. I agree with the suggestion to look for someone who is directed and results oriented and who will provide specific homework assignments.

We haven't started counseling yet because we're fighting our insurance company to have them cover it, the only one they're willing to cover is a religion based therapist which does not sit with us (and frankly I think it's unconstitutional and possibly illegal).

But I have to say that getting the clinical psych evaluation was the best $1500 we ever spent (insurance didn't cover that either). The dr we went to was recommended by our school district as being very experienced with gifted children, and told us things about our daughter that we never would have known, things that she does need help with, both psychologically and in school. They were able to recommend therapists that they know to be specialized in the areas she needs help with, rather than us going to a general counselor and hoping for the best.

While we love our pediatricians, both past and present, neither of them were even inclined to suggest she was gifted, in fact one of them went so far as to tell us we were delusional for thinking it a possibility. Both pediatricians have been fantastic on the physical medicine side, picking up on medical conditions that are easy to miss but detrimental if not caught, and I'll be forever grateful to both of them. But they're not trained psychologists and I wouldn't expect them to be able to deliver the same level of expertise in this area.

My child psych friend is disagreeing with my ped's interpretation of DD's depression screen. She says her scores are basically normal (slightly high); ped says they warrant therapy. Hmm. Meanwhile, the kid whose anxiety screen was "normal" got really worried the other night when there was a fire at a favorite business--which is probably a mile away. She was really worried it was going to spread like crazy and consume our house. Hmmmm, again.

Hi, Ultra,

IMO it sounds like your DD's worries (diagnosable as anxiety/depression or not) are getting in the way of her life, to the point where you feel it affects her and the rest of your household a lot of the time.

To me, this says the sensible thing to do is to get help in working on it. Helping her learn to manage this now will be a great asset for the future; little kids have little worries, bigger kids have bigger worries, and since she seems constitutionally prone to anxiety, giving her tools to cope with it early on is a gift.

There is no shame in getting help with this.

DeeDee

Although I remember starting with the big worries early in life, namely nuclear annihilation and the sun consuming the earth, destroying all life, at about 6 years of age.

Granted, I did move onto the heat death of the universe and existential hopelessness in high school.

In hindsight, I probably could have used some coping skills.

As long as you find someone who is a good fit, and it's not expensive, I don't really see a downside to therapy.

It may well be expensive, and it will definitely be inconvenient. I do feel we need some kind of help. However, it's confusing to get these different opinions.

Oh, and JonLaw, the death of the sun and nuclear annihilation are certainly on her list.

They were on mine too at that age, actually. I don't mean "big worries" as in the topic of the worries; but more that the anxiety that is concerning at 5 can be crippling at 9, 12 or 15, when a kid has to be so much more independent.

DeeDee

I didn't even realize that anxiety existed until I started having panic attacks several years ago.

Honestly, though, once you realize they are panic attacks and you aren't actually dying or having a heart attack and that nothing is really physically wrong with you, they become more irritating than anything else.

Fortunately, I haven't had any for several years. No therapy, though, just a job change. And one of those generic anxiety medication, which I am convinced worked as a placebo.