Gifted Issues Discussion homepage Forums Twice Exceptional Debating whether to continue therapy

DS 5 is in Kindergarten. When he was 3 he was diagnoses with Pervasive Development Disorder - Not Otherwise Specified, so basically some characteristics of Autism. His main areas of concern were a lack of reciprocal conversation and reading of social cues, and failure to ask questions. We started an ABA therapy program for him of 5 hours a week plus a social skills group once a week. When he was 4.5 we had his IQ tested and found he is gifted. Other testing established that he is no longer on the autism spectrum. He still has issues with executive function and on task behaviour when he is not interested. When he started school this year we stopped the ABA therapy sessions, but he was having a joint psychology session once a week with another boy with a similar profile. They were working on higher level social skills and emotional regulation. The therapist is going away, and we have the option to continue the sessions with a speech pathologist at the company, but I am not sure if she will be as good as the psychologist was, and I am also not sure if DS really needs a weekly session any more. We have also stopped the social skills group as we enrolled him in an academic extension program.

He is an emotional little boy, he does struggle a bit with executive functioning, but does therapy just go on forever? I know we need to keep an eye on him as being gifted can cause social stresses. And I won't hesitate to seek counselling for him if he seems to need it in the future, but I am thinking his psychologist leaving might be a good opportunity to take a break from intervention for awhile and see how DS goes. His school thinks he is fine.

As they grow up the needs change a lot.

By second grade, the expectation is definitely that they can manage themselves, accomplish their schoolwork independently, and "look interested" whether or not they are. The "when he is not interested" can turn into a major limiting factor, since school always offers at least some tasks that are not intrinsically interesting.

By fourth grade they are expected to be organizing their homework independently (i.e. bringing the right papers home, remembering to do AND turn in assignments). Teachers are often baffled by a kid who is this bright and simply cannot turn in his work.

By middle school, with changing classes, if you aren't using your planner and managing organization, it becomes a problem. The teachers are not accustomed to negotiating with parents at this stage: it needs to be in place with the child.

Socially, by 2nd grade a boy who cries or fusses at school is going to be singled out. Emotional regulation is pretty key for appropriate socializing, and becomes more and more stigmatizing if it's not in place. Being able to cope with change is important right along. Being able to cope when peers don't exactly follow the rules becomes more and more important in late elementary and middle school.

All of which is not to say "continue" or "stop." Only you can tell. But it's just to note that you need to plan to address the remaining issues so they don't become hindrances later.

That plan could be you doing the teaching on these skills, working with school as things arise, or continuing therapy. (We've done plenty of all three of those things with DS11.)

The nature of therapy changes, too. Ours increasingly looks like a "big brother/college buddy" who teaches the needed skills alongside fun activities. Definitely not what most people think of as "therapy."

HTH.

It's hard to say. Will 1st be a lot different than K? My district K is only 1/2 day, and moving to 1st is a big change.

My son when to a psychologist for about 18 months when he was 12/13. At the time he went for anxiety disorder and social skill problems. Her is borderline ASD, but no professional has ever felt that diagnosis really fits. We stopped the therapy because it started feeling like the sessions were doing anything and we had a natural break, when he was going out of town for a month during the summer. He was also attending a social skills class and that we "naturally" left after a about a year because it felt like he had gotten what he needed out of the program.

Here I am two years later and I'm going to start taking him to a different psychologist who is an expert with Gifted Kids starting next week. The goal is to more work on issue specific to giftedness and his expressive language blocks. So far his social skill continue to improve but they are far from perfect.

I would say trust your gut. What experience does the speech and language therapist bring to the table? Have you been able to meet with them? Do you know what they would be working on? At 15 my son is still slow to warm up to adults and switching who he works with might not necessary go smoothly.

Thanks for your responses.

[quote=bluemagic]It's hard to say. Will 1st be a lot different than K? My district K is only 1/2 day, and moving to 1st is a big change.

We are also looking at a skip to 2nd grade. The length of the days is the same from k-6. He seems to be fairly well adjusted in school, but I get a lot less feedback from school than I did from daycare. In daycare the teachers said he could be Challenging sometimes, but nothing out of the ordinary, and that he was not the worst behaved in the class. His Kindy teacher also thinks therapy is an overkill. So I feel sometimes like I am caught between therapist highlighting all the things he needs to work on and teachers and friends asking me why we have him in therapy. I want to do the right thing for him, but it is not always clear what that is.

DeeDee, your outline of expectations at various ages is really helpful.

I sometimes wonder how much he gets out of therapy, and how much comes from him aging. His current therapist says she thinks he really needs to have at least another kid in therapy to be worthwhile as he understands all the concepts quickly and can apply them quickly with adults, but he struggles more to apply with his peers. We do have another psychologist we saw for a little while who is a bit further for us to get to, but she is good, so I suppose we could stop the weekly sessions and maybe have less frequent appointments and work on stuff at home between sessions.

I don't think the speech pathologist has much experience with gifted children. I think her experience is more with autism.

I would say that if your primary concern is social skills, individual therapy in isolation is unlikely to offer him a great deal more at this time, as what he needs is transfer training. Having the social cognition in isolation is not going to be that much of a challenge for a high-cognitive child. It's all the subtleties and permutations in a live situation with another child that create the challenge.

IOW, he needs practice. I think conversations with his current and next-year's teacher may be in order, to establish what his baseline is in kindergarten, as far as how he interacts with peers, and to allow the sending and receiving teachers to share insights into where he is strongest, and where he benefits from adult coaching. It may be helpful to sit down with the school psych and/or adjustment counselor/social worker, and have this same conversation. He or she is in a good position to provide consultation to the classroom teacher on cueing and coaching in the naturalistic setting, and may even be able to go in to the classroom ever so frequently, or set up a friendship group at school.

I would also talk to his current therapist about what she thinks should be his next set of therapeutic goals, and what criteria she would use to measure progress toward them. This way, whether you continue with therapy right now or not, you will have some idea of what to watch out for.

Thanks aeh, your post was very helpful. I did have a talk with his current therapist before reading your post. She said exactly what you did about therapy vs practise. She said there is nothing else she can teach him cognitively at the moment as he knows it all. But he needs to practice.

I spoke to the speech pathologist who would be taking over sessions as well. She seems like a capable young woman, and she probably has something to offer DS, but we think we might take the change as an opportunity to take a break from therapy and work with the school and their support team to see if we can set up sufficient support there. School is where he spends most of his time, so it would be the ideal place for him to practice, but there is the risk that the support will not be consistently implemented. I think it is worth a shot though. I will talk to his current therapist at his last session next week, and see what goals she would recommend.

Thanks again everyone who has taken the time to respond. It is much appreciated.