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October 11, 2012

The School Solution Newsletter – Fall 2012 Therapeutic Interventions

Learning Disabilities Impact on Therapeutic Interventions

In the world of education, much time is spent on evaluating, understanding, remediating and accommodating specific learning disabilities. In the therapeutic world, much time is spent on diagnosing, understanding, medicating and treating specific mental illnesses. The problem is that children often have both.

Educators, tutors and schools are not fully trained in therapeutic issues. I attended last years’ conference of the National Association of School Psychologists and there was not one breakout on adoption, attachment or even identifying symptoms of trauma. All of these things can have a serious impact on learning and school, yet the professionals in the system who should be looking for signs are not getting the proper diagnostic training.

Therapists, counselors and psychiatrists are not fully trained in learning disabilities or how they can effect specific treatment. I have received an evaluation of a child with Nonverbal Learning Disabilities where, even though the child had serious problems processing visual information, the clinical psychologist interpreted the Rorschach (a purely visual/interpretive test) as a valid test of that child’s personality.

I find that in my role as an educational consultant I am there to bridge the gap between the educational perspective and the therapeutic perspective. When I evaluate therapeutic placements I evaluate how flexible they are in understanding the cognitive skills required to progress within their therapeutic paradigm. Sometimes it is very difficult for a clinician to see beyond the therapeutic approach they have found so helpful for so many. For instance, if a therapist is gifted in connecting with clients and depends on building a relationship to do their best work, that person would not be a good match for a client with Asperger’s or Nonverbal Learning Disabilities (NLD). Again, this all comes back to making the best match, not choosing a “good” place or therapist, but the “right” one for that child.

When considering a therapeutic placement; the first factor I consider is the cognitive skills of the client. I need to be sure the program and staff can understand the client’s behavior through the cognitive skill set of the child. For instance, if a child has very slow processing speed, are they able to prepare them ahead of time for group therapy, rather than interpret their lack of participation as oppositionality or shyness. Is a child capable of understanding the metaphor the program or therapist is using to illustrate a point or progress? At the very core of many therapeutic systems is an assumption that the child has a choice in their behavior, that they “know” the right thing to do and choose the wrong. Sometimes this is correct, but sometimes it is not. Sometimes, the child does not have a repertoire of appropriate social behavior, sometimes they need to be taught. My grown daughter has NLD; she taught me how to understand this through the years. I was always impatient with my daughter in the morning as she had to do things in a certain way, and did not have a good sense of time, both due to her NLD. One night, in her teen Learning Disabilities Impact on Therapeutic Interventions years, as we were beginning to understand each other, I told her she needed to be up by 8am, she asked: “Do you mean up, eyes open, or up, feet on the ground?” This is a constant reminder to me; are we asking too much of our clients, are we asking them in a language they understand, are we giving them the tools they need to succeed?

Before we interpret any behavior as only an emotional response it is important that we understand the cognitive skills of the student. Learning disabilities can impact how a client understands, recalls and attends to: conversation, time, social interactions, instructions, written and verbal language, and relationships. We have all seen our share of children diagnosed as having emotional or behavioral problems, and we find out they have a learning disability and have never been diagnosed. We have also seen some children who, after their crippling anxiety is treated or they are sober their IQ and other cognitive scores rise. I always get a full sober psychoeducational evaluation as soon as possible. It is critical that I understand how the child or young adult perceives and understands the world before I find the people and place that can best understand them and guide them to a healthy future.

Role of an Educational Consultant from a Program’s perspective

More Than a Referral Source

As the Head of School at a therapeutic program I know there are hundreds of programs available for at-risk pre-teens, teens, and young adults. Who is doing the homework for families, educators and mental health providers to insure the best possible placement? Frankly, the nucleus of this infinite database has to be an individual who has the time and talent to research/visit the programs, meet with the family and gather the existing data from the professionals working with the family. Then with all of the puzzle pieces on the table, tailored choices can be offered. Now, families have the ability to make informed, specific decisions on geographic location, program/school type, differentiators between programs, and costs. But, of primary importance here, parents know that their options have been narrowed to the best possibilities given the individual needs of their son or daughter.

This is the work of an Educational Consultant.

A child’s therapist, psychiatrist, school counselor, IEP team, prospective school / program and family members are all “pieces” of an informed decision. Each of them is the authority in their area; but only the Educational Consultant is gathering / analyzing the composite.

Now, here’s the best part: after the parents have been empowered to choose the placement, the Educational Consultant doesn’t disappear. They remain in the wings for at least a year. In this way, a) families have a liaison to intercede in the student’s behalf, b) programs have an adjunct staff than can assist with any issues on the home front, and c) because they have remained informed, Educational Consultants are ready and up-to-date to assist with next placement. Everyone wins.

As Head of School, I know what our staff does well and what our program can best accomplish. That will always remain our focus. We can’t do everything. That’s why it has been a pleasure for us to work with Educational Consultants who have been the caliber of Karen Mabie. Karen is the consummate professional dedicated to finding the best “school solution” for every family with whom she works. Her wisdom, dedication and straightforward approach have garnered national respect among health professionals and educators alike. Hers is important work done well.


 

About Karen

karenKaren is the current Chair of the Therapeutic Committee of the Independent Educational Consultants Association, involved in maintaining the highest standards in the profession.

I am available to discuss any questions you have about therapeutic boarding schools, boarding schools, residential treatment or wilderness programs. In addition, I am available to speak to your group about the scope of residential options and what client families they serve – just call or email.

Contact me anytime.
847.242.0865
Email

Testimonial

  As a child and adolescent psychotherapist, I have sought Karen’s guidance on a number of my more challenging cases over the years. When outpatient treatment reaches a standstill and/or the child or teen has engaged in self-destructive behaviors (e.g., drug or alcohol abuse; school refusal or failure; suicidal ideation or gestures, et al) Karen…

- John Palen, Ph.D., LCSW
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