Update/Tell me about social skills groups

[kirstenhill]

First, a quick (long) update -- DS7 finished his neuropsych eval last month, and got a diagnosis of ADHD, primarily hyperactive/impulsive type. He has an IQ brushing up on gifted range (low average on working memory/processing speed on WISC V, but 128-130 on the other subtests), and that makes some of his frustrations make a lot of sense (he gets really upset when people do things for him "that he knows how to do" or when adults try to tell him things he "already knows" -- which seems to happen often in classes appropriate for his age. Sigh.) His behavior in the last two months has been pretty bad (so, we're talking the month before and the month since our testing). Lots of anger/impulse control/easily frustrated issues.

 

The place we got the eval done is a relatively "full service" sort of place with a multidisciplinary team, so there was a brief sensory eval, and they really didn't flag anything strongly sensory-wise and that's not something I'm really seeing.

 

The psych rec'd we pursue therapy and a social skills group. We are trying 8 weeks with a CBT therapist to work on the anger issues specifically, since that is what is causing the most problems for us right now. I'm hopeful after 2 meetings that this might give him some better tools to manage what he is feeling. I know a lot of you rave about OT for some of these social issues, but at least from viewing the websites of OT places near by, they don't look like they are really dealing much in those sorts of issues. I found a couple places that DID mention things like social thinking, zones, etc but they are further away. I guess we're going to see where the CBT leads us first.

 

Despite being a "full service" sort of place, the place where we got our eval done doesn't have social skills groups for ADHD kids or that would be appropriate for 2E. Their groups focus on ASD and ID needs. The psych knew of one group elsewhere, which turned out to have no openings. I've googled a few more and for whatever reason they are located mostly located in outer ring suburbs, while we live in the center city. So, maybe 45-60 minutes each way for us once traffic is included (wouldn't you know it, they meet after school/early evening when we would fight rush hour traffic to get there!).

 

Between distance and the fact that we would pay out of pocket (they don't take insurance for these groups, it seems...not sure if insurance would cover it anyway), I'm trying to weigh the value of it. I'm not sure if any of them will be a good fit for a 2E kid anyway??? (I guess I won't know until I call).

 

For those of you that have tried social skills groups, how helpful did you find them? A lot of DS7's angry outbursts, (hitting, throwing things, screaming, and so on) have had to do with things not going "his way" -- like not getting to sit next to the boy he wanted to sit with, his team losing a game (not just physical games -- even things like a "quiz" competition in Sunday school class), not being called on first or at all, not being allowed to go first in an activity, not getting the color of paper he wanted in art class, not being first in line, etc. A lot of these things have always bothered him but not caused significant outburts before (other than the "losing games" issue). Would a social skills group help with these issues? The CBT therapist is going to work with him on this general behavior, but if a social skills group would be SUPER helpful too, maybe it would be worth the sacrifice to make it happen?

 

ETA: He has had anger problems at home getting along with siblings and playing with neighbors too...so not just problems at outside activities. This has maybe been an issue for longer than even his problems in outside activities, but it tends not to stand out as much to me since it just seems like a slightly elevated version of "normal" brother issues. Also, almost all of the neighbor kids are older (DS9’s friends), so of course it doesn't go well when DS7 tries to play their games. Who wants to play with the younger brother saying that he "is only going to play if he can be the most powerful wizard ever" or something like that? ;-). Unfortunately none of the boys in the neighborhood DS7's age are around very often, so if he wants to run with the neighborhood crowd playing in everyone's yards, it is a bunch of 9-11 year olds. Not awesome even for a typical seven year old, much less one with issues.

Edited March 12, 2016 by kirstenhill

[PeterPan]

You can buy the materials from SocialThinking.com yourself.  Anything you think fits will be good.  Zones of Reg training (the workshops) are good too.  Yes, they definitely sound like they would be beneficial to him.

 

No, not so much an OT for social.  Typically, at least around here, an SLP will be the one handling social skills.  They're going to be using the same stuff you can buy from SocialThinking.com ;)  

 

It sounds like you have a lot of impulsivity and it's allowing him to fly off the handle.  Are meds on the table?  They can definitely help that.  You could give him some coffee and see what happens.  

 

The other thing you could do is mindfulness.  There's a book Sitting Still Like a Frog that has a cd.  Just pop in and do what it says.  Just 10-15 minutes of mindfulness will bump EF by 30%!!!  That's the difference between in control and not in control for some kids.  And if your library has the book, it's FREE.  Definitely, definitely worth trying.

 

There are some books on amazon to use for anger and of course the social thinking materials.  Hopefully the psych is going to work on strategies.  So he wants you to have social skills as well?  I've read somewhere that the actual groups are worthless.  I don't know.  I can say that what I'm doing with my ds is bringing in a behaviorist.  That way it's him and it's targeted.  The title you're looking for is BCBA.  And if they don't do what you need, they'll probably know someone.  

 

[PeterPan]

I think it would be interesting if you tracked antecedent, behavior, and consequence to see what is REALLY underlying his behaviors and whether there's some pattern. For my ds, they're transitions a lot of the time.  Any time he's in transition, we're likely to see more behaviors.  You might notice a pattern if you behavior log.  And when you get more specific like that and figure out what the pattern is, you might be able to intervene more precisely.  You're saying, for instance, he's easily frustrated.  In what circumstances is he easily frustrated?  What's going on?  

 

Are they calculating a GAI for the IQ?  And did the psych do any language testing?  Anything else low?  You can do some cognitive therapy for the low working memory.

Edited March 12, 2016 by OhElizabeth

[laundrycrisis]

Our 10yo has attended groups run by a Social Thinking mentor for about a year now.  They have been great for him.  It was really hard to find a social group teaching program for him - I had been trying for about two years, and I feel like I hit a gold mine, because the teacher is not a psychologist, and she doesn't diagnose anything - she just teaches the information and the skills, and she is very good at it.  When he goes to his weekly group, it is a chance for him to be in a room with 4-5 other kids who he has so much in common with. He doesn't stand out as odd, and they are all sort of on the same wavelength.  He loves going and he has learned so much.  This has done much more for him than private counseling, and so much more than I could possibly do alone with him at home.  If you can find a place with a good teacher and groups that don't have a problem with people dropping out, IMO it is worth the drive.  As far as anger and meltdowns, I think a lot of it was coming from stress due to discomfort and frustration in social situations.  The classes have helped him so much with that, that the anger and meltdowns and low self esteem have faded away.  

 

Back to add - a couple of years ago, he had some time with an SLP who did some of the Social Thinking things with him, and he listened to her, but without other kids involved, it was harder for her to make the points make sense to him.  Then he had an OT that used it, but he wasn't all that receptive to her.  Her way of communicating the ideas felt a bit brittle and critical.  The trained mentor in the group setting with other kids in the same age group has been wonderful for him. 

Edited March 12, 2016 by Laundrycrisis2

[PeterPan]

Laundry, was the social thinking mentor listed on their site?  How did you find him/her?

[kirstenhill]

You can buy the materials from SocialThinking.com yourself.  Anything you think fits will be good.  Zones of Reg training (the workshops) are good too.  Yes, they definitely sound like they would be beneficial to him.

 

No, not so much an OT for social.  Typically, at least around here, an SLP will be the one handling social skills.  They're going to be using the same stuff you can buy from SocialThinking.com ;)

 

It sounds like you have a lot of impulsivity and it's allowing him to fly off the handle.  Are meds on the table?  They can definitely help that.  You could give him some coffee and see what happens.  

 

The other thing you could do is mindfulness.  There's a book Sitting Still Like a Frog that has a cd.  Just pop in and do what it says.  Just 10-15 minutes of mindfulness will bump EF by 30%!!!  That's the difference between in control and not in control for some kids.  And if your library has the book, it's FREE.  Definitely, definitely worth trying.

 

There are some books on amazon to use for anger and of course the social thinking materials.  Hopefully the psych is going to work on strategies.  So he wants you to have social skills as well?  I've read somewhere that the actual groups are worthless.  I don't know.  I can say that what I'm doing with my ds is bringing in a behaviorist.  That way it's him and it's targeted.  The title you're looking for is BCBA.  And if they don't do what you need, they'll probably know someone.  

 

Meds are definitely on the table.  We have an appointment with a ped who is knowledgeable about medication soon.  (Our kids usually see a family practice doc, but she doesn't do ADHD meds). The psych who primarily did the testing is the one who suggested doing both some kind of therapy and a social skills group.  She is specialized in testing, so we see someone else for the therapy (at a different clinic actually...there was a waiting list for therapists at the place we got the testing, so they suggested if we didn't want to wait to go ahead and seek therapy somewhere else.)  I haven't asked the psych who is doing the CBT what she thinks about social skills groups.  That might be a good question.  I was just going off of the testing psych's suggestion.  

 

If we did want to try the BCBA route, any tips on finding a BCBA who can be independently hired?  In my google searches so far, all the BCBA listings seem to be schools or specialized full-on ASD day treatment programs. 

 

 

 

I think it would be interesting if you tracked antecedent, behavior, and consequence to see what is REALLY underlying his behaviors and whether there's some pattern. For my ds, they're transitions a lot of the time.  Any time he's in transition, we're likely to see more behaviors.  You might notice a pattern if you behavior log.  And when you get more specific like that and figure out what the pattern is, you might be able to intervene more precisely.  You're saying, for instance, he's easily frustrated.  In what circumstances is he easily frustrated?  What's going on?  

 

Are they calculating a GAI for the IQ?  And did the psych do any language testing?  Anything else low?  You can do some cognitive therapy for the low working memory.

 

I don't have a GAI yet, but maybe we will still get one when we get the full report? We have just a "brief report" so far with the subtest scores and the fact that the full scale IQ is 121. The brief report mostly gave a summary of her impressions and the diagnosis.  What other language testing were you thinking of? I guess we don't really see any language issues (great in conversation, reading well for a 7 year old etc.). 

 

When I use the word frustration, I guess I mean what amounts to "simmering below the surface" types of anger that hasn't exploded.  Like, when the teacher in children's church asks questions to the group of kids, and calls on various kids who raise their hand for the answers, and I can see his frustration rising and rising if he doesn't get called on until he finally just blurts out the answer (once even yelled "don't you know that I know this!!").  Or as he plays with his older brother as his brother shoots down his ideas because it makes DS7 "too overpowered" in their pretend play, he is obviously simmering with frustration before he finally acts out in anger.  

 

Or he has almost zero tolerance for something not going his way in Sunday school, when he got the blue craft kit instead of the red one and some pieces were pre-cut to save time and he starts complaining like, "why does everyone always give me the ugly colors? why do they give me the pre cut pieces when I know how to cut.  I'm so frustrated. This is such a dumb craft."  Then maybe he tosses the craft across the room because of it, and that is what I was thinking of as an explosion of anger.   It's mostly frustration that something doesn't go the way he imagines it should, and rarely because he can't accomplish something.

 

I've tried to look a little at the ABC thing so far, and some of them are like I mentioned before where there is something simmering as he isn't called on in church/class or can't agree on how to play a pretend game with his brother.   But other times it seems like the antecedent is super straight forward -- some other kid sat next to his friend or got the first "spot" in line behind the teacher, and he reaches out and smacks that kid because he says " I NEED to be first" or "I need to sit next to _____".    He used to just simmer a bit and maybe seem annoyed in those circumstances, but lately it seems like the impulsiveness if way higher and it almost immediately translates into an unwanted behavior.

Edited March 12, 2016 by kirstenhill

[PeterPan]

Yeah, that's so qualitatively different from my ds'. I think the stuff you're looking at is on the right track.  

[laundrycrisis]

Laundry, was the social thinking mentor listed on their site? How did you find him/her?

She was hard to find...I don't think there is any kind of list. You can search "social skills group state" and may find some that way, but I wish they made it easier to find them. I heard about her when I attended a talk about adhd that the school district put on. I waited to visit with the guest speaker afterward so I could ask if he had groups, and he recommended this lady.

[laundrycrisis]

FWIW I was told there was no way out of the fact that our son would need medication for self control for his acting out.....it has been four years and he's come along fine without them. There has been private counseling, OT, SL and social groups, and a lot of feedback and encouragement, but no meds. He doesn't need them. I think he is happier, more relaxed and more confident now,

[geodob]

What you have described, has a lot of parallels with 'Oppositional Defiance Disorder' ODD ?

 

While this is mainly observed as a 'resistance to authority'.

Behind it, is a disordered concept of the 'Other'?

 

Where we have social contracts with the other.

I will let you sit next to my friend, or let you go first in line?

Knowing that tomorrow you will let me sit next to my friend, and go first in line.

 

Though what defines the 'other', is the level of 'trust' that we give them.

It is 'trust in the other', that defines us as social beings.

Where we will make sacrifices for each other.

Based on the trust that we have in others making sacrifices for us.

In a reciprocal relationship with the other.

 

But perhaps you could try and imagine the situation, if you didn't have this underlying concept of trust in other?

Which would leave you to survive alone, unable to trust any other.

Where what you observe as 'anger', is more of a physical defence, as a lone survival mechanism?

 

Though resolving this, doesn't simply involve learning scripted responses to different social situations?
But rather with developing a concept and sense of trust in the other.

 

From this position of trust, to be able to negotiate with the other?

Where negotiation relies in trust of the other.

So that he could negotiate to have the 'red craft kit' in next Sunday school, and trust that it will happen.

 

But perhaps to negotiate with another kid at Sunday school. To take weekly turns with the red and blue craft kits.

Trusting that the other kid, will do this next week.

 

While 'taking turns' might seem very simple?

It is based on a trust in the other.

Otherwise, it can't happen?