Therapist or speech pathologist?

[Calizzy]

I think that 8 yo dd either has an anxiety disorder or some sort of verbal processing disorder. I’m not sure which. She communicates fine in normal conversation (although very shy with people outside of family) but any time she is put on the spot she clams up. Like when asked to give a narration, for example. Or another example, We are on vacation and there were some interesting flowers we though grandma would like so I wanted to make a video of her telling grandma about them and she totally clammed up and could do it- tears ensued. So what I am wondering is, would we need to see a therapist, or a speech pathologist?

[City Mouse]

That sounds more like an anxiety issue than a speech therapy issue.

[Calizzy]

I forgot to mention, she plays the piano and can perform at recitals just fine. It is just verbal communication. At her last recital she was suppose to introduce herself and her piece. She absolutely refused to do that but sat down and played her piece perfectly. 

[PeterPan]

So anxiety resulting in her speech shutting down = selective mutism. 

You're probably going to want to plow three ends--ped for anxiety options, therapist for CBT, SLP to see if they have any good strategies.

Try also doing a google site search of the boards for selective mutism and see what comes up. 

Does she have any self-awareness or sensory issues? I would back off the on-demand stuff. Some interoception work where you work on body awareness, emotion awareness (hypostatic and affective), and then strategies she can use when she feels those things could be good. 

Sometimes therapists are a mixed bag. If she gets stressed and shuts down, that's not helping either. We had that with ds, where the idea was great but he wasn't ready to interact in that way. You're probably not talking about a fixable thing but more of coping strategies, which is why lots of angles and realizing the parts you can do with her at home (interoception, self-awareness, actively using strategies and self-advocating) can be good.

[geodob]

This can be treated, using the same approach to overcome anxiety with Public Speaking.
Which involves a graduated process. So that she experiences being relaxed when speaking with other people. 
Starting with people that she feels less anxious, to speak to.
Video could be useful, starting with making videos to you and your family members.

[kbutton]

13 hours ago, Calizzy said:

I forgot to mention, she plays the piano and can perform at recitals just fine. It is just verbal communication. At her last recital she was suppose to introduce herself and her piece. She absolutely refused to do that but sat down and played her piece perfectly. 

That strikes me as language, not anxiety. Expressive language problems, especially when receptive is fine, can be hard to figure out or notice, and this is the age when you start seeing signs. Whether it's a big enough gap between typical and not at this age is a big question. Signs can be subtle--things like you are talking about where you're saying, "It's fine in this context, but not this other one." 

You might be used to her normal conversation patterns, which means you might miss tiny things that are different or certain kinds of things she avoids. My son that has expressive language issues was like this at that age. Eventually we started noticing other stuff, but part of that is we got more and more familiar with what to look for and had more symptoms as academics increased. It was easier then to "see" it and identify places where we were just not noticing his own compensatory strategies. Also, he's a firstborn, and my second son was more typical this way--having that comparison helped make things clear.

Anxiety is totally possible, but I would want to rule out expressive language issues. I recommend the Test of Narrative Language and the Test of Problem Solving.

[PeterPan]

11 minutes ago, kbutton said:

That strikes me as language, not anxiety.

Yes, that's why she needs the SLP testing, because she doesn't know if there *is* a language component. Even something like low processing speed, poor working memory, etc. can make the language hard to get out in the moment, on the spot. And they could do narrative language testing and see if that's part of the issue. My dd would clam up with narrations and it was low processing speed. She also has poor word retrieval, so to get all the names, pull it together, get it organized, get it out, all on demand, just isn't reality for her, even when she knows the content. Her paperwork specifies getting questions ahead to let her pre-think.

So good evals are your friend, allowing you to tease apart ALL the factors. And it will take multiple people most likely, unless you get the rare psych who does narrative language testing. 

Edited September 11, 2019 by PeterPan

[Crimson Wife]

My DD has needed YEARS of explicit teaching of narrative structure as part of her speech therapy. While she does have some anxiety issues, her inability to tell a narrative was due to the language impairment.

[PeterPan]

3 hours ago, Crimson Wife said:

My DD has needed YEARS of explicit teaching of narrative structure as part of her speech therapy.

Can we kind of rabbit trail here and talk about that? I think some of us here have been feeling like failures or wondering if it's us and that's why it seems to take so long. My ps IEP and the SLP writing the goals for the ps seemed to imply one year, boom, just run through this little $10 set from TPT and it just happens. And I work with him and it just seems to take TIME to go through stages, build all the components for the next level, get it going, get it naturalized and generalized into every day speech, rinse repeat.

So to you is years the NORM? You have any data on that? I'm probably going to need some data for our IEP renewal fight at some point, sigh.

[kbutton]

17 hours ago, PeterPan said:

My ps IEP and the SLP writing the goals for the ps seemed to imply one year, boom, just run through this little $10 set from TPT and it just happens.

That's nuts. I mean, my son is making up for lost time, but I expect this to be a long-haul problem that takes most of high school to get fixed and generalized. And I still expect it to be squishy but IQ appropriate if things continue on the current trajectory (squishy as in not a lot of lit analysis, difficulty with longer assignments, will probably not be a note-taker during lectures at all). And that's with the stars aligning, rainbows and unicorns lining out path, optimal response we're currently seeing (after months of swirling the drain).

And it's still like a second-language even with good results and generalizing to real life. 

[PeterPan]

1 hour ago, kbutton said:

That's nuts. I mean, my son is making up for lost time, but I expect this to be a long-haul problem that takes most of high school to get fixed and generalized.

But in our school, that $10 TPT packet is the extent of narrative language intervention. So they gave us autism as our disabling condition when we showed narrative language deficits, but they don't know enough to know when they're continuing to stare them in the face. And ds now has the narrative language test models memorized. 

Oh yeah baby, the IEP fight never ends! LOL But I have another theory/plan/idea on how to get this language thing shown. Call me Mohamed Ali.

[Crimson Wife]

On 9/11/2019 at 8:53 PM, PeterPan said:

So to you is years the NORM? You have any data on that? I'm probably going to need some data for our IEP renewal fight at some point, sigh.

Every kid is going to be different. My DD has a fairly severe language impairment and while she has made progress over the years, it's been glacially slow. That's why the whole ASD 2 category is so misleading. Your DS and my DD are both ASD 2 but their challenges and need for support are very different. His sound like they're much more behavioral while hers are much more in language. 

[PeterPan]

2 hours ago, Crimson Wife said:

Every kid is going to be different. My DD has a fairly severe language impairment and while she has made progress over the years, it's been glacially slow. That's why the whole ASD 2 category is so misleading. Your DS and my DD are both ASD 2 but their challenges and need for support are very different. His sound like they're much more behavioral while hers are much more in language. 

No we finally did get people diagnosing the language disability. He's got behavior too, lol, but the language is definitely a component. You must have missed my thread where I rambled about taking him through every. stinking. thing. Linguisystems sold for attributes, functions, etc. coordinating all with the oop 100% Vocabulary (Rothstein). Then we started on narrative language, but reality is his issue now is syntax. With the speechie terms we worked on vocabulary and concepts, but he has issues with syntax and narrative language.

So before all the vocabulary work, he was hyperlexic. A dyslexic hyperlexic, fun stuff. So now what I see is the language issues are holding back his comprehension and hence the grade levels of reading material. And of course it's holding back what I can do with him academically. Otherwise he just memorizes and can't talk about it or just memorizes and doesn't really understand. Right now I'm using an Abeka gr4 history text with him that, if I read it to him and pause and do breakouts and discuss things, he can sort of engage with. But to read it himself and work it the way a NT student would, no not a chance. And he's supposedly gr5 per his IEP.

So syntax is what I stay up at night reading about and thinking about. The rest I seem to have good leads on, sigh.

[PeterPan]

9 hours ago, Crimson Wife said:

That's why the whole ASD 2 category is so misleading.

Also, I don't think this is the case. The language disability *is* a major marker for why the kids move from ASD1 to 2. I've had multiple professionals tell me this. It's the major assumption, a thing they're looking for, the language issues. So what's odder to me is when people are saying ASD2 kinda like oh yeah, no issues, because that's not what it's supposed to mean.