Sunday, January 25, 2015

Inside That Special Needs village: the therapists

I have broken down the professionals in your child's village into three groups: doctors, therapists, educators. This post will concentrate on the therapists.

To begin read the CDC's comprehensive website on development disabilities HERE


Psychologist (can be school personnel not only private; can include private talk therapy, CBT, social skills, circle of friends, etc) Psychiatrist is a medical doctor who did their residency and fellowships in psychiatry.  Psychologists are generally therapy oriented PhDs. Here is an article on the differences.
To understand what a psychologist does read this article in the American Psychological Association website In many, if not most, situations you will end up using both psychiatrists and psychologists. The psychiatrist is the one who prescribes medication. The psychiatrist should work in conjunction with the psychologist to keep abreast of how well therapy is going. This is essential to understand if there needs to be a tweak in the medication.

If your child does not need medication, and not every person with a developmental disability does require medication(s), there will generally be no need to see a psychiatrist. However, do note that it is recommended that for proper clinical treatment medication should NOT be prescribed without the recipient also seeking therapy. It is a joint program. Check out NAMI (National Alliance on Mental Illness) for a discussion on treatments and services for those with mental health concerns.

Social worker (can be school personnel not only private) Defined HERE. Read: how do social workers help the families of  children with disabilities? Remember too that social workers can be found in hospitals, rehab or long-term care facilities, are also court-appointed, and employed by government agencies created for the disabled.

There are a variety of organizations nationwide that promote school-based social workers. This would be a good place to start if you are trying to decide between having your child work with the school social worker or school psychologist:  
School Social Work Association of America;
National Association of Social Workers;
American Council for School Social Work 

Guidance Counselor (usually middle school and high school. Also becomes adviser in college and graduate school. Some middle and high schools have Vice Principals that specialize in special education. This may also be your go-to person if your child is having issues either behavioral or educationally.) Read: Role of the School Guidance Counselor

A major role of a guidance counselor can also be to facilitate circle of friends or group counseling on any number of issues. It greatly depends on how your school system has set up their counseling system as to whether your child will have a guidance counselor group support system or the school social worker will be the one leading the sessions. A question you would want to ask is how much experience anyone particular person leading the group has with your child's type of disability or behavioral issue. That too should be a deciding factor as to who to go to for counseling. Discussion of Circle of Friends as applied in the UK

Behaviorist (this is the person who takes your child out into society and teaches them how to be independent out in the world at large; life skills) The educational background of this therapist can be anything from psychologist, special educator, or social worker. The important point is that they know how to help integrate your child into the world and teach them the skills necessary for independent living and selfawareness. So your psychologist, social worker or even a special education teacher/para can do double duty.

Job Coach  is supported employment of someone with development disabilities. In fact typical people can use a job coach as well. The same purposes apply

 "A job coach is an individual who helps people with career development, professional goals and long-term workplace success strategies."
Read an indepth discussion from the UK HERE 
Read: US Department of Labor Disability Employment by Topics  
Watch The Art of Job Coaching.

Practicality: Entering the Adult World
Practicality: Job Interview Skills

Nutritionist and/or Dietician (many of our children either have allergies, celiac disease, specific diets due to any number of issues etc, it is important to have someone with knowledge of  how food works into our daily lives. Doctors are not given the education to do this effectively. And making certain that our children get the right amount of nutrition, while taking care of their food needs, is essential to healthy growth.) Difference between a nutritionist and a dietician.  In the end it is important that you hire someone with real experience with the issues your child faces.

I personally would NOT hire someone that thinks that with the proper nutrition your child's ASD or ADD will be cured or greatly ameliorated. Truth is the reason that your child acts better when they receive the right nutrition is most likely because they are no longer in pain and alot of discomfort. Whomever you hire also needs to be realistic and deal with your child as they are. It is about your child, and your family afterall. They cannot be of one mind to the point that they are inflexible. Example: CM2 enjoys peanut butter and jelly sandwiches every morning for breakfast with a glass of chocolate milk. It makes him happy. The nutritionist at the endocrine doctor's office worked around that, as did the private nutritionist we used that taught us about organic and whole foods.

As a lesson in who not to hire: I had gone to a nutritionist looking for a menopause diet. Instead she simply gave me the diet she gave all women in their 50s and then proceeded to yell at me when I questioned why she was forbidding certain foods. I had not asked for a diet to loose weight, but that is what she gave me. It was practically the exact same diet she gave an associate of mine. Also, when asked about an upcoming birthday party and what were the rules about dessert, she actually admonished me not to have 3 pieces of cake, but only 1 small one. As if for some unknown reason I sat all day long at home and ate entire chocolate cakes on my own. There was a huge modicum of disrespect in her approach towards me. Of course she annoyed me right away when she told me since her best friend had a special needs child she knew all about what it takes to raise one. It is important that you feel comfortable with the nutritionist you hire just as you need to feel comfortable with every doctor or therapist you employ as well. I fired her after one visit.

The following are the more well-known types of therapists. Your school will test your child in these areas and will provide services if needed. Now remember there has to be a particular deficit (defined legally) in order for your child to warrant school intervention. If the school does not provide therapy though, it does not mean your child would not benefit from outside help and support. Also even if the school provides therapy there are a variety of combinations: consult; push-in; pull-out.

Occupational therapist  Defined

Physical therapist  Defined

Speech therapist  Defined

Pull-out service is when your child is taken out of class to be provided services. It can be one-on-one or in a group or both. Your child does generally miss some class in order to receive this service.

Push-in service is when the provider comes into the class and tries to facilitate social/speech interaction or figure out support systems that would enable your child to function better within the classroom. This may also be done in conjunction with a pull-out service.

Consult service is when the therapist may not actually interact with your child, but discusses with he teacher/para alone how to help your child. You can also see this service type when dealing with special education services. In an interesting occurrence, CM2 received consult OT services in 3rd grade. Now because CM2 had a mild form of dysgraphia the OT consult offered to do writing calisthenics with the entire class. This is writing exercises done to music. It is alot of fun and all the children really enjoyed the program. So in the end, his entire 3rd grade class reaped the benefit of CM2's OT consult.


Again if you would like to share another therapist practice that you have visited and found helpful you can add them in the comments. But remember, I will not post "therapies" that have practices outside FDA, AMA, or recognized national organization approval. While you may have found them helpful, I feel it would be irresponsible on my part to include questionable practices.