REPLY from Dr. - for Bonnie

[Guest guest]

Dear Bonnie,

First, I want to say how sorry I am that your son and you had such a negative

experience at his therapeutic school. Unfortunately, 's experience is not

that uncommon. Many therapeutic schools work with students who exhibit BOTH

externalizing (acting out, aggressive) behaviors and internalizing disorders.

And from what you describe, your son appears to have difficulties with

internalizing problems only--school refusal, panic attacks, fear of vomiting

(emetophobia, which is actually more common than people realize), OCD, social

anxiety. With his difficulty with organizational skills, the thought of AD/HD

pops into my mind, but you didn't mention anything about that diagnosis. Even if

he did have some AD/HD, however, none of the problems you describe are acting

out or aggressive in nature. It doesn't surprise me, therefore, that his being

placed in a situation with students who experience externalizing problems

(throwing things across the room, threatening others) was extremely difficult

for him. It also concerns me greatly that his IEP goals and objectives, which

were supposed to have been addressed in the therapeutic day school, appear to

have been largely ignored. Allowing to pace the halls for 8 weeks

without the benefit of any educational, social, or psychological

programming/interventions flies in the face of what an IEP is designed for. As

an aside, a new alternative school recently was established in a suburb north of

Chicago that accepts only students with internalizing disorders. In fact, their

website states:

" Until now, there has been no environment in which these children could learn

without being affected by the presence of classmates who exhibit externalizing

behaviors (verbal and physical aggression, bullying, etc.). We offer students an

environment free of such distractions, and the anxieties associated with them. "

Your experience with the previous therapeutic school is in the past, however,

and it is commendable that you are focusing on the future.

Because I live in the Chicago area, I unfortunately am not familiar with schools

in New Jersey. So I am unable to give you advice regarding specific schools that

might be a good fit for your son. You may or may not know that there is an

affiliate of the International OCD Foundation in New Jersey. It may be

worthwhile to contact the folks at the NJ OCD Foundation to ask if they are

aware of schools that specifically have had success with students who have OCD.

Their information is:

OCD New Jersey

Ina Spero, President

H. Weg, EdD, Vice President

60 MacAfee Road

Somerset, NJ 08873

Phone:

Fax:

Website: www.njocf.org

Email: Weg@...

I would like to offer some thoughts to try to help you with your decision,

however:

(1) Because of your previous experience at the therapeutic school, you have a

very good idea of what is NOT good for you son. You mention, for example, that

the size of the school was overwhelming for him. So is a smaller school

something you think would be a better match for your son? Or a school in which

there was a smaller teacher-to-student ratio (e.g., private school)? (I think

it's pretty evident that being mixed with students who have serious

externalizing problems is not a good fit!)

(2) Many schools use some variation of behavior modification techniques to work

with students with emotional/behavioral concerns. For example, the level system,

in which students move to higher and higher levels by meeting their goals,

frequently is implemented. Unfortunately, while level systems and behavior

modification techniques can work very well with children who have more

externalizing difficulties, these methods usually do not work well with kids who

have OCD. Traditional rewards and punishments typically are ineffective with

these kids. What would seem to be needed, instead, is a school that provides

necessary therapeutic support (e.g., trained therapists). Moreover, I believe it

is extremely important that personnel at a special school have experience with

students who have OCD. Some therapeutic schools, for example, work predominantly

with students who have autism.

(3) I believe what you indicate in the latter part of your letter is extremely

important: a reputable psychiatrist and a good CBT therapist are critical to

your son's recovery. And the more he can conquer his OCD symptoms, the better

able he will be to succeed in any school. I believe that caring school personnel

who are informed about OCD and are flexible enough to deal with OCD--an

unpredictable illness--may be a student's greatest ally in terms of succeeding

in school. Even a wonderful teacher, counselor, school psychologist at a

school--someone I sometimes refer to as a " voice or reason-- " can make a bigger

difference than a particular program or placement. The people in a school and

the school atmosphere often can make or break a student's experience. To some

extent, I think you may be answering your own question when you say, " I am

thinking that if he has a good school environment and a good psychiatrist...as

well as a caring therapist skilled in anxiety disorders, he does not need to be

in a school where kids act out chronically. "

(4) Because a therapeutic day school is quite a restrictive environment, and

IDEA requires that a student be educated in the least restrictive environment in

which his or her goals and objectives can be met, I would strongly suggest that

you request a meeting with the special services team at your son's home school

and revisit his IEP and placement. And be sure to bring the new information you

have (the academic, psychiatric, and developmental testing being done at Yale).

And remember that an appropriate placement MUST address his IEP goals and

objectives. Also remember that placements can and should be flexible: are there

any parts of the school day during which he could be in the regular classroom

with his peers? Would there be times when a resource room would serve some of

his needs (for math, for example)? Combinations of settings may be most

appropriate for some children.

(5) Your son is 12 years of age. I believe he is definitely old enough to be an

important part of the decision-making process. I'd recommend that you allow him

to advocate for himself and let his voice be heard. And I'm very pleased you had

your son participate in the last therapeutic school you visited (even though it

was a less-than-stellar experience!!).

I wish I had a crystal ball that would tell me what the best solution is for

your son. But I hope these ideas provide some food for thought.

All my best on your journey,

Gail

>

> I am currently looking for a school for my son who is 12 yrs old. He was

attending a therapeutic school for 6 months, but i took him out because they

allowed him to spend 8 weeks pacing the halls of the school without education

without trying CBT/ERP, without consulting his doctor, and without informing me.

>