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Family Dynamics

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In the days when Elna Yadin was the age of her average client, having a tutor was embarrassing. “Loser,” she jests now, forming the letter “L” with her index finger and thumb and pasting it to her forehead. “Our clients today have tutors because they want to.”

Child Study Institute director Leslie Rescorla at Bryn Mawr College. (Photo by Luigi Ciuffetelli)With a Ph.D. from Bryn Mawr College, Yadin is a licensed psychologist and a neuroscientist. An international expert in manual-based treatments for anxiety disorders, she works with children and adults with obsessive-compulsive disorder, post-traumatic stress disorder, social phobia, panic disorder and specific phobias, splitting her time between the Center for the Treatment of Anxiety at the University of Pennsylvania and the Child Study Institute on the campus of Bryn Mawr College. As it turns out, the Main Line area provides some of Yadin’s most compelling cases.

“With anxieties, we go where the anxiety lives,” she says. “If someone is afraid of bees, we go looking for bees. If it’s spiders, we take a spider trip. I go to the malls, to houses, wherever.”

A little-known private clinic, CSI has been providing services to area families and children for more than 60 years. With its psychologists (many on the faculty of Bryn Mawr College), educational specialists and speech-language pathologists, no other place in the area has a better bead on the latest trends and relevant theories surrounding our kids—or can determine what’s unique about the Main Line family and why.

“Because we’re on the Main Line, we’re taking advantage of the area’s resources and the willingness to pay for some pretty sophisticated programs—and also of the stressful lifestyle that the lives of the rich and famous create,” says Leslie A. Rescorla, CSI’s director since 1992.

Of course, the most popular CSI is the hit TV show. At Bryn Mawr, CSI investigations are fascinating in their own right, and the solving of mysteries heartfelt. “We have our teeth fixed, so why would we want to live with mental cavities?” Yadin asks, rhetorically. “If we’re suffering, it’s all about the suffering—and suffering should be treated.”

When Bryn Mawr’s CSI began in the 1940s, it provided special support services for the Lower Merion school district, doing so into the mid-’80s. Since then, it has greatly expanded its comprehensive assessments of children, its educational support programs and its therapy services. The staff has developed family treatment models, begun a number of group projects, and offers psychotherapy and group skills designed to improve social reactions and responses to teasing. Others are designed to increase play and cooperation skills.

Before Rescorla arrived in 1985, there were three or four psychologists and about six tutors. Now there’s a staff of 18 psychologists, 14 tutors, three speech pathologists and one occupational therapist. On average, they complete 200 evaluations a year. Another 150 seek after-school tutoring, and another 200 get help with school admission testing. About 30-40 people a year are considered therapy clients. No one prescribes medication—though, if necessary, referrals are issued.

“It’s not a highly medical environment,” Rescorla says. “It’s more of a homey feeling. We’re noncommercial and nonthreatening. Many families send multiple members, maybe one for tutoring and another for therapy.”

The Phebe Anna Thorne School on the Bryn Mawr campus offers a half-day and full-day preschool program for children ages 3-5 in its “traditional” program, as well as an afternoon program for kids with language delays (the Language Enrichment Preschool Program). It recently added a program for toddlers (ages 2-3), who attend a few hours a week along with their mothers. In addition, the Thorne School offers two full-day kindergarten programs in a renovated farmhouse building on the Haverford College campus. One program serves typically developing children who would benefit from an extra year before entering kindergarten. The other serves children with language delays.

“We have the ability to do a lot of things,” says Rescorla, who has a Ph.D. from Yale University.
 

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Rescorla’s clinical interests cover everything from learning disabilities, language delay and pervasive developmental disorder, to attention deficit disorder, anxiety problems, oppositional defiant disorder, and psycho-educational intervention with adolescent underachievers. At CSI, says Rescorla, “we’re pragmatic; we’re problem solvers. It’s not like you need psychotherapy every Tuesday at 4 p.m.—how much and how long is up to the patient, and if you learned everything today and never need us again, that’s OK, too. It’s about a return to health. Most people over-pathologize in today’s society.”

It’s unusual to have a clinic as diversified as the Child Study Institute in a small college setting. Though connected to Bryn Mawr, CSI operates semi-autonomously as a group private practice that’s interconnected by its academic discipline. It gets support from the college with physical plant space, personnel, computing services and accounting, but it’s a nonprofit.

Here, cases don’t seem that cold. Clients don’t feel like they’re “coming to the shrink,” Rescorla says. “No one is stigmatized. It’s not like a chiropractor’s office with regular appointments. We try to finish patients. Many cases lead to adaptive function or healthier lives.”

Some systems require you to pay six months up front. At CSI, you pay as you go. Although no insurance plans are accepted, a sliding fee scale is available. Rescorla calls it a pediatric mindset: You don’t have to come to the clinic every week. But if there’s a problem, clients are welcome to come anytime—even if it’s been a few years and you have an OCD flare up and need a refresher.

“Like a booster shot,” Yadin says.

Services at CSI have expanded the most for early childhood clients, particularly in the areas of multidisciplinary “arena” evaluations of preschoolers (many of whom are referred for possible autism spectrum disorders) and early intervention classroom programs for preschoolers with special needs. At these screenings, multiple examiners observe developmental skills in multiple environments, then recommend intervention. The goal is to optimize treatment and prevent larger social problems as the kids get older.

Programs have also expanded for adults seeking career counseling and accommodations in higher education for learning differences. The newest CSI initiative is an organizational coaching program designed to improve executive functioning. Goals may include work on self-help skills, time management, selection and implementation of appropriate study skills, plus organization of thoughts and actions to improve academic performance, independence and general success. “We’re always exploring and open to new niches where there’s a need,” says Rescorla.

Like other well-regarded specialists, Yadin brings her own caseload to the center. She says there’s a plan for CSI’s expansion and direction—just no master plan. But it’s not serendipity, either. “A lot of places do assessments, but few say what you should then do about it,” she says.

Society, though, is changing—and parenting skills are in retreat. “We tell parents they have our permission to say no,” Rescorla says. “Everyone is so busy doing 1,000 things that we have 12-year-olds who tell us they just want time to themselves. They want to put their feet up in the air on their bed and read.”

There are developmental stages at all ages. That said, CSI contends that evaluating developmental signs at, say, 5 or 7, is a must. And it’s important for parents to have expectations. But they should also set limits, be involved and notice danger signs—a lack of speech or play, or aggressive, impulsive behavior. “The longer you wait, the more problems you may have,” Rescorla says.

Roberta Brobeil Krauss is a licensed, school-certified psychologist who worked in the Delaware County Intermediate Unit before joining CSI’s staff. She speaks of resisting societal urges to keep up with the Joneses, become expert scientists, or play every instrument. “It’s OK just to go build a fort with pillows in the living room,” she says.

So what’s taking place in society—especially with our young people and their parents? CSI staff says parents are on top of things. They want to correct deficiencies rather than say, “They’ll grow out of it.”
 

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Today, parents in affluent areas like the Main Line want to be proactive. And children and teenagers are less tolerant of stress and discomfort. They’re asking for help more often.

Likewise, schools are better at identifying problems. They provide CSI with numerous referrals. “Because we’re not psychiatrists, we’re not seeking the role of churning out diagnoses,” Rescorla says. “We’re not shrinks. We evaluate strengths and weaknesses based on tests. We’re not diagnosis-driven.”

Krauss adds, “A lot of times we talk a diagnosis down.”

One of Rescorla’s young clients has anger outbursts—so much so that an aid accompanies the child in school. “In the time I’ve seen her, we’ve cut the aid’s time in half,” she says.

Today, there’s also less of a stigma attached to deficiencies. Functional dyslexics, for example, are more willing to admit it. The openness has been fostered by media coverage—mostly of celebrity plight—plus self-help books, online sites and movies.

There’s also more research-based treatment evidence, plus more validity and scientific justification. There’s less mystery surrounding various disorders, and more general access to resources to investigate and locate help. “In a child-centered society, parents will do anything to help their children be happy, successful and functional,” Rescorla says.

To learn more about the Child Study Institute, visit brynmawr.edu/csi.

 

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