Development Assessment

Development Assessment

Reflection – Friday evening.  I’m sitting here with a Smirnoff’s Ice – Raspberry and listening to Pearl Jam’s Vitalogy.  I recount the day’s events, as well as the dreaded child development assessment. 

I had one of those days today when I wake up and get the three kids out the door to their three different schools.  Then I get to have my time.  My time to fall apart.  It’s ok to cry.  And it happens.  A day when everything yucky comes to the surface.  Like the children’s book by Judith Viorst.  I had a crappy, weepy, awful day.  Could anything go well to lift my spirits?  My week started with a few appointments Monday, Tuesday, and Wednesday afternoons for my daughter.  The child with special needs.

I endured a three hour interview on Monday at a children’s hospital’s development and rehabilitation unit.  My daughter got to draw, eat a snack, and answer a few questions, like:  Who lives in your household? Do you have friends?  I got asked all the other questions filling up the remainder of the three hour time. Questions like:  Could you talk more about that? Could you describe situations?  Could you talk more about that so I can visualize how that looks?  This was precisely the reason why I had dreaded this appointment, I was wiped out that evening. 

I will receive a detailed report in a few weeks.  But at the end of this interview, the psychologist offered a brief assessment:  Most likely, my kid was deprived her first year in life and also in her foster home of three years.  She didn’t get her emotional needs met.  There was likely a food scarcity in BOTH homes.  I interrupted to point out that several of the people in the foster home were morbidly obese…

The clinician reported that food scarcity is common with obesity — the unstructured meal times, the ups and downs of food amounts.  She went on to tell me that my child received little to no structure and stimulation in the foster home which would explain the simplistic play behaviors, the lack of coping skills and the obsession with food and tv.

I thought to myself while she talked: I know, I have heard this, why were we on a six month waitlist to be seen here?

The psychologist said to lower my hopes and expectations as she won’t be changing anytime soon. “You basically need to lay down a different foundation, as you slowly remove the old one.”  Really? I said, somewhat sarcastically.   She continued, “Yes, expecting her to change quickly would be like letting your original foundation just crumble and fall apart without any support in place.”

Somewhere I hear my sister and brother-in-law laughing.

She said my kid CAN change over time, a long time, if the parents and every teacher is consistent each and every time with the same rules and repeated direction of adaptive coping skills.  Wow, I thought. Long time. Each and every time. Every single adult at home and school. Yeah! No problem.

Perhaps my depression is now better understood. Tuesday I informed my child’s therapist after another play therapy sand table session what was discussed at the children’s hospital.  She had more to say on this matter.

Friday rolls around and I couldn’t stop crying.  Every time I thought I had gained composure, I looked at myself in the mirror to get cleaned up. And every time, I saw my puffy eyes and eyelashes coated in Kleenex dust.  And every time, I whimpered: is she ever going to change?!  

I picked up my child at dismissal time at her school.  She tossed her name badge to her teacher when she saw me.  I waited for her teacher to make eye contact with me and to call out my child’s name.  Then my kid turned to face her teacher and pestered:  Did I have a good day? Did I? Did I? Did I have a good day? Did I?  Her teacher continued to dismiss the other twenty first graders, but stopped.  “Well, let’s talk to your mom about what happened.”

As I hustled closer so that Ms. T could tell me how my child stole a dinner roll from someone, I bumped into another mom’s arm.  I looked back and apologized.  The woman was wincing and rubbing her right shoulder.  Yup.  That was the finishing touch to my sh*tty day.

Sandplay Therapy

Sandplay Therapy

My daughter is doing sandplay therapy.  Our counselor discussed the concepts and I consented to this form of therapy.  The two of them are in a room with a sand box table. They sit opposite each other. Along a wall are a few long shelves crowded with figurines, dollhouse furniture, beads, stones, and animals — all sorts of props. The therapist gives a simple instruction– create something, or set up a situation, or go ahead. 

Near the end of the session time, I am invited in. My daughter points to what she has placed in the sand and tells me a comment or two about what is happening. “The lion is sitting near the tree, getting shade. This stone here is for the lizard to lounge on.” That sort of talk. After she leaves the room, our therapist offers a few interpretive statements. “It’s very early, it’s only our third session. But again today, there are mostly animals, only 1 or two people, well one is a fairy, and there are situations that involve safety.”

Am I up for this?

We have returned to therapy after two years. Last Spring, we started her on psychotropic medications prescribed by the clinic’s child psychiatrist. I’ve attempted to follow through on our therapist’s recommendations at home.  But she continues to stump us.  Even our therapist said to the psychiatrist during the last medication appointment: There is something unusual about her, I can’t pin point it.

So for various reasons, I agreed that using sand therapy to tap into her unconscious struggles would be of benefit. I am very curious about this process. I am mixed about receiving valuable information, and being confronted with my difficulties. I even entertain and prepare myself for possible themes:

Mean, restrictive mother

Appeasing, inconsistent father

Rejecting, older brothers

Harsh homelife with too many rules

I asked Beth, “So….I’m just wondering how this works. Do you plan for eight sessions, or do you go week to week and decide when you have themes?”

Beth explained she follows the child’s work and when there appear to be consistent themes, they’re done with the sand therapy.

Somewhere deep in my mind, I hope that we will get some answers. Some treasure that has been hiding, buried for years. Latent explanations for the lying, sneaking and stealing behaviors still plaguing our weekly lives. I understand she engages in these primitive antics when anxious. Yes, I understand. But what is driving the anxiety? What is it?

What is the Right Dosage of Ritalin

June 20, 2016

We are in the process of determining the right dosage of Ritalin for my kid. We went in for another medication review appointment with a child psychiatrist.  I noted the improvements — there are two. She has been better about taking re-direction and there has been a noticeable decrease in emotional meltdowns at home. However, the non stop chattering, interrupting, and pestering remains the same. Likewise, her teacher noted she still has strong reactions to little things in the classroom to the extent of requiring a school staff person to be called in to help calm her down.  In her defense, the end of the school year can be difficult for a lot of children. It’s emotional.  The psychiatrist discussed things further with me — asking questions, asking for descriptive situations. The doctor recommended a slight increase in the dosage, a slight titration. We would meet for another medication review in a month.Right dosage of Ritalin

The bio-chemistry relationship involved with psychotropic drugs continues to fascinate me.  Could we have a little more of this so that we get a little less of that? A little more chemical input to decrease the behavioral output. I was hoping that once my daughter could pull in the reins on her running thoughts, I would be able to do therapeutic exercises to help her stop, pause, and make a good choice.  Maybe medication is similar to finding a fertilizer that works best on the yard — bringing out the desirable green grass, encouraging new growth, and suppressing the unsightly weeds.

I tried not to examine each blade of her existence. Yet, I wanted to carefully keep note of behaviors improving, antics remaining the same, or difficult ones increasing in frequency. We had a little of each. What a relief to have fewer emotional meltdowns over for example, “Please go play outside, it’s nice and sunny and your brother wants to practice his drums in the playroom.” Still the same ones of non-stop chattering and nonsensical arguing. And then the last one. More stealing and sneaking behaviors– taking notecards from my desk, emptying out brother’s emergency inhaler (placed on his bedside table), and climbing onto the counters to reach an item on a high shelf. I even tried out this one because I doubted her abilities. I climbed up on the countertop. I remained on my knees to account for her 42 inch height and reached my arm up high. Yup, it was doable. It was totally possible to reach the now consumed 8 pack hamburger bun package. Silly me for placing it there, for thinking that our family of five could have Sloppy Joes later this week. Instead we had pasta with meat sauce, a tangy BBQ flavored meat sauce.

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Isolation as a Special Needs Parent

Isolation

We went camping with 12 families over the long holiday weekend. We were invited to join this large group for a three night trip. We had not gone camping for a while — my youngest not able to handle the usual activities of hiking, quietly sleeping with others in a tent and appreciating the outdoors. So initially, I was ready to spend just one night with her, ready to pack up our belongings and drive back home if necessary. Instead we decided our family would join the others early Saturday and return home late Sunday night. We all wanted this to work out.  I know the names of all the parents and kids. I can identify the makes of the SUVs and vans they all drive. I can closely guess the grades the kids are in and the professions of the parents. Yet, I really don’t know most of these families that well. What I did find out during that weekend was that in our group, about ten households had an issue. I came to this awareness from listening to a parent of each family unit describe something troubling going on with their child — behaviors, medical concerns, mood disorder and social issues, sexuality, and learning problems. We all had children with special concerns. We all needed to seek professional help for our kids. I didn’t feel so alone anymore. I saw my daughter in a different light– a more gentle glow. And my hubby and I relaxed a little. We were not going to stand out, we were not so different from the others. All those times we suffered behind our closed doors, disturbances were occurring in the privacy of other homes.

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Starting on Ritalin

Starting on Ritalin

Week 9

We started Ritalin the beginning of this month. “You’ll know within two weeks if this is working, it’s pretty fast acting,” said the psychiatrist. I am strangely excited and encouraged. Why can’t most difficult situations have a fast acting response time.

Last weekend my husband took the boys and the dog to stay in a cabin. One night, two days away, four creatures not around the house. Just the two of us left behind to deal with each other. The pair that has had difficulties tolerating and enjoying each other. We had a delightful time.

 She had been on the medication for four days. We had tried another ADHD medication, a non-stimulant, for over a month and the only change we saw was irritability. Uh, no thanks, could we take that off the plate? So here we are, going into week 9 after that initial medication evaluation and trying out Ritalin.  Our doctor told us that most kids respond well, most respond quickly, and most experience only a few side effects. Since our medical specialist informed us that her heart murmur is in no way a reason to avoid stimulants, we received the green light to proceed with this category of medications.

Starting on Ritalin young child

Changes could occur from a pill

Off they went with a frozen pizza, sodas, Fruit Loops, pancake mix that requires only adding water, dog food, one change of clothes and toothbrushes. Not my choice of foods, his idea. Not my idea to pack so lightly, his choice. Have fun! I yelled. I braced myself for endless difficulties of being with my daughter. It’s not pleasant to feel this way towards your child. Sometimes I need to be nudged, if not pushed into certain situations. I really don’t think of myself as overly cautious. But I’ll admit, I am not eager to enter an arena of battles. I know that  I need certain circumstances to be in place to make me deal with a problem.

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Eating Issues – Kids

Eating Issues- Kids

Reflection – Monday

I think my life could be a reality show on the Lifetime channel. Unscripted. The stuff that happens, the stuff that goes down, the stuff that I experience would make most people gasp and laugh. I’m sitting with a glass of Trader Joe’s cabernet sauvignon, listening to Radiohead’s In Rainbows cd and thinking back on a recent day.

The other day, a typical day, I had just placed the baby gate in the doorway to prevent my youngest from taking food from the kitchen. There is a lock on the fridge doors, a lock on the cabinet doors where we keep the garbage, and the yummies are placed high above the fridge. I got the bowls of cat food ready to take upstairs. (FYI- the cats seem to enjoy their space away from the dog.)  As I ran upstairs with the bowls, I heard the baby gate get pushed outward which woke the dog from his nap. I plopped the bowls down and sprinted down the stairs, opening the kitchen door to assess the situation. The dog ran by me and upstairs. I snatched the food item out of her hands, gave her a nudge back to the playroom and placed the gate back in place. I then ran upstairs — AAAAAAAAAaaaaack! Too late. The dog had eaten the cat food.

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ADHD Medication

Waiting for the Effects of ADHD Medication

Week 4

We did not go away for Spring Break. Get the tissues out, boo-hoo. This happens for us with my husband’s career. I’ve been really supportive to his work and demanding hours. I get it. It’s just that sometimes seeing everyone around us pack up their cars, hearing everyone’s plans for the week off, and feeling the need for something different to our routine, I feel sorry for myself when we stay home during any of the school year breaks. This year I changed that.

My solution has been to rent a cabin for a few days about an hour away. We take the dog, we bring food for all the meals, and for two nights he is able to put work on hold. The boys take a respite from their electronic devices. They flip a coin over who will sit next to the pooch; the loser sits near her. My husband attempts to delegate duties of packing the car. This never goes well. He does most of it, huffing and muttering up and down the driveway. I opt to stay inside programming the auto-feeder for the cats. Every time we go on this kind of trip, we manage to leave an hour later than planned, our bodies are crammed into the vehicle, trash bags for suitcases stuffed in every space and my hubby annoyed that his guitar never fits. The excitement increases over car ride games. I pop in an old Pearl Jam cd. We’re off!

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Stealing and Lying Behaviors

Stealing and Lying Behaviors

Reflection – Tuesday 

Parenting — the good, the bad, and the ugly behaviors.  I am sitting here with a pilsner and listening to The Essential Johnny Cash cd. I think back on what happened earlier today.

I was waiting my turn.  I stood behind a few other parents — we have the difficult ones, the children who have rough days. Other parents wait across the blacktop or are in deep conversations, quickly glancing up and nodding to Mrs. M that they are present for dismissal.  I moved up the line.  Mrs. M informed me of how my child hurt another classmate’s hand. She goes on to briefly describe other parts of the day.  I asked her where on the spectrum in her class of twenty does my child’s behaviors fall; how typical are her behaviors? Mrs. M quickly responded: far from typical. Mrs. M bent down and said gently to her, “I really hope that you have a better day tomorrow.”

stealing and lying behaviors

Despite all the difficulties, we assure her she is well loved.

Why do I feel defeated, why do I personalize my children’s difficulties?  A few times a week I am hearing from her kindergarten teacher an entire day of disruptive and/or aggressive behaviors. The time has come.  When we returned home, I took a deep breath and composed an email:  Can we return to see you again? She is not doing well.  I need help too.  

I have been reluctant to write to Beth, to ask if we can return to therapy. I thought I could figure this out, try another reward system, give it time and let her mature on her own. I fluctuate between acceptance of having a special needs child and wanting to defend her actions, to rationalize her personality traits. My youngest has a different energy than her older brothers. She loves to be silly, she wants people to laugh at her, she’ll do anything to get attention. She does not care for rules — she decides when she wants to follow them.  She is chatty, she is loud. Well actually so are the boys — at times. They know when and where to be comical, when and where to rebel, and how to make friends. Does everything challenging need to be directly related to her adoption from foster care?! Is she going to have special needs for the next 12 grades?

I was perusing the hundreds of informational websites on adoption. I came across an interesting post from creatingafamily.org. There was a list of questions that potential adopting parents should consider. One was: if she were to not get any better than the way she is now, could you handle her behaviors?

I know we have made tremendous progress in our home over the past three years. Yet, this past weekend was a doozy.  She snuck food, she took items from family members,  and she lied. She fed the dog an entire box of frozen appetizers from Trader Joe’s. That is what she answered when I found the empty box. Or did she lie and consume all 15 pastry pups herself? We waited nervously for 12 hours monitoring our dog’s digestion. She took items from her brother’s room. I confronted her, inquiring about the items. With a quizzical face she answered, “I don’t remember doing that…”  I observed to her that the dog was circling her, did she have food with her? She answered, “Not in my hands.” I searched the entire playroom, then found sesame seeds in a lego container. Not my jumbo bagels, I had three left! I had just re-arranged our kitchen by placing all the yummies on higher shelves in the pantry cupboard. I didn’t know how else to protect the contents of the larder.  My husband said to her:  do we really need to put cabinet locks everywhere? even here (pointing to the base cabinet), where the condiments are? would you eat this?  She informed him she would not be interested in the sealed glass jar of thai curry sauce as the glass jar would make a noise when she opened it.

* OMG *

The food obsession, stealing items from others, and lying. I don’t understand how and when she had become wily; she’s become a master of deceit. Will I be able to handle these behaviors lasting a lifetime? Maybe being able to tolerate is a better way to phrase that question. Maybe it’s a question I don’t want to give much thought.  I think about her negative behaviors.  All of them involve an outburst of some kind — emotional or physical, and a lack of judgement.  She has no impulse control.  She doesn’t have that skill, that ability to pause; she just reacts. Is this anxiety? a heightened sense of arousal due to her early trauma? is this a form of ADD/ADHD?

I know sage advice is to not take things personally. For me, it’s difficult to heed that saying when parenting is involved.  I’ve invested time and emotions into raising my kids. I’ve entwined myself with their difficulties.  And yet, something is off, something feels different.  Her hypersensitivity and impulsivity are looming large — lengthy words and heavy conditions. We don’t have a grip on either or both. It’s been three years and she is now 6 ½. I took a deep breath, I tell myself:

We are parents to a special needs child. She is floundering at her school and at home. It’s time to return for professional help.  We need strategies and we may need medication.

Beth, please email me soon.