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?

Giving Advice, Getting Advice, Wanting Advice

Giving Advice, Getting Advice,Wanting Advice

Reflection

I am listening to the new Radiohead album. It’s layered, moody, and sophisticated;  I play it every day while I sit with my pen and steno pad. I listen a little. I write a little. I think some more. I write some more. I listen some more. My initial reaction is conflicted. The music critics are lauding it, so I attempt to be patient and learn.

My therapist has told me it is time for the next move. She is no longer gently nudging me and giving me support around my household needs. She tells me I have lost too much of my identity. She says my kids keep getting older and I am not progressing. She points out that addressing my social isolation, identity voids, and personal interests will be better served with experiences outside the home. She reminds me that my volunteer activities were not satisfying. She tells me I am missing out. Basically reminding me that the world has continued to spin and I am stagnant. I have actively job hunted for over a year and remain unemployed.  She tells me that by our next appointment I need to meet with the Admissions Counselor at the local university to explore Master’s Programs. In our last session, I felt she was pushing her agenda. I returned home and cried my eyes out. Do I really need for someone to decide what is right for me and tell me what to do?  I don’t want to get another Master’s; I don’t want to return to school. Instead I am signing up for a six week series of writing workshops this summer. So there.

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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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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 Food

My Young Child is Stealing Food

Week 2

young child is stealing food

How about stealing time to play!

Stealing food from children. Really? That is how Mrs. M wrote it in her message. We are starting week two of medication or in other words, it is day eight. I know in my heart that I am uncomfortable with my child needing medication. But as I put it to her brothers, it’s like needing glasses. All that squinting, missing homework assignments written on the whiteboard, not seeing the lacrosse ball– my kid needed corrective lenses for better focus. Did this completely change his life? Yes and no.  The non-stimulant ADHD medication will hopefully change her life and ours for the better. After I had returned to our therapist for a consultation, after having a medication evaluation and after a few days of starting the medication, I got a long email from her kindergarten teacher. As soon as I opened it, I braced myself. Four paragraphs. What now?  Well, turns out that for the past 6 or so weeks food has gone missing from her students’ lunch boxes. And surprisingly while we were on a family trip for three days, nothing happened. Yet when we returned, the missing of items resumed. Mystery solved? Yes. Problem corrected? No.

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ADHD – Impulsivity

ADHD Impulsivity

Week 1

It was time. She was having rough days 9 out of every 10 school days.  Her impulsivity was significant — she was lying, stealing, and sneaking food each weekend. Every once in a while, we had that uneventful day. The last one still fresh in my memory.

“Isn’t it great I had a good day?” she asked me, her wide toothy grin in the rearview mirror. She has the look of wanting validation.  “Yes, it is. It’s a day you can have every day.”

ADHD impulsivity

Her special needs are not immediately visible.

Again, she revisited the topic. “Isn’t it so special! I had a great day! Are you happy, Momma?”  I answered, “Yes, I am. I know you can have lots of good days.”

The self-praises continued that afternoon. By dinner time she had revised once more, “I love having good days! I was so special today, right Momma?”  I made the silent coyote signal with my hand, gesturing for her to be quiet. Then I corrected, “It’s not special and you are not behaving special. Your teacher said it wasn’t a bad day. That’s what she said!”

And there it was, my words cutting through the glee. Yes, it is time. Our former therapist emailed me back with instructions to fill out the intake paperwork so that we can schedule a consultation with her. Within 18 hours, I had completed the hefty packet and hand delivered it to her office. I wrote her: when are you free?

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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.

Anxiety and Trauma

Anxiety and Trauma in a Young Child — Let Me Explain

Our First Year of Adoption – Part 3

Our new therapist Beth reviewed anxiety and trauma related behaviors. She described what anxiety looks like in a young child, like ours. She noted we may hear non-stop questioning of the same issue. I experienced this first hand. Every day, a flurry of questions related to dinner. When will a meal be served, what will be served, will she receive this meal, who else?  I remember how S asked about the dinner meal and I would answer. Not a big deal for me, everyone is curious about dinner. She then started asking earlier and earlier in the day, and more often throughout the day. After a week, she sat there with her breakfast and while chomping, she asked, “So what are we having for dinner tonight? …ok and what about tomorrow? What are we havin’ for dinner?”  Tearful distress when I laughed in response.  Beth went over the non stop chatter to fill the void. Yup, we knew that expression. Lived with it. S opened her mouth from the moment she opened her eyes, and closed it when she fell into a deep sleep.  Beth described S as an empty well, explaining that she had not experienced love and nurturing before. As a result she has a lot of anxiety around feeling loved. Oh yes. That must be why it is nearly impossible for her to be alone in a room and to be denied attention.

anxiety and trauma

All households have differences

Beth reported underlying this constant stream of neediness were key questions: will I stay here, will I be accepted, will they take care of my needs. Beth told us three birthdays, three Thanksgivings, three Christmases, and three school years for the older kids. Then, she will relax. What’s that? Beth noted S experienced three of each event in the foster home and was suddenly removed from that home. She was then transferred to our home. So yes, three of each. Then she can relax.

Beth talked to us often about how our young child knows only a handful of feelings, most likely happy, sad, angry, and curious. We needed to explain and describe other feelings. She was probably experiencing different versions of anxiety and not understanding that particular emotion. Saying things like, “I wonder if you are feeling _____ about (the situation)” would help her understand feeling anxious, bored, frustrated, nervous, worried, eager, and irritated. Beth discussed from time to time the need to go over her story. It was not necessary to repeatedly go over details like one is cramming for an exam, but rather to talk about her past like you do with any kid and a special memory. Beth suggested reminding our daughter of just the significant events. When she is older, if and when she wants to, she can tell others her story.

Part 4 – Her Story

Therapy for Us

Therapy for Us – Off We Go!

Our First Year of Adoption – Part 2

When our child first came to us, she was in therapy with a counselor. She was assigned to our child when the judge changed the permanency plan to adoption. The counselor’s focus of therapy was to “prepare” for the adoption. Now, I don’t know what exactly was covered in those sessions from January to June. I know that the biological mother made an appearance and said goodbye. After our daughter moved in with us, we continued with weekly sessions. The counselor inquired how things were going? were there any new problems? did she have any accidents? was she eating? sleeping? were we following her advice on talking about first mommy, second mommy, and me as the third mommy?

The counselor did a certain weekly exercise with my daughter. She got out a floor mat that had 12-15 faces with different facial expressions. She piled rocks on the side. She said to my child: put rocks on the faces you have been feeling this week. Sometimes S piled them all on the happy face. Other times each face received a stone. Another time, a different arrangement. I had to reach down deep to hold back my smirks. During one session that my husband and I both attended, the counselor was persistent on addressing the timeline of parents for our daughter. She went over Mommy number one and Mommy number two. She asked several questions and reviewed the actual answers with our child: your first parents were so-n-so, do you remember? and your next parents were the foster parents and their names are such and such. She kept drilling this information to which our child started grunting in response. She regressed before our very eyes, letting out non-verbal gutteral sounds. It was painful to watch. My mouth went dry. I looked sideways at my spouse– his mouth and eyes open, frozen like. I endured these sessions for a few months, then I insisted to our caseworker that WE needed help.

therapy for us

This should be read by all forever mommies

We were blessed to get approval to transfer to a counseling clinic in our part of town. There, the therapists are trained specialists in the areas of foster care and adoption. The first few sessions, our new therapist Beth observed S and myself interacting in the playroom office.  She then interviewed my husband and me. Another time, she interviewed just me. Finally, after weeks it was time. In that session, she informed me that she had read over the case records and previous mental health assessments. Then she started talking of why my daughter behaved, reacted, and responded the way she did. I can only say that the best analogy is having a translator interpret a small provincial dialect. The fog lifted. I heard words that made sense. There was finally clarity.