This blog is my place to vent and share resources with other parents of children of trauma. I try to be open and honest about my feelings in order to help others know they are not alone. Therapeutic parenting of adopted teenagers with RAD and other severe mental illnesses and issues (plus "neurotypical" teens) , is not easy, and there are time when I say what I feel... at the moment. We're all human!

Friday, May 20, 2016

Dysregulation and Meltdowns

We've all experienced it. A child demands something he/ she knows we won't allow. When we say, "No," out comes the attitude, the meltdowns, the whining, the demands, the picking (on, at, over...). It's not a RAGE (although the reasons behind it are often similar and it can quickly escalate to one). {Dealing with Rages} It's more like a meltdown or a tantrum.

The child in a meltdown usually has some control over how far they will go. They can still escalate in to fight, flight, or freeze mode easily, but instead of physical aggression we see mostly verbal threats, (although Kitty's still been known to kick cabinets and bite and scratch in a meltdown). We can usually reach her and calm her down fairly quickly (Calming Techniques), if not actually de-escalate her, before she “melts.”

Sometimes when Kitty is especially dysregulated she deliberately picks a fight with me so she can have somewhere safe to express her emotions. She can't let others outside the family see that she has issues, that's not "safe." So she processes them with me. Which SUCKS!

We rarely know what trigger starts an individual meltdown. A test. A bully. A holiday. A traumaversary. HALT (Hungy, Angry, Lonely, Tired). A "life changing event" (positive or negative). Even the let down after a good day or worry that they can't keep up the positive behavior so they self-sabotage.

{BTW, we're going to pretend I handle meltdowns like the perfect therapeutic parent  every time}

Dysregulated - When it's not just a single meltdown

For whatever reason, there are times when my child gets stuck in dysregulation. We see things like:


  • The RAD Stink {You've heard of the "smell of fear"? Well, the smell of dysregulation in attachment disordered kids smells like feces and the worst body odor you can imagine.}  
  • Acting Out - physical or verbal threats and/or aggression, picking fights
  • Suicidal threats/ ideation
  • Acting In 
    • Manic/ Hyper: agitated; overly-sensitive; loud, pressured speech; over-zealous in relationships; loud, barking laughter; "vibrating" leg(s); popping knuckles (only does this when under stress); impulsive; difficulty concentrating

    • Self-Harming: gouging skin with finger nails; stabbing with pencil; burning skin with eraser... technically this is an "acting out" behavior, but Kitty has been known to do it secretly in public and often expresses concerns that she might self-harm and asks for supervision to prevent it.

    • Depressed: Statements she wishes to die; statements or acting as though she wishes to "give up;" statements that others "hate her;" belief/ statements that she is worthless/hopeless/unlovable...

    • Escape/Dissociate: physically leaving room or "checking out;" unfocused; changing subject (often apparently at random); distracting (asks question or makes comment that changes the subject); napping/head down; appearance of being exhausted; "shutting down"

    • Somatic issues: aches; pains; exhaustion; hunger. Has difficulty identifying correct emotional and physical feelings so is prone to emotional eating and ascribing real or perceived aches and pains to incorrect sources. Ex. If Kitty is feeling depressed or suicidal (possibly because she forgot to take her meds, skipped a meal, hormones, chemical imbalance, was triggered by a traumaversary or event...), she might blame this on a recent event (such as a fight with her sister) that may or may not actually be related.

    • Depressed: Sad; crying; whining; begging to go home

    • Overwhelmed: low frustration tolerance; disorganized; needs others to "chunk" assignments (break down into smaller more manageable pieces); forgets assignments or needed materials; hurries through assignments; requires frequent breaks to relax and regroup; frequent requests to leave the room; needs frequent redirection and individual attention; difficulty remaining focused and on task - needs frequent assistance/ reminders.

    • Anxious: hyper-vigilance; worry; hurries through assignments; obsessed with following the rules

    • Poor Boundaries: inappropriate interpersonal interactions. Inappropriate sharing/ venting with peers and others, particularly about abuse and perceived abuse (past and present); participating in or allowing physical and/or emotional teasing/ bullying; inability to recognize other's "boundaries" and bothering them; perceives others as threatening or abusive; tattling about rule breaking; verbal lashing out; gossip (has spread vicious rumors regarding siblings/ friends and accused them of doing the same); threatens or hits peers (yes, this is an "acting out" behavior, but it is one that Kitty has acted on in school and the community).
  • Chronic Anxiety at a level 3 or above  
  • Fidgeting, chewing/ sucking, tapping, can't sit still...
  • Constant visits to the nurse - or other means of getting out of stressful situation
  • Verbal diarrhea - cannot stop talking - usually about irrelevant nonsense
  • Dissociated - can't stay focused. Not always functioning in reality. Easily distrac- SQUIRREL!
  • Cycling between sensitive, emotional, and fragile or aggressive, angry, and frustrated sometimes within minutes.
  • Disturbed sleep patterns - chronic insomnia or sleeping all the time (shutting down to avoid dealing with life)
  • Etc.

Many times a child won't actually exhibit these behaviors anywhere but at home, because only home feels "safe" (this is a perceived safety not physical safety). Kitty would literally rather die than let others see she has "issues." I try to remind myself this means she trusts me more than everyone else, but that doesn't really make it easier to handle. (Why Does My Child Act Differently Away From Home?)


Getting a Child Regulated

Sometimes etting a child regulated can involve psych hospitalizations, med changes, increase in therapy, possibly even residential psychiatric treatment. In the meantime, I try to remove as much stress as possible and do what I can to make my child feel safe.

When Kitty gets dysregulated, I make her world smaller. We cocoon. We have a letter party (shopping at a time of day when no one is there because crowds are stressful!) or some special treat (pizza, homemade comfort food, fast food). We veg in front of the TV with a favorite video (or something I pick up at Red Box).  No chores. No school work. No company. No expectations. 4 foot rule. Line of sight supervision. Lots of calming techniques.` Childproofing instead of consequences and punishment.

Believe me I get that it's the last thing you want to do. I get so mad at her that I just want to pinch her head off. I try to repeat my mantra - "She's only 6! She's only 6!" and remember that there are only 2 emotions (love and fear - Beyond Consequences) and she's so scared that this feels life or death to her. She's so terrified, that she drops into fight, flight, freeze. Hopefully, if I can get her regulated again, she'll go back to being my sweet kid, and stop asking for stupid stuff we both know she can't handle.

Then I do a LOT of self care to refill my bucket after pouring all that support into her.

I work with the school to try to make my child's world less stressful there too. Anything I can do to get my child regulated again.

I wrote this for a fellow Trauma Mama whose children are reacting to school starting.
When my children acted out, which was always worse around holidays, traumaversaries, starting or ending school..., when I wasn't so frustrated at them I could scream, I pulled them in. I reminded myself that they were terrified. This was life or death to them, and they couldn't really handle change or added stress (this has gotten better as they healed). Even my bio kids reacted this way, just not to this extreme. Some insight into why kids act the way they do. Our kids need a LOT of structure and support, especially when they are overwhelmed.
I reminded myself that they were really so very much younger than they looked, and I was expecting a lot from them. I tried to change my parenting to better match their emotional age.  I tried to remind myself that they were SCARED and punishment for something that was out of their control was not just mean, it was pointless. What they needed was to feel safe and loved. That meant I couldn’t take away all fun stuff (even though I wanted to!!!)
Most of all, I gave them a LOT more structure and support. We went back to line of sight supervision, time ins instead of time outs, removed as many overwhelming events as possible (not just avoiding throngs of hyper children in places like sporting events and the park, but also the grocery store and Sunday School). Yes, there were things I could do nothing about (school/ daycare), but I could talk to the teachers and minimize as much stress as possible.
I tried to find calm, quiet, but still fun, things to do so they wouldn't feel punished (taking a walk, letter parties … ). This wasn't about being in trouble or loss, they'd had enough of that; this was about making their life smaller. So they would feel SAFE.
At home, I did things like strip their room (helping me was overwhelming so I did it when they weren't there, although I let them know ahead of time) to a bed, a book/ quiet toy, and a stuffed animal, at one point I even had my daughter's dresser in her room, and she "checked out" her clothing by bringing me the dirty ones, THIS WAS NOT A PUNISHMENT. I tried to find ways to help them understand that. I pointed out that now cleaning their room would be a lot easier!    
When stress was high, my kids’ life was like being in the FAIR Club (our family discipline method  ), but without actually being in the FAIR Club.

I used calming techniques a LOT.

A lot of time I screwed up. I lost my cool. I gave up.  Then I did a lot of Caring for the Caregiver because this is HARD WORK. I forgave myself, which was REALLY HARD. I put on my big girl panties, tried to find the joy, apologized to my child for not keeping them safe, and started over. Being a therapeutic parent SUCKS, but it does get better.





Friday, May 6, 2016

Help! It's Summer!

Summer plans. What do you do with YOUR kids during the summer?

Some of the things we've done when our kids got too old for daycare and summer camps:


  • Week long theme camps at the local MUD.
  • Counselor in Training program at the local MUD or summer camp.
  • Volunteer work with programs that provide a lot of structure (animal shelter, local equine therapy places are always looking for sidewalkers, horse handlers and stall muckers - my kids love horses and outdoors) we found one program that often works with people needing to do court-ordered community service so there was a lot of supervision.
  • Summer Job (for those that could handle it).
    Freelance - Through my work, I was sometimes able to hire the kids to do things like data entry or research. They got paid as contractors by the company I was working for, or I "subcontracted" some of my tasks to them.
  • Intensive Outpatient (aka Partial Day Hospitalization)
  • Hire a Nanny - a friend of the family with kids with special needs who "gets it," Grandma, Someone you hire from Care.com or the like - Here's some interview questions for caregivers/ respite providers
  • Vacation Bible Schools - (with a heads up to the administration) my kids are actually really good with younger kids.
  • Summer school  
  • Structured days. For example:
    9am -9:30am aerobics,
    9:30- 10:30am chores,
    10:30am - 11:30am Free time
    11:30-12 Help make lunch
    1pm -3pm Quiet activities (nap, study, reading, quiet play)
    3pm - 5pm Get ready and go to pool or park or craft store...
    5pm-8pm TV/Movie/ Electronics/ Quiet Time/ Dinner
    8-8:30pm Bedtime Routine (showers, stories)
    8:30/ 9pm (depending on age) Room Time (Quiet activities or sleep)
  • (Mostly) Free Activities. 108 Alternatives to being bored and Trapped in the House 
  • Attachment Challenge 
  • Integrity Study or similar
  • Hang out at work with parent (obviously only works if an option) - my kids had Homeschooling Workbooks (summer assignments, PACE workbooks, or just a grade level appropriate workbook that we found at the local teacher supply store) that they could do while I worked. We also had a lounge they could watch TV in if they got their work done. We'd go for walks on my lunch hour.
Leave a comment with what you do with your kids!

Thursday, February 18, 2016

Contact with Biofamily

Why do kids want contact with biofamily? 

There are lots of theories. I think this article and my response, Five Hard Truths About Adoption Adoptive Parents don't want to Hear - A Response, answer some of these.

1.  There is not one 'real' mother. 
I totally agree with this one. Both biomom and I are my children's "real parents." This generally isn't an issue in our house unless my child is mad at me, at which point I may hear, "You're not my Real mom." I try to take this in the spirit it was intended (a way to strike out because my child is feeling upset).
"You're not my real mom."
"That's funny, I feel real. Honey, do I look plastic to you? Believe me baby, this is not a Barbie body!"
Do be aware that even though our heads understand this, it still hurts to hear it.

2.  No matter how good our childhoods are, most of us fantasize about our origins.
I think EVERY child fantasizes about their origins. I remember wondering if I was adopted or really an android or an alien... and wishing it were true!  This is a hard line to walk with my kids though. I firmly believe that it is vitally important not to hit my kids over the head with the realities (or suspected realities) of their family of origin (or allow them to vilify them either - which Bear liked to do), but at the same time we need to keep it real so that they don't focus all their energies on the dream and miss out on being a part of our family. This is especially hard with their black and white thinking.

NOTE: One thing I firmly believe is one should never criticize bio family to the children, something I learned from my mother, who never criticized my father in front of me, despite a nasty divorce.  Knowing my children are idealizing their bio family doesn't change my belief, but it is a little frustrating to know that my lack of reality checks makes some of their fantasies possible.

I think they want to go back to biofamily to live the fairy tale/ fantasy they have used to escape over the years.  That little Orphan Annie reality  that my "real family" is perfect, rich, will never make me do chores or be held accountable for anything I do (not that I'll do anything wrong, because it was everyone else's fault)... I also know that deep down, the thought terrifies them! Kitty especially - she fantasizes that her biofather (who doesn't even know she exists) in his shining armor will ride in on his white horse and carry her off to his castle and make her a princess. While at the same time, she's afraid that this stranger will come in and take her from her family and the life she's finally allowed herself to trust enough to want.


4. My reunion will most likely be disappointing because reality never lives up to dreams. This does not mean it isn't needed.

I firmly believe that whenever possible kids should have a reunion with their birthfamily, but when they're adults --> a chance to explore their origins and imagine what their life might have been like, when they are hopefully emotionally stable, and secure in the knowledge that they have a loving family which they are very much a part of and that any relationship with this other family is a "bonus."

Especially with social media, more and more kids are being reunited with birth families when they are not emotionally ready, often causing additional trauma.  The waters got "muddied" in our case, because the children had sisters that stayed behind with biomom, and we wanted to keep that door open so they could maintain that relationship.

Because of their black and white thinking, my kids felt torn by massive loyalty issues -- that if they allowed themselves to be a part of our family then they were betraying their birth family. Bear always had one foot out the door anyway, to avoid being abandoned again. It wasn't rational, but he felt that if we weren't forcing him to stay (which we would never do!), then we were kicking him out. He never allowed himself to come all the way in to try and see if he wanted to become part of our family, because that other door (with the tempting fantasy that everything would be perfect if) was always dangling just outside his reach. I think that "escape hatch," especially during those volatile teen years, kept him feeling abandoned  over and over again - constantly picking at a raw, open wound and preventing any healing.

Not allow contact?
I often wish that we'd done what a lot of my friends have done: Not allow the child to make contact with bioparents until they are 18. It sounds harsh, but I'm not saying we should deny the connection or feelings -- just stop the contact until the child is old enough to have established his her identity and place in the world. Torn loyalties are hard enough for adults to handle. We tried to do this to some extent. We let the children know that the courts (not us!) have said that contact should not be made by either party until the child is 18. Unfortunately this is hard to do in today's world (phones, texts, IMs, social media...).

Bear's issues were more about "loyalty." In his black and white world, he felt that to attach to our family was betraying his biofamily. I think he also has a "sour grapes" philosophy - he's afraid that if he does trust us enough to get close - then we'll reject him (because we'll find out he's not perfect). So he uses his fantasy of biofamily as an excuse to not get close to us and therefore reject us before we can reject him.

{Bear reached out to his biofather repeatedly over the years. Each time, his biofather would indulge Bear for awhile, then Bear would abuse this by calling and texting multiple times a day (often every 5 minutes), causing issues at biofather's work. Until at last the biofather would just shut down all communication. Every time this happened, Bear felt abandoned all over again. We didn't know about all of this - all we saw was that every now and then, Bear would shut down and retreat in to himself. He would also push us away even harder.

The last time, Bear's biofather showed up while Bear was in jail. Biofather apologized for not being there for Bear, promised Bear he was clean now and going to be a part of Bear's life. Bear never heard from him again. Months later, Biofather and his mother were killed, and Bear's half sister was seriously injured, in a car accident. All the papers only mentioned Bear's 2 half-siblings that his bio-father had custody of, when he let Bear go in to foster care and terminated parental rights. }


SOME REASONS ADULT CHILDREN GO BACK TO BIRTH FAMILIES

1.  The biggest is that they want to negate the rejection/ abandonment.  They don't want to believe that the family didn't want them, because that means the child is unworthy and unlovable. They may believe that contact with biofamily will "prove" that their family really loves and wants them.

2.  Extreme denial.  My kids can dissociate from reality, and distort it to the extent that they rewrite history, and BELIEVE the new version.  They don't remember, or want to remember, the real past - good, bad and everything in between.

3.  Black and white thinking.  People are either evil or on a pedestal.  Our kids literally don't see the shades of grey that describes all humanity.  Most people are wonderful, caring, supportive, relationship possibilities (best friend, girlfriend, new mom..)... until Bear or Kitty flips a switch and ALL they can see is the person's flaws.  My son is especially bad about this.  He goes through girls like Kleenex, discarding them when they show the tiniest sign of imperfection (I believe my son thinks that love means they are instantly and totally devoted to him, anything less and he's afraid they will abandon him, so at the first sign of independence, he rejects them before they reject him) or they get too close (and he runs before they can see his flaws and reject him).

The kids have idealized many members of biofamily, and literally don't remember any of their flaws.  When Bear went to live with his bio Grandpa, real life quickly took over, BioGrandpa became human (worse, a human who had some authority over Bear), and Bear couldn't accept that.  In less than a month, he was ready to move on.

4.  Escape.   "My adoptive parents and everyone else are the reason things aren't going right.  If I can get away from them then my life will be perfect."  Hubby and I tell our kids that they have to work on their issues instead of running away from them, because the issues are inside of them, and will follow them everywhere.  They don't want to believe us.

Obviously these characteristics are all linked to each other.

Our Story
When our kids came to us from foster care at ages 11 and 13, relationships with biofamily were "complicated." Bear was old enough to have phone numbers memorized, so we really had very little control over his contacts with biofamily. Although physically 11 years old, emotionally Kitty was only about 4 (on a good day) so she didn't understand why she needed a new family (Kitty's bio on the online adoption site where we found her specifically said that Kitty didn't understand why she needed to be adopted).

I have been told by the kids' former therapist that Biomom was not allowed to see the children in foster care because she determinedly blamed them for what happened. Both kids felt they were sent to foster care because they were "out of control." In therapy, we worked hard on helping Kitty understand that going in to foster care was not her fault – mostly successfully I think.

I know better than to run down a birth parent in front of the kids (from my experience as a child of divorced parents) so I’ve always avoided making Biomom look bad to the kids, and even tried to help the kids understand why she may have done the things she did. This sometimes came back to bite me in the butt as Kitty has “forgotten” all the "bad stuff" and desperately wants to go “home.” Still, we have been dealing with this as it happens, and through EMDR and attachment therapy we’ve been trying to help her process her severe PTSD.

Contact with Biofamily/ biosiblings before 18
We've always allowed contact with biofamily, except for my children's birthmom. We especially wanted our children to have a relationship with their biosisters, even though they still lived with Biomom. We did set up some ground rules so everyone would feel safer.

We encouraged the kids to write letters and send birthday cards, but they didn't really like to write. We allowed phone calls, but tried to only have the kids talk to their sisters when the girls were visiting Biograndma.

We had a big problem with Biograndma sharing a lot of information (usually negative) with Bear and Kitty. I had to specifically ask her to be careful about the information she shared with the kids, because it was extremely upsetting, especially for Kitty, to hear about Biomom's most recent abusive relationships, among other things. Sometimes Biograndma complied with my request, sometimes she didn't. I know she felt that Bear could handle it so shared more with him - unfortunately, he tended to pass on the information to Kitty.

My Contact with Biomom
Bear had been emailing the half-sister of one of his biosisters. Although not related to Biomom, this older teen was living with Biomom as her "nanny." The girl had been communicating with Bear on MySpace before he lost his internet privileges, and he asked me to contact her. She seemed willing to answer some questions and gave me some insight into many of Bear's "stories" about his childhood. Unfortunately, I decided to use e-mail to send her some current pictures of the kids - and that's where it got sticky. The girl gave my e-mail address to Biomom and included some of the questions I'd asked her (about gangs and drugs for Bear, why they were both behind a year in school, whether or not Bear had been in treatment facilities...).

The great part about it was biomom answered some of the questions, and was willing to share baby pictures(!) and some information about the biofathers. This was especially important for Kitty whose father left after only a week-long stint with biomom, I'm assuming because the carnival moved on - he never even knew she was pregnant as far as we know. Kitty had no pictures or information. Biomom also told me more about things like who they were named after, and how much Native American blood they had.

When Bear heard that biomom was pregnant again. I confirmed it with her, and presented the news to Kitty in attachment therapy (only because she was about to have a phone visit with her younger sisters and I didn't want her to find out from them).

In the beginning, I was talking to biomom every couple of weeks. I sent her a picture of Bear and Kitty at Christmas and on their birthdays. It made Bear crazy to know that I was communicating with Biomom and he asked me not to tell her anything about him. I respected his wishes. I also told her that the kids were unable to handle direct communication with her, and asked that anytime their younger sisters were visiting grandparents or something to please let us know so that Bear and Kitty could talk to them on the phone without having to be concerned that Biomom was present.

Over the years, Biomom would send a message that she was planning on giving the kids a gift (birthday, Christmas) and maybe include something from their childhood (Bear's wrestling medals, a blanket that Kitty had loved...). We only ever received one package. The continuing disappointment was traumatic for the kids.

Biomom Visit
And then she requested a visit!

My first instinct is to say, "h*@#  NO! I did NOT sign up for this!" We never agreed to anything but a closed adoption, and had been told that this was definitely in the children's best interest.

After much deliberation, I decided to leave it up to Bear. After years of saying he hated her and didn't want any contact, Bear surprised me by agreeing to the meeting (I discovered later that he'd been in communication with her all along).

Kitty's therapist reaction
I talked to Kitty's attachment therapist and we went back and forth about whether or not to allow Kitty to see Biomom during the visit. Kitty had been having lots of issues and had recently been in a psych hospital. We had decided to pull Kitty out of private school (they couldn't accommodate her special education needs any more and we couldn't afford it anymore). Biomom's visit was the day before the new semester starts, which is when Kitty would start public school for the first time in 1 1/2 years. Great timing, huh?!

We had a lot of reasons why Bear should get to see biomom and Kitty shouldn't. (He's older, he didn't just get out of a mental institution, his therapist agrees that he's at a stable point in his life and can handle it...). I worried that she wouldn't forgive me if I said no. It felt like a lose/lose situation.

finally, I told Kitty in therapy that Biomom was coming and gave her a choice on whether or not to see her. Kitty chose, big shock, to get to see Biomom. We told Kitty that we had many concerns, and listed a few of our reasons this might not be a good idea. No effect, but at least we got them out there.
Kitty stated, "I know it's strange, but I still love her." We reassured Kitty that that is not strange at all!

We asked Kitty what would she like to get out of the visit. Kitty asked about Bear's rules and goals. I told her that Bear wanted to confront Biomom about putting him in foster care, and ask questions about Biodad. Kitty didn't understand why Bear was angry at Biomom. When we asked her what questions she had, she mentioned Biofather (although she had no ideas on specific questions) and at one point wanted to know if the Grandmother she was named after (birth name) was dead (Bear had told her that she was). She had no intention of asking anything "controversial" or confrontational.

Ground Rules:
We informed Kitty that there were some things we wanted her to understand.

  1. This does not mean she is going to start seeing or talking to Biomom all the time - maybe not until she is 18.
  2. This meeting is for closure.
  3. We do not want to share a lot of personal information about our family (although biofamily sisters, grandmother, aunt, cousins - know almost everything and have most likely shared).
  4. If we feel that she is getting overwhelmed we will stop the meeting immediately or change the subject (we made that part of the ground rules).

Our ground rules for Biomom (most of these came from the therapist and I and/or Bear):

  1. No lies (Bear specifically wants the truth about TPR - Terminating Parental Rights).
  2. Biomom acts like the adult (no cussing, no yelling, no blaming)
  3. This visit does not mean ongoing contact.
  4. The therapist, Hubby, and I can change the subject or end the session at any time.
  5. Bear added: No hugging or touching, and
  6. No talking about the future (he believes it is none of her business).

I think Kitty was more excited about the fact that she gets to eat out then the actual visit. She is disappointed that their younger sisters will not be coming.

Letter to Biomom: 
Hi (Birthmom),

As two people who love (Kitty's birth name), I need to discuss something with you. I probably shouldn’t talk to you about this, but I’m not sure what else to do. I’ll be honest and tell you that I have almost cancelled this visit several times, and I’m still not sure I’m doing the right thing for (Kitty). I haven’t told (Kitty) about your visit yet for many reasons. One being that she is going through an extremely difficult time right now and we’re not totally sure why – it could be some recent med changes, it could be hormones, it could be the holidays, it could be a lot of things. Over the last two years she has made a lot of progress. She has slowly bonded to our family, and although she is still very hurt by all the abandonments (perceived and otherwise) that she’s had in her life, we’ve seen her slowly begin to trust us and believe that we love her and won’t send her away – even when she’s acting up.

I know you never intended to hurt her, and she loves you loyally. I have always tried to explain to the children that it must have been so hard for you dealing with their issues as well as your own troubles. I have always made it clear to the children that I fully expect them to always love you. You were their first mother. My problem is that (Kitty) has never really understood why she can’t just go “home.” She has unknowingly built a fantasy about her life before foster care and adoption. She only remembers the good things, and denies any hurts or problems. Those concerns are of course still there, affecting her life and relationships. We work hard to get her to address them in therapy so that she can deal with them now instead of allowing them to fester and negatively affect her.

January 1st - 5th, (Kitty) went into an inpatient mental health facility. This is the first time this has happened since we’ve known her (about 2.5 years) - although I understand she has been hospitalized for similar issues a couple of times when she was younger. She is so emotionally fragile right now. I am VERY worried about her.

I plan to tell her about your visit at her next therapy session (Tuesday). I feel stuck between a rock and a hard place on this, and I am hoping you can help us. The way I see it I currently have 3 choices.

One, is to stick to the original plan, and let her know you are coming, but that her therapists and I feel she is not at a good place for meeting you. That Bear is older and more emotionally stable. I know she will not understand and will completely disagree (she usually ignores and denies her feelings). I feel that most likely this will damage my relationship with her, possibly permanently (I hope I don’t sound overly dramatic here, but I know you must remember being a teenager and fighting for your independence and identity with your parents? I know how rejected I felt by my parents who had a nasty divorce. My father tried to manipulate me and use me as a pawn to hurt my mother. I still have never really forgiven him). We had planned to have her write a list of questions and things she wants us to ask you about, but I doubt this will be sufficient to make up for not getting to see you.

Two, to allow her to see you and just deal with the inevitable fall-out. I’ll be honest, what terrifies me about this is that she will ask you to take her home or something similar. That you will (of course) tell her that you love her and that you never wanted to give her up, or worse, that it was her fault she was placed in foster care because she was out of control. She will blame my husband and I for keeping her from you (I know it’s not rational, but very likely), and the damage is still done to our relationship. Plus, she feels abandoned/ rejected by you when you have to leave her here.

So, as one mother to another, I’m begging for your help with this. Do you think that (with the assistance of her attachment therapist), you could help us give (Kitty) the closure she needs, and ask her to honor the bond that she has with us? I’m not asking you to tell her you don’t love her, just to encourage her to know it is OK with you for her to love my family too and be loved by us. That there is room in her heart for both of us, and that she belongs with my family now. I fully believe that if we work on this together that we will both benefit from the abundant love this child is capable of. I know that (Kitty)’s therapist (different from Bear’s) has offered to help us with this.

Please be honest with me. I feel that Kitty is in a very dangerous situation here and that we will need to walk a fine line to help her. If you do not feel that you can do this, then I will just stick to the original plan and hope that she doesn’t hate me too much. Can you tell her that you love her, but that she is where she needs to be?

Just to make things more difficult, Kitty starts public school on the 20th (the day after your visit). We’ve had her in a tiny private school for the last year and a half, but cannot afford it now because of the economy. She is excited about this, but it will still be VERY stressful for her.

Mary

Biomom Agrees to Ground Rules:
Biomom's Response

Planning the meetings:
Letter - Therapists' opinions
Kitty's EMDR therapist's concerns

The meetings:
Our meeting with Biomom and therapists (no kids)
Biomom - Kitty visit
Biomom - Bear visit
Biomom's letter after first visit.

Second Biomom visit - 3 years later with siblings
Second Visit - Biomom with siblings

Other Contact with Biomom
Letters with Biomom about reading my blog

Going Back to Birth Family (after age 18) 
Like many adoptive families with a closed adoption from foster care, we never intended our children to have contact with their birth parents until after age 18. We had been told by the kids' "Team" that this was definitely in the children's best interest. We always let the kids know that we understood that they still loved the bioparents (even the ones they'd never met). Of course they did! We encouraged them to talk about their feelings and let them know we accepted them. This post talks about why this is so important to our kids.

We made a lot of mistakes. We did a lot of things right. Every family's experience is going to be as unique as they are. I wish you much luck in whatever you decide.

Wednesday, February 17, 2016

Interview Questions for Caregivers and Respite Providers

Interview questions for caregivers and respite workers. 
Compiled from various sources and adapted by Sarah Hedge.


  • Look for people who are willing to work with kids with special needs. 
  • Do a full interview process (phone screening, in-person interview in a public place, opportunity to meet kids in your home for those who pass everyyhing else).
  • Don't forget to ask questions about how the person would handle specific situations that you think may come up. 
  • Do background checks, reference checks, and drug screening. 
  • Look for two people, one preferred and a back-up person too. 
  • She used care.com, but this would work in other situations.


Phone Interview Questions:

1. First, I want to tell you a bit about what we are looking for and what we can provide:

We are a very active family who is involved in a wide variety of activities. We are looking for a consistent caregiver so that we can meet each of our kids' individual needs more directly, have some time together as a married couple, and to have some time for parent self-care. Our family is looking for a non-smoking, college-educated caregiver who is comfortable with a friendly cat and an energetic dog. To best fit our family's needs, the caregiver is relationship-oriented, with a warm and fun personality, but who is also comfortable following established routines and maintaining established boundaries in an empathetic manner. We are looking for someone who is communicative and reliable, active, creative, and willing to be trained in how to best meet the special academic and emotional needs of our kids.

2. Given this information, is this a position you might still consider?

3. Tell me about yourself.

4. Why do you enjoy taking care of children?

5. Why are you interested in this position with our family?

6. What are you seeking in your next position?

This summer, our family needs a consistent caregiver NUMBER OF DAYS PER WEEK. Dates and times may change as activities do. We are mostly looking OUR PREFERRED DATES AND TIMES FOR RESPITE.

7. How many hours are you available per week?

8. What are you looking for in terms of schedule?

9. When are you available to start?

10. The role would depend on the day and time, but may include any or all of the following:

  • supporting kids in following through with our family's established routines, 
  • academic help, such as listening to kids reading aloud, or help with math work, 
  • supporting the kids in cleaning up after themselves or helping the kids complete their assigned chores, 
  • simple meal preparation and resulting dishes, 
  • using your own safe and reliable car to drop off at or pick up from kids' activities, and 
  • having fun, of course! 

We can be flexible with these roles and times with the right caregiver. Is there anything on this list that you would prefer not to do?

11.  We are happy to provide $10-$20/hour depending on your experience and the roles you play, training to address the academic and emotional needs of our children, and established routines and expectations so there isn't any (or much) guesswork involved. What hourly rate are you looking for?

12. What are your key skills and strengths as a caregiver? If you were hired, how would you propose to use those skills with our family?

13. Of course, everyone can always improve their skills. What do you want to do better when taking care of kids? What is your plan to improve your skills in that way?

14. Now, I’m going to ask specific questions about your background:


  • Eligible to work in the U.S.?
  • Valid DL? Car insurance? Clean driving record? Safe & reliable car?
  • Ever been convicted of a crime?
  • Ever had involvement with Child Protective Services?


15. What questions do you have?

NEXT STEPS:
Phone Interviews through DATE
In-Person Interviews through DATE (bring DL, proof of work eligibility, references)
Checking references, background checks, drug testing
Kid Visits through DATE
Hiring Decision ASAP after that!

16. Given our conversation today, is this a position you would still consider for yourself?



***************

In-person Interview Questions (in a public place):

1. What do you enjoy most about working with kids? What do you find most challenging?

2. What are you most proud of as a caregiver?

3. Could you tell us a bit more about your experience working with kids who have emotional and/or academic needs?

4. Do you have any formal education or training that would be relevant to working with our kids?

5. How would other parents describe you? How would kids describe you?

6. What types of kids would you enjoy spending time with for hours at a time? Who would enjoy spending time with you for hours at a time?

7. If hired, what would you do especially well?

8. What is your view of disciplining children, and what should be the caregiver’s role?

9. Describe the most challenging child you have worked with. How did you address the challenge?

10. How do you handle kids that are pushing boundaries? Being sassy or talking back?

11. What would you do if one of our children begs for something we say is off limits?

12. What are your personal interests and/or hobbies?

13. If you had 5 hours to spend with our children, and no particular agenda, how would you organize your time and day?

14. Do you view your personality as flexible and easy to roll with change, or do you need more structure and ability to plan ahead?

15. What’s your five-year plan?

16. Why should we hire you?

17. What questions do you have?

NEXT STEPS:
In-Person Interviews through DATE
Checking references, background checks, drug testing
Kid visits through DATE
Hiring Decision ASAP after that
Nanny Contract
Tax Forms
1 month trial period to see if it’s a good fit

18. Given our conversation today, is this a position you would still consider for yourself?

LOGISTICS: Take photo of driver’s license, proof of car insurance, proof of work eligibility, references


***************

Reference Check Questions:

1. What were the starting and ending dates s/he worked for you and what were his/her responsibilities? What were the ages of the children s/he cared for?

2. What are her strengths in working with children, and what are her weaknesses?

3. Did you ever do a performance review with her? If so, what areas was she working on? What were your goals for her?

4. What were the circumstances of her departure? (If there are two sides to the story and you feel like there’s a red flag, probe the issue further.)

5. Would you hire him/her again?

6. How would you describe his/her personality and temperament?

7. On a scale of 1-10, how would you rate each of the following: his/her maturity ______, initiative _____, responsibility _____, ability to communicate _____.

8. How did you supervise him/her and what kind of style worked with him/her?

9. Did s/he like to get feedback? How does s/he handle feedback? Is s/he open and approachable? Give an example of when you asked him/her to do something differently. How did it go?

10. Did s/he feel comfortable bringing an issue up with you? Give an example, explain how you worked through it.

11. Is there anything I need to know that would help me supervise him/her better?

12. Did you and s/he share the same philosophies on things like discipline, or how neat to keep the house?

13. Can you give me an example of when s/he had to manage a challenging behavior with a child? What was the situation and how did s/he handle it?

14. Did you ever have a concern about how s/he handled a behavior issue with a child?

15. Did you ever suspect that s/he had a drug or alcohol problem?

16. Did you notice anything – personal or professional – that interfered with his/her ability to do his/her job? Was there any specific safety-related feedback you needed to give him/her?

17. Did s/he come to work on time? If s/he was late, what do you think the reason was?

18. Did s/he ever take the kids any place without your permission? Did s/he let friends or a significant other come to the house without permission?

19. How did s/he respond to a real emergency? What happened and how did s/he handle it?

20. Is there anything else that I should know about him/her?

THANK YOU SO MUCH FOR YOUR TIME!

Tuesday, February 9, 2016

Books and Methods Review - Therapeutic Parenting - Ross W. Greene

Marythemom:  I really like this book and found that it describes my kids pretty well.  I’ve found a lot of the techniques he uses are easily incorporated into what I do with my kids, and the understanding into why they act the way they do is invaluable in helping me stay calm and better deal with my children’s behavior.

Amazon.com Review -  Flexibility and tolerance are learned skills, as any parent knows if they've seen an irascible 2-year-old grow into a pleasant, thoughtful, and considerate older child. Unfortunately, for reasons that are poorly understood, a few children don't "get" this part of socialization. Years after toddler tantrums should have become an unpleasant memory, a few unlucky parents find themselves battling with sudden, inexplicable, disturbingly violent rages--along with crushing guilt about what they "did wrong." Medical experts haven't helped much: the flurry of acronyms and labels (Tourette's, ADHD, ADD, etc.) seems to proffer new discoveries about the causes of such explosions, when in fact the only new development is alternative vocabulary to describe the effects. Ross Greene, a pediatric psychologist who also teaches at Harvard Medical School, makes a bold and humane attempt in this book to cut through the blather and speak directly to the (usually desperate) parents of explosive children. His text is long and serious, and has the advantage of covering an enormous amount of ground with nuance, detail, and sympathy, but also perhaps the disadvantage that only those parents who are not chronically tired and time-deprived are likely to get through the entire book. Quoted dialogue from actual sessions with parents and children is interspersed with analysis that is always oriented toward understanding the origins of "meltdowns" and developing workable strategies for avoidance. Although pharmacological treatment is not the book's focus, there is a chapter on drug therapies. --Richard Farr 

Lost at School: Why Our Kids with Behavioral Challenges are Falling Through the Cracks and How We Can Help Them
Psychiatrist and Harvard professor Greene follows up The Explosive Child with an in-depth approach to aid parents and teachers to work together with behaviorally challenging students. Greene's philosophy is driven by the recognition that "kids who haven't responded to natural consequences don't need more consequences, they need adults who are knowledgeable about how challenging kids come to be challenging." Greene's "Plan B" system, which is fully and clearly explained in the course of the book, emphasizes identifying challenging behaviors-acting out, hitting, swearing, poor performance in class-and then working with students to find actual, practical ways to avoid them. Helpfully, Greene uses a fictional school for examples, devoting several pages to illustrative anecdotes in each chapter, greatly increasing the material's accessibility. Greene's technique is not fail-proof, principally because it requires the good will and hard work of all participants; a section on implementing Plan B in the face of real disagreement or apathy would have been helpful. However, Plan B has all the qualities of accessibility, logic and compassion to make it a solid strategy for parents and educators. 
The first comprehensive presentation for clinicians of the groundbreaking approach popularized in Ross Greene's acclaimed parenting guide, The Explosive Child, this book provides a detailed framework for effective, individualized intervention with highly oppositional children and their families. Many vivid examples and Q&A sections show how to identify the specific cognitive factors that contribute to explosive and noncompliant behavior, remediate these factors, and teach children and their adult caregivers how to solve problems collaboratively. The book also describes challenges that may arise in implementing the model and provides clear and practical solutions. Two special chapters focus on intervention in schools and in therapeutic/restrictive facilities.

Books and Methods Review - Therapeutic Parenting - Christine Moers


This is probably going to sound like a commercial or like I'm a total fan girl (which I am), but I have to tell you about my favorite Therapeutic parenting "guru," Christine Moers, a foster and adoptive parent of children from "the hard places."

I like that she's so approachable and doesn't pretend to have it all together. She's nothing like me -- she's got dreads and tattoos, was a pastor's wife, and owns a trailer park -- but at the same time we're kindred spirits. She's walked the path I'm on. I've met her several times over the years, and she is exactly the same in real life as she seems in her videos and on her blog.


YOUTUBE VIDEOS
She has an amazing series of YouTube videos on Therapeutic Parenting. If you haven't checked them out, go do it! I'll wait.

See! I told you she's awesome!


DVD
Now, I know you want more. You're in luck! She worked with Billy Kaplan ( President and Clinical Director at House Calls Counseling) to create a video called Chaos to Healing:  Therapeutic Parenting 101  The author, Daniel Hughes, writes VERY good books about attachment, but (in my opinion) they are very academic and pretty dry. Christine Moers and Billy Kaplan have created an entertaining, practical description of Daniel Hughes' concept PACE (Playfulness, Acceptance, Curiosity, Empathy). They also explain what Safety means to our kids and why it's so important.


BLOG
Christine Moers has been blogging for years at http://www.welcometomybrain.net/ She has a very real and open style of writing that doesn't feel preachy.


PARENT COACH
For some of us, this gig is hard. Whether a friend sent you to this site or you stumbled across the page in the middle of the night as tears are streaming down your face ... you just found someone who understands. Look around to see if Christine might be just the cheerleader you are looking for.
- See more at: http://christineparentcoaching.com/#sthash.RIlp3gwC.dpuf
She gets it. She really does, and she helps you become better at "getting it" too. After talking to her you feel inspired and empowered to believe that, you've got this and the added tools in your toolbelt to do it.

Sunday, January 17, 2016

My Child Is Raging

Recently, a trauma mama asked, what do I do when the rages of an older (10+) child become violent? What about keeping the other children in the home safe?

You said, "he won't make the choice to stop." Just to let you know, that's probably not a choice he is capable of making at this time. Once our kids slip in to "Fight/ Flight/ Freeze" mode, the thinking part of their brain literally stops working. They react instinctually.

Fight/ Flight/ Freeze - A child who is dysregulated and/or in fight/ flight/ freeze mode is “thinking” with the reptilian part of the brain (survival!). Their behavior is a purely instinctual response to what the brain believes is a life or death situation. The rational part of the brain just isn't online. Their eyes frequently glaze over, they are out of control, and it is like the child isn't "home." Afterwards they do not remember what happened just before or during an episode. Holding a child responsible for what happens when in a true fight/ flight/ freeze is pointless- it’s better to just move on after it's over and try to figure out what triggered it so you can avoid it in the future.

Rage versus Meltdown A “meltdown” is different from being in Fight mode which usually looks more like a rage. During a meltdown, the child has some control over how far things go. It is still possible to "reach" the child and de-escalate the situation and calm him/her down.

Our bodies' nervous system is very basic - it doesn't know the difference between say, excitement and anxiety. Medications, calming techniques, and maturity can help the body stay calm and keep from sending "AiieeeAiieeeAiiee" signals to the brain stem. Bear tends to go into "Fight mode" when he's upset, worried, anxious, afraid... Whereas Kitty tends toward "flight" or "freeze" and she dissociates (distracts herself).

WHY IS THIS HAPPENING?!
Every kid is different and so many things could be causing the rages and meltdowns. Knowing why our child is acting the way they do, can help us decide how to address it.



DOCUMENT, DOCUMENT, DOCUMENT -

Documentation helps protect us, get services for our children, and refreshes my memories of past issues so I can see progress and make sure chronic issues get addressed correctly. It can help you get a higher level of care (like RTC) or if you need proof that you're not a child abuser (most people with kids like ours will get accused of child abuse at least once), or even just so you don't have to repeat a treatment technique that didn't work.

When dealing with police, CPS, getting your child services and treatment, trying to get people to understand and believe what you're going through... it's amazing what they'll believe when it's in writing, versus hearing it from the parent - even if you're super calm and logical about it. For this reason, I always carry a one page summary of my child's current meds and diagnoses.

One of the main things to remember about documentation is to do it as SOON as possible after an incident. Adrenaline and time really alter memories quickly.

Our children are especially prone to false allegations for many reasons -

  • an actual distortion of the events in their mind - their perception is off when they describes events that led up to a meltdown. My daughter will say "Daddy was yelling at me," when all he said was, "Who left the butter out?" in a totally normal voice
  • they get events mixed up with things that happened in the past - remembered abuse by a female caregiver gets projected on to the new female caregiver
  • they don't remember anything when they're in "fight/ flight/ freeze mode"
  • it's a defense mechanism to reject you before you reject them (deep down our kids believe they are unlovable and unworthy) so to give themselves the feeling of control of the situation they push you away
  • ...

To protect all involved, I recommend writing an "Incident Report" and keeping it in a log, sending it in an e-mail to the child's therapist or whomever might keep track of the info, and/ or on the child's timeline:

Antecedent - what was going on before the behavior or possible/probable triggers.

De-escalation - what we said/ did to try to prevent the event (if we had time) - calming techniques used

Behavior/ Event - with as much detail as possible
Intervention - what we we did during and immediately after the event - how we tried to calm the child, confrontation, redirection, distraction, sitting with them, time-ins, holding, rocking..,

Follow-up - how you processed what happened with the child. Injuries, damage, repairs needed/ made (emotionally and physically)... What consequences were given (if any). Agencies contacted. Reports filed.

Contact Log:
Especially when dealing with bureaucracy (like insurance or school!), try to keep as much communication as possible in writing (e-mails, notes). If the person insists on phone calls and face to face meetings, take detailed notes and IMMEDIATELY type up a transcript afterwards with as MUCH detail as possible. Include names, titles, agencies and affiliations, DATES and TIMES! When you need documentation you can use these transcripts and they are MUCH more admissible then saying, "Well Ms. So and So said he was doing this a few weeks ago." Once again, people believe what they see in writing.



PROTECTING YOUR CHILD AND FAMILY

Our kids were big when they came to us, and our biokids were younger and smaller, so we had the same concerns about protecting the other children (and ourselves).

We put in place a lot of regrettably necessary rules, like:

  • No physical touches between siblings - this included hugs, tickling, wrestling...
  • If someone says, 'Stop.' then you HAVE to stop.
  • You cannot be in the same room with your siblings without an adult present. This might mean that if I had to go to the bathroom, then they needed to be in their room. If I was cooking in the kitchen then they needed to hang out with me (I tried to make Shadowing seem like a reward).
  • When needed, we had the same rules for the pets.
  • If a sibling is raging, STAY OUT OF IT! The other kids would sometimes accidentally/ deliberately make things worse.

DE-ESCALATE THE SITUATION
Most important thing we did is to try to de-escalate before things got to the point they were out of control -

Prevention -
Establish Structure, Support, Routine and Boundaries - as essential as child-proofing your home.
Recognizing Triggers
Handling Child Stress

Calming/ De-escalation Techniques
Co-regulating emotional levels - matching emotional arousal


DURING A RAGE

Many of our kids have such a small window of tolerance that there's not time to de-escalate the situation. All of the sudden you're in the middle of a full out rage. So what do you do?

Once they hit fight/ flight/ freeze level, which for our kids can be 0 to 60 in 10 seconds, it feels like there is so little we can do. Calming techniques won't work in the middle of the storm. They are for before (if you can) and afterward. You can do physical restraints to protect yourself and others if you need to, but they are a last resort.


  1. Stay calm. (I know. This is the hardest one for me. I am super triggered by conflict and violence.) Use those calming techniques on yourself. If there is another adult present, switch out, and give yourself some time to get yourself under control. Being in this situation can trigger your own fight/ flight/ freeze mode or trigger Secondary PTSD
  2. Keep everyone safe - We've been known to send the other kids to another room (scary as all get out to them, but we've had them lock themselves in our bedroom to watch a movie on our TV). If one of your kids hurts another, YOU are legally liable for failure to protect. It's important to keep the other kids safe. Note: Often the other kids accidentally/ deliberately made things worse, so removing them from the situation was best.
    Self-Defense - If you've done everything you can to de-escalate the child and they become aggressive and attack you, here's a video of some self-defense moves. Better examples.
    Practice these self-defense moves (with someone other than your child) so they become instinctual.
  3. Do not engage or interact. I sooo wanted to argue and point out how irrational the child is being and threaten them with consequences... anything so they'll stop. I had to keep reminding myself that there is no one home right now - the thinking part of their brain is offline.
    **Threats, Consequences and Punishments - any attempt to use these during a rage will have NO EFFECT - long-term consequences don't exist when your brain is off line.
    **Prisoner of War - When dealing with PTSD, the inside of our kids' heads is like living in a war zone all the time. No punishment would work on severely traumatized kids that is worse than what they've already been through.
  4. Avoid direct eye contact. Eye contact is often hard for our kids anyway, and can feel like a challenge which can escalate the situation.
  5. Speak softly.  If I speak at all, I try to keep a calm, monotone, soothing voice.
  6. Deep breathing. Slow, deep, even, LOUD, breaths. (Maybe not as loud as Darth Vader, but close). Your child will begin to unconsciously mimic you, helping them calm down. Bonus, it helps you stay calm too. 
  7. Stay present - (feelings of abandonment make things worse), but distant. We usually used the 4 Foot Rule (also known as line of sight supervision). My child usually said they wanted me to leave, but I would quietly repeat in a monotone, that I needed to be there to keep him/ her safe.
    4 Foot Rule - My daughter knows this is what we do, so I think that sometimes she initiates it deliberately to feel safer. The "4 Foot Rule" means an adult must be within (approximately) 4 feet of the child at all times (usually just means line of sight not 4 feet exactly). If I know she can't hurt herself (like if she's holding the door shut then she can't hurt herself without moving away from the door), I might sit outside the door.
    A more ongoing (rather than crisis mode like the 4 Foot Rule) line of sight technique that we use is Shadowing – Have the child stay close to you and follow what you do or you stay close to them.  It is not a punishment- it’s an opportunity to help the child regulate safely.  To get compliance, it can even be presented to the child as a reward.  “You can be my special helper and help me pass out snack.”
  8. Call the police. If you cannot keep yourself, your family or your child safe then you need the police. It's different in every state and even county, but where we live, we ask for a "mental health deputy." This is a police officer who is trained in assessing people with mental illness to see if they need psychiatric hospitalization (suicidal, homicidal, or psychotic) rather than juvenile detention or jail.  I have to have a regular officer come out first and then they'll call the MHD. One time when my child had punched me in the face, they called for a psych hospital with an available bed and transported my child (who had finally calmed down) and I to the nearest psychiatric facility with an opening (2 hours away). They might take you to the nearest emergency room instead.

    It may be a good idea to contact the police before there is an emergency  (don't call 911), to give them a "heads up." Explain your situation and ask for their advice on what you should request next time. It will probably make that emergency call go smoother, because they know a little about you and your situation - they're less likely to get the "scared straight," "just smack the crap out of him," you're a "bad parent," "boys will be boys"... kind of stuff that cops who don't "get it" might do/ say. 
    Current Meds and Diagnoses summary. If people understand your child has a mental illness or trauma disorder, they are more likely to help you get the psychiatric care your child needs and less likely to threaten the child (scared straight methods don't work on our kids!) or take the child to juvie.
  9. Psych hospitalization - it's tough, but if your child is suicidal, homicidal, or psychotic - your child may need hospitalization. Ways to get there: take your child to the nearest ER (if you can safely transport), call the psych hospitals on your own asking about a bed, crisis counselor can make recommendations and even call ahead for you, call the cops and ask for transport...
  10. Physical Holds/ Restraints - We only used this as a last resort to protect our self or another family member, or to protect the child from hurting him/herself. Because this can be dangerous (children have been known to suffocate and die from improper restraints), I don't believe proper restraints are even being taught anymore. We used the standing basket hold or sitting basket hold, and were always very conscious of the child's breathing.

    There don't seem to be any good examples on the internet. So I'm giving you an example of the Wrong Way to use a holding restraint (the child's arms should be crossed at the waist rather than across the chest which can restrict breathing, hold arms above the wrist joints to prevent strain, if a child is kicking and struggling then I have put one leg over the child's legs, make sure to tuck your head to one side - preferably behind the child's shoulder - to prevent the child from throwing their head back and breaking your nose).

    The sitting basket hold worked best for us. As the child calmed, I was able to loosen the hold, until it became more of a comforting hug. We often stayed like this after the child was completely calm and we could process what happened.  When the children first came to us, I believe our children often needed physical comfort, but were unable to express it or accept it because of their attachment issues, so they initiated events that would lead to this hold.



Management:


Self-care - Dealing with conflict is not in my nature. I hate it. I avoid it. It is so DRAINING to me. Self care is ESSENTIAL to being and staying in a good place emotionally. I need it to stay calm, cool and collected.

Self-care is a Necessity!  PLEASE, PLEASE take care of yourself and keep your tank full!




CALLING IN REINFORCEMENTS

For a child who still cannot get himself under control, I would:

  1. Make a safety plan with your child's therapist/ treatment team. Look at worst case scenarios, make a decision about how to handle each of them. Reassure your child this is to keep the child and all the family safe. Mine were convinced that this was a precursor to being kicked out again (it always had been). Words were not totally convincing, but that combined with the fact that we ALWAYS took them back helped a lot. 
  2. Have a serious talk with your psychiatrist about a PRN medication for calming the child - if there's a possibility the child will take it. Mine were pretty med compliant. Hopefully, you've been working with your psychiatrist on medications already. Definitely keep the pdoc posted on all changes and behaviors.
    I found that it's a fine line with meds. Sometimes whatever triggered my child just overwhelms the meds. That's why I like to have a PRN, something they can take when the meds aren't enough, but don't need all the time. I have to admit, we never really found a good PRN. My kids needed massive doses of everything to even function on a daily basis.
    Finding the right combination of meds is what finally stopped the rounds of hospitalizations for us. Once their brain was calmer and under control, their window of tolerance was bigger and they could handle things without becoming violent as a first option.
  3. Have a crisis counselor on speed dial (our local MHMR equivalent had one - 24/7 availability and they would come to us to do an assessment).
  4. Get the police involved. It may be a good idea to contact the police before there is an emergency  (don't call 911), to give them a "heads up." Explain your situation and ask for their advice on what you should request next time. It will probably make that emergency call go smoother, because they know a little about you and your situation - they're less likely to get the "scared straight," "just smack the crap out of him," you're a "bad parent," "boys will be boys"... kind of stuff that cops who don't "get it" might do/ say.  
  5. Residential Treatment - this is why you document, document, document. If your child cannot be in your home safely then they may need to go to residential treatment. This could be for a few weeks to find the right med combination. It could be a few months to try to learn some coping strategies (like DBT). It could be for years for a child who is not actually capable of living in a family environment safely. 


THE RAGE IS OVER. NOW WHAT?

Probably with your help, your child is able to regulate his/ her emotions again. Your child's brain is coming back online.

Emotional Release
Like most physical activities, after a rage a person's emotional
defenses are lowered. We made more therapeutic progress in the 20 minutes after a rage, then we would in weeks of therapy.

This is the best time to emotionally reconnect and start the healing process with your child. 

Start mending your relationship, and reassuring your child that you still love them and are not going to abandon them or let this push you away. This is NOT the time to start talking about consequences. 

Before Bear went to residential treatment and got on his current medications, he exploded on about a monthly basis. All emotions were stuffed inside and converted into angry lava. You could see it seething and bubbling inside him. When he lost control the volcano exploded in an angry outburst. Afterward, for about 10-30 minutes he would exhibit true emotions - he usually cried and talked about his feelings of abandonment, fear, anxiety and anger (accessing the emotions he kept stuffed inside).

Much as I hated Bear's rages, I felt his healing progress slowed dramatically after medicating his bipolar disorder stopped the rages.

Now Bear has his anger under control, but he still stuffs his feelings inside instead of processing them. Now they go in what appears to be a huge box inside him. When Bear had an outburst, that box got opened and examined and maybe processed a little. Now that he has no more outbursts, the box stays closed, the emotions untouched and buried deeper and deeper.
Bear is making progress academically and socially. He does talk about things and has even cried, but it tends to be current stuff. He is getting more mature, and can control his emotions- which is a good thing don't get me wrong! But I can't believe that not dealing with all the bad stuff that I know is festering in that box is a good thing. I can't believe that him not dealing with most of his feelings is a good thing.
Before, he wasn't able to learn anything because his life was in constant chaos - and now he is advancing academically and socially. He will never be off medication completely, but I wonder if it's time to start lowering his doses so that he can access his "box" and deal with his emotions. Or should we give him more time to be successful in all the areas that had been falling by the wayside while the rages kept his life in chaos?
Update: Looking back, I'm glad that Bear got treatment for the rages. When he did decide to go off his medication at 18, he had much more self-control, learned in those years when his life wasn't out of control with rages. I don't know if he would have been able to access and process his emotions anyway.


CONSEQUENCES

Don't be surprised if your child cannot remember what happened immediately before, during, or after a rage. Ask someone what happened during a traumatic event (like a car crash), and most times they cannot tell you. I'm sure someone could explain the scientific reasons (adrenaline rush, thinking part of the brain gives way to the instinctual, dissociation is a protective measure...), all I know is I've seen my child with tears stains on his/her face and still dripping with sweat, "flip a switch" and have no idea why I'm upset, and no memory of the events that occurred mere minutes before.

Discipline versus Behavior issues
Discipline problems (noncompliance, misbehavior) occur when the caregivers have not structured the child's environment for success, or when parents are inconsistent (expectations or consequences), non-responsive, or inaccessible. When adults adjust their behaviors and attitudes, often children with discipline problems can be brought under control in as few as 3 to 7 days.

Behavior problems on the other hand lie within the child. These are persistent behaviors that do not disappear even with the best parenting (although good parenting can help to control the behaviors). These can include impulsivity, inattentiveness, and other behaviors like ADHD, FAD and immature behaviors associated with missing capacities in object relations.

YOU CANNOT EXPECT PUNISHMENT OR DISCIPLINE

TO "FIX" BEHAVIOR PROBLEMS!



So how do you give consequences to a child who doesn't know what you're talking about and has little to no control over his/ her rages?

FOCUS ON PREVENTION NOT CONSEQUENCES. I finally realized that the need for consequences and punishment for my child was my problem. I knew they weren't having any effect on my child except to damage our relationship (if you're being punished for something you don't even remember doing then it must be happening because your parent is mad at you/ rejecting you... because you're unloveable and unworthy of love).  

  •  Structure, support, routines, and boundaries.
  • Make your child's world smaller so they feel safe (this feeling of safety has nothing to do with physical safety. It is a leftover defense mechanism, a life or death feeling. It is not rational - it cannot be changed with persuasion or logic. A child who feels unsafe is a scared child. A scared child will act out (or act in) to try to feel safe again.)
  • Discover your child's triggers. 
  • Empathy. The premise of the Beyond Consequences books is that there are only two primary emotions, love and fear.  For example, when a traumatized child shows anger it is because he or she is scared. It helps me to remember that during a meltdown, my child feels like a cornered or injured animal and is lashing out to protect himself. He is a scared little boy. This helps me be empathetic, which makes it easier for me to be therapeutic.

For when there just has to be some consequences. 
Maybe so the other kids won't see this child "getting away with" something and decide to start emulating it. Here's a couple of things we've tried: 

The FAIR Club - When a child is old enough to understand abstract concepts emotionally and intellectually, we use the FAIR Club. If a child is not being RRHAFTBALL (pronounced "raft ball") or is complaining that life is not fair, then they go in the FAIR Club, which is designed to provide boundaries and additional support while the child practices and gains (or regains) the ability to be RRHAFTBALL.  This involves removing a lot of the distractions and drains of life (like electronics, phone, friends, even where to sit) and adds ways of dealing with stress (earlier bedtime, spending time with parents who can role model, only going places as a family).  
To demonstrate they are ready to get out of the FAIR Club the child must be RRHAFTBALL and complete their writing assignment and extra chore.  Assignments and consequences are based on the child’s developmental age, Logical Consequences and Restitution.   

The Trust Jar - This is a visual, concrete way to explain trust to a child.  The trust jar is a very visibly placed large vase filled with cotton balls, lima beans, anything not intrinsically appealing.   The vase should be mostly full, so if the child is 6 and the jar was less than half full, the child would get the life of a 3 yr old....constant supervision, no friends houses, or paints, or scissors etc... If the jar is near full the child has full rights to everything a 6 yr old can do....playdoh access, bike riding, friends’ houses, big kid books etc...

Things that don't work:
  • Sticker charts 
  • Reward or Point Systems
  • Level Charts
  • Spanking or other physical punishments (or threats) - In the middle of a rage, their brain is turned off so they don't understand it. After a rage, punishing a child for a behavior problem won't be effective at all, because by definition a behavior problem is out of their control.
  • "Scared Straight" type methods - don't work for the same reason punishments don't work - this is out of the child's control. Many children don't understand long-term cause and effect so in their mind, this will never happen, plus, they often cannot "learn from their mistakes." Prisoner of war mentality - there is nothing you can do that is worse than what has already happened to them.