We were hoping that now that Kitty has friends at the new "school" that the meltdowns at home would decrease, but no such luck.
Got a call from the PDH's psychiatrist. She's been out of town for the last week and now the insurance company is pressuring her to make med changes (since obviously that's all that's wrong with Kitty. *sarcasm drip*). So she called me and started suggesting new meds?! I asked her if she'd discussed these with Kitty's psychiatrist (who Kitty can't see while she's in the PDH program, but has a lot more info about Kitty's past then I do and she has been in his care for over 2 years). Nope. She hadn't contacted him about Kitty at all. I mentioned that the psychiatric hospital had planned to change her meds until they discussed it with our psychiatrist, and changed their mind. I was fine with any changes she wanted to make - as long as she had discussed it with our psychiatrist first.
She'd said she'd call him that day (Bear had an appointment that evening so we knew she hadn't called), but she apparently did finally make the call this morning. We're going to be changing a lot of meds for Kitty. Wellbutrin for the depression (not supposed to make bipolar kids manic and decreases appetite so we might get rid of those extra 50lbs Kitty has put on since this Summer). She'll start that tomorrow morning. Early next week she'll start on Lithium for the bipolar and once that's in place we can start decreasing the extremely high dose of Trileptal Kitty is on - assuming it works of course. Then Adderall in place of the Concerta. Who knows?! Maybe this will help?!
We're still questioning whether or not the PDH is the right placement for Kitty. She is getting so much more aggravated during the day (stress is higher at this school because of the type of kids she comes into contact with), that she is coming home and taking it out on the family - much worse then when she was in public school. She is having a LOT more meltdowns at home. She has also started cussing a lot more (and not "naughty" words, but real cussing). Some of it could be the schedule change. Instead of leaving the house at 8am for school, she has to leave at 6:30am. That's a LOT less sleep, and with the added stress, she's probably not sleeping as well either.
She is often justifying her behavior with "I have issues" and "that's just the way I am." That does NOT make it acceptable behavior, but I'm not totally sure how to address it either.
Because of her PTSD (which is not really treatable by medication) once she is triggered into "Fight, Flight or Freeze" mode she is no longer rational and is reacting purely on instinct. If she were a small child and behaving like this (typical for those terrible twos!), I would just put her down for a nap, and try to eliminate whatever stress triggered the incident (food, tired, overwhelmed...). No long term consequences of course. The problem is, while at the time she is a small child emotionally... chronologically and in the eyes of the other kids (and later even herself) she is not a small child, and therefore should be held accountable for her actions. Every time she "gets away" with this type of behavior she sees it as permission to continue with it.
Because of the RAD (again, not treatable by medication), most of her issues are at home with her family of course, so all the extra therapy she's getting at the PDH is, I'm sure, helpful, but not with this issue. Once a week family therapy that's not conducted by someone who is very familiar with attachment disorders will not solve this "issue." I'm a little concerned that by admitting she has "issues" with family to this therapist that she will now reinforce her self-perception as someone who doesn't need/want a family. In other words it will become part of "who she is." Just like being a "girly girl" or "friendly."
In the 2 1/2 years we've had Kitty she HAS gotten attached to us. She does trust us not to hurt her (I think as evidenced by the fact that she will hit and scream at us - which she would never do with a stranger or Bear- aren't we lucky?!). She will occassionally admit that she loves me, sometimes will let me cuddle her and tell her that I love her, and will even sometimes that she loves Hubby, but it's rare. Most of the time though she denies that she wants to be part of the family, says she hates to be touched, and rages about how much everyone hates her. If we tell her we love her, the first word out of her mouth is "NO." Sometimes it's so hard to remember to tell her anyway. It's easy to convince someone you don't love them, but how do you convince them you do?! Just keep doing what we've been doing I guess.
Kitty has been in therapy more then half of her life. She knows and uses all the buzz words like, "I have anger management issues" or "I need to work on my behavior management." She knows what the therapists want to hear and she is EXCELLENT at changing the subject with tangents or other distractions.
I have no idea what our alternatives besides residential treatment would be, and I can't see residential treatment as being a good alternative for her. She is becoming more violent, but it seems to me that most of her issues are caused by her Complex PTSD (which being around agressive kids would aggravate even more, in addition to the fact that she's already afraid she's becoming "like her brother" - out of control and violent) and her RAD (which should alleviate significantly when she's not around the family as much, but certainly won't help her progress any).
Though keeping her at home is causing major problems too. Hubby is starting to feel like the warden again. Bear's PTSD is triggered by Kitty's meltdowns (last night he had to leave the house), and of course the other kids aren't getting a lot of attention (although they are not scared of Kitty like they were of Bear). I have to admit I'm highly frustrated because I feel a lot of pressure to "fix" everything. Mommy guilt makes me feel like there's a "right" way to handle situations or a "right" thing to say that would make it all better. My head knows that's impossible, but...
We had our second family therapy session today. Much of the session was just Hubby and I talking about our concerns to the therapist (who now reads this blog, "Hi, Mr. O!" - so I better watch what I say!). When Kitty did come in she started the session with this new quiet voice that I've only really heard her use with this therapist. He commented on the fact that he's never heard her use this voice before either.
Then, breakthrough! He started talking to her about an incident yesterday (she witnessed two girls coming to blows at the PDH) and what happened when she got home (meltdown with Grandma that involved cussing and yelling and then the same with Hubby and I that denegrated to hitting Hubby). The "real" Kitty started coming out. She talked about her hatred for our family, gave the therapist several "real life" examples of her vengeance issues (he'd been asking us about it), and generally showed him the side of her that only us as her family and a select few of her therapists get to see.
Not a very productive session, but for some reason I always feel a little better when other people see her acting like this, and how we respond (calmly). I often feel like "they" think it's all in our head or we are "provoking" it (by yelling at her or treating her badly). With Bear it was a lot easier because he was unable to control his behavior at all when he "lost it" so it wasn't always directed at us. Kitty puts up the charming, friendly facade that is so typical for RAD kids.
So now what? What are our options?
1. We can put her back in public school where at least there was less stress at school. She will continue to fall apart, but it probably won't be as fast.
2. We can stick it out with the PDH and hope that the med changes will take effect quickly.
3. We can move her to residential treatment and hope that the neurological assessments make a big difference (and she won't be home while they make med changes which would be easier on the family).
4. ???!!! I've thought about an attachment intensive, but she has so many other issues that would make that so complicated. And more importantly (unfortunately) this would cost a lot of money and time that we just don't have. I haven't found a local therapist willing to do an intensive. Most of the few I can find on the internet are in Colorado (not just a hop, skip and a jump from here!). I do have family in CO, but the other 3 kids need us too. Not to mention that she is now 14 so attachment therapy at this age is VERY difficult. Of course emotionally/ developmentally she is only about 4-5 years old so maybe that helps.
Purplewalls - thanks for the suggestion regarding TinkerBear. I am strongly considering it! Say hi to the ladies at the C&C board for me. In my 3 computer change this year I managed to lose my user name and password and I can't get it to e-mail it to me. *sigh* Will keep working on it! Do you know if the user name is an e-mail addy or a name? That would narrow down the choices some.