Can I change my mind?

When I drove up to the psych hospital with Kitty, she told me she'd changed her mind. She didn't want to go. I tried to reassure her, and reminded her that this was necessary. She was not happy, and that she needed the doctor's help to feel better. I reinforced that she had to tell the truth about her symptoms, the whole truth, or the doctors couldn't help her.

We spent the 4.5 hours of check-in time (no idea why it takes that long - especially since she's been there before, we'd faxed in tons of documents, they knew we were coming, and had a bed for us) with her completely shut down and snuggled in to me on an uncomfortable plastic loveseat. Every 45 minutes or so, someone would come and talk to one of us or both of us, we'd fill out some papers, and then they'd send us back to the waiting room. The TV was on an inappropriate channel so we sat with our backs to it and ignored it. The lobby was semi-crowded, but at least this time no one was bothering us and they even fed her dinner.

When I left her she gave me yet another big hug, and walked off to be checked over by the medical doctor.

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I talked to her on the phone the next day. She did not want to be there, but she sounded the same. Our conversation was brief because she had a stomach ache and wanted to go lie down. I told her I was sorry we couldn't come visit that night, but we'd see her the next afternoon.

---------------------------------------------------------------

Yesterday on the way to a meeting with the psychiatrist at the phosp I talked to a friend of mine with a daughter that attends Bear's special school. Bear had confided in this family friend that he felt like we were deliberately keeping him out of the loop about his sister. I know last time she went to the hospital he felt a sense of guilt, as though it was his fault. This time he felt the same, probably partly because we've been working really hard with him, trying to keep him from teasing and pestering Kitty while she's in this emotionally fragile state. Will try to reinforce to him in therapy today that this isn't his fault, but he really cannot tease and pester her.

---------------------------------------------------------------

Met with the psychiatrist at the phosp, and not really encouraged. They want to replace Kitty's Abil*fy and Trazad*ne with Clon*dine, and her Conc*rta with Foc*lin. This makes me really nervous, because Abil*fy is what finally got Kitty stable 2 years ago when this happened last. She's been on an admittedly mega high dose of it ever since. I talked to her therapist later and she is nervous as well. *sigh* My only reassurance was that at least it would happen there... probably. Of course they're just as likely to start the process and then send her home, like they did with the Proz*c at the last phosp.

Honestly I wasn't terribly upset by this until I met with Kitty afterward. I should have known what was coming when the pdoc asked us to talk about how Kitty ended up in the phosp. We talked about the day she ended up at the last hospital less than a month ago.

My version:, Kitty hadn't done her chores, and chose to sneak onto the computer anyway. It took me 20 minutes of "nagging" to get her off. Ponito got home from a playdate and I told him to do his chores. He said no, and then mentioned he had homework... on the computer. I let him get on and Kitty went ballistic so I put her on the "4 foot rule" until she could calm down, but she couldn't get regulated. It escalated to her punching me in the face.

Kitty's version: She was happily playing on the computer, and mean mom made her get off. Then Mom let horrible little brother play on it because she loves him more.

-----------------------------------------------------------------

Tell me again why I took Kitty to the hospital? Admittedly having a 150+lb growth permanently attached to my hip was draining, but I have to admit I was enjoying the loving part of her dependence. Yes, the meltdowns were awful... OK, I know why I took her, but... I CHANGED MY MIND!

-----------------------------------------------------------------

During our entire visit with Kitty she was perched on the edge of the seat, anxiously watching to see if the boy she was "interested" in was on his way out the door (he was being released). She gave us a quick, stiff hug when she was sure no one was looking - once when she arrived and once when she left. She wouldn't allow me to touch her. Her entire leg shook with the staccato tapping her foot was doing.

She spent the whole time railing at us about how we don't treat her like the 16 year old girl that she is, and that it's because we love the other kids more than her.

One proof that we don't love her: She NEEDS a Facebook page (she's not allowed to maintain contact with kids she meets in the phosp, but of course everyone breaks the phosp rule about it), EVERYone else in the house has a Facebook page except Ponito (We've changed the password on Bear's, but he still technically has one. I told her I don't actually have one, I just use Bear's. I've chosen to not notice Bob's). She promised me that this time she wouldn't be friends with Bear (biofamily found her last time because he was linked to them. When I discovered that, he lost his account again).

Kitty had also told Hubby her "best friend" was released earlier that day. I reminded her yet again that people she met in the phosp were people with issues, and as such were not capable of being good friends. This is why the phosp has the rule of no continued contact (which we enforce). She chose to pretend that she needed Facebook to keep in contact with school friends, and see this as yet more proof that we didn't love her.

We reminded her that we treat all our kids differently based on their needs, which has nothing to do with love, and actually very little to do with trust. She's heard all this a thousand times and can even answer me when I ask her why we do things the way we do, but she adamantly couldn't/ wouldn't process it.

Proof that we love the biokids more: Kitty brought up that Bob is starting to show signs of bipolar and therefore she and Bob should be treated the same. I tried to explain that even if Bob does become bipolar, Bob didn't have all the issues/ trauma that Kitty did growing up. Kitty missed out on a lot of things that Bob got, and now Kitty is having to play catch up and learn those skills. Plus, Kitty has proven over and over that she's not ready for the responsibilities yet, so she can't have the privileges. Kitty finally just admitted that she felt she deserved the privileges without the responsibilities.

So I tried a new analogy. She's 16 now and many 16 year olds can drive. So would it be right for me to give her the keys to car and send her to the store for me? She's never had a driving lesson and doesn't have a learning permit. Unlike Bear (who frequently sounds like Rainman saying, "I'm an excellent driver."), she admits that she doesn't know how to drive. Kitty agreed that this would be inappropriate and the police would probably get involved, but of course she chose to ignore the parallel to her not being prepared for the privileges she feels she's entitled to.

After all the conversations we've had about Super Sweet 16 birthdays, we've talked frequently about how kids who are given all the privileges they want frequently turn out to be unhappy, spoiled brats, and Kitty can parrot back what would happen if we gave her all of the privileges she wanted - whether she could handle them or not... but she was having none of it.

She remained shut down and agitated. When I confronted her on this, she said if she wasn't shut down she would cry (good insight at least). The group started lining up for dinner, and she was not able to participate in a conversation so we let her go. I'm sure she'll remember the meeting as us yelling at her. *sigh*

--------------------------------------------------------------

After our visit I was pretty shook up. Kitty was convinced that she would be going home in the next couple of days, and while that was most likely not true with all the med changes they were proposing... there was no way I wanted to take this child home. She'd regressed so far back in her attachment and was so shut down and angry. Usually after leaving a phosp or RTC she's homesick and grateful to be home and we get a honeymoon. I don't get the feeling that is going to be the case this time.

I decided to ask to talk to a social worker there. Sort of tell someone "our side" of the story so that maybe in group she would not be allowed to reinforce this distorted perception. Her point of view sounds typical and even developmentally appropriate for a teenager (Parents don't understand me. Trying to be independent and they won't let me. Treat me like a younger child.), - problem is of course that she's NOT a teenager in the ways it really counts.

I talked to a part-time social worker for an hour. She doesn't do groups with Kitty, but promised to pass on the info. Who knows if it will make a difference.

Temper Dysregulation Disorder with Dysphoria

Temper Dysregulation Disorder with Dysphoria is a proposed disorder for the new DSM V (THE big mental illness diagnostic manual used by mental health professionals). . T-triple D is supposed to be an alternate diagnosis for kid's with pediatric onset bipolar. There is a lot of controversy regarding whether this is a legit diagnosis or going to be the new over-diagnosed dumping ground (like ADHD and pediatric bipolar have been in the past). Here's some interesting takes: justification, precursor to bipolar?, what happens with misdiagnosis?

I want to read The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children , which I've seen recommended before. It's supposed to be highly applicable. It's on my Amazon Wish List (with a lot of other great books!).

T-triple D can easily describe my kids, but so do their current diagnoses, including the Reactive Attachment Disorder, Complex Post Traumatic Stress Disorder and the Bipolar Disorder. I often think they could also be diagnosed with Oppositional Defiant Disorder. I hear in therapy often that I'm assigning their behaviors overly much to a diagnosis - justifying or blaming Bear's issues with me on RAD for example. I've done a lot of reading and research over the years, but I have more of a generalized knowledge than specialized and sometimes I think people assume I know something I don't so don't always explain things to me. I'm guilty of stopping short of doing all the needed research too, and end up making mistakes like not recognizing side effects of meds or settling for behaviors that could improve with treatment.

I just wish it was like diagnosing diabetes. We know what it is and how to treat it. As long as we follow the rules and with a little luck, then we should do OK. Having more than one diagnosis, the kids' ages and history, different body chemistries... makes it so complicated! I'm just so tired. I want to get it right, but I know there is no such thing.

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


Temper Dysregulation Disorder with Dysphoria

A. The disorder is characterized by severe recurrent temper outbursts in response to common stressors.

1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.


2. The reaction is grossly out of proportion in intensity or duration to the situation or provocation.


3. The responses are inconsistent with developmental level.
   

B. Frequency: The temper outbursts occur, on average, three or more times per week.

C. Mood between temper outbursts:

1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).


2. The negative mood is observable by others (e.g., parents, teachers, peers).

D. Duration: Criteria A-C have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-C for more than 3 months at a time.

E. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.

F. Chronological age is at least 6 years (or equivalent developmental level).

G. The onset is before age 10 years.

H. In the past year, there has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day for most days, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of three of the “B” criteria of mania (i.e., grandiosity or inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences; see pp. XX). Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation.

I. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (e.g., Major Depressive Disorder, Dysthymic Disorder, Bipolar Disorder) and are not better accounted for by another mental disorder (e.g., Pervasive Developmental Disorder, post-traumatic stress disorder, separation anxiety disorder). (Note: This diagnosis can co-exist with Oppositional Defiant Disorder, ADHD, Conduct Disorder, and Substance Use Disorders.) The symptoms are not due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.

Hospitalized

Kitty was admitted to a psych hospital this evening for suicidal ideations. If possible I'd like to keep the Parent/Teacher conference on Monday morning, to discuss how to handle her return.

She'll need school work to do at the hospital as well. I signed a release form for the hospital to talk to everyone. I'll go through her backpack tomorrow and see if I can find any work for her. I know she has a science project, but I'm not sure what kind of collection she can do in the hospital (unless you want a diorama of 10 psychotropic meds?).

Mary Themom
cell (###) ###-####
Founder: http://groups.yahoo.com/group/PCT_ParentsofChildrenofTrauma/

There are no seven wonders of the world in the eyes of a child. There are seven million.
~Walt Streightiff

E-mail Novel - Part 2

I called the crisis hotline tonight, and we're going to bring Kitty into MHMR for evaluation tomorrow. I don't know what the results will be of course, but I'm assuming she will probably be hospitalized. None of us can continue this way.

Kitty got off to school OK today, and made it through her Science benchmark exam. I hadn't given her any Klon*pin (anti-anxiety med) because I was afraid it would make her too tired. After she finished her test she asked for the Klon*pin to help her deal with the anxiety about how she did. She then apparently laid her head down and slept for an hour. When she woke up, she went to the nurse because she wasn't feeling well. It was only an hour until I was supposed to pick her up anyway so I had her lay down until I got there. I took her home for lunch and a nap (I didn't know she'd slept at school, but she definitely didn't sleep well last night - bed late because of the meltdown, got up several times to eat, get water and potty).

In the afternoon she started whining for privileges (buy her a movie, take her to the store for a snack/ treat...). I told her no, and that she needed to pick up her room as it was in pretty bad shape. She had moved the entire contents of the playroom to her room and I told her she needed to put it back. Meltdown. She locked herself in the pantry (although she opened the door when I insisted). She cried, hit walls, kicked the door, and demanded I leave her alone (which I couldn't do), because... I hated her, she hated this family, I should prove I love her by giving her what she wanted. I gave her another Klon*pin (didn't see any results), and tried everything I could think of to calm her down. I finally got her calmed enough to get off the floor of the pantry and help pick up her room for a few minutes (mostly she watched me and alternately cried and yelled at me)... but then it was time for therapy. I managed to get her in the car (she locked me out of it for about a minute, but then let me in) and to therapy... where she continued to meltdown in the parking lot for 20 minutes (she wanted a treat, she wanted me to rent her a movie, I don't love her, I love the other kids more than her - because they never "misbehave"/have meltdowns like she does, I never buy anything for her...)

We finally got into the therapy session, where she calmed down and let me hold and comfort her while she talked to the therapist in a subdued, quiet voice. She said one reason she was so upset was the stress of TAKS on Thursday and being so behind in school. I told her I had just decided she will not be taking the TAKS. I can't see torturing her (and us) with the stress of a test that isn't going to be accurate anyway in the state she's in. I will keep her home on Thursday and if the school has a problem with it, then they can come up with a better alternative. She perked up a little, but as soon as therapy was over and we got back to the car she started begging for treats again, melting down again, superficially self-harming, crying and angry. We got home and she locked herself in the bathroom until she realized I was calling the MHMR crisis line. She was afraid I was calling the police or a psych hospital and started wailing louder and came out.

The Crisis line gave us 5 options
1. Call the police and have her taken to a psych hospital immediately - probably where she needs to be, but emotionally so damaging that I don't want to do this.
2. Take her to the MHMR center where they will do an immediate evaluation (but this would take quite awhile, and Hubby is teaching scuba all this week, so I'd have to have Grandma watch the other kids until we/I got back.
3. Take her to the ER for an assessment.
4. Wait until tomorrow morning to call and give MHMR center a heads up that we're coming so they'll be ready for us and possibly can arrange to have Kitty's new case manager there to meet us.
5. I don't remember 5, but we chose option 4.

I finally got Kitty calmed down. I told her I knew she wasn't "misbehaving" (her word) on purpose. I explained that I thought her meds weren't right, because her body has changed or sometimes meds just don't work the same after awhile. That we're trying to change her environment to be less stressful too. I told her that I know she is hiding her symptoms (which surprised her, she said she didn't think I knew) because she is afraid she will have to go the psych hospital, but that she HAS to tell the doctor about all her symptoms (including the racing heart, racing thoughts, anxiety and suicidal thoughts...) so that the doctor can get her on the right medications and she can get better. If she doesn't tell the doctor, then nothing will change... and things can't go on as they are or she will end up back in a psych hospital anyway. I have to keep her safe.


Mary Brush
cell (###) ###-####
Founder: http://groups.yahoo.com/group/PCT_ParentsofChildrenofTrauma/

There are no seven wonders of the world in the eyes of a child. There are seven million.
~Walt Streightiff

******************************************
RESPONSES to Yesterday's e-mail Novel:

-----Original Message-----From: Ms. Skills Trainer
Hi Mary,

Thank you very much for your email. Kitty's case manager and I would like to discuss these issues with you tomorrow at our meeting at 10:30am. I am concerned about her possibly hiding suicidal thoughts and would of course encourage you to call the crisis hotline immediately if she voices any suicidal ideation or attempts to hurt herself again (never hurts to at least talk to an intake person at crisis and see what they have to say...). The crisis hotline number is: 1-800-###-####. I think it would be helpful for Case Manager and I to talk to Kitty alone during part of the meeting and ask her about her intentions if any.

Please give Case Manager or I a call if any further concerns arise...

Take care Mary and hang in there!

Ms. Skills Trainer

-----Original Message-----From: Ms. EMDR therapist

I am thinking that you need to consider long term residential treatment for Kitty; and that what you are now doing (which is the most you can do) is not working. I think she needs to be told that it is clear that home is not the most helpful place for her, The only other options would be to place her in in long term treatement. Mary, you all have done all you can. This is so much more than any of what has been figured out. I feel she needs to understand that without her being able to function in the home or school; more is needed than you can provide. It doesn't help her to continue like this; when you have done all you can do. Think about it. If you feel you want to consider this; then we can talk about it before Friday. Always, Ms. EMDR

Ms. EMDR therapist, M.S.; LPC-LCDC
Trauma and Addictions Specialist

Another e-mail novel

I don't know what to do! Tonight Kitty had a major meltdown, but at least she kept everything to threats, with no actual physical harm (although she claims she scratched/gouged herself, but it didn't leave a mark because she "needs to sharpen her nails"). She didn't want me to have an excuse to call the police. Honestly I probably could have gotten her to take the Klon*pin to see if it would have made a difference, but I thought I'd left it in my car because we'd used it at school (and Hubby wasn't home so I couldn't leave her alone to go get it). Honestly I don't know how much more of this I can take. I know she's lying about not having suicidal thoughts. She slips and talks about them, but she's afraid we'll send her to a psych hospital if she admits to it.

Kitty has a school parent/teacher conference to "discuss options" on MONDAY, MAY 2ND at 9:15 AM. Including the week at the psych hospital, Kitty has been mostly out of school 4 weeks now. She started half days (2 out of 4 periods) almost 3 weeks ago. She has only made it through both periods once or twice. I don't think she's made it to a single math class yet (it's the last period of the day).

Tuesday she apparently had stomach flu (and threw up at the parent support group - sorry!). So I kept her out of school the next day. Bear had started throwing up too, so I took him to the doctor Wednesday night and he was diagnosed with Strep. So I assumed Kitty had it (she's highly prone to it) and kept her home from school Thursday. On Thursday, the doctor said she had a stomach virus, but not Strep. Friday was a holiday, no school and Kitty was in a great mood most of the day. Saturday, no school and Kitty was in a good mood most of the day. We were foolishly starting to feel that we'd finally gotten Kitty stabilized again. That all the "evil" SSRI's were out of her system and now we could focus on getting rid of the anxiety that triggered her visit to the psych hospital in the first place.

On Sunday we started the Klon*pin and she went to Sunday School. She came home tired and nauseous all day. Tiredness is a side-effect of Klon*pin. Vomiting/nausea is not.

This reinforced my belief that Kitty's biggest (not only) problems are related to social interactions. Her world is so black and white that she can't handle other people's "naughty" acts, and high school teens are notorious for being "naughty." Kitty won't say anything to them though. She just internalizes it and brings it home. She's sooo empathetic that she absorbs the guilt she thinks they should have! I think what really started this downhill slide was when a boy she was attracted to was cutting and depressed. She stated it made her feel that way too. Monday, today, she took the Klon*pin in the morning and we had a quiet morning, and went shopping (for something for her). She was engaged and fine although she complained about some sore muscles. Another reason to believe a lot of her issues are school anxiety. I had told her to bring a lunch because we might not get back in time for her to eat lunch. About 11:30 she said she was hungry (she'd had some veggies for breakfast - she knows better. She's supposed to eat something with protein). I thought we'd have time for lunch with Grandma so I told her to go ahead and eat her lunch (peanut butter sandwich and some goldfish).

On the way to school we got stuck in a bad traffic jam and I realized we might not have time to stop by Grandma's for lunch after all. When I said her sandwich and crackers was going to have to be enough, she lost it (food is often a trauma trigger for her). She started crying and saying she wanted to die. That I hated her and she wasn't going to school. I called Grandma to ask her to have a peanut butter and jelly sandwich ready for Kitty to take to school. Kitty continued to meltdown, because she didn't want another peanut butter sandwich. I mentioned a ham sandwich and Kitty perked up for a second, but then continued the meltdown.

We made it to Grandma's with a little more time than I'd expected. I gave Kitty a Klon*pin (making this her second of the day) and she ate a small lunch. She plodded into school. An hour later I got a call from the nurse's office. Kitty had vomited and wanted to go home. I let her rest in the nurse's office for 1/2 an hour, but she could not rally. I took her home. I hadn't left the school, because I had spent the hour in my car talking to a charter school on the phone - they said it might work... next year, if she got in (waiting list), and could handle the fact that they mostly did everything in self-paced workbooks, and they were losing most of their special ed funding so there would be less special ed assistance next year than the little they offered this year (maybe 3 hours a week if she was lucky).... Another big problem with Kitty being plastered to my hip is I can't talk about her, her issues, or alternatives - especially ones she would hate, like psych hospitals and possible RTC.

She spent the rest of the day alternating between complaining of nausea and begging for food. She really does have emotional eating issues, and little ability to hear what her body is saying.

This means it has been a month since she has gone to math class (last period of the day). Science benchmark is Tuesday. I'm sending her but I doubt she'll make it through the whole thing, or that it will be very accurate if she does. Math TAKS is on Thursday. She's only a freshman so it's not the end of the world if she doesn't pass it. She apparently has had a packet to work on for at least a week, but never told me about it and never took it out of her backpack that I know of.

FYI, tonight's meltdown was because she clogged the toilet and rather than tell me about it, she locked the door to the bathroom from the inside which wasn't discovered until bedtime. When I got a little frustrated with her and asked her to next time please just tell me instead of locking the door, apparently I spoke to her in a "mean way" and then I "ignored her" (while I removed the doorknob and cleaned up the poo soaked bathroom.) Not sure it's clear here. Kitty is not supposed to use our bathroom to poo (there are 3 other bathrooms in the house that don't have carpeted floors). She knew this was a "no no." She also knew the most I would do was correct her and have her help me with clean up (maybe not even that since it usually requires a snake to clean up, Daddy would normally do this, but I managed to get it unclogged myself). She was not inside the locked bathroom. She was wandering around the house acting as though she knew nothing about it.I finally got her to go to bed (1 1/2 hours after her bedtime) and stayed with her until she almost fell asleep (Hubby got home and I needed to talk to him).Mary
cell (###) ###-####

Founder: http://groups.yahoo.com/group/PCT_ParentsofChildrenofTrauma/

There are no seven wonders of the world in the eyes of a child. There are seven million.
~Walt Streightiff
PS. Didn't bother to send this to the school or pdoc, but apparently Bob spent 2 hours crying in the laundry room. When Bear discovered her, he told me and it took me quite awhile to get her to tell me that the reason she didn't want to talk to me was because she was upset that I hadn't noticed she was gone for 2 hours even though she'd "walked past me" while I was in the kitchen making dinner! I finally convinced her that she spends hours in her room and so of course I don't notice when she's not there.

She calmed down enough to tell me that she didn't have a reason for crying in the first place. She's just felt like this all day. *sigh* Getting harder and harder to deny the fact that she probably has adolescent onset bipolar. We don't have health insurance. Hubby makes too much money to get on Medicaid. This sucks!

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

Hubby felt incredibly guilty that he was teaching scuba tonight so wasn't home for any of this. After Kitty fell asleep, we talked about the fact that we're stuck between a rock and a hard place. Contract work pays well and is the only reason we're mostly keeping up with our bills. If he gets a "real" job then we'll have health insurance, but he'll have to take a major pay cut. He was going to wait until I got a job and then I could pick up the slack, but I can't get a job until Kitty gets stable or we get Kitty into a program like the local partial day hospitalization program, which doesn't take Medicaid, so we'd have to pay for it with private insurance, which we don't have because I can't get a job because Kitty's not stable...

Did I mention last night I went to bed after 3am, so I'm doing all this on less than 4 hours of sleep? It's midnight now. I still have to take a bath because I smell like poo (although I did get smart and wear gloves this time).

School Days

Triplehmoms: "I thought I remembered you saying that Kitty had low to low average IQ and other issues surrounding learning too. I was just asking what you expected her to "get" out of school.


I am not sure what is available in your area in terms of alternate schools. I know here, we have different alternatives, both public/charter or private. It just seems that SO much of Kitty's school issues surround the other kids, not necessarily the work she needs to complete. So, perhaps a different school setting is in order, even an online setting. This would just give her the option of 'self-paced" to complete her work and not have to deal with the kids. Yes, I realize that she will eventually have to deal with the public in the work force, etc. but she doesn't HAVE to do it now. I hope that makes sense."

Generally both kids have general IQs in the low 90s, which isn't bad. EXCEPT, they have major issues with memory, they have many areas areas they don't do well in (especially math, reading and writing/spelling), and when they are under stress or feel anxiety, they can't process well and regress to about 2nd grade level. Add in the fact that they are emotionally disturbed...

Will be interesting to see if the new evaluation tells us anything different. Of course taking it during her current issues seems like it would skew everything, but it's probably always going to be something.

***********************************************************
Our adventures with schools

5TH GRADE

Kitty came to us 1/2 way through 5th grade with an IEP for her ADHD and learning disabilities. She was working on about a 2nd grade level and we were told she HATED school. Just before school ended for the Summer we got her put on Concerta and she jumped academically to about 4th grade! She was mostly in the resource room, and was failing the few regular ed classes with inclusion help that she had.
(That's Bob in the background. Kitty on the right. The other girl was one of Bob's best friends)

Kitty was much more focused on being popular, especially more popular than Bob (who has been with most of these kids since she was age 3, but is introverted and not interested in being popular). Bob tried to warn her about the popular girls (who could be very mean), but Kitty couldn't accept her warnings.

Kitty tried to make friends with the other kids by making Bob look bad. She also tried to ingratiate herself with the popular kids, and briefly she was new and the kids were paying lots of attention to her, but while Kitty is very friendly, she doesn't have many social skills so couldn't maintain the friendships. Plus her black and white thinking got her into trouble pretty quickly as the other kids did things that she considered wrong and she started taking sides.

The public school said they intended to mainstream Kitty with inclusion help, despite the fact that she was failing all her mainstreamed classes. We couldn't let that happen so we started looking into private schools (we'd never heard of charter schools). No one would touch a kid with Kitty's learning disabilities. A neighbor started teaching at a small private school (less than 40 kids in the whole school Pre-K through high school!) that took kids with special needs - focused on kids with attention differences (quite a few kids had ADHD and Aspergers).

6TH GRADE
We enrolled Bob, Kitty and Ponito. (Bear was in residential treatment and then the special school, and with his issues there was no way the private school could/ would accommodate him anyway - although they had let him attend "Summer school" briefly right before he got into the RTC. We had him zombified on Dep*kote until a bed opened up, so while there he mostly slept or cried for a few hours a day - giving us a little respite.)

The first year was pretty good. They did assessments and started helping Kitty fill in the gaps and get caught up. We assumed that most of her academic issues were the untreated ADHD and social issues. The school used a workbook format so Kitty could work at her own pace and none of the other kids were aware that she wasn't working on the same level as everyone else. I was surprised that she did OK with the workbooks, but maybe it worked because she could switch subjects whenever she needed to. The teachers (one of which was our caring neighbor) were right there to answer any questions.

Kitty's relationship with Bob improved (partly because we'd moved them out of the same room, and partly because Bob got significantly taller than Kitty and Kitty was afraid of Bob). Kitty made friends with the only other girl in their age range. Bob wasn't interested in the gossip and made other friends.

Kitty continued to have issues with academics though. She was also chronically tired, "ill" (headaches, stomach aches, tooth aches...) and frequently smelled so badly (RAD stink) that she had to be sent home. She wouldn't/ couldn't let me help her with makeup work and slipped further and further behind (she was supposed to do a certain number of pages a day, but wasn't able to get them done). We tried to continue on over the Summer to get her caught up, but it didn't go well and we experienced multiple meltdowns.

7TH GRADE
Kitty's only friend, the other girl in the class, went back to public school. We were having major issues affording tuition. Kitty's learning disabilities seemed to be causing her more and more issues. I think academically the concepts were getting more abstract, which Kitty couldn't grasp. We had her assessed by the public school system in the school district she attended private school in, (telling them that no matter what they wouldn't have to provide services), and got a pretty accurate assessment (in my opinion). They said Kitty was still acting as though she had just left a war zone and that was why she was having so many issues with anxiety. When she was under stress, she dropped from operating on about a 5th grade level to a 2nd grade level.

Half way through the 7th grade, we finally decided we had to put Kitty (and Bob) back in public school. (We'd already put Ponito back at the beginning of the year). With a lot of advocating we got Kitty back in all resource classes. She was in and out of psych hospitals all that year.

9TH GRADE


The school said they wanted to put Kitty in several regular ed classes with inclusion help. I pointed out that she had never successfully had a class with homework, and felt that starting high school with homework too, seemed stupid to me. I managed to convince them to put her in all Applied classes and suggested they assign homework. They haven't done that yet, so I don't see them convincing me to put her in mainstream classes.

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

We've looked into charter schools, but most of them won't take kids with Kitty's learning disabilities. Online and homeschooling is not an option for the same reason. Plus Kitty is an extrovert and craves being around other kids. I wish we could put her in a school with younger kids who don't have the same issues that she's exposed to in public school (private school was a little better, but not much when it came to other kids' attitudes and drama).

Bonding time

Got to spend bonding time with a sick Bear (who wasn't feeling sick enough to really act sick). He did lay his head in my lap at the doctor's office (he was laying across 3 chairs and I was signaling him to sit up, but when I realized he was just going to lift his head so I could sit in one of the chairs I decided to take what I could get).

The 9 yr old girl who was sitting nicely next to her mother while her 7 yr old brother quietly complained of being hungry (Bear was doing the same thing, but not as quietly), was confused by Bear. We chatted for a few minutes about "always being our mother's 'baby,'" but she still didn't get that Bear was my son. She finally caught on and told me she had thought he was my boyfriend and that he was 20. I just assured her that happens alot, and he's really only 17.

He actually chatted with me in the office (which was mostly him teasing me and being obnoxious, but still fairly compliant). Complaining that the doctor asked too many questions, that he had nothing to do, that I'd never heard of AlQuada (sp?), that it was hard to spell words like "clarity" and "celebrity"... I'm not sure what the doctor was thinking about him. She didn't have access to his records (he fiddled with the mouse and the wires before I could stop him - bored kid with ADD... *sigh*).

Bear kept insisting that he was throwing up only because he hasn't slept in over a week (we know he has been sleeping at least a couple of hours maybe longer, but either way he doesn't feel rested). Last night I gave him an over the counter sleep aid (Valeri*n) in addition to his regular sleep medicine, but he said it made no difference at all. When the doctor started addressing his sleep concerns that was when we really noticed the lack of records. She suggested Melat*nin and I started naming off the prescription sleep meds Bear has tried but that haven't worked for longer than a couple of weeks. When she heard he'd had a sleep study last Summer, she basically said that she wouldn't be able to give us any advice. *sigh* I decided to try Melat*nin tonight. I already put in a call to his psychiatrist in case that doesn't work.

Bear likes to diagnose himself (decide what's wrong and how to treat it). He tends to wait weeks to tell me about important stuff (like bleeding when he urinates, not sleeping for over a week...), and often when he does finally tell me, it's usually casually (so I may not realize he's really hurting and do something about it) and/or at a time when there's not much I can do about it (like today at 4:50pm he told me he'd been vomiting for two days - luckily the clinic was still open). On the other hand he tells me about lesser injuries or psychosomatic symptoms (my heart hurts, my knee hurts and I need surgery on it, you have to take me to the doctor for my shoulder...) ALL THE TIME.

My favorite example of this frustrating behavior: he once mentioned, years ago, that sleep meds "don't work after a couple of weeks." From this I'm supposed to infer that every time we try him on a new sleep med that it will stop working after two weeks. If I assume, because he doesn't say anything, that the med is continuing to work, then I'm being neglectful and unloving, because he told me and I didn't do anything about it.

Anyway, Bear has STREP. Which means Kitty has strep too, because she is incredibly prone to it. So she's really sick, and I'm a bad Mommy for sending them to school anyway. Actually the doctor said Bear could go to school tomorrow anyway (thank goodness, because two of them home would kill me). Kitty has an appointment tomorrow morning.

Plea for help letters

Letter to Kitty's school, mental health providers, therapist, and the head of the special school that Bear attends:

Hi guys,

I feel it’s time to request an ARD (IEP meeting) to see if we can come up with a plan F, G… not sure what letter we’re up to… as this is just not working. Everybody has been amazing and super supportive, but Kitty is still so unstable. On top of the stress/anxiety that started all of this, now Kitty is adding to her own anxiety because she knows she’s getting further and further behind due to missing so many classes. She told {school psychiatrist}that she’s having suicidal thoughts, which we know about, but of course still have to address. This is worrying me because she’s starting to try to keep this from her mental health team and myself because she knows we might have to put her back in the psych hospital if she’s suicidal.

She’s starting yet another med tomorrow, but it’s only supposed to be a PRN (it can be addictive) so I don’t think we can expect it to make changes in the underlying issues. My biggest concern is that it feels like we’ve maxed what {the high school} is capable of providing Kitty and it’s just not enough. If you guys have more suggestions I’d love to hear them. I do think we should consider {the Special School for emotionally disturbed kids that Bear attends} or some other type of contained classroom for Kitty, at least for the rest of the school year.

I know TAKS {Texas standardized testing} is coming up next week. I need to get her schedule so we can try to get her there for the key times when at all possible.

Kitty has been complaining of bad stomach pain and threw up once last night and once this morning. No fever, but it could be stomach flu so I kept her home today (Bear said he hasn't slept in a week and that's why he's throwing up, but since that makes two, it's probably stomach flu). She’s resting now. We have not started the anti-anxiety med yet, as it is supposed to be PRN, and with her vomiting and not in school anyway it would be difficult to tell if it is working or causing side effects. Assuming she’s feeling better tomorrow she’ll start it then.

We’re working with her mental health provider to introduce a new skills trainer and case manager, who would like to meet with her at school since that’s where Kitty seems to need the most services right now. I realize this is made even more difficult by the fact that we’re having trouble getting Kitty to stay in school at all (she
appears to be only able to make it through a class a day). Plus {school psychiatrist} is trying to get Kitty’s testing done for the new FIE {school psych eval}. Next week because of TAKS we’ll try to have the meeting at home.

Thanks for everything you guys are doing to help Kitty through this!
Mary

Sent to the Nebraska casemanager who is trying to help us access post-adoptive services if she's able:

Hi Kari,

I'm not sure if there is someone else I'm supposed to be working with here, but here's what I found out this week.

Good news! I talked to the TX adoption specialist with CPS. They said they'd extend Bear's TX Medicaid to age 19 (instead of cutting him off when he turns 18) as long as they have a letter stating Nebraska is extending services with a subsidy to age 19 (which of course you are because that's how long it goes anyway). The 601 form that was filled out by ICAMA that qualified him for TX Medicaid when he was adopted, with the extension to age 19, must be sent where it was sent the first time in 2008 (when Bear was adopted). The ICAMA coordinator is {###}. If there is someone in Nebraska that I should speak directly to about this, please just give me the contact info and I will. Obviously if we're going to do this for Bear, then it only makes sense to do it for both kids at the same time.

Additional help urgently needed:
Kitty went to a psych hospital 3 weeks ago for domestic violence (she punched me in the face) and suicidal threats. She was there less than a week and then was released, but they put her on an anti-depressant which triggered self-harming behaviors (she's never really self-harmed before). They tried a second SSRI (anti-depressant) with similar results. Currently she's not taking anything new (she's on quite a few meds), although we have an anti-anxiety PRN med she'll start taking. So here's where I need help. The school is unable to keep her feeling safe, she still has suicidal thoughts, and despite cutting her back to half days, she's still coming home after attending only one class (so is getting even further behind in school. which adds to her anxiety). I don't think she needs to be in a psych hospital (we seem to be able to keep her safe so far), residential treatment seems a bit extreme at this point (although we're heading there), and her psychiatrist is suggesting partial day hospitalization (school and therapy all day, but she comes home every night). Unfortunately there is only one place in our area that offers this type of program and they don't take TX Medicaid. They take other kinds of insurance though. We had residential treatment written into our adoption subsidies for the kids (- if we can't get funding on our own, then Nebraska will pay for it). Partial day hospitalization is not residential treatment, but we're hoping that Nebraska can help us get it to prevent needing residential. This is absolutely desperate. Kitty is getting worse and I am on the edge trying to keep her stable. Can you help?


Mary

Warning Whiny Post! Please Skip this post!

WARNING! WHINY POST! Please skip so you can maintain the positive image you have of me. I know others are having a much tougher time right now.

Waahh! My life sucks right now. Literally. I have a 160lb growth suctioned onto my hip that requires constant attention. She hasn’t made it through more than 1 ½ hours of school since she got home from the psych hospital (almost 3 weeks ago – seems like longer), and I’m spending most of that time sitting in the assistant principal’s office waiting for “the call” (“Moooommmyy, I don’t feel good…”) or talking to various administration trying to figure out if we have any alternatives (they’ve been great, but this is still killing me).

The rest of the time I’m driving her to doctor appointments, weekly pdoc appointments, 3x weekly therapy appointments… plus all the regular stuff that goes along with having 4 kids.

She belongs in a partial day hospitalization program, but the only one in town doesn’t take Medic*id, which is all she has (she and Bear are the only ones with any insurance at all). We’re finally getting the self-harming taken care of by getting her off the SSRIs she shouldn’t have been on in the first place, but now she’s vomiting and she told the school psychologist she still has suicidal impulses (to jump out her bedroom window – which wouldn’t kill her, but we’ve always allowed her to believe that, just in case). I don’t know when she’ll get stable. We try her on a new med (complete with scary addictive side effects) tomorrow.

Bear claims he hasn’t slept in a week, and of course believes that justifies his behavior (being an ***hole and picking on everyone – including Kitty, with the imagined results).

Bob is almost caught up after spending almost a week home from school with a major muscle strain from coughing (still hasn’t totally recovered, but has finally stopped laying around and moaning about it).

Ponito is in trouble for breaking a family rule, but other than that is just acting like a typical tween with all the accompanying hormonal induced behaviors.

Hubby still hates his job. He has been picking up odd jobs (teaching scuba, judging business plan competitions), so isn’t home much. Plus the bank has made a huge error that has put our house into foreclosure. Everytime they assure us they've gotten it fixed... they haven't. Also, he's worried about me, and frustrated with Odd's behavior - because he doesn't see her when she's feeling at her worst (she's like a pitiful puddle on the floor). He only sees her at the end of the day when she is more like herself (which is not exactly pleasant to be around, because she's whiny and defiant as she decompresses from the daily anxieties).

Bear is aggravating my PTSD; I’m not sleeping because of my bipolar, and I have NO down time or nap time because of my "leech" problem. I can't job hunt, and couldn't work right now even if I found one. I was expecting this to go much faster.

Hugs and thanks again for skipping this,

Mary

Sweet Sixteen

Kitty saw this cake at the grocery store and decided she wanted one like it, except she wanted Elmo, for her 16th birthday party. Looking back I realize I probably should have looked at a picture of Elmo, but she was happy. Struggling to Stand already took me to task for all the red food coloring (it was even red velvet cake).

Kitty is constantly calling me to come pick her up from school. This recent episode has regressed her back to an anxious attachment and if she's not attached to my hip, she's afraid she's going to hurt herself or she just doesn't feel good. If I'm not right there and totally sympathetic and giving her her way in everything, then she feels unloved, and she starts ramping up. To top it off we're dealing with some birth mom issues too and the stupid bank can't seem to get an escrow issue really fixed so keep calling us to say the house is in foreclosure (it's their mistake, we've been walking through it with them for many months, they say they fixed it, then call again demanding payment - they returned the last two payments!) - which scares the heck out of Bear and Kitty.

Kitty's been on the Trazad*ne for a little over a month (for sleep issues, but it's also an anti-depressant which can trigger mania), but the psych hospital tripled it because she was so terrified about being there, that she couldn't sleep. They told us to drop it to doubled (100mg) when she came home. They also put her on Proz*c, despite my protestations, because they said she'd only been "going downhill" for the last few months and since she was suicidal and therefore "needed" to be on an anti-depressant, it would be "fine" because she'd been stable on the mood stabilizers (Trilept*l and Abil*fy) for years, and they would keep her from going manic.

I've been pushing for an anti-anxiety med for months because I felt Kitty needed to be rediagnosed with an Anxiety Disorder in addition to the bipolar, etc. I was pushing for Clonip*n, but they said that was only PRN (which I know is not true). They chose Proz*c because it addressed both anxiety and depression. The side-effect of daytime sleepiness didn't bother them. They just said switch her to taking the Proz*c at night. I finally put my foot down because she's NEVER had self-harming behaviors before and after less than a week on Proz*c she'd begun clawing herself and begging me to never leave her alone (so I could keep her from harming herself). Tuesday they switched her to Cel*xa and the self-harming urge has faded to the point she can mostly control it herself, but she still is suffering from anxiety (headaches, nausea, clinginess...). She's constantly calling me to come get her from school after only one class.

She hasn't been on it long enough to say it's making things worse though. Today I took her in to her pediatrician and discovered she's suffering from allergy congestion so bad she's almost completely clogged (so no feelings of nasal stuffiness because it's practically solid and she's used to it).

Monday I had taken her in and they finally cleared out the ear wax in her ears that had completely blocked one of her ears to the point she failed the hearing test on it last week (every doctor has mentioned she had a lot of wax, but no one did anything and apparently what I did was ineffective). Ironically being able to hear better has made her even more sensitive to noise, so she's even less tolerant of school than before - which I didn't think was possible.

Now I'm looking at the chronic stomach aches with a new eye. I'd always assumed they were from her chronic constipation, anxiety, or psychosomatic, but it could be nasal drainage, GIRD, or something else.

How do you know?!

Currently we got the school to agree to 1/2 days (alternating mornings and afternoons so she doesn't miss all the same classes), and got the pdoc to sign a note saying ALL absences are excused from April 1 (the day she got out of the psych hospital)! The school has been amazing, especially since she NEVER shows any signs of issues at school (except for almost daily visits to the nurse with headaches and stomach aches). It's been 2 years since she was last in a psych hospital and I almost wish we'd not been doing everything we could to keep her from escalating, since we're finally getting some cooperation and changes made.

The other children are still having trouble too.

Bob has managed to strain all the muscles on her ribcage from coughing so is constantly in major pain and 800mg of Motrin doesn't even touch the pain. Plus she's too young for muscle relaxants and allergic to codeine - so options like hydrocodone are out. To top it off, sometimes she just starts bawling for no real reason, and I'm really starting to worry about adolescent onset BP for her.

Bear is struggling with all the trauma triggered by watching his sister deal with the police and going to the psych hospital (reminds him of his not too distant past).

Ponito is just hitting adolescence and so is experimenting with talking back, lying, not doing chores (no one else is doing them right now either) and generally being belligerent as only a tween with mentally ill older sibs of trauma for examples can be. "I hate you." "I'm going to kill myself." "You don't love me..."

Most days I'm handling it, but days like today... well, lets just say my BP and PTSD were triggered and let it go at that. Luckily Hubby was able to come home and help. So it's 12:30am and I'm on my computer trying to decompress and hoping I don't have more stress dreams about being dressed like a hooker in highschool with scary old men hitting on me when I dropped my lunch tray, not being able to find my documents, and adopting a teenage girl (not one I already have. ANOTHER ONE) who thinks I did something to her mother, all while trying to clean up after a wild birthday party in which my youngest and his friends were all dressed up like authentic Samurai warriors... oh, and for some reason I have to take them all to the grocery store with me for a major shopping trip...

Can You Hear Me Now?

• Kitty has been complaining for over a year that her ear feels blocked. When we go to the doctor for other things I have them look at it, and they usually say there's a lot of wax and we might want to use Debrox or something, but nothing to worry about. The psych hospital though said that her ear was completely blocked. So I used one of those bulb syringes and flushed her ear out with Debrox, warm water, and hydrogen peroxide. As part of the evaluation process, the school tested her hearing, and said she still couldn't hear out of that ear!


• So on Monday, since she only had a half day of school, I took her to the doctor, and they flushed out both her ears. Gross! Suddenly she could hear again!! (yes, they tested). Unfortunately, she discovered that she was much more sensitive to sounds and it added to her anxiety level. *sigh*

Responses to comments

• First, I want to apologize to everyone for how the posts are reading. I swear to you I've done everything I can to get this stupid program to put spaces between paragraphs. I've entered multiple spaces (like 10), I've tried typing a period on each line between paragraphs. Nothing works. So thank you for all of you who managed to make it through! I'm going to try bullet pointing and see if that helps.


• I tried responding to your comments in the comments section, but Blogger ate my comment too! Aargh! So I'm going to give my abbreviated reply here:


• 
  

  Miz Kizzle: Does Kitty know anyone who actually had a "super sweet sixteen" party with all the expensive trimmings?



• No, but apparently she saw that stupid MTV show ("My Super Sweet 16") while in foster care, plus TV shows and movies (like "16 Wishes") and the movie "Bratz." Honestly though I don't think it's about the party itself, because this came up too often in therapy when we were talking about something she didn't want to talk about. Whenever Kitty wants to distract/ dissociate, she asks for something she know she can't have (like, "let's leave right now and go to McD because I'm staaaaarrrrvviinngg!"). This party has been coming up in therapy for months.


• 
  

  
  

  Tracey: I can't help but think that to some degree if Kitty is being treated like a mental patient she will act like one. I find I have a lot of success with my 14-year-old daughter by reinforcing the idea that she's a "normal" teenager. She's not, of course... she came to me at age 11 with RAD, PTSD, ODD, ADHD, possible Bipolar, and of course a long history of trauma and loss. She was angry and violent and destructive and off in a fantasy world most of the time. She was in a group home and on the verge of being declared unadoptable.

  
  

  I know all kids are different but I can't help but think that learned helplessness is a valid concern here. I praise my daughter for being "normal" and reinforce how far she's come and how proud I am of her and she just beams. She still has her moments, of course, and plenty of them. But we talk about why the behavior occurred and what she could do differently the next time.

  
  

  As for school... My daughter became a zillion times more happy and successful in school when I STOPPED being involved. When I was involved she would leave class (and the building), have tantrums in the classroom, one time she even tried to strangle herself while sitting at her desk. Finally I basically just threw up my hands and told them to deal with it, and oddly enough that has made an enormous difference for everyone. She actually started to realize that it's easier and much more fun to be normal at school.



• What a coincidence! Kitty also came to us at age 11 and had similar diagnoses, but your daughter's behavior sounds more like Bear. Kitty was angry and destructive early on, but it tended to only come out at home (once she left foster care and moved in with us - before that she acted out everywhere, but was not yet considered unadoptable). She tried to keep the school from seeing it. Bear tried to as well, but had a MUCH harder time accomplishing this until we got his meds correct.


• I do try to keep school and home separate. Sort of a, "What happens in Vegas, stays in Vegas." Most of the time it works, but I think there's a big difference between your daughter and my kids - IQ, brain chemistry and the ability to adapt. My kids have low IQs and brain damage that affects their memory and processing. They want to be normal, but it's not that easy. School's focus is on the short-term - academics, behaving in school, and getting the kids to pass to the next grade and graduation. My focus is on the long-term - helping them become happy, healthy, productive citizens able to have relationships and learn what they need to be able to get and to keep a job.


• **************


• I feel like such an idiot. I finally got around to reading the side-effects of Proz*c which is Kitty's newest med... and discovered that one of the common side-effects is daytime sleepiness! So maybe Kitty isn't as overwhelmed as we thought. Maybe this isn't a slow recovery. Will alert the pdoc tomorrow.

Home from the hospital - Now what?

Kitty came home on Friday. We had a quiet weekend (Boy was it hard to keep her home from Grandma's on Saturday night and have to miss our date night, but we knew she needed it). I decided not to send Kitty back to school until we'd made a plan with the school about how to proceed. . . . Tuesday morning, Kitty had a pdoc appointment - no med changes, but next appointment is in 2 weeks and gave us some quick dissolving Abilify tabs to use if Kitty starts to have a meltdown. . . . A couple of hours later we had a school ARD (to revise her IEP and approve further testing). Kitty had told me she felt uber stressed during her 2 general ed clases and lunch. "Plan B" was to rearrange the seating in the general ed computer class so that another child who is willing to help Kitty (less embarassing to Kitty than having inclusion help), to let her go the the learning lab when her general ed speech class got overwhelming, and we helped her think of several alternatives for who to sit with and where at lunch to decrease the stress. All of the rest of Kitty's classes are special ed so already have small class sizes and easier assignments. . . . Wednesday Kitty went back to school, and called me to pick her up right after lunch. Here's the e-mail I sent Thursday evening when I realized that things were not getting better, even on "A day" which Kitty told me weren't as stressful:

Hi guys, Well, obviously Plan B did not work. Here’s what happened from Kitty’s point of view: Yesterday, “B day” Period 5, DIMM (computer class): Went well. The seat change putting B (student) next to Kitty to subtly help her, Kitty claimed it helped. Period 6, Speech: Not good. It really upset Kitty that the teacher didn’t know what was going on (probably our fault for keeping Mr. J (Assistant Principal) after the meeting so he ran out of time to talk to the teacher). Kitty apparently did get to spend the time in the learning lab as planned, and went to some of her teachers to get makeup work to work on during this period. Lunch: Thank you Mr. J for coming up with a Plan C and D for this. Apparently the first option (asking her friend to eat outside) wasn’t an option because the friend was talking to Kitty’s ex-boyfriend, P, who likes to tease her. Second option (sitting with friend, M, in the cafeteria) didn’t work because M was in the hospital, but Kitty found another friend to sit with… until he left. Then Kitty hung out with another male friend, but got too close to ex-boyfriend who teased her about hugging the male friend. Period 7, Science: Kitty was given several make up assignments. This overwhelmed her and she called me to come home. She went to the AP’s office to wait for me – where Mr. J found her “vibrating” and moved her to a quiet conference room. Wednesday evenings we do volunteer work with kids and horses, so we went, but we had Kitty mostly do quiet work instead of working with her usual “exuberant” client. Today, “A day” Period 1, PE: Went “fine.” Period 2, English: Got fairly caught up. Took a test she "might have to take again." Felt it went OK. A Lunch: Sat with a quiet friend. Period 3, World Geography: Given a makeup assignment that the teacher told her needed to get done in class. Kitty didn’t think she could get it done and left to go to the nurse where she called me to come home. Kitty is feeling a lot of pressure (seems to be mostly put on herself rather than the teachers) to get caught up and do well. She doesn’t want to go back to school tomorrow and to just start with a clean slate on Monday (which starts the new 6 weeks). To lighten her feeling of pressure, I suggested talking to her science teacher about cutting back on the assignments, prioritizing them, working on them in the learning lab (since she doesn’t have an assignment in speech), and taking advantage of the fact that she has good grades to just coast through this. Kitty was still too overwhelmed. If I’m going to get Kitty to go to school tomorrow I really need someone to call me with a plan. She agreed that I could bring her in after lunch (since she hasn’t been to last period math yet), but she really wants to just skip it all. When I picked her up she was depressed and let me know she doesn’t feel “safe” (which means she is having suicidal thoughts again). Please call me at (###) ###-#### and let me know how to proceed. I’m also not sure who I should be informing/alerting when I pick Kitty up. Mary (###) ###-#### " Saying "no" is not being negative. Negative is saying "yes" to things that are destroying you."

I sent Kitty to school Friday morning and told her I would meet her there and tried calling EVERYone in the school, but couldn't get hold of anyone for quite awhile. In the meantime I talked with Hubby about what we should do. Oh my goodness, we are sooo on different pages. Hubby is having a really hard time with Kitty not getting over this and getting back on track. All my NAMI classes have reinforced to me that Kitty is going to take a long time to recover, but even I struggle a little with the feeling that she's "getting away with something" or never going to try to progress - learned helplessness. I think after a long talk, Hubby did realize that nothing has gotten better and in a lot of ways was worse. Kitty was declining and a hot mess of anxiety before she went to the psych hospital. The hospital exposed her to violence, kept her from her family, triggered memories of past trauma, increased her sleep med (which did help) and added an anti-depressant - which takes weeks to get to full strength. Now she's got make-up work and emotional healing to do, so of course she's overwhelmed. Hubby is still not convinced that picking her up whenever she feels bad is the right thing to do (she might not ever go back to school!). ******************************************* I FINALLY got hold of someone at the school and Kitty's casemanager sat with her for all of second period helping her prioritize and work on assignments. The CM assured Kitty that she would be given an incomplete in whatever classes she needed them in and she has until graduation to get it done (Kitty is only a freshman). The CM said Kitty was out of it, lethargic, sleepy and couldn't do things that normally didn't give her problems. The CM was convinced. I sat with her and the AP and we decided that Kitty will do half days for awhile (alternating between mornings and afternoons). Kitty's pdoc is willing to write a vague, open-ended note stating that Kitty needs to miss school - so we don't have to worry about truancy. I picked Kitty up after 3 period (there are 4 periods in a day). At least she made it a little longer today. She seems comfortable with the changes. ******************** On another note, Kitty has been obsessing about her "Super Sweet 16 birthday" for MONTHS. She wants this big, expensive party with lots of friends, and brings it up whenever she doesn't like what we're talking about (usually in therapy). She knows that we can't afford it and don't think she can handle having a lot of friends over. No matter what I do, she tries to work it into a big battle - sounding as though it's in a couple of days, instead of not for months. Finally her birthday really is in a few days. Today she quietly said she wants it to be just a family party. Still wants lots of expensive presents though!

Developmental Stages - Six to Early Adulthood Transition

I've been saying for a long time that Kitty is about age 6 years old, but I realized it had been a while since I'd reviewed what the developmental stages entail. I think Kitty has actually progressed. Although Kitty was chronologically ("calendar age") 11 years old when I met her, emotionally/developmentally she was about 4 (when a major trauma occurred). She's lived with us 4.5 years, and she has come a LOOONNNNGG way! I've been saying she's about age 6 for the longest time because I remembered that 6-year-olds are the "police of the playground," but in reviewing these stages, I think she's closer to 10 (no higher since she isn't able to grasp abstract concepts very well. Bear doesn't understand them at all).

Here's a good Developmental Stages Chart

GIRLS 6 TO 8

(from Child Development 101 - Austin Therapy for Girls)

Here are some behaviors and developments to look for in your daughter of this age:

• Your daughter may view things as very black-and-white, right or wrong, good or bad, with little gray area in between. For example, she may talk of having a “best” friend and an “enemy.”
• Children this age enjoy copying down designs, shapes, letters, and numbers, but may still write some printed letters backward.
• Attention span begins to increase around this age, and your daughter may begin to show more pronounced interest in projects, creating extravagant collections, building things, and reading.
• Hand-eye coordination improves at this age, as your daughter may begin to tie her own shoelaces and become skilled at using scissors or other small tools.
• Friendships become increasingly important. You may notice that your daughter begins to prefer friends of the same gender.
• At this age, children begin to be able to see others’ perspectives but are still very self-centered. They find criticism and failure especially difficult to cope with and show strong motivation to do things correctly and impress others.
• Your daughter likely still struggles with logic and cannot grasp abstract or hypothetical concepts.
• You may begin to notice your daughter’s developing ability to distinguish between left and right, as well as starting to understand time and the days of the week.
• Children this age often enjoy caring for and playing with younger children. 

Ideas for parents:

• Children this age often show enthusiasm for rules and rituals. Provide opportunities for your daughter to hone this understanding by playing simple table games like cards, tic-tac-toe, or Candyland.
• At this age, children relish a sense of accomplishment. Offer opportunities for them to help out and feel they’ve achieved something, such as building models, cooking, crafting, or playing an instrument.
• Another great idea to make your child feel that she is helping out and that her input is valued is to try working regular family meetings into your family’s schedule. Check out our blog post on family meetings for suggestions on what this might look like: http://austintherapyforgirls.com/2013/08/family-dinners-are-important/
• Make sure your child has ample opportunity for active play, such as jumping rope, tumbling, or playing ball.
• Foster your child’s social development and sense of cooperation by offering noncompetitive team activities like completing a puzzle or building a fort.
• Children this age are curious and eager to explore. Bring your child to new places like museums or different workplaces where she can learn and expand her understanding of the world.
• Encourage reading and writing by helping your child write stories, create and perform plays or puppet shows, or conduct experiments.

SIX YEARS

§ Six - Six-year-olds have longer attention spans and continue to prefer structured activities to more open-ended experiences. They enjoy taking on new roles and responsibilities, but still require much direction and guidance from adults and frequently ask questions to ensure that they are completing tasks the right way. 
§ Social and emotional development-  six-year-olds are confident and delight in showing off their talents. They start to display an increasing awareness of their own and others' emotions and begin to develop better techniques for self-control. Six-year-olds enjoy sharing toys and snacks with friends, although conflicts among peers may remain quite frequent. Predictable routines are important sources of stability and security for children this age. Six-year-olds also draw emotional stability from their interactions with adults with whom they feel secure, particularly during challenging situations and circumstances.

SEVEN YEARS

§ Seven - Seven-year-olds enjoy having the opportunity to share their knowledge with others. They display a longer attention span and the ability to tolerate less-detailed directions and last-minute changes. Seven-year-olds are curious and frequently ask adults and peers questions to satisfy their need to know. They utilize increasingly complex and creative strategies to solve problems at home and at school. 
§ Social and emotional development-   seven-year-olds enjoy having and making friends and take pleasure in imitating the actions of friends and peers at school. While they typically prefer structure and routines, they may also choose to work or play independently when frustrated. Children this age often choose to develop games with rules and are likely to treat peers with respect during play. In addition, they start to experiment more with handling their emotional and social lives independently; they show that they can take some initiative socially and that they have the capacity to understand others' actions and feelings.

EIGHT YEARS

It's not until age 8 that the child's belief system syncs with their behavior.  This means:  "Just saying to a child, 'You know this is wrong. Why do you keep doing it?' may not be an effective strategy before the age of 8," Davis-Kean said. "Younger children may know it's wrong, but they haven't associated that knowledge with their own behavior."

§ Eight - Eight-year-olds enjoy having the opportunity to solve problems independently. They are able to concentrate on tasks for longer periods of time and begin to use their own resources prior to seeking adult help or they may seek out peers for assistance. Eight-year-olds demonstrate more highly-developed thinking skills as well as the ability to solve problems with creative strategies. 
§ Social and emotional development-   When interacting with others, eight-year-olds enjoy sharing their viewpoints on a variety of topics. They have a clearly developed sense of self-worth and may express frustration in response to activities that they perceive as areas of personal weakness. Eight-year-olds begin to understand the concept of masking emotions and can vary their use of coping strategies to deal with challenging situations. In peer interactions, they may start to engage in leadership, goal-setting, elaborate fantasy play and an assortment of interactive games. Eight-year-olds still rely on adults for a sense of security, but are proud of their independence and will want to express it. Under emotionally stressful circumstances, they will seek adults in less direct ways but still need contact.

NINE YEARS

§ Nine - The nine-year-old has definite interests and lively curiosity; seeks facts; capable of prolonged interest; can do more abstract thinking and reasoning. Nine-year-old boys and girls differ in personalities, characteristics, and interests; are very group and club oriented but always with same sex; sometimes silly within group. Boys, especially, begin to test and exercise a great deal of independence. Is most interested in friends and social activities; likes group adventures and cooperative play. 
§ Social and emotional development-   Morally the nine-year-old is very conscious of fairness; is highly competitive; argues over fairness; has difficulty admitting mistakes but is becoming more capable of accepting failures and mistakes and taking responsibility for them. Is clearly acquiring a conscience; is aware of right and wrong; wants to do right, but sometimes overreacts or rebels against a strict conscience.

TEN YEARS

§ Ten - Socially the ten-year-old is affectionate with parents; has great pride in father; finds mother all-important. Is highly selective in friendships; may have one best friend; important to be "in" with the gang; may develop hero worship (Kitty, obsesses about a particular boy or actor). 
§ Social and emotional development-  The ten-year-old is concerned with style. Is casual and relaxed. Likes privacy. Girls mature faster than boys. Not an angry age; anger, when it comes, is violent and immediate; seldom cries but may cry when angry. Main worry concerns school and peer relationships. The ten-year-old has a strong sense of justice and a strict moral code. More concerned with what is wrong than what is right.

ELEVEN YEARS

§ Eleven - The eleven-year-old challenges adult knowledge; has increased ability to use logic. May have interest in earning money. Is critical of own artistic products. Is becoming interested in world and community; may like to participate in community activities. 
§ Social and emotional development-   The eleven-year-old is critical of adults and is obnoxious to live with. Strives for unreasonable independence. Has intense interest in teams and organized competitive games; considers memberships in clubs important. Anger is common; resents being told what to do; rebels at routines. Often is moody; dramatizes and exaggerates own positions (e.g., "You're the worst mother in the world!"). Experiences many fears, many worries, many tears. Morally the eleven-year-old has a strong urge to conform to peer-group morals.

TWELVE TO FIFTEEN

§ Twelve to Fifteen - Thrives on arguments and discussions. Increasingly able to memorize; to think logically about concepts; to engage in introspection and probing into own thinking; to plan realistically for the future. May read a great deal. Needs to feel important in the world and to believe in something
§Withdraws from parents, who are invariably called "old-fashioned." Boys usually resist any show of affection. Usually feels parents are too restrictive; rebels. Needs less family companionship and interaction. Has less intense friendships with those of the same sex; usually has a whole gang of friends. Girls show more interest in opposite sex than do boys. Annoyed by younger siblings. 
§ Social and emotional development-  Commonly sulks; directs verbal anger at authority figure. Worries about grades, appearance, and popularity; is withdrawn, introspective. §Knows right and wrong; tries to weigh alternatives and arrive at decisions alone. Is concerned about fair treatment of others; is usually reasonably thoughtful; is unlikely to lie.

SIXTEEN TO NINETEEN

§ Sixteen to Nineteen - May lack information or self-assurance about personal skills and abilities. Seriously concerned about the future; beginning to integrate knowledge leading to decisions about future. 
§ Social and emotional development-  Relationships with parents range from friendly to hostile. Sometimes feels that parents are "too interested." Usually has many friends and few confidants; dates actively; varies greatly in level of maturity; may be uncomfortable, or enjoy activities, with opposite sex; may talk of marriage. May be strongly invested in a single, romantic relationship. 
§ Worries about failure. May appear moody, angry, lonely, impulsive, self-centered, confused, and stubborn. Has conflicting feelings about dependence/independence. 
§ Is confused and disappointed about discrepancies between stated values and actual behaviors of family and friends; experiences feelings of frustration, anger, sorrow, and isolation. 
§ May be interested in sex as a response to physical-emotional urges and as a way to participate in the adult world (but not necessarily an expression of mature intimacy).

EARLY ADULTHOOD TRANSITION

§ Seventeen to twenty-two - This transition stage is characterized by an overlap of both the pre-adulthood stage and the early adulthood stage, and typically occurs around age 17-22. At this point, physical growth and development are complete and independence is fairly well established. 
§ Social and emotional development- Individualization is becoming more prominent because one is now better suited to make decisions in preparation for their future. An important concept relating to this era is the modification of relationships; by which a person increasingly distances themselves from their family in order to solidify their transition into adulthood. Upon termination of the transition stage, maturity is established and one is fully prepared to enter the adult world.