Legal Guardianship documentation

As you know, we're in the process of getting legal guardianship of Kitty, and while her psychiatrist is totally in agreement, and we owe no explanations to anyone else, I've found that currently her school is sabotaging us with Kitty and even making it difficult for Kitty to get services, so I decided to create this document.  (The school has been communicating with DARS which is a program that provides job coaching and help getting employment for adults with disabilities, and have managed to convince DARS that Kitty is "doing great" to the extent that DARS is now requiring an unnecessary new psych eval to reconcile what the school is saying with what we're saying -- and all the documentation shows).

Plus, when it comes time for Kitty's psychiatrist to fill out the form, I want her to have a handy reference for the information she might not have readily available.  Then too when it comes time for us to stand before the judge, I want to be able to give well-documented, concise, unemotional responses, and not get flustered and say something like "She just can't, because I said so!" and look like the over-protective, emotional mama that the school is portraying me as! (My current nightmare!)

The first section is Kitty's current diagnoses, issues and medications.  The orange section are the legal criteria for legal guardianship.  A judge will determine which of these rights should be removed (all, some or none),  Guardianship can be granted for only the financial part, or for the "body," or both.  We believe Kitty needs both.

The last section of this post is using information from the Ansell-Casey Life Skills Assessment which is a VERY comprehensive assessment for foster children aging out of the system.  A lot of this assesses the part of Kitty's life that the school doesn't see, and I believe they make a lot of assumptions about how Kitty deals with life based on the small part of her life she does let them see.

Legal Guardianship

Diagnoses: (04/17/12) -Residential Treatment
Axis I:  309.81  Posttraumatic Stress Disorder, Chronic, by history
296.80  Bipolar Disorder NOS, by history
314.01  Attention-Deficit/Hyperactivity Disorder, Combined Type, by history
294.9    Cognitive Disorder NOS (deficits in processing speed, working memory, executive functioning, and visual memory) - Cerebral Dysrhythmia (TBI) – right temporal lobe. - which controls memory, hearing, understanding language (receptive language), organization, and sequencing.
995.54  Physical Abuse of Child, Victim, by history
995.53  Sexual Abuse of Child, Victim, by history
995.52  Neglect of Child, Victim, by history
307.6    Enuresis, by history
Axis II:  799.99  Diagnosis Deferred (R/O Borderline Personality Disorder - Emerging)
Axis III:         Obesity
327.3   Circadian Rhythm Sleep Disorder (diagnosed 4/13)
        564.0    Constipation
       Acne
               Esophoria – an inward deviation of the eyes, particularly when tired (diagnosed 5/12)
Axis IV:      Problems with primary support group
     Social Environment
     Educational
Axis V:  GAF = 35-40 (current)
Mental Status Examination:
Mood: Stable| Thought Processes:Goal Directed |Judgment:Significantly Impaired |Insight: Poor
H’s Emotional/ Social Developmental Age set at approximately 6 years.
Previously diagnosed with Attachment Issues and 313.89 Reactive Attachment Disorder of Infancy or Early Childhood - not completely resolved.
11/16/2011 Neuropsych -
Full Scale IQ -             74 (4th %ile – Well Below Average), 
Verbal Comprehension –           87 (19th %ile – Below Average)
Perceptual Reasoning –             90 (25 %ile – Average)
Working Memory –            71 (3rd %ile – Well Below Average)
Processing Speed –            65 (1st %ile – Lower Extreme Range)  
7/26/12 Tested for Central Auditory Processing Disorder -scored within normal limits (better than 2 standard deviations below average for an adult - anyone > 12 years of age) on 9 of the 11 MAPA subtests administered. She scored below (worse than) -2 SD on the Tap Test and SINCA (right ear) tests.  She is considered at risk for CAPD, but does not have it.  - All information must be presented shortly, simply and concretely in a calm, quiet, environment for Kitty to have maximum comprehension.  Kitty’s ability to handle stressful situations is low, particularly when aggravated by loud, chaotic environment, and she shuts down when overwhelmed.
8/20/09 – 9/5/09  Neuropsych results from residential treatment center
P300 is absent.  (Means she has ADHD).
Cerebral dysrhythmia (brain damage/injury) in right temporal lobe.  {Temporal lobe controls your:
Memory, Hearing, Organization and sequencing, Understanding language (receptive language).
Temporal lobe disorders: Exaggeration of emotions is sometimes seen with disorders of the temporal lobes.  Deep in the temporal lobes is the “limbic system,” a primitive system involved with emotions and memory (and to some extent sexuality).  Disorders here can turn anger into rage, sadness into suicidal depression, or anxiety into panic.  Electrical disorders in this area can result in atypical psychotic symptoms, inappropriate sexual behavior, and unusual fears.  Memory problems are common.  Temporal lobe patients are prone to “bad days” when their behavior is out of character.  They are unpredictable and may become depressed or explosive without provocation.
Right hemisphere disorders:The right hemisphere is important in visual spatial reasoning, visual memory, and organizational ability and pattern perception.  In addition, the right hemisphere is involved in the non-verbal aspects of communication such as facial expression, body language, gestures, and voice inflections.  Individuals who cannot express or comprehend such non verbal signals are at a social disadvantage.  Even with normal language, their lack of non-verbal signals makes their communication dull and ineffective.  If they cannot see patterns of social relationships or communicate effectively they may seem odd and be rejected by peers, resulting in problems that peak in adolescence.  Visual processing problems can produce learning impairments which impair schoolwork in math, science, and other visually learning classes. ~From Neuropsychiatry by Dan Matthew, M.D and Larry Fisher, Ph.D.

Current Psychotropic Meds:  Trileptal 1800mg (mood stabilizer), Seroquel XR 400mg (atypical antipsychotic), Wellbutrin XL 300mg, Lamictal 250 mg (mood stabilizer), Intuniv 4mg (regulator for ADHD), Ambien 10mg (PRN sleep med), Loratadine 10mg (allergies).


Disclaimer thrown in for Kitty's school and the DARS caseworker that will be removed before this is given to the psychiatrist:
I will readily admit that MOST teenagers do not meet the criteria for being able to live independently; however, we feel, and Kitty’s psychiatric evaluations show, that Kitty ‘s severe deficits/issues  in cognitive, judgment, insight and coping skills – due to her disabilities – including brain injury, mental health disorders, severe trauma and relational issues – are not showing meaningful improvement.  Our goal is to support Kitty while she reaches her full potential.

Criteria for Legal Guardianship:

 YES  NO [X]   1. Ability to make informed judgment as to marriage 
While we would love for Kitty to be happily married, and of course would take her wishes into consideration, we would need to be assured that Kitty’s potential spouse could handle her medical needs from her permanent brain damage and other diagnoses, is capable of handling her many appointments, finances, and accessing and handling her many needed government benefits and services.  Kitty has a very limited understanding of what to look for in an appropriate spouse, and has severe unresolved relational issues (313.89 Reactive Attachment Disorder of Infancy or Early Childhood and 799.99 Borderline Personality Disorder).  She is very vulnerable, and often a victim, her issues with boundaries and judgment leave her open to being taken advantage of by predators or others not looking out for her best interest.  

 NO YES  2. Ability to make informed judgment as to voting 
I have no opinion on this one.  Kitty is more likely to care about voting Team Jacob than for the president.  I think she would choose whomever her friends like, unless one president is cute.  In that respect she’s not much different than most of America.

 YES  NO [X]   3. Ability to apply for and receive governmental benefits 
This requires a level of planning beyond Kitty’s capabilities.  She requires the assistance of a trusted, qualified supervisor to access and manage her governmental benefits and services and prevent lapses in services.  She refuses to read documents and will sign anything she is asked to without comprehension of the contents.  She does have limited comprehension if the document’s contents are broken down into short, simple and concrete information, which is then given to her verbally.

 YES  NO [X]   4. Ability to operate a motor vehicle 
The following are a few of the actual questions on the Texas driver’s license application:
• Do you currently have or have you ever been diagnosed with or treated for any medical condition that may affect your ability to safely operate a motor vehicle?  
Esophoria (eye disorder causing dizziness and double vision), 
Chronic Sleep issues – Circadian Rhythm Disorder - causing general inability to focus, sleepiness, dizziness, and inability to process.  
Cognitive Disorder NOS – Permanent brain injury that severely affects her judgment and processing (processing issues – if under stress or feels she is in loud or chaotic conditions, her processing ability drops to 65 (intellectually disabled).  Includes an inability to multi-task.
ADHD – inability to focus.  
• Within the past two years, have you been diagnosed with, been hospitalized for or are you now receiving treatment for a psychiatric disorder?  
YES!  See page 1 of this document for diagnoses.  Recent psychiatric hospitalizations: 3/11, 4/11, 8/11, 10/11, 11/11, 12/11.  Recent psychiatric residential treatment 12/11 to 4/12.  Currently under care of a psychiatrist and multiple therapists.
• Do you have any alcohol or drug dependencies that may affect your ability to safely operate a motor vehicle or have you had any episodes of alcohol or drug abuse within the past two years?  
The majority of her medications have severe contraindications to operating a motor vehicle (cause sleepiness, dizziness, impaired judgment…).  She has frequently made mistakes in taking (or missing) her medications that would cause additional severe issues with safely operating a motor vehicle.

YES  NO [X]   5. Ability to make decisions regarding travel 
Requires qualified supervision to maintain her medical and emotional needs.  Skills needed that she does not currently have:  medication management and obtaining appropriate health care, judgment regarding where/when it is safe to go and with whom, obtaining a hotel room, financial budgeting/ management  – including purchasing tickets and food, ability to read and follow a map or timetable, feeling safe on a plane, train or bus...  

YES  NO [X]   6.  Ability to seek or retain employment  
With a lot of support, I believe Kitty could seek, obtain and keep a part-time job.  She will need assistance with job hunting and finding an employer willing to accommodate her special needs, including an inability to work early morning hours due to her sleep disorder.  She has limited understanding of her issues and how they may affect her ability to handle herself safely on the jobsite.  She will need limited hours, particularly if the environment is demanding or chaotic in any way.  She has not been able to demonstrate the ability to cope with the demands of employment for more than brief periods of time.

 YES  NO [X]     7. Ability to contract and incur obligation 
Kitty has a does not comprehend the obligations and effects of a contract.  She has a limited concept of money, debt, budgeting, recordkeeping and finances.  She has NO understanding of credit cards, interest rates or payment plans.  Kitty does not appear to have the ability to plan for the future or the consequences of her actions and makes emotional, impulsive purchases without thought toward future goals or practical needs.  She has little interest in where money to pay for things will come from, instead focuses on purely emotional justification for purchases.  

 YES  NO [X]   8. Ability to sue or defend lawsuits 
Kitty has a concrete, black and white sense of right and wrong, primarily based on how it affects her.  She has a severely limited ability comprehend complex legal documents or concepts (see #3) or understand the full consequences of her actions.

 YES  NO [X]   9. Ability to manage property or to make any gifts or disposition of property 
The level of planning required to manage property or make decisions regarding financial dispensations is beyond Kitty’s capabilities.  

 YES  NO [X]   10. Ability to determine residence 
While we will certainly take Kitty’s wishes into consideration, we would need to be assured that Kitty’s future residence could handle her medical needs from her permanent brain damage and other diagnoses is able to get her to and from work and her many appointments, and can provide constant support and guidance - including frequent prompts and direction, regarding basic self care, emotional regulation, common daily living activities and emergencies OR that Kitty lives close enough to her family that we can provide those services that the place of residence cannot or will not (such as transportation to appointments or shopping, financial services…).   At this time, Kitty does not have the ability to contract with someone and ensure they receive payment for services rendered.

 YES  NO [X]   11. Ability to consent to medical, dental, psychological, and psychiatric treatment and to the disclosure of those records 
Kitty does not have a good understanding of her diagnoses, medications or treatments.  She exhibits great difficulty understanding, evaluating, and tracking her medication and its side effects, the efficacy of different treatments, and even her own needs.  She demonstrates limited comprehension regarding her health and mental health issues, even exhibiting strong denial/refusal of medically-determined needed treatment.  She has strong psychosomatic issues and low body awareness.  She is generally compliant with taking her psychotropic medication (with multiple reminders), but refuses to take anything but pills, so is not in compliance with her prescribed nasal sprays and other types of meds.  

YES  NO [X]   12. Ability to handle a bank account 
Due to her cognitive issues, Kitty has a very limited understanding of money or budgeting. She requires extensive support in all financial matters. 

YES  NO [X]   13. Ability to make decisions regarding financial obligation 
Due to her cognitive issues, Kitty has a very limited understanding of money or budgeting. She requires extensive support in all financial matters. 

 YES  NO [X]   14. Ability to enter into insurance contract of every nature 
This requires a level of planning beyond Kitty’s capabilities.  She requires the assistance of a trusted, qualified supervisor to access and manage her financial and contractual concerns.  She does have limited comprehension if the document’s contents are broken down into short, simple and concrete information, which is then given to her verbally BUT would be unable to ensure the contract was enforced.

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Life Skills:

1. Motivation for personal goals: initiative, engagement, willingness to try new things, persistence, work ethic, commitment, and a drive to pursue interests and personal development.
Kitty is very compliant and will set to any task assigned by those from whom she masks her issues (generally everyone but family).  This need to please and mask her issues often leads to overwhelming, incapacitating feelings triggering shutdowns, rages, and/or suicidal ideation.  Kitty requires both constant and extensive emotional support from people knowledgeable about her diagnoses and trained in meeting her needs, and a calm, contained, controlled environment in order to help her maintain the level of emotional stability needed to keep her from requiring frequent psychiatric hospitalizations and/or residential treatment.  While Kitty’s dissociation from reality has improved over the last few years, she still has great difficulty grasping the duties and responsibilities necessary to establish and achieve her goals while maintaining her health and safety.

2. Executive functioning skills: planning ahead; organization; execution and completion of projects; informed decision-making; judgment; concentration; and self-monitoring.
This is an area strongly affected by Kitty’s brain injury/ cognitive disorder.  She has well-documented, severe issues in all of these areas requiring extensive support.

3. Independent living skills and self-reliance: self-management with regard to:

• money
She has significant difficulty with money and budgeting (no, or limited, understanding of:  the cost of eating out, pre-packaged food, weekly menu planning, inability to calculate discounts and tips…).  Limited understanding of the difference between personal needs and wants.  Able to set saving goals, but unable to stick to them due to impulse purchasing.  No interest in reading documents, maintaining records and keeping track of her finances  Easily influenced by advertising.  Unable to identify, access and utilize programs and services for assistance.
She has great difficulty with memory and forgets how much she has, what she owes and why, and for what she wants to save her money.  She talks of expensive trips and items, with no concept or interest in acquiring them herself, but instead assumes someone will give them to her.  She has no understanding of budgeting.  She refuses to keep records.  Although she does have some understanding of comparison shopping (as long as it’s in the same area of the store), coupons, and sales – it’s all relative.  She can identify the less expensive pair of shoes, but has great difficulty with impulse buying and emotional purchasing.  If she wants new shoes she buys them, she doesn’t think about future consequences (for example, not having enough money to buy bread or pay her water bill).  She has a severely limited ability to save money (requiring a lot of support and reminders).  She has stated she has NO interest in working hard to acquire money.
She has serious issues with math (ex.  Kitty has asked me how much a pair of $10 shoes would be that were marked 50% off.  Knowing the date, December 21st, she asked me how many days it was until Christmas and still couldn’t figure it out even after I told her Christmas was December 25th.  She does well in special education and modified math at school, but has limited ability for practical applications).  She has had a checking account for 2 years, but is not able to use it and relies on us to tell her if she has enough money to make a purchase, remind her of things she wanted to save money for, and then say yes or no regarding impulse purchases, knowing she can’t control the impulse and will be upset later.

• nutrition – 
Kitty can cook with supervision.  She does not understand the need for moderation or  making healthy, nutritious dietary choices (skips meals, emotionally eats, chooses to eat foods to which she has allergies/ intolerances, limited to no understanding of serving sizes, gorges on snacks and sweets…).  Appears to have limited to no food safety and food handling skills (manual dexterity issues, will leave food at room temperature for hours, doesn’t understand the dangers of working with raw meat, stores food uncovered for extended periods of time…).  She is oblivious to the big messes she makes, and even when prompted, frequently refuses to clean after herself.  She has made dangerous mistakes with the microwave and stove.  She has difficulty reading and following recipes (skips steps, ignores words she doesn’t know, makes measuring mistakes…), difficulty reading nutrition labels and ingredients….

• laundry; -
Kitty is capable of handling her clothes with minimal supervision, but needs reminders to pick up dirty laundry, wash her clothing, and put it away.  She needs consistent reminders and redirection to wash bed linens and towels or she will not do so.  After a reminder to clean her room (covered in used clothing, sanitary napkins, tissues…), she will throw everything in her laundry basked and has washed shoes, books, sanitary napkins, rewashed clean clothes, dry clean only items, electronics…  She requires frequent reminders of what clothing is appropriate for the weather and occasion, and does not notice stains, holes or odors.  Often she will discard out of season clothing, or clothing she no longer likes, without thought of replacement.

• independent living –
She lacks many of the basic skills needed to ensure health and safety, including food prep, medication management, laundry, shopping, cleaning and maintenance of the home…  She will also need assistance managing her estate/ finances.
Kitty is capable of doing simplified, basic chores, with frequent reminders and redirection; these are age-appropriate for her developmental age of 6.  (see attached Chore Chart and Level System – we discontinued the level system because she was stuck at Level 1 and it was damaging her self esteem).  She cannot multi-task so these chores must be broken down into incremental steps and given to her in small doses with multiple breaks.  Will not independently do needed cleaning not on her chore list (ex.  Picks up dirty dishes – her chore - but leaves them near the sink full of napkins and other trash and/or rotting food).  Several chores (washing dishes, vacuuming, mopping… have consistently triggered an emotional trauma response to the point that these chores are no longer assigned).

• self care and hygiene
Kitty requires frequent reminders to bathe and brush her teeth, use deodorant, dispose of personal hygiene products properly, keep track of personal items, and get enough sleep -- She has circadian rhythm disorder, which means she has a difficult time getting a full eight hours sleep due to an inability to fall asleep at a reasonable hour and stay asleep throughout the night.  Sleep medications are ineffective.
Kitty has high psychosomatic issues, but very little awareness of her physical body (hunger/ satiation, constipation, tiredness, tension…) this has improved greatly with somatic therapy (she now has awareness of things like food on her face and can feel now feel touches on her extremities, including physical pain, when her extremities are injured.
She refuses to comply with the medications and treatments for her severe issues with constipation, acne, and allergies and generally refuses prevention measures for these and other issues such as chronic ear infections and compacted ear wax (causing hearing loss) and frequent urinary tract infections.
Kitty requires an adult to make appointments and ensure attendance at appointments for doctor/ dentist/ psychiatrist/ specialists/ therapist… Kitty has limited to no knowledge of personal and family health history.  She requires others to maintain up to date medical records including current medications and diagnoses.
Ex.  When Kitty was tired of being poked and prodded at the beginning of the summer for some very serious health issues, she began refusing treatment and denied she even needed them.  Conversely, she frequently demands appointments for minor or psychosomatic issues.
She has no interest or ability in maintaining her complex medications (including filling med box, taking them in a timely manner, side-effects, awareness of what she takes and why…)

• time management
Kitty is unable to set or awaken to an alarm clock.  She requires multiple verbal prompts to awaken.  She has little sense of time and does best with multiple prior notices of transitions and changes.  She is unable to read a non-digital clock.

• personal safety
Kitty has consistently demonstrated an inability to acknowledge and handle minor household emergencies, such as hazardous spills, overflowing toilets (common occurrence due to her chronic constipation) or appliances malfunctioning. She doesn’t notice the problem, refuses to handle the problem (such as breaking something glass and refusing to clean it up without significant pressure from an authority figure), and/or she panics.  We have not assessed her on fire safety (such as the use and maintenance of a fire extinguisher or avoiding overuse of extension cords) or home safety (such as proper storage of cleaning supplies).  She frequently shows reckless disregard to personal safety, computer and internet safety, and prevention of breaking and entering into the home.
• medication and health care
Kitty requires constant supervision and direction in taking her medication.  She requires verbal instructions, with reminders, when taking new medications (cannot interpret instructions provided on prescription drugs and over-the-counter medications, including dose frequency, contraindications, warnings, recommended storage (e.g., safety cap use) and possible side effects).  While she is generally very compliant with taking most (but not all) of her medication, she has no interest or ability in filling and maintaining her med box or learning about her meds and their side effects.
She requires adult direction in treating minor issues such as pain, cold/allergy,stomach upset or diarrhea… and in first aid beyond a bandaid. Requires assistance in determining if something beyond first aide is needed.
• public transportation
Kitty has never used public transport.  We do not live in an area that provides it.
• job experience (with job application, interviewing, working hard, accepting criticism and following directions).
See previous notes.  Limited to no skills in filling out a job application (She does not understand a lot of the words/ concepts on the application, and standardized testing shows she reads and comprehends well below grade level; she writes at about a 3rd grade level.  She has few skills and even less interest in researching and obtaining services, refuses to fill out applications and has little to no memory of the information needed to accurately complete the forms).  Dedicated, hard worker, who works best with clear directions.  Frequently assumes criticism is implied even when it’s not.  Finds work very stressful and draining.  Acknowledges that she will need a job with a late start due to her sleep issues.  Currently receives vocational support, including a job coach.

4. Academic skills: basic skills to achieve age-appropriate educational goals; intellectual curiosity; study habits; and value on learning.
Kitty is being told that she has the skills needed to go to junior college.  Little to no evidence has been produced that she can register and determine what classes she needs, sit in a classroom of more than 8 people, listen to a lecture and take notes, read a textbook and summarize what’s relevant, do more than 20 minutes of homework, write a research paper…

• Kitty cannot take effective notes, does not study independently, and currently takes only modified tests in a small group environment.
• Kitty could get to class with assistance, prompts, and reminders.  Kitty has consistently shown an inability to work on and complete multistep long term projects
• Kitty has no, or limited, note taking skills due to her inability to summarize and take what is important from written and verbal communication. Tasks must be broken down for her.
• Kitty must have modified testing, and writes and spells on about a third grade level.  Kitty has limited writing abilities beyond the concrete; she consistently demonstrates an inability to write using abstract concepts.

5. Physical fitness and healthful habits: value and self-care in relation to exercise, sleep, eating, health maintenance, and limitations on risk taking, substance use and media overuse.
Kitty requires frequent reminders and assistance in: regulating her food intake (she’ll gorge on sweets and junk food), overuse of media, going to bed and getting up (She is under a doctor’s care for her severe issues with sleep).  Kitty will occasionally walk in the backyard or in the neighborhood with a friend, but otherwise refuses any exercise (although she is compliant with an exercise program at school).

6. Emotional awareness, reflection and regulation: recognition and appropriate expression of feelings; empathy for others; ability to control impulses; and coping with negative emotions.
Kitty’s issues with emotional awareness is very linked to her somatic issues and she has made equal progress, but she still has severe issues with insight, emotional regulation, judgment, impulse control… Her problems with suicidal ideation and self-harming are currently under control after a med change and with reduction in stress levels. She is able to ask for and accept help.
Stress - Kitty is at close to max capacity for stress while remaining stable and able to have emotional regulation in public.  She has almost nothing left when she gets home.  Her home life has been modified, structured and regulated to reduce her stress level, giving her as much flexibility as possible to handle her public behavior.  She would literally rather die than let non-family, friends and professionals, see her as anything less than perfect.
Kitty has difficulty correctly identifying:

• situations which may cause conflict between people and lead to stress.
• sources of conflict or fear in a stressful situation.
• strategies to reduce stress and maintain good emotional health (e.g., exercise, deep breathing, simplify schedule, journal).
• signs and symptoms of depression and other emotional health problems. 

She has learned strategies to reduce stress  (e.g., exercise, deep breathing, neurofeedback techniques…), but is unable to access these techniques when under stress or feeling strong emotion.  
Empathy - Kitty has shown increasing empathy for others, but is still severely limited in this area.  Improvements might be more about hyper-vigilant concerns for her own safety and needs than an actual concern for others’ feelings. 
Insight – Kitty’s lack of insight, combined with her inability to process Dialectical Behavior Therapy strategies, caused her removal from psychiatric residential treatment.  

7. Social skills: ability to size up interpersonal situations; cooperation with others; communication skills; conflict resolution skills; gaining perspective; and accurate self-appraisal in groups.
Kitty behaves appropriately in public and gives the appearance of adequate social skills, but they are immature for her chronological age.  Kitty’s emotional/social development is significantly delayed (between 6 and 10 years of age).  She has very little personal insight and often sets inappropriate boundaries.  Her social skills have improved in the last few years; although her world is still very black and white, she is more tolerant of others breaking the rules than she has been in the past.  She is learning to accept that faults in others, including what she perceives as their mistreatment of her, does not mean the relationship has to end.
Kitty is very easily influenced by her peers and struggles with cognitive distortions.  While she will often strongly stand by her convictions, even if presented with rational evidence that she has made an error in thinking, at other times she will completely change her position to reflect the views of whatever individual or group with which she wants to assimilate.  (E.g. While in residential treatment, Kitty, who prior to this had been strongly Christian, suddenly became Wiccan, like her new roommate.  When the roommate graduated the treatment program, Kitty went back to being super Christian, without ever noticing how easily influenced she was by her peer).  Our concern regarding relationships is that Kitty is easily convinced that a boy cares about her, and if the boy can get past her sexual abuse issues and convince her to sleep with him, and then she’ll want to keep any resulting baby – despite having NO  realistic way to support it. She believes events will ensue, behaviors change instantly or things materialize because she wills it, rather than focusing on working a plan, learning calming techniques or behavior management, or earning and saving her money.  (Ex.  She’ll say she won’t have another rage/ meltdown, because she “just won’t.”). 
Boundaries – Kitty does not always set appropriate boundaries with peers, particularly involving teasing and personal space.  She frequently initiates a teasing relationship and then allows others to increasingly tease (physical and emotional) until it reaches the point of being inappropriate.  She requires adult intervention to reset more appropriate boundaries.  

8. Relationship skills and values: ability to maintain relationships over time; friendship development; conversational ability; balancing needs of self and other in romantic relationships; and intimacy skills.
Kitty has strong verbal skills and can hold an appropriate conversation on topics in which she has an interest.  She makes friends easily, but has difficulty maintaining friendships.  She has difficulty with boundaries and is very easily influenced by peers, because she desperately wants to fit in and be accepted.  Due to her attachment disorder and emerging borderline personality disorder, Kitty greatly struggles with her intimate relationships especially long term.
  
9. Moral behavior, integrity and character: standing up for what’s right; conscientiousness; and responsibility for oneself and the less fortunate.
Kitty has strong beliefs and character and is willing to fight for what’s right; however, she can be VERY easily influenced by peers, especially when it validates or reinforces her RAD issues with family.

10. Spirituality and a purposeful life: ability to accept and cope with adversities; emotional resilience; drive for a meaningful life; and a value on reflection and growth over time.
Kitty has very little emotional resilience and insight,  She tends to focus on the negatives, and will distort reality to match this perception, including having extreme dissociation and completely blocking the memories of an event.  She is very reactive to situation and in the moment rather than planning ahead or dealing with the past.