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

Saturday, October 10, 2015

Anxiety Scale

Kitty has severe issues with insight, emotional regulation, coping with negative emotions, recognition and appropriate expression of feelings, judgment, impulse control… She usually operates at close to max capacity for stress and anxiety. When she is under even slightly more stress and anxiety than usual, remaining stable and able to have emotional regulation in public becomes much more difficult for her.  She usually tends to shut down in public and has almost no emotional reserves left when she gets home.

For an example of the effects of this type of stress, see The Spoon Theory. We have modified, structured and regulated much of her life to reduce her stress level, giving her as much emotional flexibility as possible to handle her life outside the home {Structure and Caring Support}.

In her freshman and sophomore year of high school, Kitty was in and out of psych hospitals for suicidal ideation and we were attempting to get her into residential treatment but were having funding issues {Finding and Funding RTC}. She was struggling so much that she usually couldn't make it through a whole day of school. She often would attend half of one class and call me to pick her up (usually going straight to the psych hospital), but the school insisted this was a "home problem," because she "wasn't showing any signs" of issues at school {Acting In}.

We had a lot of issues with the school not wanting to see her "Acting In" behaviors. It took us quite a while to force the school to come up with a Crisis Plan because Kitty didn't tend to act out or disrupt class when she was dysregulated. She'd literally "rather die" than let people at school see that she had "issues." 

I have to believe that some of the school's actively ignoring what was going on with Kitty was also to avoid liability/ responsibility. If the school acknowledged that Kitty's disability was affecting her education, they would be forced to make accommodations, like paying for residential treatment or moving her to a more structured environment like the secret special school for emotionally disturbed students that had only 3 students to each staff member and all the staff were trained in handling kids with behavior and emotional issues - hence way more expensive than regular school! 

Kitty has learned strategies to reduce stress  (Calming Techniques - e.g., exercise, deep breathing, neurofeedback techniques…), but she is unable to access these techniques when under stress or feeling strong emotion. So she needs assistance from someone trained in these techniques. We needed to know when she needed that assistance (and when she needed more than that). 

The school claimed that liability issues meant they could not ask Kitty if she felt suicidal. After much work, they admitted they were willing to ask if she felt anxious. We had "being able to express her feelings to school staff" formally put into her IEP. 

Behavioral IEP Goals:
  • Using a scale, Kitty will verbalize or express her feelings to a trusted adult in the school setting a minimum of 1 time a day
  • When Kitty is expressing anxious feelings or exhibiting "acting in" behaviors, she will request the assistance of a trusted adult 5 of 5 times

The problem was that they wanted Kitty to tell them how she was feeling on a scale of 1 to 10, and Kitty doesn't have a strong grasp of this concept. 

Rating scales need to be more concretely defined for Kitty. Kitty needs to understand exactly what the scores on the rating scales mean. When asked, “on a scale of one to ten, how suicidal do you feel?” she told the crisis assessment counselor she was a 6. When asked to elaborate, she said she felt suicidal, had a plan, but unlike a "10" she didn’t have the means (no rope or belt in her hand). To me, this would be more like an 8 or 9! Obviously, the crisis counselor agreed because she sent Kitty to the hospital.

I came up with an Anxiety Scale for Kitty to use. {Unfortunately, the school decided this was too complicated and had her put a card on her desk that was green on one side and red on the other. Kitty was to flip the card to red when she was anxious. This was too simple, and meant that Kitty couldn't get help with calming techniques while she was still regulated enough to use them.}

0 – Cool as a cucumber.  INTERVENTION:  No intervention  needed
EX:  On the third day of a long vacation, soaking alone at a spa.

1 – Everyday minor stress needed to function.  Occasional twinges of minor discomfort.  
INTERVENTION:  No intervention needed.
EX:  Alarm clock goes off.  First bell rings.

2 - Minor bother.   
INTERVENTION:  Self-initiated calming skills.  No outside intervention needed.
EX:  Need to move quickly to get to class.  Momentarily can’t find homework.  See a cute boy.

3 – Anxiety annoying enough to be distracting. 
INTERVENTION:  Coping/calming skills still work, but might need outside reminders to use them.
EX:  Loud, chaotic environment.  Quiz you’re prepared for.  Ex-boyfriend standing 15ft away.

4 - Can be ignored if you are really involved; still distracting.  Somatic symptoms (upset stomach, headache...).  
INTERVENTION:  Brief breaks with adult support and assistance using coping/calming skills.  Can be redirected back to class.
EX:  People arguing.  Test you're prepared for.  Presenting a well-prepared presentation with a group.

5 - Can't be ignored for more than 30 minutes.  Thoughts of hurting self intruding, but controllable.  
INTERVENTION:  Brief breaks with adult emotional support.  Might be able to access coping skills with assistance.  Can probably be redirected back to class or work independently in less stressful environment.
EX:  Giving a speech to a group.  Getting feedback or gentle teasing.  Feeling behind in schoolwork

6 - Can't be ignored but still can work.  Wants others to keep her safe from acting on feelings of self-harm.
INTERVENTION:  Leave stressful environment and continue work.  Learning Lab?  Talk with behavior specialist.  Coping skills might work after calm down a little.
EX:  Picked on/teased by peers.  Test in class struggling in.

7 - Hard to concentrate, bothers sleep.  Can still function.   Feel need to escape.  Suicidal thoughts.  Needs stressors limited by others or will escalate.
INTERVENTION:  Leave stressful environment and not able to access cognitive part of brain for school work.  Can’t access coping skills.
EX:  Feels personally attacked by someone close to her.  Overwhelmed because behind in classes. 

8 - Activity limited a lot. Can read non-school books and talk with effort.  Suicidal thoughts with a plan, but not seeking out means.  Paranoid others hate her and are out to get her.  Acting out behaviors if can’t escape/ act in.
INTERVENTION:  Reduce stressors as much as possible.  Consider hospitalization, but can wait for an open bed.

9 - Unable to function. Crying out or moaning.   Acting out.  Fight/ Flight or Freeze Reactions.  Suicidal thoughts with plan and means, threatening, but not actively attempting to commit suicide.  
INTERVENTION:  Immediate removal from all stressors.  Hospitalization.

10 – Totally Stressed Out. Eyeballs explode.

Additional Post:
Handling Child Stress


concernedmom said...

very good

Anonymous said...

That's super unfortunate they wouldn't help you. Have you heard of the 5point scale? They have a bunch of books. I know one is called A Five is Against The Law. That's what I used when I taught and that's what they use at the 7 year olds school. Wish they had used it then.

marythemom said...

I've never heard of that. Sounds interesting.