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!

Tuesday, October 3, 2017

Fetal Alcohol Spectrum Disorders (FASD)


Guest blog, our story
We adopted T. at age two from a Russian orphanage. Minimal information was given on her life before age two.  There was a cute video of her interacting with a caregiver, and that was it, we loved her!  We knew that she had some kind of sad past, probable neglect, and we were willing to do "attachment therapy", or whatever it would take to overcome her delays.  We, meaning my husband and I, already had a bio daughter who was eight at the time and lovely, so we thought of ourselves as great and experienced parents.  
T. was evaluated in Russia as having normal intelligence and "usual orphanage delays" so we were confident we could help her overcome her past.  
From the beginning there were difficulties but we were ready!  So we thought.  T. could barely walk, very unsteady on her feet yet she would NOT hold our hand, she would rather fall it seemed.  We had to force our hand holding for safely.  Trying to bond was difficult, I would rock her with a bottle, trying to make eye contact, as was recommended by the social worker.  
In retrospect, I think we overwhelmed her with attention, sensory overload, etc.....It was a hate/love relationship from the beginning, she would push me away, but then if I left, she would cry for me.  All very confusing, and we were in constant contact with the social worker.  The social worker said it would take approximately two years for us to become a "family", to make up for the two years she had no one.
So, we waited patiently until she was four.  T. seemed quite smart, could dress herself, learned to read even. But stubborn!!!!!  Loving arguments, wanting her own way ALL THE TIME.  We fought her, becoming more strict, determined not to let her be the boss of us, which seemed her constant goal.
School was a nightmare, she hated it, hated the other kids, hated being told what to do...
Many doctor appointments were going on through these early years since T. had Tuberculosis and other infectious things happening.  At every appointment I would mention her behaviour but it was never too bad at the doctor appointments, she did her charm routines and fooled everyone.  She was learning ok at school and labelled as "a bit hyper".  
The summer after grade two was a game changer.  I was determined to do a little school work each day with T., and this is when I realized she could not remember much of what she'd done in grade two.  Red flags were popping up more and more, regarding her learning and behaviour.  On the internet, we found an adoption clinic near us and made an appointment.  
It was there that Tanya was diagnosed with Alcohol Related Neurological Disorder at age 8, based on her smaller head circumference, and behaviour issues.  The 4-digit diagnostic code was used for FASD diagnosis, photos and measurements were done.  Attachment disorder was also diagnosed.
That same summer I had stumbled upon the book "Damaged Angels" by Bonnie Buxton, which is the true story of Bonnie finding out about her daughter's FASD.  So we were somewhat ready for the diagnosis. It gave an explanation for what was going on.
We were able to get T. into a multiple exceptionality class at school, after her diagnosis and some psycho-educational testing. Fast forward to the present.  With all the help and encouragement T. has received over the years, she has still not been successful in getting her highschool diploma, or a job.
We did keep a binder of all medical and school reports through the years so she has been able to qualify for the Ontario Disability Support Program. [How Do You Keep Your School Stuff Organized?]
What will the future hold, so unknown? 
T. wants all the things she sees her older sister having, a boyfriend, friends, a job, etc.  But she's very unrealistic about her goals, doesn't take the first step to make a goal happen, wants to be "in charge" of people for a job but refuses to wipe tables, or take any kind of beginner job. She refuses to take advice from people who are smarter than she is, very frustrating.
We manage her day to day, letting a lot of our rules go by the wayside for the sake of peace and harmony in our home.  For example, she eats whatever, whenever, and not usually with us. We "bond" by watching a tv show together, her request.  She wants to "bond" on her terms but I have to get my way too.  Our bonding tv time is between 9-10 am so she will be UP out of bed.  Some kind of routine is necessary so she will be awake during the day, sleeping at night.  At least.
We do try to say YES as much as possible, but will get her to do a chore BEFORE the yes, because promised chore will never happen if she gets the YES first.  Such is the way of her attachment difficulties, she does not help me out of LOVE but only to get a YES about something she wants.  
I refuse to argue with her and I have changed my mindset to not stress about things.  
Somehow, through the years, acceptance has settled in and a realization that no matter WHAT we do, the FASD and attachment issues will NEVER go away.  LIfe goes on.



Fetal Alcohol Spectrum Disorders (FASD)

Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term describing the range of effects that can occur in an individual who is prenatally exposed to alcohol. These effects may include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis.


Diagnoses under the FASD umbrella include:

  • Fetal Alcohol Syndrome (FAS)
  • Partial Fetal Alcohol Syndrome (pFAS)
  • Alcohol-Related Neurodevelopmental Disorder (ARND)
  • Alcohol-Related Birth Defects (ARBD)
  • Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE)Source: National Organization on Fetal Alcohol Syndrome FASD Terminology Summit, 2004 

Medical issues you might see in a person with FASD:




  • Eye/vision and ear/hearing involvement
  • Palatal concerns
  • Growth concerns
  • Immune system concerns
  • Spinal concerns
  • Cardiac/renal abnormalities
  • Sleep problems

Common misconceptions that many people believe about FASD.

"Alcohol crosses the placenta. the fetus does not have the ability to metabolize it. It 'pickles' the brain and it causes brain damage. Even with all the drugs that our birth mother did, it was the alcohol that left the legacy that Ellie has."
Saving Ellie: Adoptive Parents Give Up Ill Daughter with FASD

Fetal Alcohol Syndrome (FAS)

Defined and named in 1973, Fetal Alcohol Syndrome (FAS) is a disorder resulting from prenatal  exposure to alcohol. Confirmed maternal use of alcohol might or might not be documented.

The diagnosis of FAS follows a specific outline. Individuals with FAS are generally found to have:

  1. Growth problems (e.g. unusually low birth weight and size, before and after birth)
  2.  Facial dysmorphia (e.g. small head, small eyes, underdevelopment of the upper lip, indistinct groove between lip and nose, flattened cheekbones)
  3. CNS abnormality (e.g. delayed brain development, intellectual impairment)

It is important to note that these criteria are for FAS and not Fetal Alcohol Spectrum Disorders (FASD). FASD is an umbrella term that refers to the range of effects, including FAS, that can result from prenatal alcohol exposure. FASD is not a diagnostic term.
Sources: CDC’s Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis (2004)
“Fetal Alcohol Spectrum Disorders: From Research to Policy” Alcohol Research and Health (2010)

Individuals exposed to alcohol prenatally who do not have identifiable deficits in all three domains required for an FAS diagnosis might be diagnosed with one of the other conditions under the Fetal Alcohol Spectrum Disorders continuum, such as Partial Fetal Alcohol Syndrome, Alcohol Related Neurodevelopmental Disorder or Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure. Source: FASD Competency-Based Curriculum Development Guide (2008)


Alcohol-Related Neurodevelopmental Disorder (ARND)

ARND is a condition under the Fetal Alcohol Spectrum Disorders (FASD) umbrella. ARND refers to a complex range of disabilities in neurodevelopment and behavior, adaptive skills, and self-regulation in the presence of confirmed prenatal alcohol exposure. 

Specifically, individuals with ARND do not have the FAS facial abnormalities, but may have developmental disabilities including structural and/or functional central nervous system dysfunction (brain damage) with behavioral and learning problems. Source: Recognizing ARND in Primary Health Care of Children Consensus Statement, Interagency Coordinating Committee on FASD, 2011



Alcohol-Related Birth Defects (ARBD)
Alcohol-Related Birth Defects (ARBD) describes the physical defects linked to prenatal alcohol exposure, including heart, skeletal, kidney, gastro-intestinal, ear, and eye malformations in the absence of apparent neurobehavioral or brain disorders. Source: FASD Competency-Based Curriculum Development Guide (2008)




Discipline Problems vs Behavior Problems

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


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





YOU CANNOT EXPECT PUNISHMENT OR DISCIPLINE TO "FIX" BEHAVIOR PROBLEMS!




Having behavior problems is like being born with poor eyesight. No amount of punishing or controlling is going to fix this problem. Glasses might help. However, the parent will be responsible for taking the child for regular eye check-ups, teaching him how to care for his glasses, and restricting activities where glasses might break. The goal is that by the time the child is 18, he will be ready and able to take full responsibility for the care of his own eyes and glasses.


How Do You Tell the Difference?

So how do you know if your child has a discipline problem or a behavior problem? The best way is to change the home environment. If the behavior stops or improves it is most likely a discipline problem. It it remains unchanged but more in control, and the parent is acting consistently, it is likely a behavior problem.

from Therapeutic Parenting: Chapter 2 Discipline vs Behavior Problems


HOW WE HANDLED IT:

I'm not actually sure if my children have an FASD. I do know that they both have permanent brain damage and the resulting behaviors and issues are similar if not the same. 

We did 3  things:
  1. Changed Our Expectations. 

    Really changed them. Redefined success for my children.  We lowered our expectations to what they could actually handle, not what their neurotypical peers could do or what their teachers and other professionals thought they "should" be able to do.. See this Level Chart post for some examples. 

    Changing my expectations also helped ME immensely (Finding the Joy).  I'm less frustrated by their inability to do things that would be "normal" for a teen.  I do have to constantly remind myself "She's only 6!  She's only 6!  She's only 6!"
     
  2. Parented with LOTS of Structure and Caring Support. 

    It took me a long time to believe it, but my children actually 
    craved caring structure. 

    When I began providing Caring Structure, I thought for sure they would rebel and make our lives miserable. They didn't always like it, but it seemed like their few complaints were based on what their peers thought about it, rather than something they were truly feeling. Unlike my neurotypical, biochildren who understandably would have protested the strict structure their adopted siblings required, most of the time, my adopted children just accepted it and moved on.


    Without this structure or when we "lightened up," my son would act out until he had to be returned to the stricter structure level. Somewhere deep down, subconsciously, his brain knew he needed that structure to feel Safe.

    My kids were easily overwhelmed and had a small window of tolerance. They were easily frustrated and were often dysregulated. We had to simplify their lives a LOT to
     lessen the feeling of “overwhelm.”  
    We did this by making their world smaller. 
    This was often like childproofing – avoiding and removing things and events that can be triggers. 

    See this post for how we did this - Structure and Caring SupportAnd this post for dealing with Dysregulation and Meltdowns.
  3.  Switched to Therapeutic Parenting

    Found my children's developmental/ emotional age and began therapeutically parenting them based on that age - Therapeutic Parenting Based on Emotional Developmental Age.

Thursday, September 28, 2017

Clutter, Hoarding, and Cleaning Their Room

Excerpts from The Psychology Behind Hoarding When does cluttered turn to hoarding?Posted Sep 05, 2014 Gregory L. Jantz, PhD 
Hoarding is considered an offshoot of Obsessive Compulsive Disorder (OCD), but recently this categorization is being reevaluated. It’s estimated that about one in four people with OCD also are compulsive hoarders. 
Without exception, hoarding is always accompanied by varying levels of anxiety and sometime develops alongside other mental illnesses such as dementia and schizophrenia.
Recent neuroimaging reveals peculiar commonalities among hoarders including severe emotional attachment to inanimate objects and extreme anxiety when making decisions.
Hoarding both relieves anxiety and produces it. The more hoarders accumulate, the more insulated they feel from the world and its dangers. Of course, the more they accumulate, the more isolated they become from the world, including family and friends. Even the thought of discarding or cleaning out hoarded items produces extreme feelings of panic and discomfort.

Symptoms of hoarding (Mayo Clinic):

  • Cluttered living spaces
  • Inability to discard items
  • Keeping stacks of newspapers, magazines, or junk mail
  • Moving items from one pile to another without discarding anything
  • Acquiring unneeded or seemingly useless items, including trash
  • Difficulty managing daily activities, procrastinating and trouble making decisions
  • Difficulty organizing items
  • Perfectionism
  • Excessive attachment to possessions and discomfort letting others touch or borrow possessions
  • Limited or no social interactions

Commonalities among hoarders (Mayo Clinic). 

  • Age: While severe hoarding is most common in middle-aged adults around the age of 50, their hoarding tendencies began around ages 11 to 15. During these early teenage years, they typically saved broken toys, outdated school papers, and pencil nubs.
  • Personality: Oftentimes hoarders struggle with severe indecisiveness and anxiety.
  • Genetics: Although hoarding is not an entirely genetic disorder, there is some genetic predisposition involved in the disorder.
  • Trauma: Many hoarders experienced a stressful or traumatic event that propels them to hoard has a coping mechanism.
  • Social Isolation: Hoarders are often socially withdrawn and isolated, causing them to hoard as a way to find comfort.

Why Children with Attachment Issues Are More Likely to Have Issues with Clutter, Hoarding, Chores, and Cleaning Their Room


Chaos feels normal

A child who grew up in chaos might act in ways to trigger that chaos, because that is the "norm" for their neurological system. Even a child who came straight from the hospital to your home, still might have been "pickled" in stress hormones in the womb. To them, chaos feels "normal," and they will act in ways to make their life feel normal and Safe (this is a "perceived safety" and has nothing to do with their current situation - where of course they are safe. Why Doesn't My Child Feel Safe?)

How we handled it:

Children NEED Structure and Caring Support to feel safe and start to heal. This feeling of safety is not about physical safety and rarely based in reality – it is a perceived feeling of safety. It feels life or death to them! To help them feel safe, we increased the level of structure we provided.

By helping them get and stay regulated, we saw fewer meltdowns and other dysregulated behaviors (like hoarding and being unable to keep their room clean). The more structure and regulation we provided, the more it felt normal to them. Chaos finally started losing its appeal. 



Executive Functioning - ex. Attention Deficit Disorder (ADD/ADHD), PTSD, and damage to the frontal lobe
It's common for kids with attachment disorders to have issues with executive functioning. 
Executive functions are a set of processes that all have to do with managing oneself and one's resources in order to achieve a goal.

  1. Working Memory - Being able to hold something in mind and then use it (like a list of tasks/ chores or how you told them to do something).
  2. Cognitive Flexibility - the ability to think about things in more than one way to solve a problem.
  3. Inhibitory Control (self-control) - being able to regulate emotions, ignore distractions, and keep from acting impulsively.
Sound familiar? All of course are required to be able to do chores and clean their room! See the post Chores, Responsibilities, and Other Things my Children Can't Handle.

How we handled it:
 This depended on what was causing the issues. For the ADD/ADHD - we mostly chose the medication route, but this post has some additional ideas. For the PTSD and other trauma issues, it took time and therapy. This post has some additional ideas. Unfortunately, for the brain injuries, like damage to the frontal lobe, we were able to help the children learn some "work around" techniques. This post has some additional ideas.

Too Many Steps 

An overwhelmed child will often freeze or even regress to more child-like behaviors. Kitty was not able to do things independently, like clean her room. Especially in the early days of her time with us. 

How we handled it. 

First, I cut back on the chore expectations. I changed what I thought she "should" be able to handle, to more (emotional) age-appropriate tasks. 

I would break down tasks into small steps and give them to her one at a time. Instead of saying, "Clean your room," which was overwhelming and just didn't happen. I would say, "Empty your trashcan." and when that was done, then I would say, "Put your dirty clothes in your laundry basket." When that was done, I would say, "Put your laundry basket next to the washing machine." Most of the time, I would have to do these things with her (not for her, but be present in the room, often helping clean near her). Chores, Responsibilities, and Other Things My Kids Can't Handle.


Eventually, she got to where she could do a few tasks at a time, but the chaos in her head will always be reflected in the chaos of her room. I still help her keep it regulated. Therapeutically Parenting the Adult Child






Sexual Abuse

A sexually abused child may try to make him/herself "unattractive" by being "dirty" or smelly. This can include his or her room.

How we handled it:

Chapter 6: Abuse
A related post about why my child's room (and person) reeked and how we handled it - The RAD Stink.


Addictive Personality

The Addictive Brain
Finally an article that puts in to better words why my son has an "addictive brain." We've seen evidence of it for years, and knew it wasn't the drugs themselves, because the addiction shifted often and he could stop seemingly cold turkey (drugs, alcohol, tobacco, but also sugar/ junk food, sex, stealing, adrenaline, chaos...).

"Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It's how we get our satisfaction. If we can't connect with each other, we will connect with anything we can find -- the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about 'addiction' altogether, and instead call it 'bonding.' A heroin addict has bonded with heroin because she couldn't bond as fully with anything else."


So my son remains "addicted." In part because his attachment issues - the (in)ability to make human connections - haven't really healed, but also because his Chronic Post Traumatic Stress Disorder means he is stuck living in a "war zone" 24/7. He carries his old "cage" with him wherever he goes.


How we handled it: 

The Addictive Brain


Food Hoarding
This post has more information about why kids hoard food, which has some commonalities/ similarities to why they hoard trash and clutter.

How we handled it: 
Food/ Hoarding/ Diet


Hypervigilance/ Living in a Warzone
Kids of trauma are often easily triggered, extremely sensitive to emotions, unable to regulate their emotions... causing them to react as if they are in a warzone.  You can't learn and attach if you don't feel safe and you're living in a war zone!  Hypervigilance (obsessively monitoring their environment) is super common among kids with PTSD.  It relaxes when they start to feel safe, but probably doesn’t ever really go away.

How we handled it: 

Why Doesn't My Child Feel Safe?


Poop and Other Bodily Fluids

 It's part of them. Some children develop an irrational fear of the potty or "losing" part of their body (poop).  I have seen a child "hold it" all day to avoid having to use the restroom at daycare, waiting instead until she was put in a diaper at night - causing serious intestinal issues. 

I've heard of kids hoarding/ hiding jars of pee, dirty pull-ups, used kotex... I can only assume at least part of this is related to whatever causes them to hoard. 


How we handled it: 

Potty Issues - What's That Smell?



Low Tolerance/ Overwhelm
Our kids tend to have a low tolerance for stress and are easily overwhelmed. 

How we handled it: 


Simplify

It is sometimes necessary to simplify a child’s life a LOT to lessen the feeling of “overwhelm.”  This can be like childproofing – avoiding and removing things and events that can be triggers.

Make Their World Smaller

This can be making their world smaller and lowering expectations. Level Chart post.

Strip The Room

Following a therapist's advice, we stripped the child’s room to only a bed, one or two stuffed animals, a book, and not much else. In times of extreme stress, we moved our child's dresser to our room. The child had to bring dirty clothes to “check out” clean ones.  This helped with hygiene issues, and lessened the amount of overwhelm. It made cleaning the room easier for the child to do him/herself (if they were able to do it alone at all). 

Room and Belongings Searches 

Bear frequently stole things and hoarded food and other items. Usually when searching his room, I gave it a good cleaning and removed all contraband and health hazards. While I usually did this randomly when he wasn't at home, Bear was aware that we did this for his safety, and rarely protested - even when I found contraband and gave him consequences.

Age Appropriate Expectations

Expectations are reduced to the child's emotional age. Kitty may be 16, but when dysregulated, emotionally she'd drop to about 6yo. Her daily chores became super basic.
We had a long discussion with Kitty about being emotionally 6 (still ticks her off to hear that), and that it wasn't fair to expect her to be able to handle certain things, and we felt it was cruel to dangle higher level privileges she couldn't actually achieve over her head. So therefore, I was going to stop "punishing" her for not being able to do things she wasn't ready for yet. Age Appropriate Expectations 

Chores-
We gave Kitty fewer chores and they are very simple and concrete. They were chores that would normally be given to a younger child (her emotional age). She did the same chores every day instead of rotating like the other kids. Chores

Put It in Writing

Lists cut down on the arguing. It always surprises me how much less the pushback is when I say, "Is your list done?" instead of, "Do {this} now." I think it's because there is less implied "criticism" from a list. Criticism is probably one of Kitty's biggest triggers, even if there was no criticism happening. It's not a reality based thing, it just feels like it to her.

Changing Your Expectations

Changing my expectations has helped ME immensely (Finding the Joy).  I'm less frustrated by her inability to do things that would be "normal" for a teen.  I do have to constantly remind myself "She's only 6!  She's only 6!  She's only 6!"

Declutter

At home, I did things like declutter and clean the child's room myself (Decluttering), because even with me helping them clean, it was overwhelming. So I did it when they weren't there, although I let them know ahead of time.  I left nothing but a bed, a book/ quiet toy, and a stuffed animal, at one point I even had my daughter's dresser in my room, and she "checked out" her clothing by bringing me the dirty ones, THIS WAS NOT A PUNISHMENT. I tried to find ways to help them understand that. I pointed out that now cleaning their room would be a lot easier! (Explaining Age-Appropriate Parenting to Your Child)


DE-CLUTTERING IDEAS:

Decluttering Post

Kid school projects

For all the cute school stuff the kids brought home, I'd put it in a folder marked with their name and age/school grade. A couple of years later, surrounded by the detritus of 2-4 kids' massive amounts of awards, report cards, stories, art projects I am able to go through it again and be fairly vicious. You can also take a picture of the item and trash the original.

Moving Time

Every time we move stuff around (like when I had to give up my sewing room to Bob for a bedroom), I try to go through it again with an eye to "what have I used recently... or never"?

Santa is Coming

Twice annually, I try to have the kids go through the house and de-clutter their own stuff. It works especially well to do it over the Thanksgiving holiday. I think I've blogged about this before. Basically I tell the children that Christmas is coming and they have too much stuff. Lots of kids would love the stuff that they no longer play with and the more they give away the more room they'll have for new toys from Santa!

Numbers Game

When going through items they had many of, I told them they could keep "X" number of items. I tried to make it sound like I hadn't just pulled the number out of the air. Sometimes it was based on their age, how many they needed (7 days in a week so 10 shirts), or how much room the toy took up (Ex. Ponito got to keep more match box cars than his age that year, but Bob could only have 10 stuffed animals). I didn't tell them my reasoning, just said, "You can keep 10 stuffed animals." This way the control issues were kept to a minimum and they didn't argue with me about what should be kept (it wasn't my decision it was theirs!). Helped them learn to prioritize what they like and wanted.

Fashion Show

I don't know how the clothes manage to accumulate like bunnies (except for socks of course, which disappear singly). Rather than just having them try on clothes, we make it a little more fun with a "fashion show." Once we have clothes pared down to just what fits, then they have to pair it down to just what's needed (the rest can go in the Clothes Closet or Good Will bag), usually one for every day of the week, plus a couple of extras. They get to choose which clothes they want to keep.

Clothes Closet

Clothes are back to being a huge issue for me because the girls and I wear similar sizes and all of us fluctuate in weight so it's harder for me to get rid of the clothes (I want to hang on to them just in case). I tend toward classics so it's not as easy as throwing away all the acid wash jeans with zippers and the ripped up sweatshirts (am I showing my age)?

Garage Sale Prices

I paid the kids $1 a bag (large kitchen trash bags) for all the toys they got rid of - the theory was I would sell them at some future date in a garage sale and this way they got their share of the money now instead of waiting and hoping it would sell. We got rid of a lot of those McD*nald type toys that clutter up everyone's toy boxes! I also paid them $1 for full bags of trash (to try to avoid the kids putting trash in the sale bags to fill them up faster).

Sort Immediately

Laundry is my nemesis. I try to put the laundry basket near the drawers or closet where the majority of them go and put them away directly into the appropriate drawer, but I have to admit, we have a couch in our bedroom that is draped with sorted piles of clean clothes (my husband's shirt stack, my shirt stack, his undies, my undies, matched socks, folded towels...). Not sure why I have trouble doing that extra step of actually putting them away.

Paperwork is my other big clutter issue. Hubby keeps every bill we ever had - mostly not opened because he pays online - and that's a LOT! I have IEPs, psych evals, applications, reports... for both kids. I've gotten a little more organized about that, because otherwise the piles will eat me (I love my 3" 3-ring binders). Now that I'm in two NAMI classes, trying to study for my social work license, and keep up on my reading, that adds up too. I try not to even go to the mailbox unless I'm ready to sort right then. Hubby's, Old Company, Mine, and Trash (recycling). Coupons and stuff go in my car - which I usually end up throwing away as they expire.


Inspiration

I read books about de-cluttering, watch lots of trash TV including things like Clean House and other decorating shows for inspiration. I signed up for Fly Lady at one point - which was really helpful. Of course the kids are old enough now to do lots of stuff for themselves (laundry, dishes, etc.) as evidenced by our chore chart.

More posts on techniques for stripping/ decluttering the room:

Adult Boarder vs "Family Girl"


Sunday, August 27, 2017

9 Year Blog Anniversary



I can't believe it's been 9 years since I started this blog!

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 children adopted as teens who have RAD, trauma other severe mental illnesses and issues (plus "neurotypical" biokids), is not easy, and there are often time when I say what I feel... at that moment. We're all human!

It started out as a way to vent
My First Blog Post
In our house, it's called the "Three Vent Rule." In my need to talk through my problems, I discovered I was not only burdening my friends and family with my problems, but I was also "ruminating" and actually making myself feel worse. 
I eventually came up with the "Three Vent Rule" - which stated that I could only whine/ complain on any one subject to no more than 3 people. I try to spread the love around too so no one person bears the burden of all my whinging (except Hubby - poor baby always has to listen, but that's why I married him - because of his broad shoulders - designed to bear all the weight of my world, and then some). I also had an unwritten rule to try to make the story as entertaining as possible so no one would notice what a total whiner baby I really am.

Another big source of venting for me was the long e-mail (Hubby calls them novels). I would write all about what my children were in to (or more likely up to) and the whole adoption team was FORCED to read them. Now that my children's adoptions are FINALLY final, I no longer have a captive audience. I'm hoping that this blog will allow me to vent without overwhelming my small support group.
So now I begin the journey into blogging.


5 Years Ago - Where Did Your Blog Go?
 I had shut my blog down when I discovered the kids'  biofamily were reading it. When I decided to put it back up, these were my reasons:  
    1. As a place to vent and get support from other moms who "get it."  When I first started blogging I didn't have access to this amazing community, and the few people I knew who'd adopted, even those who'd adopted RAD kids, had adopted younger children.  
    2. To share and provide support and education for other trauma mamas.  Over the years I've had to acquire a crash course in RAD and trauma and I didn't want others to have to go through what I did and make the same mistakes I made.
    3. To provide information to those in my kids' lives that needed it (like Grandma), without having to repeat myself or chance having the kids over hear it.
    4. To maintain a record of events.

    I seriously considered closing my blog permanently after these events.  It had become harder and harder to find the time to blog, and as I was becoming more despondent and hopeless over the fact that Kitty was getting worse and worse and we had fewer and fewer options. I was blogging from a more and more negative place, and that felt awful.  I chose not to stop because:

    1. While I do have other places to vent, most of them don't know the "back story," and therefore most of their support is sending hugs and prayers (which are greatly appreciated!), but less practical.  This group has helped me be a better advocate and therapeutic parent for my children - through support, advice, and even helping me write documents.  It also helps to get validation from people who know I'm not a saint or evil personified.  In the weeks since I've closed down the blog I've realized how much I need and care about all of you!
    2. I get a lot of positive feedback and personal satisfaction out of my role as educator and advocate.  It is extremely helpful to be able to say, "Oh, I learned a lot about that at Katharine Leslie's seminar or here's how we handle discipline at our house - here's a link."  I can't imagine just throwing all those resources away.  When you don't get a lot of positive feedback from your kids, it helps to get it from somewhere!
    3. It helps me maintain my link to this community and its resources.


Present Day
Now, I mostly blog for different reasons.

I've become very active in the trauma/ attachment issues community, working with foster, adoptive, bio, step, blended... families dealing with children with attachment challenges. Among other Facebook groups, I moderate a large online support group called Parenting Attachment Challenged Children. In giving advice, suggestions, and resources it helped to have it all written in one place to refer to rather than having to rewrite the same information over and over.

I still do the occasional update about my family, but now they are all legally adults and stable (mostly), it's more about supporting this community.

I don't blog as much as I used to, mostly when someone asks me a question I don't already have a post about. I'm looking forward to the coming years!

Thursday, August 24, 2017

What's That Smell? Potty Issues

There are many different causes for "potty issues" (aka "enuresis" - wetting and "encopresis" - pooping).  Often there is more than one cause.  

"Potty issues" can be bed wetting, refusal to poop, daytime wetting or pooping, pooping or wetting in inappropriate places or at inappropriate times, "painting" with poop...). 

Dysregulation, trauma triggers, a need for control... can cause issues and regression in this area. These can also cause the "RAD Stink" which has little to do with potty issues, but usually smells worse.

The RAD Stink - You've heard of the "smell of fear"?  This is the smell of dysregulation.  It usually smells like a combination of poo and the worst body odor you can imagine.  Yes, sometimes our kids' hygiene is not the best, but this stench doesn't go away, even with thorough washing and a change of clothes (although we have found that using a combination of antibiotic waterless hand soap under the armpits and a change of clothing can frequently keep the school from sending her home yet again!). 

Developmental - lack of readiness for potty training. 

This can be emotional development too! Your child could be 8 years old, but operating emotionally at the level of a toddler. Age Appropriate Therapeutic Parenting
My Potty Training Philosophy is that it is better for children to switch straight from diapers to underwear when they have all of the signs of readiness (Showing an interest in the potty.  Able to take own clothes on and off.  Staying dry for over an hour or so - Children who are not physically ready will “dribble” all the time, rather than hold the urine).

Physical causes - Potty issues can be caused by:
  • Chronic constipation (which can also cause urinary tract infections), 
  • Urinary/ bladder/ kidney infections,
  • Problems with the "plumbing" (Kitty and my sister had to have surgery to correct issues with their "plumbing" - the "tubes" leading from the bladder being too small or the valves from the kidneys not working correctly), 
  • Allergies can cause severe gastrointestinal issues, 
  • Medications and med changes can cause gastrointestinal issues and other issues
  • Sleep issues - deep sleep (which can be caused by exhaustion, medications, or be biological/ genetic predisposition...) can mean the body may not "hear" the signals that the bladder or intestines are full
  • Hormones (trauma can trigger early onset of puberty meaning hormones can come into play at a much younger age!),
  • Hernias (my nephew had a hernia at age 8 that caused him to wet his bed at night)...
  • Scarring body may not "hear" or recognize the signals


Emotional causes - This subject will always make me think of Christine Moer's  "Pee Song."

  •  It's part of them. Some children develop an irrational fear of the potty or "losing" part of their body (poop).  I have seen a child "hold it" all day to avoid having to use the restroom at daycare, waiting instead until she was put in a diaper at night - causing serious intestinal issues.
  • Distracted, forgets, or doesn't like transitions  - to stop what they're doing and go potty). They may be dissociating - not aware of the world around them, or the opposite- too focused (hyper focused) on what they are doing to stop and use the restroom.
  •  Doesn't want to draw attention to themselves.  The child may be afraid or uncomfortable asking or interrupting to ask to go.  
  •  Dissociation from physical self or lowered awareness of body - not knowing they need to go until it is too late - this can include not realizing or not caring that they have wet or messed their clothing.   
  •  Sexual abuse can cause a fear of bathrooms (might reminds them of the place they were abused), unwillingness to be naked (for toileting, baths, or showers), and unwillingness to touch themselves in places they were abused (causing issues with wiping and hygeine as well). A sexually abused child may have tried to make him/herself "unattractive" by being "dirty" or smelly. 
  •  Outdated defense mechanism -  A way to protect themselves emotionally. Sometimes old defense mechanisms outlive their usefulness, but the child can't stop.Defense mechanisms can feel life or death and the child doesn't feel safe without them (this is a "perceived safety" and has nothing to do with their current situation - where of course they are safe). Why Doesn't My Child Feel Safe?
  • Regression or delayed development.  Frequently children with trauma issues will remain stuck in earlier developmental stages or will regress - especially when dysregulated or triggered. The child may not be ready for potty training yet (or any more). It might be a way for your child to tell you they need the support and attention you would give a younger child - like kids who start baby talking, "forget" how to do things they used to be able to do, and wanting to be fed by you.
  • Way of expressing without words that they are unhappy or in emotional distress. Sometimes it really is a way of saying, "I'm pissed," or "Poo on you!" It also could mean "This is a poopy situation!" or "I don't give a poo!"
  • Entertainment and attention. Enjoys watching others jump around and get upset. Draws attention to them (negative attention is still attention!).
  • Feeling in control of their environment - a lot of kids feel that they can't control what's going on in their lives, but they can control what goes in to and out of their bodies and what happens to it.
  • Hoarding. An irrational fear that can be caused by a loss of everything when moved to a new situation (like foster care) or due to a mental health disorder like obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and/or depression.
  • The smell feels "normal," maybe even comforting. A child who experienced neglect at a young age, may have consistently sat in wet/ dirty diapers or surrounded by this smell. Just like a child who grew up in chaos might act in ways to trigger that chaos, because that is the "norm" for their neurological system.
  •   Proof you love them. Only parents handle pee and poop and still love you. 
  • Pushing you away before you can reject them - Many kids of trauma "know" they are unworthy or unlovable and believe that when you find out you will leave like everyone else - so to get control of that they find ways to push you away - If You Find Out I'm Not Perfect You'll Leave.
  • For reasons we don't always understand!  I worked with a neurotypical fully potty-trained child in a daycare situation who liked to change her clothes... frequently.  When told she couldn't just change her clothes for no reason (teacher didn't have time to stop everything and let her change multiple times a day) - the little girl "made" a reason!  It took us awhile to figure it out, and the first thing I tried (stopped allowing her to change into her pretty princess panties and cute outfits and providing her with gender neutral clothes from the class stash) caused her to step up her game, until eventually she even started finger-painting with poop. We had to back up and stop making it a control issue.
  •  Some combination of the above - Dysregulation, illness, hormones, med changes, trauma triggers... all can suddenly trigger or worsen issues. 


So What Do You Do About It?

This is why part of our job as a therapeutic parent is to be a detective. Figuring out why it's happening can help us figure out how to stop it.

Handling it - 

  •  Avoid shaming or making it a control issue.
  •  Remain as calm and matter-of-fact as possible
  •  Expect the child to help clean up, but try to keep within their developmental abilities. Remember an emotionally delayed child should only be expected to do what is developmentally appropriate for their emotional age. For example, you wouldn't expect a 2-year-old to mop up all the potty water from an overflowing toilet, disinfect the room, cleaning supplies and themselves.
  •  A child in fight/ flight/ freeze is acting purely instinctually - the thinking part of the brain is not online so it is best to address things when they child is regulated. Dysregulation and Meltdowns
  • Social Skills. Sometimes having outsiders comment on the child's smell/ hygiene will help, but it could also feel shaming. Plus, most adults won't do it. They'll politely suffer through the smell instead (and tell you about it). Other kids will usually just avoid your child. I have warned my children that it can cause social issues, but it rarely worked.
  • Keep a change of clothes (or 3) with the child (back pack, locker, cubby...) or in the nurse's office or somewhere the child can access it. Waterless, antibacterial handsoap can often help with odors and cleaning.
  • Give the child some socially acceptable words/ euphemisms they can use to explain to others what happened. My 16yo daughter called me from school once asking me to bring her a change of clothes, because she'd, "lost an argument with the water fountain."
  • Make a schedule. Does the child need reminders to go potty? Assistance getting up in the middle of the night to go to the bathroom.
  • Make an appointment - have a doctor make sure the cause isn't a medical issue.
  • Keep hygiene lessons brief - but do give them. I let my kids know that not changing underwear/clothes/ sheets with pee or poo in it can burn the skin and lead to infections. I also gave lessons (with clothes on!) in how to wipe and clean. (Also in how to change out a toilet paper roll!). These do have to be repeated as needed. My kids took a long time learning this. 
  • Cleaning - Wear gloves! This was less from worry about germs or the ick factor and more about the fact that the smell of poo really adheres to your skin. When cleaning up yet another overflowing potty I always wear gloves!
    When cleaning bedding - we generally use vinegar.
    When cleaning carpet -
    -- For poo - I've used Arm&Hammer Cat Box Litter! I sprinkle it on the carpet, wait a while and vacuum it up.
    -- For pee - using something absorbent, I try to dry up as much as possible (assuming it's still wet). Then I use Odormute (which you can get at pet stores, Wal-mart, whereever). You have to  use enough to let it soak into wherever the pee touched (including the carpet pad).One box has lasted me a long time.
     
    ·     Check often. My daughter slept in a loft bed. I frequently had to give it a smell test. I also had to watch for wet pull-ups, which for some reason she liked to hide.

    A trick for frequent bed wetters - We had a plastic mattress cover (of course) and made the bed as usual (fitted and flat sheet). Then we covered that with a plastic layer of some sort (I liked shower curtain liners - preferably ones that didn't make crinkly/ crunchy noises). Made the bed again (fitted and flat sheet). Repeat for several layers. Keep some clean pjs (and pull-ups if used) by the bed - we used a little wooden chest.
    When the child woke up in the middle of the night to wet sheets, all they needed to do was strip the top layer of sheets and their pjs, the plastic sheeting generally kept the urine from getting everywhere. Put on new pjs - kept in the box/ drawer/ whatever right next to the bed. Grab a new blanket if needed (we kept folded up comforters/ blankets on a shelf at the bottom of the bed.
    Voila! Back in bed ready to sleep in minutes. Could be done multiple times in one night if needed. In the morning, the child could put the whole mess in the washer (with some hydrogen peroxide and/ or vinegar or whatever you like to use).

    Low Tolerance/ Overwhelm
    It is sometimes necessary to simplify a child’s life a LOT to lessen the feeling of “overwhelm,” which can lead to potty and other issues

    This can be like childproofing – avoiding and removing things and events that can be triggers.  This can also be making their world smaller and lowering expectations. 


    One thing Kitty's therapist recommended was stripping her room. Nothing but a bed, one book, and one stuffed animal. It was NOT a punishment, and not something they could "earn" back (or actually not earn back, because my kids are afraid to be emotionally attached to things as it gives others power over them so they affect indifference to them. ).

    For a time, I even took my daughter's dresser out of her room and had her check out her clothes each day (this cut way down on the wet pull-ups and worse stuffed behind dressers and other places).

    We also cut back on the chore expectations she "should" be able to handle. I would break down tasks into small steps and give them to her one at a time. Instead of saying, "Clean your room," which was overwhelming and just didn't happen. I would say, "Empty your trashcan." and when that was done, then I would say, "Put your dirty clothes in your laundry basket." When that was done, I would say, "Put your laundry basket next to the washing machine." Most of the time, I would have to do these things with her (not for her, but be present in the room, often helping clean near her). Chores, Responsibilities, and Other Things My Kids Can't Handle. 

    Eventually, she got to where she could do a few tasks at a time, but the chaos in her head will always be reflected in the chaos of her room. I still help her keep it regulated. Therapeutically Parenting the Adult Child