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!

Friday, May 20, 2016

Dysregulation and Meltdowns

We've all experienced it. A child demands something he/ she knows we won't allow. When we say, "No," out comes the attitude, the meltdowns, the whining, the demands, the picking (on, at, over...). It's not a RAGE (although the reasons behind it are often similar and it can quickly escalate to one). {Dealing with Rages} It's more like a meltdown or a tantrum.

The child in a meltdown usually has some control over how far they will go. They can still escalate in to fight, flight, or freeze mode easily, but instead of physical aggression we see mostly verbal threats, (although Kitty's still been known to kick cabinets and bite and scratch in a meltdown). We can usually reach her and calm her down fairly quickly (Calming Techniques), if not actually de-escalate her, before she “melts.”

Sometimes when Kitty is especially dysregulated she deliberately picks a fight with me so she can have somewhere safe to express her emotions. She can't let others outside the family see that she has issues, that's not "SAFE." So she processes them with me. Which SUCKS!

We rarely know what trigger starts an individual meltdown. A test. A bully. A holiday. A traumaversary. HALT (Hungy, Angry, Lonely, Tired). A "life changing event" (positive or negative). Even the let down after a good day or worry that they can't keep up the positive behavior so they self-sabotage.

{BTW, we're going to pretend I handle meltdowns like the perfect therapeutic parent  every time}

Dysregulated - When it's not just a single meltdown

For whatever reason, there are times when my child gets stuck in dysregulation. We see things like:

  • The RAD Stink {You've heard of the "smell of fear"? Well, the smell of dysregulation in attachment disordered kids smells like feces and the worst body odor you can imagine.}  
  • Acting Out - physical or verbal threats and/or aggression, picking fights
  • Suicidal threats/ ideation
  • Acting In 
    • Manic/ Hyper: agitated; overly-sensitive; loud, pressured speech; over-zealous in relationships; loud, barking laughter; "vibrating" leg(s); popping knuckles (only does this when under stress); impulsive; difficulty concentrating

    • Self-Harming: gouging skin with finger nails; stabbing with pencil; burning skin with eraser... technically this is an "acting out" behavior, but Kitty has been known to do it secretly in public and often expresses concerns that she might self-harm and asks for supervision to prevent it.

    • Depressed: Statements she wishes to die; statements or acting as though she wishes to "give up;" statements that others "hate her;" belief/ statements that she is worthless/hopeless/unlovable...

    • Escape/Dissociate: physically leaving room or "checking out;" unfocused; changing subject (often apparently at random); distracting (asks question or makes comment that changes the subject); napping/head down; appearance of being exhausted; "shutting down"

    • Somatic issues: aches; pains; exhaustion; hunger. Has difficulty identifying correct emotional and physical feelings so is prone to emotional eating and ascribing real or perceived aches and pains to incorrect sources. Ex. If Kitty is feeling depressed or suicidal (possibly because she forgot to take her meds, skipped a meal, hormones, chemical imbalance, was triggered by a traumaversary or event...), she might blame this on a recent event (such as a fight with her sister) that may or may not actually be related.

    • Depressed: Sad; crying; whining; begging to go home

    • Overwhelmed: low frustration tolerance; disorganized; needs others to "chunk" assignments (break down into smaller more manageable pieces); forgets assignments or needed materials; hurries through assignments; requires frequent breaks to relax and regroup; frequent requests to leave the room; needs frequent redirection and individual attention; difficulty remaining focused and on task - needs frequent assistance/ reminders.

    • Anxious: hyper-vigilance; worry; hurries through assignments; obsessed with following the rules

    • Poor Boundaries: inappropriate interpersonal interactions. Inappropriate sharing/ venting with peers and others, particularly about abuse and perceived abuse (past and present); participating in or allowing physical and/or emotional teasing/ bullying; inability to recognize other's "boundaries" and bothering them; perceives others as threatening or abusive; tattling about rule breaking; verbal lashing out; gossip (has spread vicious rumors regarding siblings/ friends and accused them of doing the same); threatens or hits peers (yes, this is an "acting out" behavior, but it is one that Kitty has acted on in school and the community).
  • Chronic Anxiety at a level 3 or above  
  • Fidgeting, chewing/ sucking, tapping, can't sit still...
  • Constant visits to the nurse - or other means of getting out of stressful situation
  • Verbal diarrhea - cannot stop talking - usually about irrelevant nonsense
  • Dissociated - can't stay focused. Not always functioning in reality. Easily distrac- SQUIRREL!
  • Cycling between sensitive, emotional, and fragile or aggressive, angry, and frustrated sometimes within minutes.
  • Disturbed sleep patterns - chronic insomnia or sleeping all the time (shutting down to avoid dealing with life)
  • Etc.

Many times a child won't actually exhibit these behaviors anywhere but at home, because only home feels "safe" (this is a perceived safety not physical safety). Kitty would literally rather die than let others see she has "issues." I try to remind myself this means she trusts me more than everyone else, but that doesn't really make it easier to handle. (Why Does My Child Act Differently Away From Home?)

Getting a Child Regulated

Sometimes getting a child regulated can involve psych hospitalizations, med changes, increase in therapy, possibly even residential psychiatric treatment. In the meantime, I try to remove as much stress as possible and do what I can to make my child feel safe.

When Kitty gets dysregulated, I make her world smaller. We cocoon. We have a letter party (shopping at a time of day when no one is there because crowds are stressful!) or some special treat (pizza, homemade comfort food, fast food). We veg in front of the TV with a favorite video (or something I pick up at Red Box).  No chores. No school work. No company. No expectations. 4 foot rule. Line of sight supervision. Lots of calming techniques.` Childproofing instead of consequences and punishment.

Handling the Anger (my own!)
Believe me I get that it's the last thing you want to do. I get so mad at her that I just want to pinch her head off. I try to repeat my mantra - "She's only 6! She's only 6!" and remember that there are only 2 emotions (love and fear - Beyond Consequences) and she's so scared that this feels life or death to her. She's so terrified, that she drops into fight, flight, freeze. Hopefully, if I can get her regulated again, she'll go back to being my sweet kid, and stop asking for stupid stuff we both know she can't handle. {Finding the Joy}

Helpful Tip from a fellow trauma mama:State, "I'm not interested in arguing," and walk away. That used to floor her. 

Then I do a LOT of Self-Care to refill my bucket after pouring all that support into her.

I work with the school to try to make my child's world less stressful there too. Anything I can do to get my child regulated again.

The amygdala is part of the lesser-known limbic system which supports motivation, learning and memory. AND the ability (or the inability) to maintain emotional regulation.
For children, teens or young adults who experienced early trauma, receive a PTSD, RAD or other mental health diagnosis, or even struggle with typical stress, the challenges are real. When they’re overwhelmed, the amygdala goes into overdrive.  Dysregulation results. Over time the amygdala can expand and increase emotional intensity
With their brains stuck in high gear, they overreacted to the perceived threat – leading to absolute fear. 
By being re-traumatized, they felt compelled to survive. They felt compelled to be the one in control. They felt compelled to enter the fight or flight zone {I usually add "freeze" to this}

Handling Dysregulation:
No Commands or Demands
I avoid the direct, in-your-face approach. Clear commands – or reasonable demands – seem logical but usually do the just the opposite, whether at home or school. “Calm down.” and “You need to stop.” are two examples, often overused when dysregulation begins.

No "Why?" Questions
Any question requiring insight doesn’t help the situation either, such as “What’s wrong?” and “Why are you upset?” 

Most importantly, I seek to engage my child – as soon as symptoms appear. 

Sometimes the re-regulation process can take two to four hours, which explains the drastic change in a child’s mood when waiting and waiting for emergency room care after a severe incident at home. And the subsequent denial of psychiatric admission.
Therefore, I never rush my child.

Using the power of the brain, I focus on my child’s cortex – and its four lobes – to counter the negative response from amygdala. In other words, I create a powerful diversion within the brain. I call it “my quick fix of the wiring.”
At the same time, I am mindful and highly intentional in my efforts.

Engage the Frontal Lobe - Factual Questions
To engage the frontal lobe, I ask a question or two based on fact – definitely not personal emotion. Questions starting with “what, who, where or when” are a safe bet, not “how or why.” Each question can be off the wall and fit the child’s interests or level of knowledge.
What color was the Joker’s hair? What about the Riddler’s suit?
Where does the President live? What color is the White House?
When is Grandma’s birthday? What age will she be on her 85th birthday?
Who is the king of rock and roll? Mine, not yours!

To engage the parietal lobe, I attempt movement if my child’s agreeable. Exercise – especially anything that applies deep pressure – has long been associated with emotional regulation. A neck massage or back rub can also hit the mark.

Pictures and Music
To engage the occipital lobe and temporal lobe, I use visual or auditory stimulation. Vibrant pictures or instrumental music often do the trick. A little Mozart can work wonders without mom or dad saying a word.

Engaging the Whole Brain - Make 'Em Laugh!
How about playing music, while dancing and asking a few silly questions? Nothing stops “fight or flight” like humor in my opinion, especially when my children laugh at me.
I’d much rather have my children laughing at me than physically attacking me.

{I wrote this Handling Child Stress post for a fellow Trauma Mama whose children are reacting to school starting.}

When my children acted out, which was always worse around Holidays, Traumaversaries, Starting or Ending School... when I wasn't so frustrated at them I could scream, I pulled them in. I reminded myself that they were terrified. This was life or death to them, and they couldn't really handle change or added stress (this has gotten better as they healed). Even my bio kids reacted this way, just not to this extreme.

Some insight into why our kids act the way they do.

Structure and Support
Our kids need a LOT of structure and support, especially when they are overwhelmed.

I reminded myself that they were really so very much younger than they looked, and I was expecting a lot from them. I tried to change my parenting to better match their emotional age.

I tried to remind myself that they were SCARED and punishment for something that was out of their control was not just mean, it was pointless. What they needed was to feel safe and loved. That meant I couldn’t take away all fun stuff (even though I wanted to!!!)

Most of all, I gave them a LOT more structure and support. We went back to line of sight supervision, time ins instead of time outs, removed as many overwhelming events as possible (not just avoiding throngs of hyper children in places like sporting events and the park, but also the grocery store and Sunday School).

Yes, there were things I could do nothing about (school/ daycare), but I could talk to the teachers and minimize as much stress as possible.

Feeling SAFE
I tried to find calm, quiet, but still fun, things to do so they wouldn't feel punished (taking a walk, letter parties … ). This wasn't about being in trouble or loss, they'd had enough of that; this was about making their life smaller. So they would feel SAFE (this is perceived safety, -usually feeling unsafe is a leftover defense mechanism that is hard for our kids to get past)

At home, I did things like strip their room (helping me was overwhelming so I did it when they weren't there, although I let them know ahead of time) to 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,


 I tried to find ways to help them understand that. I pointed out that now cleaning their room would be a lot easier!    
When stress was high, my kids’ life was like being in the FAIR Club (our family discipline method  ), but without actually being in the FAIR Club

I used calming techniques a LOT.

Some other things we tried when Kitty got stuck:

We began making Kitty's life a little more "uncomfortable" though so she might be motivated to work on her issues. Little things like,
"I know you would like to stay home instead of having to do the grocery shopping with me, but dad is staying home with the other kids, and you have issues with dad and men, and you chose not to work on those issues in therapy, so you will be coming with me."

Because her issues were worsening, we shutdown her world and removed as many stressors as possible.

Just like when someone is allergic to an unknown food you might put them on the elimination diet (- remove all possible allergens and add them back one by one watching carefully for allergic reactions). This can help you discover the food(s) that are causing the allergic reactions and possibly the amount of tolerance (like she can handle "this" and "this," but not if she's also around "that.")

  • No interactions with siblings,
  • No interactions with Hubby unless it is attachment related,
  • No being left alone with anyone but me, which means no Grandma's house on weekends (she will have to go to bed early so Hubby and I can still have our alone time),
  • I will be the one supervising her chores (when they are not done before I get home),
  • No PG movies or Y7 TV shows,
  • She can still have her Bratz dolls (*blech!*), but no more playing with her sister - it becomes more like play therapy and her sister doesn't need to hear the attitude and behaviors, so she can only play dolls with me - the rest of the time they stay locked in my toy box,
  • Stripping her room more than it already is,
  • Go back to issuing one outfit of clothes a day (to reduce the stress of choices, putting away her clothes, and not being able to find socks or other things),
  • Reduce dramatically the number of chores (and allowance),
  • No more sitting in the front seat of the car (she tends to yell at Hubby and I),
  • I will make her school lunches and serve her meals,
  • 4 foot rule applies whenever we leave the house (must stay no more than 4 foot away from me),
  • No playing with neighbor children or in the front yard without me or Grandma present.

Hubby was afraid that I would essentially become her "warden" and the family's quality of life would deteriorate more than it already had. but I was not ready to give up on her, and we didn't really have a lot of alternatives. In the end, she thrived under the added structure (and attention), and the family's quality of life actually improved somewhat.

Age-Appropriate Environment
Looking back, I realize that we were actually providing a more Age-Appropriate Environment for her. In a lot of ways, she was emotionally only 4 (especially when she was dysregulated) and expecting her to act her physical age put so much stress on her that it made things worse.

Helpful Posts
A lot of times I screwed up. I lost my cool. I gave up.

Then I did a lot of Caring for the Caregiver because this is HARD WORK. 

I forgave myself for not being a perfect parent and putting my child first, which was REALLY HARD. Prioritizing Yourself, Your Family, and Your Child - In That Order!

 I put on my big girl panties, tried to Find the Joy, apologized to my child for not keeping them safe, and started over. 

Being a Therapeutic Parent often SUCKS, but it does get better!

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