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!

Sunday, November 6, 2016

Structure and Caring Support

Guest Blog Post by Traci B, a fellow Trauma Mama

One thing my son said to me a while back,


"It's easier for me to be bad than it is to be good. 
I've always been that way and it's hard for me to change." 

This hit home for me. He really had no idea how to be anything different. His brain was wired to "be bad." We did not use those words. He did.

This hit home for me. I had to change his thinking and the way his brain was wired! 

This is about my adopted son and what we did to help him:

A little background - we got custody at 11 years 10 months straight from the psyche ward at a local hospital. He knew nothing!!! Walked out in front of a car in the parking lot. Never even looked! The behaviors were through the roof! Getting his some of his behavior under control and making him feel safe were our priority.

As I have written before, Nancy Thomas' book When Love is Not Enough helped with this and other stuff. Then we began working on changing his brain! This post is about that -

Concrete Thinking
To him everything to him was black and white. He could not think of other ways to do things. To him there was only one way!

 If I allowed him to do something one time then he used that other times by saying "But you said or you did" and then whatever it was. It was like just because I got him a drink one time he thinks I knew what he wanted and should just get it for him. Or I let him eat doughnuts one morning so he should have them every morning. I let him watch TV one day when it had been taken away because he was exceptionally good so he thought I should do this every time he lost something. The list goes on!

My son has never earned privileges or rewards. He self sabotages at every turn. He feels he does not deserve them. So rewards were in the moment only. I swear my son's brain/thinking was the total opposite of what you would think.

Changing His Brain
I started teaching my son to change his brain. Gave him toys he had to figure out or build (using his brain) and I'd help minimally.

He'd ask a question that I knew he knew the answer too, so I would not answer it but make him. If he chose not too then the discussion ended.

At times, I made him come up with at least two acceptable answers, even if they weren't ones I wanted or the correct answer, but would work.

I limited any electronics. Matter of fact, my son was not allowed any video games, cell phone, iPad, iPod etc up until two years ago and then it's very limited. The only electronic he was allowed was music and TV but also limited.

He would walk around bored so we made a list together of things he could do (108 Alternatives to Being Bored and Trapped in the House) and when he was bored he had to choose one.


To answer the question should you give him things he wants without asking. NO! 


He has to ask 
He was so manipulative and getting me to do stuff for him and using my brain.

So, we had him ask for everything for a while - to go to the bathroom, snack, what clothes to wear, to go outside, to watch TV and the list goes on.

If he did not ask then I'd turn the TV off until he did.
Make him come inside until he asked.
Put his clothes in my room so he had to ask.
Snacks locked in my room, and so on.
One day, I even locked the bathroom door until he asked although I made him use it first thing in the morning, afternoon and at night. He seldom was went more than twice a day so three was good!

Sounds mean, but he had to learn to ask. 
He had to learn that others will take care of him. 

I got his breakfast, made his lunch, dinner etc. He could ask for what he wanted for breakfast and lunch at times but mostly I chose for him. I had to take total control from him for a while.

Now doing this, I thought he would melt down left and right, and he did some at first, but then he seemed to be glad that he did not have to make any decisions.

Slowly, we added choices in - let him choose between two things for breakfast and so on. Let him get a drink of water whenever he wanted (had to ask for other stuff partly because he'ed drink it all), and use the bathroom.

Now at 17 1/2, he has his clothes in his room and picks his own out. He makes dinner sometimes. Basically, he has learned to use his brain a lot more and has a lot more freedoms.

We have lots of discussions, especially now, about behaviors that come up, his refusing, wanting to be independent and demanding (actually this is control issue which is increasing the closer to 18 he gets).

Taking Away Control
He had to be in control of everything, so we took control away to teach him he would still be safe, get fed, have clothing etc.

One major thing we did was not tell him where we were going (therapist appointments, ice cream, dinner, family's homes, no where!). He'd ask and we'd just say, "You'll see." And answer no other questions about it.

Again, we thought he'd rage/tantrum, but he did not. It even lowered his anxiety. Everything seemed to work the opposite of what you would think it does.

Opposite Parenting
So we learned to think {highly structured parenting}. Our first thought, we seldom did, but instead went with the opposite for the most part.

It's like you have to teach them how to use other parts of their brain because they only use the animalistic part (the reaction of Flight, Fight or Freeze**).

So, those are some of the things we did and it worked for my son. I hope this helps.  ~ Traci B.


** Fight/ Flight/ Freeze
Fight/ Flight/ Freeze - A child who is dysregulated and/or in fight/ flight/ freeze mode is “thinking” with the reptilian part of the brain (survival!). Their behavior is a purely instinctual response to what the brain believes is a life or death situation! The rational part of the brain just isn't online. Their eyes frequently glaze over, they are out of control, and it is like the child isn't "home." Afterwards they do not remember what happened just before or during an episode. Holding a child responsible for what happens when in a true fight/ flight/ freeze is pointless- it’s better to just move on after it's over and try to figure out what triggered it so you can avoid it in the future.





Structures and Support -
Children NEED structure and caring support to feel safe and start to heal.   This feeling of safety is usually not based in reality – it is a perceived feeling of safety.

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.

Consistency - 
We learned the hard way that when we didn't stick to our guns, even once, then the child seemed to work even harder to get what they wanted again.
Ex. Let's say you don't allow dogs on the couch (Yes, I know our children are not dogs. I was looking for an example that people might have already seen or experienced). You have a new dog that loves to curl up on the couch and sneaks up there all the time. 97% of the time you drag him off and tell him, "No!", BUT every now and then, you're just too tired to mess with it and you let it go. You have now guaranteed that dog will always jump on the couch in the hopes that this time it will get to stay.

When our daughter came to live with us, she knew that if she argued, fought, cried for long enough then the adults in her life would give in. I felt like the crappiest mom in the world saying, "No" to this poor little kid who'd had such a hard life, but we HAD to break the cycle or we would all be miserable.

When we back down - let our kids argue, intimidate and manipulate us into changing our minds, we are sending a mixed message to our child. That message is that we cannot keep our child safe.

If the child feels that they are in control instead of us then their world is not SAFE.

I say "safe" a lot. That's because I believe it's one of the most important motivators our children have. They do not trust and they do not feel safe. An insecure, scared child behaves in increasingly bizarre and scary ways to get control of their world. When they have control, instead of the adults, then they get more afraid and things cycle even farther out of control.

Caring Structure
It took me a long time to believe it, but my children actually craved caring structure. Their favorite teacher at school was a behavior staff person who always called them on their behavior - if they were acting like a turd, she said so, bluntly, BUT, unlike the teachers who let them do whatever they wanted, or were super strict, but didn't actually care. Even though their favorite teachers were super strict, the kids knew that they legitimately cared about them.

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

Low Tolerance/ Overwhelm
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.  This can be making their world smaller and lowering expectations. Level Chart post.

  • School - reducing or eliminating homework, getting the child in smaller class sizes, limiting or removing after school activities...
  • 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.

    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!"
  • Chores
    • She has fewer chores and they are very simple and concrete.  
    • She does the same chores every day instead of rotating like the other kids.  
    • She gets to go places even if she'd had a fit recently, because I don't hold her accountable for her behavior like I would a teen.  
    • If I go places like the grocery store I take her with me.  Period.  The other kids frequently have the option to go, but you don't leave a 6 year old at home alone.
    • She can have "playdates," but they are well supervised.  
  • Room and Environment. At the therapist's suggestions, 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).

    Some posts on techniques for stripping/ decluttering the room:
    Decluttering
    Adult Boarder vs "Family Girl"
    Maid Service

FAIR Club - This is the discipline method we used at our house for many years (until we realized that our children with trauma issues were usually too emotionally young for it - Age Appropriate Expectations).  The premise of the FAIR Club is that life is not fair, nor do we want it to be.

The FAIR Club is designed to provide boundaries and additional support while the child practices and gains (or regains) the ability to be RRHAFTBALL.  This involves removing a lot of the distractions and drains of life (like electronics, phone, friends, even where to sit) and adds ways of dealing with stress (earlier bedtime, spending time with parents who can role model, only going places as a family).

Supervision

We stopped telling our children that we were putting them in the FAIR Club, because we discovered that they needed the structure and support of the FAIR Club 24/7. I do feel that the FAIR Club helped us and Bear work up to the stricter supervision that he obviously needed. He wouldn't have tolerated this level of structure and supervision when he first got here. By giving him the supervision when he got in trouble we were able to slowly introduce the stricter levels of supervision, and then not lighten up as much when he got out.

I know this sounds really awful and controlling, but Bear really did feel safer knowing we cared enough to pay attention to him. I believe Bear acted out when he felt unsafe just to increase our level of supervision. {Now that he is an adult, he is in prison - one of the few ways to get the level of supervision he needs (jail/ prison is the biggest mental health facility in the country). Another option was the military, but Bear wasn't eligible due to his mental illnesses.}

  • Line of sight - Generally Bear was on line of sight supervision at all times unless he was in his room alone. This was a huge deal, and made Hubby and I feel like wardens, but he NEEDED it. We tried to make it feel more like we were spending quality time with him than that we didn't trust him.
  • Bedroom door and window alarms - while we did have window alarms (that prevented Bear from sneaking out of the house), I felt like we should have had a door alarm too (still not sure why it bothered Hubby so much).

    Bear often left his room in middle of the night - usually to steal food or some other item. I know many parents that had to worry about the safety of family members, and installed door locks on bedroom doors. Not to lock children in! But so they could lock their own doors and feel safe from their sibling.
  • Never alone - Bear was NEVER left without the supervision of an adult who was aware of his needs and issues. Since he was too old for childcare, this often meant hiring after school care providers or Grandma, having him in structured volunteer or extracurricular programs, us going to the mall and movies with him... we tried to give him at least the illusion of having his space (ex. when at the movies, we sat several rows away where he felt we couldn't easily see him), and we gave him as much privacy as we could.
  • 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. 
  • School - My kids required a LOT of structure at school. We often had to battle the school to get this for them (even filed due process once). Both Kitty and Bear ended up in a special program/ school for emotionally disturbed students. The staff were all trained in special education and behavior management. Most had worked in residential treatment facilities. The student to teach ratio ranged up to 8 to 1 at the most. Even when on his home campus, Bear received extra supervision - at one point even being escorted any time he left the classroom.


Rules, Routines, and Boundaries


Rules are like fences. Kids need them to feel safe. 

Children need rules, routines, and boundaries –Boundaries are like fences, they keep children safe.

Think of children as researchers. Some children are very aggressive researchers; they will continuously test the rules over time to see if they are still firm and clear.

Rules make children feel safe.

Only when a child feels safe can they trust enough to feel loved.

 “No”
 There is nothing wrong with saying, “No.”  Provide lots of structure from the beginning.  Set up the child’s environment so that he/she doesn't hear a lot of "No"s.  There just shouldn't be an option of doing things that need a “no.”  Think of it like childproofing.

 Rules should be simple and few.  
Make sure rules and consequences are very clear and consistent.  Go over rules with the children often!  It only takes 2 minutes to tell the children (or have them tell you!) the rules, and the consequences if they are not followed.

Positive and Concise!

Try to keep the rule to no more words than the age of the child and phrased positively. 
(3 words for a 3 yr old, 4 words for a 4yr old...)

Instead of saying "No running!"
For a 3 yr old you would say, "Use Walking Feet."

Instead of, "Shut UP!  Why are you always screaming?!  You're making Mommy crazy!  Why can't you just play quietly for 5 minutes?!...."  Keep it short and simple, and quietly state "Inside Voices."

Instead of "Quit standing on the furniture!"  Try, "Chairs are for bottoms (not feet)."

“DON’T” 
When you tell a child “Don’t” you just increased his chances of doing what you’ve just asked them not to do tenfold.

Instead of telling a child what not to do, we need to tell them what to do.  

Create a positive picture.
The more enthusiastic and happy you are the more likely they are to listen!  Really!
{I know most days this may sound impossible, but this post, Finding the Joy, helped me find the strength.}

Praise
Like most kids with trauma issues, praise was a huge trigger for my kids. Often, they felt they "didn't deserve it" and/or were afraid they'd be expected to live up to it all the time.(Why Do They Act Like That?),  Feeling triggered would usually set them up for a meltdown.

A fellow trauma mama suggested finding a unique thing about this particular child that sets the child apart AND can also be praised. Using "labels" that identified this child, and this child alone. Even if these labels were often a result of their trauma/ attachment issues. This gives the child something to feel proud of without the direct praise that could trigger a negative reaction.
Ex. The "Family Finder" The fact that the child could find anything because she was hypervigilant wasn't the point. This child really could find almost anything someone was looking for. If a sibling couldn't find something, the mom would shout out, "Well the FAMILY FINDER can find anything!"


Especially when delivering consequences, make sure your message is clear and direct.  
Be firm and FOLLOW THROUGH! 
 Stay calm and pleasant.  

Fresh starts
Fresh starts should be soon – a whole week is ineffective.  “I’m sorry you forgot the rule.  Tomorrow (after nap time, after dinner…) we will try again.”

Choices
Never give a child a choice you don’t want them to make.  Give them one or two options (both of which are acceptable to you).  If you ask a child if they want to get in the car or continue to lie on the floor and throw a fit, guess what they’re going to pick?!

 “Okay?”
By ending a statement with “Okay?”, you are asking their permission and sending them an unclear message. Drop Okay? from your vocabulary, okay?

Things to remember
Eye contact
Be Specific
Simple rules
Follow through

Setting Boundaries for Teens
I highly recommend a book called Stop Walking on Eggshells!

I LOVE it for setting boundaries with my attachment challenged teens and young adults (and it helped with the crazy early teen years with my neurotypical bio kids too). It made my Top 10 Things I Couldn't Do This Without list.

Technically it is for people living with someone with Borderline Personality Disorder (which is an "adult" disorder), but there are a LOT of similarities (Some people say that when a child turns 18, and technically "ages out" of being RAD, then it often becomes BPD. Kitty was diagnosed with "BPD Traits" before 18).

The first half of the book gives insight into WHY they act the way they do, which helped me with understanding what they needed and why, so I could better decide what to do about it. The second half of the book is actual PRACTICAL ADVICE! Which I found to be really on target.


It's a quick and easy read... except that it's hard to process. Everything hit home so closely, that I found myself reading it in small chunks. (I kept it in my car to read during the kids' doctor appointments, while waiting in line, anytime I had a minute alone. The second time I read it, I put it in my bathroom, and read it when using the potty, getting ready in the morning, and taking a bath.) I'm re-reading it now actually.

Stop Walking on Eggshells - This book also helped me understand why self-care was so important, and made me feel less guilty about prioritizing it.

Self-Care 
Providing this level of structure is probably one of the hardest things I've ever done. So I can't say enough how important it is. I had to fill my bucket, because kids with attachment disorders are incredibly draining. Especially since others usually thinks you're "overly strict, overbearing, controlling...." I worked really hard at not needing validation, but it took a long time, and I still struggle often.

More posts about Therapeutic Parenting:
Chap. 1 Parenting based on Developmental/Emotional Age
Chap. 2 Discipline vs. Behavior Problems
Chap. 3 Structure, Support, Routines, and Boundaries
Chap. 4 Nurturing
Chap. 5 Discipline and Guidance
 Chap. 6 Abuse '
 Chap. 7 Misc.
TBRI

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