Puddle Girl

Letter to Kitty's therapists and psychiatrist case management staff:

Kitty was released today at 6pm. She was agitated and manic, but the nurse at the psych hospital thought she looked “normal” considering she was anxious about release. Kitty has alternated between being a puddle (which you guys have all seen) and irritable - pushing us away and ranting about how we love the biokids more than her and don’t treat her like a teenager. This was the first time I had seen her manic though. I was nervous about bringing her home. She seemed OK, but I was afraid that if there were any stresses/upsets that she would be too emotionally fragile to handle it. She did make it through the evening OK, although she got a little belligerent at bed time.

Kitty had apparently gotten upset a few hours before discharge because another girl had told her to shut up. Kitty told the nurse that she felt like hitting the girl and was given a Klon*pin (her first during hospitalization as far as I know). The discharge nurse couldn’t tell me if Klon*pin was still prescribed for Kitty. It wasn’t included on her med list.

Med list
Tril*ptal –900mg am and pm. Unchanged.
Abil*fy – 40mg. Removed!
Trazod*ne – 100mg. Removed.
Conc*rta - 54mg. Unchanged.
Clonod*ne- .05mg am and .1mg pm. Added.

Will let you know how tomorrow goes. Will probably try her at school if she continues to be up and seems stable. She is meeting with her therapist right after school.

No one at the hospital mentioned residential treatment, but they didn’t see much of her behaviors. Kitty was under a greatly reduced/ changed amount of stress so was able to hold it together (plus of course their expectations are based on the kids they have there, not Kitty). I think this is definitely something we need to discuss. Possibly look into whether or not {Residential Treatment Center over an hour away, but that takes Medic*id} would be a good option. Most of the people I know who’ve had kids there, liked it but said their kids were more severe/ aggressive. Kitty is so emotionally young it worries me to put her in places where she doesn’t feel physically safe and she is surrounded by kids with mega issues and behaviors that Kitty can’t handle.

School: We still have to get it approved in the IEP meeting, WEDNESDAY at 1PM!! but we have tentatively decided:

1. Kitty will only go to school her last period of the day (4th and 7th) for rest of the school year. This is her double blocked math class. The teacher is also her case manager, and is willing to let Kitty do work on other classes. I will take her to school, probably do volunteer work during the 1 ½ hours and then take her home again – no bus.





2. If Kitty seems to be OK with the one class then we’ll add a 3rd period study skills class. Obviously we can add more if she’s capable of handling it.





3. We will be adding 4 hours of homebound schooling.





4. We are suspending the FIE (school psych evals) for now. Testing her academic levels at this point would not be accurate.





5. We are looking at getting {Bear's special school} to come out and evaluate her for possibly attending there next year.





6. I will continue to look into Charter schools to see if we can find something that works with Kitty's emotional needs and learning disabilities/ special ed needs. Would love some help.

Can I change my mind?

When I drove up to the psych hospital with Kitty, she told me she'd changed her mind. She didn't want to go. I tried to reassure her, and reminded her that this was necessary. She was not happy, and that she needed the doctor's help to feel better. I reinforced that she had to tell the truth about her symptoms, the whole truth, or the doctors couldn't help her.

We spent the 4.5 hours of check-in time (no idea why it takes that long - especially since she's been there before, we'd faxed in tons of documents, they knew we were coming, and had a bed for us) with her completely shut down and snuggled in to me on an uncomfortable plastic loveseat. Every 45 minutes or so, someone would come and talk to one of us or both of us, we'd fill out some papers, and then they'd send us back to the waiting room. The TV was on an inappropriate channel so we sat with our backs to it and ignored it. The lobby was semi-crowded, but at least this time no one was bothering us and they even fed her dinner.

When I left her she gave me yet another big hug, and walked off to be checked over by the medical doctor.

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I talked to her on the phone the next day. She did not want to be there, but she sounded the same. Our conversation was brief because she had a stomach ache and wanted to go lie down. I told her I was sorry we couldn't come visit that night, but we'd see her the next afternoon.

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Yesterday on the way to a meeting with the psychiatrist at the phosp I talked to a friend of mine with a daughter that attends Bear's special school. Bear had confided in this family friend that he felt like we were deliberately keeping him out of the loop about his sister. I know last time she went to the hospital he felt a sense of guilt, as though it was his fault. This time he felt the same, probably partly because we've been working really hard with him, trying to keep him from teasing and pestering Kitty while she's in this emotionally fragile state. Will try to reinforce to him in therapy today that this isn't his fault, but he really cannot tease and pester her.

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Met with the psychiatrist at the phosp, and not really encouraged. They want to replace Kitty's Abil*fy and Trazad*ne with Clon*dine, and her Conc*rta with Foc*lin. This makes me really nervous, because Abil*fy is what finally got Kitty stable 2 years ago when this happened last. She's been on an admittedly mega high dose of it ever since. I talked to her therapist later and she is nervous as well. *sigh* My only reassurance was that at least it would happen there... probably. Of course they're just as likely to start the process and then send her home, like they did with the Proz*c at the last phosp.

Honestly I wasn't terribly upset by this until I met with Kitty afterward. I should have known what was coming when the pdoc asked us to talk about how Kitty ended up in the phosp. We talked about the day she ended up at the last hospital less than a month ago.

My version:, Kitty hadn't done her chores, and chose to sneak onto the computer anyway. It took me 20 minutes of "nagging" to get her off. Ponito got home from a playdate and I told him to do his chores. He said no, and then mentioned he had homework... on the computer. I let him get on and Kitty went ballistic so I put her on the "4 foot rule" until she could calm down, but she couldn't get regulated. It escalated to her punching me in the face.

Kitty's version: She was happily playing on the computer, and mean mom made her get off. Then Mom let horrible little brother play on it because she loves him more.

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Tell me again why I took Kitty to the hospital? Admittedly having a 150+lb growth permanently attached to my hip was draining, but I have to admit I was enjoying the loving part of her dependence. Yes, the meltdowns were awful... OK, I know why I took her, but... I CHANGED MY MIND!

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During our entire visit with Kitty she was perched on the edge of the seat, anxiously watching to see if the boy she was "interested" in was on his way out the door (he was being released). She gave us a quick, stiff hug when she was sure no one was looking - once when she arrived and once when she left. She wouldn't allow me to touch her. Her entire leg shook with the staccato tapping her foot was doing.

She spent the whole time railing at us about how we don't treat her like the 16 year old girl that she is, and that it's because we love the other kids more than her.

One proof that we don't love her: She NEEDS a Facebook page (she's not allowed to maintain contact with kids she meets in the phosp, but of course everyone breaks the phosp rule about it), EVERYone else in the house has a Facebook page except Ponito (We've changed the password on Bear's, but he still technically has one. I told her I don't actually have one, I just use Bear's. I've chosen to not notice Bob's). She promised me that this time she wouldn't be friends with Bear (biofamily found her last time because he was linked to them. When I discovered that, he lost his account again).

Kitty had also told Hubby her "best friend" was released earlier that day. I reminded her yet again that people she met in the phosp were people with issues, and as such were not capable of being good friends. This is why the phosp has the rule of no continued contact (which we enforce). She chose to pretend that she needed Facebook to keep in contact with school friends, and see this as yet more proof that we didn't love her.

We reminded her that we treat all our kids differently based on their needs, which has nothing to do with love, and actually very little to do with trust. She's heard all this a thousand times and can even answer me when I ask her why we do things the way we do, but she adamantly couldn't/ wouldn't process it.

Proof that we love the biokids more: Kitty brought up that Bob is starting to show signs of bipolar and therefore she and Bob should be treated the same. I tried to explain that even if Bob does become bipolar, Bob didn't have all the issues/ trauma that Kitty did growing up. Kitty missed out on a lot of things that Bob got, and now Kitty is having to play catch up and learn those skills. Plus, Kitty has proven over and over that she's not ready for the responsibilities yet, so she can't have the privileges. Kitty finally just admitted that she felt she deserved the privileges without the responsibilities.

So I tried a new analogy. She's 16 now and many 16 year olds can drive. So would it be right for me to give her the keys to car and send her to the store for me? She's never had a driving lesson and doesn't have a learning permit. Unlike Bear (who frequently sounds like Rainman saying, "I'm an excellent driver."), she admits that she doesn't know how to drive. Kitty agreed that this would be inappropriate and the police would probably get involved, but of course she chose to ignore the parallel to her not being prepared for the privileges she feels she's entitled to.

After all the conversations we've had about Super Sweet 16 birthdays, we've talked frequently about how kids who are given all the privileges they want frequently turn out to be unhappy, spoiled brats, and Kitty can parrot back what would happen if we gave her all of the privileges she wanted - whether she could handle them or not... but she was having none of it.

She remained shut down and agitated. When I confronted her on this, she said if she wasn't shut down she would cry (good insight at least). The group started lining up for dinner, and she was not able to participate in a conversation so we let her go. I'm sure she'll remember the meeting as us yelling at her. *sigh*

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After our visit I was pretty shook up. Kitty was convinced that she would be going home in the next couple of days, and while that was most likely not true with all the med changes they were proposing... there was no way I wanted to take this child home. She'd regressed so far back in her attachment and was so shut down and angry. Usually after leaving a phosp or RTC she's homesick and grateful to be home and we get a honeymoon. I don't get the feeling that is going to be the case this time.

I decided to ask to talk to a social worker there. Sort of tell someone "our side" of the story so that maybe in group she would not be allowed to reinforce this distorted perception. Her point of view sounds typical and even developmentally appropriate for a teenager (Parents don't understand me. Trying to be independent and they won't let me. Treat me like a younger child.), - problem is of course that she's NOT a teenager in the ways it really counts.

I talked to a part-time social worker for an hour. She doesn't do groups with Kitty, but promised to pass on the info. Who knows if it will make a difference.