Why does my child act differently away from home?

A friend of mine with lots of kids (including 2-year-old triplets!), has one of them in Residential Treatment for the first time. She's being told by the RTC {psychiatric residential treatment} that he's doing great and is sweet and wonderful. She knows in her head that he's honeymooning, but it still hurts and makes her question her parenting. I want to share what I wrote to her:

RTC Is Not The Real World
How we parent is based on life in the real world... not life as it is in RTC  with 24/7 staff, quiet rooms, and PRN (as needed) tranquilizers. Staff are looking at short-term solutions that will keep the child compliant while they are in RTC. Our kids can often honeymoon for a long time. Things like Level Systems appear to work because the child can "work the system" short-term. 
{Level/ Point Systems and Sticker Charts - Why They Don't Work With Our Kids}

Parenting is Long-Term
Parenting styles HAVE to be different than what works for an RTC. Kids are going to react differently with RTC staff, teachers, other parents... people who are not trying to get them to emotionally engage and are not looking at long-term solutions or how your child's behaviors affect the rest of the family. 
{Prioritizing Yourself, Your Family, and Your Child }

You are a good parent!!!! There is no “right” way to parent our kids (although there are definitely some wrong ways!), but I can tell that you know what works for your son in your home. It’s good that you know that when he plays video games he gets dysregulated, just because for whatever reason it’s different at the RTC, doesn’t mean it’s not true at home. Stick with what you know is right for your child!
{Structure and Caring Support}

Be very aware that this is a tough life and having people telling you that you're doing it wrong is incredibly draining on your limited emotional reserves. Please take care of yourself!! I know it can feel impossible, but look at this time as respite and focus on healing yourself. You can't parent effectively if your emotional reserves are empty.
{Self-Care! Caring for the Caregiver}

Why kids act differently in RTC (or school or anywhere else):

1. YOU are not there (at the RTC). You are the symbol of all mom caregivers, and you dare to try to “inflict” your love on him {See the Frozen Lake Story at the end of this post}.

2. Reduced Stress. In an RTC, our children don’t have to deal with the stress of family and emotions, school is usually easier, and staff and teachers have lower expectations. This may reduce their stress to a point where they can handle it better.

3. Some kids are too “broken” to function in a family and do better in RTC. They NEED an environment without emotions and long-term consequences and need people to keep them, and those around them, safe because they are not capable of doing it for themselves. I’m not saying this is true for your son, but for now, he is not capable of being home.

4. Structure. My son deliberately acts out at public school until he gets sent back to the special school because he needs and craves the structure and support provided by the special school to feel safe. {Structure and Caring Support, Why Doesn't My Child Feel Safe?}

5. It is not possible to live real life like an institution (although it sometimes feels like come close in our house), especially when you have 2 other special needs kids and 2-year-old triplets like you do! We cannot always provide the structure and concrete expectations that our kids need/ crave, especially over the long-term. RTCs have better staff-to-child ratios and back up than we ever could!

6. Staff can avoid telling the kids what they don’t want to hear (like “no”) because RTC is ultimately short-term and our child’s best interest is not their problem. So our kids behave better because they like people who rarely tell them no. They can get away without telling your child "no" because;

• This is a locked campus that goes way beyond childproofing, so staff doesn’t have to deal with watching him and correcting him when he gets into things that could hurt him or others or worry about him hiding or running away. 
• No vulnerable people or animals. There are no small 2-year-olds or pets running around that he could sexually abuse, torture, torment, or just be cruel to. They don’t have to protect a whole family, just kids who are not exactly perceived as defenseless.
• Kids KNOW they have little to no flexibility or “wiggle room” on most subjects because it's "policy" so they don’t bother to argue with staff about bedtime, computer time, respectful words…
• It’s not personal for staff. It’s just a job. Staff can walk away, they can quit, they can let someone else take over for a while… We have to protect ourselves and the rest of the family and that influences how we handle our child. Staff doesn’t have to do anything that isn’t in their job description. If someone vomits that’s the job of the cleaning staff. If a staff person has the flu, she can take a sick day. We have to deal with everything our children throw at us, no matter what, and it often hits home and gets personal especially when we're under continuous stress. {Continuous Traumatic Stress}

7. Living with your abuser. Unlike an RTC, when a child is rude, horrible, scary, threatening, tries or succeeds in hurting a family member - we have to continue living with this child. If our significant other treated us the way our child does, then most likely the spouse would go to jail, or everyone would be encouraging us to leave him, but when it’s our child, we’re just supposed to handle the emotions and stress, not show it in any way to our child, and be warm and loving all the time.

8. RTCs are easier for the kids!

• School is easier, with lowered expectations and lots of one on one instruction.
• Concrete expectations (there are very few gray areas to figure out - or manipulate).
• Fewer decisions to make (bedtime, where to sit, what to do next, during what little spare time they have there are very few choices).
• No social/ emotional skills needed or required. No one expects the child to care about anyone else’s feelings.

9. Blank Slate - 

• If the child messes up… he/she gets to start all over again with a blank slate the next day.
• NO long term expectations at all. No one cares about long-term consequences (except you!).
• No history – no one cares what the child did last Summer (no grudges, no expectations, no hurt feelings, no holding the child to a higher standard because you know what he/she has accomplished in the past…)
• The child knows that if someone doesn’t like him, or he doesn’t like them… just wait, they’ll leave and/or go home soon.
• No one knows your family. They mostly only know what the child tells them. If he says his parents beat him every day or won't let him have a cell phone because they are unreasonably strict ... well, as far as the staff and other kids know, it's entirely possible. The staff and other kids will validate the child's every entitled feeling.
• The child has "rights." Rights to refuse meds. Rights to refuse to see parents. Rights to refuse treatment.

10. RTCs can be fun. Tiny successes are celebrated and rewarded. Even with almost no positive behavior, they get to go on field trips, go to the playground, have dessert… get to go out to eat with parents, and can eat all the fried foods they want. Things they get to resent you for because you don't allow them to do it all the time at home.

11. RTCs feel normal. My adopted kids grew up in an environment of chaos, and that feels normal to them. Nice, quiet homes feel abnormal and “boring.”

12. RTCs are scary. Tranquilizers, lockdown, big scary kids who fight back… RTCs are scary places. It’s not safe to fight.

13. Honeymooning:  My daughter will lie, shut down/ dissociate, “talk the talk” (which she knows from years of therapy and being in hospitals)… anything to get out. With the right meds and enough motivation, they can hold it in for months – up to a year depending on whether or not their honeymoon behaviors are successful.

14. Trust: The kids trust you enough to “let their hair down.” They finally believe that you love them enough to put up with the behaviors. Which is true, but sometimes I wish mine didn’t trust me that much! My daughter “holds it together” all day by cramming everything inside and ignoring it – then, she gets home and lets it all out on us. Those feelings have to go somewhere, but they can also hold it for a long time when they know it’s life or death (which it usually feels like it is). {If You Find Out I'm Not Perfect, You'll Leave}

15. Different expectations. I always forget that staff’s definition of “normal” and “sweet” needs to be taken with a truckload of salt. Remember who they are comparing your child to – NOT neurotypical children his age! Children who are in a program for kids with issues.

My son is the best-behaved kid in the school for emotionally disturbed youth that he attends. They’re always trying to promote him back into regular public school, but that’s because they don’t even notice his “minor” behaviors, like crying, cussing, punching lockers, being rude and oppositional to staff but complying in the end… because they have kids that are listening to the voices in their head that tell them to kill, spitting in people’s faces, constantly screaming and cussing in the middle of class at other students (because he broke up with her to date her twin – yes this was my son *sigh*), destroying property…

16. Superficial Charm. The staff is used to being treated like scum, so any child that is nice to them… The staff doesn’t necessarily recognize or care that it is manipulative. 

My kids are what I call “Charming” RAD – they hug and are warm and sweet to everyone (as long as they aren’t family!). This helps them feel safer. They don’t actually trust or care about these people, but they are pretty believable, so the staff, case managers, teachers… have no clue. They want to protect this sweet, loving child from obviously crazy, overly strict parents with Munchausen by proxy syndrome. Which feeds right into what the child wants.

17. They don’t know your child’s history or what is normal for him or her. They don’t recognize his anxious behaviors. We were told our daughter was “a little homesick,” but other than that was doing great. On the same day, they gave her an anti-anxiety med PRN because our daughter told staff that she wanted to hit a girl for telling her to “shut up.” They don’t know violent behavior is totally out of character for our daughter.

18. They tend to believe the child if he tells them that you beat him daily, or “hug him too much” (yes, my 14 y.o. son told the staff that was one of the main reasons he was there – even though we’d known him less than 6 months at that point and he was in an RTC for violent behavior… let’s just say that was NOT why he was there). They’re not used to working with kids with loving, involved parents. They’re not used to working with kids with attachment issues. The staff and other kids will validate your child's every entitled feeling and pressure the family to give the child the same privileges a normal teen "deserves." Example of how we handled this once.

19. ALL the kids in RTC have poor social skills so no one will notice that your child is not “good friend” material. Now he can have lots of friends if he wants. Plus my kids are naturally attracted to other kids with issues (probably because kids with issues are more tolerant of the poor social skills or maybe because they crave chaos since that’s what they grew up with) so they have a large pool of choices… who can’t escape! It's all short term too so they can even appear to be popular. {Like Attracts Like}

20. Validate the child's beliefs. The kids in RTC will reinforce your child’s beliefs, and make them feel better about themselves (usually at your expense), based on whatever the child chooses to tell them. Ask my daughter how many of her “friends” think we are evil, strict parents, and have offered to kidnap my daughter and let her live with them – most of them call us names (which she loves to share with us) and some of them have offered to hurt us for her.

21. There’s always something to do and people to entertain you. For example, if we try to stick to a schedule that says we have dinner at 6pm, of course, we have to leave the child(ren) to their own devices for ½ an hour or so while we make the dinner. In an RTC, there is staff with them entertaining them all the time, and then they get up and walk to the cafeteria where dinner is magically ready. The child rarely has to self-entertain in an RTC.

22. My daughter feels “safer” when someone who knows her issues is monitoring her 24/7. The child is so well supervised that they don’t have to stress about making bad choices. They can’t suicide, self-harm, use drugs or tobacco (supposedly anyway – my son found a way to sneak chewing tobacco). {Why Doesn't My Child Feel Safe?}

23. Safe med changes. RTCs can make dramatic med changes, whereas we have to work with small increments and don’t have access to 24/7 nursing/ psychiatric care if our child has a reaction.

There’s more I’m sure…


What we did: 

I constantly reassured my kids that I would help them deal with these feelings (and find others to help) and that I wouldn't allow them to push me away. I also reassured them that I knew these behaviors and feelings were caused by their "issues," and that as they healed the behaviors and feelings of fear and wanting to hurt us would get better.

At the same time, I set up boundaries/ rules/ structure that let them know they were safe (this is a perceived sense of safety - nothing to do with real life physical safety). I let them know that while they were healing, I would be there to keep them and the rest of the family safe. That hurting me and the family was not OK, and that I would not allow it.

I took away most of their control (even about little stuff like when they would be eating and where they sat in the car), and by doing so they knew that I was strong enough to handle them and love them despite their issues. It took me a long time to understand that they didn't just need someone to love them unconditionally - they didn't believe in that, they needed someone to make them feel safe. Their favorite teacher was the strictest teacher, one of the staff in the behavior unit at school. She tolerated no nonsense, but they knew she really cared about them.

They were afraid (deep down) of the teachers/ people that they could manipulate, that they could fool into not realizing that the child was not perfect and was "unlovable and unworthy of love." People that gave them a blank slate every day, that forgave them every time, that didn't hold them accountable for their actions... those people weren't strong enough to keep them "safe."

I think me staying, no matter what they did, was a big part of what helped them heal, but I think a bigger part of that was providing the structure and support needed to make them feel safe and know that someone else was in control. That was, I think, one of the hardest things I have ever done. It was not the way I had parented my other children, most of the people involved in the kids' life thought I was overbearing and controlling, and it was NOT my personality (I'm a pretty laid back unstructured person), but they NEEDED that structure and loving support to heal.

The Frozen Lake Story
"In order to understand what an unattached child feels like, one must understand his perspective. Imagine that you are the young child who must cross a frozen lake in the autumn to reach your home. As you are walking across the lake alone, you fall suddenly and unexpectedly through the ice. Shocked and cold in the dark, you can't even cry for help. You struggle for your very life, you struggle to the surface. Locating the jagged opening, you drag yourself through the air and crawl back into the woods from where you started. You decide to live there and never, never to return onto the ice. As weeks go by you see others on the ice skating and crossing the ice. If you go onto it, you will die."

"Your family across the pond hears the sad news that the temperature will drop to sub-zero this night. So a brave and caring family member (that is you, the parent!) searches and finds you to bring you home to love and warmth. The family member attempts to help you cross the ice by supporting and encouraging, pulling and prodding. You, believing you will die, fight for your life by kicking, screaming, punching and yelling (even obscenities) to get the other person away from you. Every effort is spent in attempting to disengage from this family member. The family member fights for your life, knowing you must have the love and warmth of home for your very survival. They take the blows you dish out and continue to pull you across the ice to home, knowing it's your only chance."

"The ice represents the strength of the bond and your ability to trust. It was damaged by the break in your connection to someone you trusted. Some children have numerous bonding breaks throughout their young lives. This is like crashing them into the ice water each time they are moved, scarring and chilling their hearts against ever loving and bonding again." By Nancy L. Thomas

Other posts:
Why Do They Act Like That? - If You Find Out I'm Not Perfect, You'll Leave
Prioritizing Yourself, Your Family, and Your Child 
Structure and Caring Support
Chores, Responsibilities, and Other Things My Kids Can't Handle
Document, Document, Document!!!

School after RTC

Jennie recently wrote a post about her daughter's return to school after being in psychiatric residential treatment (RTC). The child's IEP had to be modified upon the child's return to public school. Wheile the child was in RTC school she succeeded without the modifications written into her IEP so upon her return they had to remove them. Of course RTC schools are incredily different from regular public schools, such as 6 to 1 ratios instead of 29 to 1 and teachers experienced in dealing with children with major psychiatric behavior issues.

My recommendation was that they remove the modifications, but ONLY if they follow the modifications that the RTC had! ..in a classroom with 6 kids and a trained behavior specialist. If they can't accomodate that, then they need to find other modifications. This is something we really had to fight for for Bear. We were lucky in that he already had a special public school program in place that had these accomodations based on his behavior issues in school before entering residential. I know that if these hadn't already been in place, then we wouldn't have gotten them based on his behavior upon returning from RTC because his behavior was so radically improved.

Jennie's concern was that her daughter, Sissy, has yet to demonstrate her behaviors in the gen ed classroom in a way that they have documented it as being an issue to her academics. The law says she can't qualify for Emotional/Behavioral Disability (EBD) just because she has the issues. The law says those issues have to impact her education and her behaviors in the classroom. Sissy was passing core curriculum before RTC. Plus she was triangulating the crap out of everyone so that I Jennie) was the only one that got her behaviors.

Jennie's "unspoken plan" then was to shorten Sissy's leash by making an education plan we know she'll fail at which will drive those behaviors into the classroom which can then be documented as negatively impacting her academics and then PRESTO! she qualifies for EBD IEP and a pscyh ed class. it's horrible, it's miserable, it's absolutely absurd but it's the only way to get Sissy to quit hiding her behaviors when with the "powers that be" It'll happen, and pretty quickly. And who knows, Sissy might surprise us all and rise to the occasion!

Jennie I know exactly what you are talking about!

We fought to keep the services that Bear had qualified for when he was out of control and needing RTC. The problem was his new meds, combined with a honeymoon period during which he controlled his behavior (now that he finally could), and the fact that he thrived in the structured, small group setting with low staff to student ratios, made it hard to justify the more restrictive environment and the extra services. It's such a catch 22! The kid is in the right environment so they do well, so the stupid law says we have to move him to the "least restrictive environment."

Bear is now completely in mainstream schooling (although he is still in "applied" classes which means 6 to 1 ratios - and that is mostly for academic reasons rather than behavioral). He has been mostly flying under the radar because the majority of his behavior issues are being caught at home. Suddenly he has begun failing classes, but I know that's not enough to get him back in the special school program.

So we are doing the same things Jennie is doing for Sissy - setting Bear up in a school situation that will force his behavior issues to the surface... at school! Like Jennie as well, I hope he surprises me and rises to the occasion. He's surprised me before.

Best of the Worst Parenting Advice

This post started off as a comment on a comment at Parenting 24/7 to a person who implied something along the lines of "All teens do that, " but then I read this post over at Accidental Mommy , and realized I had to participate in her Best of the Worst Parenting Advice, and this was a biggie for me.



There is not one thing that can make me crazier, especially at a meeting with people who work with my children, than hearing something along the lines of, don't worry about it, that is just typical teen behavior. Whether it's "Oh, my son does/did stuff like that all the time," "Well, it's understandable that he would act that way," or "That's just how teenage girls are." In other words, I'm overreacting, crazy, expecting too much, and/or too strict.



It can be sooo hard to work with teens with RAD because they have all the same hormones and drama that "normal" teens do, but on top of that they have all the trauma, trust issues and actual brain damage from the RAD. Unlike kids with cerebral palsy or mental retardation, they don't have a lot of overt signs that there is something wrong. This means that those who haven't educated themselves about RAD, PTSD and other related issues may think what they are seeing is normal teen behavior, and maybe some of it is, but it is much much more intense and not something they're just going to grow out of without a LOT of therapeutic treatment.



A "normal" teenage girl might be moody, irritable and a loner. A child with RAD usually lacks the feeling of support (since they trust no one) and the skills and ability to handle these feelings and behaviors. Their issues are 10 times more intense, and usually are focused on family and anyone else they feel is getting too close. My children are experts at hiding their feelings and issues from adults and peers, saving it up to inflict on the family.



Closeness actually causes physical pain for kids with RAD. Imagine that as a small child you almost drowned when you fell through the ice in a frozen lake, and now people you don't trust are trying to get you to go ice skating. You're going to react as though they are trying to kill you! Logically as an adult you may know that they are not trying to kill you, but your emotional reaction is that of a child.



It is not possible to deal with a child with RAD as though they were a "normal" teenager, especially when it comes to discipline.





They do not have the same strengths and supports that a typical teen does. They think anyone trying to get close to them is trying to hurt them and abandon them. The child knows that he or she is a horrible people and if you get too close you will find out; so they must reject you before you reject them.





They do not understand cause and effect (if/then) because they didn't learn this as infants (if they cried, no one came to fix it, or they might have even been beaten instead of cuddled or fed). They learn to ignore their physical and emotional needs to such an extent that they can't feel anything even after the trauma is no longer part of their daily life (my daughter is not ticklish and does not feel pinches, she also cannot tell when she's hungry or full, she cannot tell you what emotion she is feeling....).





In other words, these children don't understand and have no faith or trust in themselves or the people and world around them. The slightest reprimand can trigger an emotional flood and overreaction, while at the same time if they are used to beatings or worse, then the threat of a time out obviously has little to no effect.





Parents of RAD teens deal with a lot of "behind the scenes" issues and many children deliberately make the parents look like mental cases who are overreacting, too strict, horrible disciplinarians picking on a poor, innocent child. Giving the child the "benefit of the doubt," "innocent until proven guilty," "blank slate," "it's a new day" approach reinforces all the wrong things. This child who already has issues with understanding consequences learns that all they need to do is move on to a new school, teacher, program, family... and they can do whatever they want with no repercussions. It may be a "new day" for each new teacher, principal, or behavior program, but it is most definitely not a new day for the family who have to be there to pick up the pieces, deal with the backlash, and live with this child especially if there are siblings involved. Many families, including mine deal with symptoms of PTSD from my "typical teens."



My other favorite piece of advice:



"Don't let him escalate."



That's it. We even took a mandatory class to learn that. Don't you wish you'd known that would solve all your child's issues?





This was my 5'9" 200+lb 13 year old (undiagnosed and untreated for bipolar and RAD yet), with us for less than 2 months after being placed for adoption from another state... son, who had been raging, often for no apparent reasons, but definitely if told No. (this is a picture of him at age 12!)



Some of the behaviors he was exhibiting all the time:

Threatening suicide


Running away (police would eventually find and return him every time),


Physically attacked Hubby several times - throwing punches, biting (Hubby still has the scar), kicking - almost always requiring police intervention,


In his first week of school, threatened to throw another 7th grader out a 2nd story window, cussed out a female teacher, and threatened physical harm to the vice principal,


Threw furniture (upholstered recliner), and various other household items at family members and into walls.


Cussed, screamed, threatened and intimidated all family members, all the time.


Repeatedly running away from respite when he (and his sister) was pulled from our home pending a child abuse charge (he got a tiny bruise on the day he had to be restrained because he was kicking Hubby, threatening to jump through a 2nd story window, had sliced his arm with a homemade razor, bit a chunk of flesh on Hubby's forearm...).





We put him on a wait list for residential treatment (luckily his home state paid for RT since TX never would have), and had to decide what to do while we waited for a bed to open up. Never telling him no was an option I guess, but with 3 young children in the house it wasn't a good one. Luckily the psychiatrist was willing to chemically sedate him (large doses of Depakote). At one point we asked Bear if he wanted us to reduce the dosage and he asked us not to because it was the only way to control his behavior which scared him.





Because the only support we got from the adoption agency was this lovely piece of advice, and there was NO WAY to comply, we would have had no option but to disrupt and return him to Nebraska. Luckily he was not the ward of Texas so we were able to keep him in the residential treatment center long enough to get him properly diagnosed and medicated before he was returned (6 months).

Insurance Stinks!

Kitty who has RAD, complex PTSD, bipolar disorder, ADHD, LD, ODD… and a half a dozen more letters was placed in residential treatment on 8/19. This year she’s been hospitalized twice for suicidal issues, and went to a partial day hospitalization program that made her worse because the kids were out of control and the staff didn’t do anything about it. We pulled her out after 3 weeks, because we couldn’t handle the almost daily rages at home anymore. She has always behaved well at school and in public of course. Gotta love RAD!

This Summer I stayed home and we made her life as simple as possible. Grandma watched the other kids and I stayed near Kitty to help her regulate and stay calm (she can’t do it on her own). She verbally threatened the life of Grandma and our youngest son, MANY times. I don’t know that she would actually follow through with physical violence to them or herself, but that does mean I don’t want her to be in the care of Grandma with her little brother around all Summer. Meanwhile we started the process to get her authorized for residential treatment (RT).

She was adopted from another state, Nebraska, and we had RT written into her subsidy because TX Medicaid doesn’t cover it. So the RT recommended we get their pre-authorization prior to going through our primary insurance. Took them 3 weeks to say, well it’s up to your insurance, but we’ll cover her as long as we deem it’s medically necessary. When we talked to our primary insurance they approved it and she was in the facility the next day! That was the good news.

8 days later our primary insurance said she didn’t need to be there, because she wasn’t acting out. My child has RAD, so her issues are mostly with family. Plus, although it almost killed the family, she’d spent an entire Summer almost stress free. Hello! Can you say honeymoon?! The RT appealed because they saw the need to have her there (for one thing, she didn’t talk much, but had told the psychiatrist that she had suicidal thoughts). Appeal denied. They contacted NE who thought about it for a couple of days then left a message after hours saying they were refusing to cover her either. So she comes home tomorrow.

We are flat broke so the RT will have covered 9 days out of their pocket! They also pushed all the neuropsych testing (the main reason we chose them) and it will be finished today. (Can’t wait to see the results although we’ll probably have to wait a couple of weeks). Contact me off-list if you want the name of this RT. They do not specialize in RAD and are VERY expensive if you don’t have insurance, but they are great to work with.

So at least we got 2 ½ weeks of respite out of this and the neuropsych testing (our insurance doesn’t cover any mental health testing which seems short sighted to me). *sigh*

Mary in TX
http://marythemom-mayhem.blogspot.com
Mom to biokids Ponito(10) and his sister Bob(13)
Sibling pair adoptive placement from NE 11/06
Finally finalized on Kitty(14) on 3/08 - 2 weeks before her 13th birthday!
Finalized on her brother Bear(16) 7/08. He turned 15 the next day.

" Life isn't about how to survive the storm, but how to dance in the rain."

Expectations

There are 2 residential treatment centers in our area. Someone was thinking about taking their child to the one that is closest to us (T.O.). (I'd be happy to share the names, but not on this blog). I shared my experience with them, and want to share it with you. Not because I want to slam the center, but to point out that our expectations can have such a huge effect on children.





I know T.O.. We live nearby and researched them. If at all possible, run away! We talked about taking our son there, and met with one of the therapists. Her first question was:





“The majority of our population is minorities, are you OK with that?”





My answer: “No problem, our son actually prefers to hang out with minority children.”





Her SECOND question!“Because your son is aggressive, he will be on the ward for aggressive boys. Are you OK with him getting beaten up daily?”





My answer: “Um, NO?!”





Needless to say we did not take him there.





Flash forward 2 years. Our daughter needed partial day hospitalization and the only provider in the area, Ma., is on the campus of T.O.. We did not realize how much interaction she would have with the children from the residential side. Plus, children released from T.O. as early as the day before were sent to Ma., many of which went back in less than 3 days.





Our daughter who is emotionally/ developmentally about age 5, and sheltered by us to avoid triggering her PTSD went into this program for 3 weeks before we pulled her. She witnessed several fights in which punches were thrown (usually in the face); she began cussing like a sailor (even the van driver – one driver, 8 emotionally disturbed teens!) was listening to music filled with cuss words; one of her classmates managed to pull up some soft porn on the computer; one female classmate made a pass at her; on her first day a girl called her a b***h several times and told her she smelled like a litter box (the van driver didn’t hear and my daughter would never snitch); and so on and so on… we pulled her after 3 weeks.





Someone asked me if I felt the agency should be investigated, and our insurance offered to let me file a formal complaint regarding our daughter (maybe I should), but I do honestly think they believe this is just how these kids are. Like when you hear people say, "boys will be boys."



It's not how these kids "are," or at least not how they have to be. I believe if my son had gone to T.O. he would have been beaten up every day. Having nothing to do with the second treatment center getting his diagnoses correct and him on the proper medication, this is purely based on T.O.'s expectations.



My son did physically attack one of the staff at the second treatment center within the first week. They restrained him, and when he wouldn’t/couldn’t calm down, they gave him a tranquilizing shot. There is no tolerance for aggressive behavior there. He NEVER got physically violent again (some of that was helped by getting him on the correct meds though). They didn’t tolerate the cussing and intimidating behavior either. Night and day difference between them and what we witnessed at T.O.



Our daughter is at the second treatment center now. She is homesick, but she is not terrified. She is not cussing like a sailor. She is not full of the "teenage bratitude" she learned was OK at Ma./T.O.. Truthfully I wish she was a little scared or defiant, because then we might not have to be fighting so hard to keep her there (she's not showing any negative behaviors at all and so the insurance company is saying she doesn't belong there!).



Another example of expectations:





When my biodaughter, Bob, was little (2-3 yrs) we had a lot of issues with her being aggressive. Some of it was her personality, but it got worse when I was pregnant with her little brother, coincidentally at the same time she started a new daycare. I asked the staff repeatedly if they were having issues with the aggressive behavior there. They said no. Until the day when she ran from me and hid in a playstructure. I was about 15 months pregnant (OK, it just felt that way!) and couldn’t get her out. She put her hands on another child’s throat, pressed him against the wall and refused to let go. I was yelling for the staff and she walked away from us toward the front of the room?! She got out a bag of candy and offered a piece to my daughter!! Admittedly it worked. My daughter did stop hurting the little boy and came out of the playstructure. I freaked though that they were teaching her she would get rewarded with candy for aggressive behavior. The school decided that my daughter had gotten in with an aggressive group of little girls and the best way to solve the problem was to move my daughter up to the 3 year old room. She was super tall and very bright, and we didn’t have a lot of options so we agreed.

The aggressive behavior at home continued though and they continued to deny seeing it at school. I figured that was typical for her, angel at school and then letting it all out at home (– little did I know this was God’s way of prepping me for my RAD daughter!). Until one day I left the baby with my mom and came to pick Bob up, and found her watching a movie. I thought I’d let her finish the movie (found out later it was Iron Giant – a PG movie that the three year olds were watching). Usually the baby and I were swarmed. That day the children were engrossed in the movie. So I finally got to watch the kids interact. One child would bump into another accidentally. That child would turn and shove them. Raspberries were standard as was the pushing, shoving and pinching I’d been seeing at home. No wonder my daughter was so aggressive! The staff saw it as totally normal 3 year old behavior so ignored it. That’s why they denied seeing any of her aggressive behavior – to them she was perfectly normal!

We pulled her out of the daycare the next day. Went on a two week vacation then started her at a new preschool where there weren’t 35 children in the room, and the kids were well –behaved. At the time we were trying to adopt from foster care, and the state had insisted we take our daughter with all the “behavior issues” to therapy before they would do our homestudy. 3 weeks after we left the preschool the therapist saw Bob again and couldn’t believe it was the same child. Bob was calm and talkative. She saw her once more to be sure then released her from therapy. (We were still turned down by the state, but that’s another story!). After the fact, I started hearing that all the kids in this childcare center had major boundary issues.



Long way of saying, it’s all about expectations. One treatment center expects kids with issues to act up and hurt each other. Another expects it, but doesn't allow it to continue. One child care center expects preschoolers to play roughly and be aggressive. Another expects them to be polite and helpful.



My adopted children expect to be treated badly. They "know" that "ALL" kids/teenagers act up and are rude to their family. My biokids expect to be loved and cared for. If a family member hurts them or their feelings they assume it's an accident or that the parents are there to keep them safe from any real harm.



When Bear was raging out of control and physically violent to the parents, the whole family felt the stress, but the biokids knew everything was going to turn out OK. Our adopted children did not. They "knew" that our son was going to be beaten, kicked out, and abandoned again. Our daughter "knew" that he would hurt her if she got in his way, and that when he was kicked out, she was soon to follow.



Our son is no longer raging and the biokids are "over it, " their expectations have been met. They are probably a little stronger and better people for the experience. Kitty might always live in fear. The world she expects is a pretty horrible place.

Why worry?

Kitty went to residential treatment today. We got a call yesterday morning saying they would call us back when the insurance company approved it. He called back at 5:30pm and it was official. We needed her there with all her paperwork and stuff at 2pm the next day.

So the logistical nightmare begins.

Hubby had to go to work.
Prescriptions and updated immunizations had to be picked up.
Laundry had to be done so Kitty would have clothes to take.
Kitty had to get packed. (She admits she doesn't have a toothbrush, toothpaste, hairbrush or socks).
It's a 30 minute drive to the residential treatment center and they think it will be about 2 hours to drop her off and get the paperwork done.
Bear had to be at Football practice at 2:30pm.
Hubby had to teach a class at 4pm. The person was leaving for a trip at 3am so it couldn't be rescheduled.
All the kids (including my niece and nephew) usually go swimming from 4-5pm.
Ponito's teacher was supposed to drop by to meet him sometime between 4 and 6.
Bear has a 5:30pm psychiatrist appointment downtown (with rush hour traffic - easily a 45-60 minute drive there).
Bear had to be picked up from football practice at 7:30pm.

We only have one car, although my mom lets me borrow hers sometimes. I stressed and worried all night and most of this morning.

I should have trusted God.

So Bear's psych appointment they'd told me on Monday couldn't be rescheduled for any other time this week? One call saying we'd be registering our daughter and couldn't make it... they said they have an appointment next week in the morning. Perfect. New appointment doesn't interfere with football practice and school doesn't start until the next day. They didn't charge me for rescheduling with less than 24 hours notice either.

Borrowed Grandma's car and got all the errands run (including all the care products Kitty didn't have - with a $5 off coupon I'd found in the mail this morning!).

Kitty packed while I found paperwork etc. (Note to self: Never let Kitty pack for herself - even though you ask her 10 times if she remembered items like socks, underwear and shorts and she says yes? Somehow they'll mysteriously disappear out of her suitcase - I've got to take her a ton of stuff tomorrow, but she at least had enough to get through tomorrow.

A friend I trust, picked up Bear for a "playdate" with her older son, and offered to drop him off at football practice since she had to go anyway! When she came to pick him up, she caught us going out the door. She had her daughter with her. Her daughter was released not too long ago from the same treatment center. They were able to give Kitty some information about the apparently great therapist she would have and what she could and could not take.

Hubby got a call from his student saying she needed to move back her class to after 6pm because she couldn't get off work!

We got home at 5:30pm, just in time to meet Ponito's teachers who drove up at the same time we did.

Hubby had enough time to grab some food and meet his student. They finished in time for Hubby to pick up Bear from football practice.

Kitty's biggest concern about going was that she would have a roommate that she didn't get along with and might make a pass at her (had a couple of bi-sexual roommates while hospitalized this year.) which scared her. We met her roommate, who appeared to be sweet and "special." She had Tinkerbell sheets which is Kitty's favorite. Everyone was nice and accommodating. Kitty is still nervous, but seems to be feeling safer.

So it all worked out. God works in mysterious ways.

Provoking stress for residential treatment?

Got a call from Nebraska today (finally), they basically said go ahead and apply for Kitty to go to residential treatment. It took them 3 weeks of dithering about to say, well, put her in and if we want to, and your primary insurance won't cover it, we might cover it. Really reassuring and helpful! (insert sarcastic snarl here)

I could have had her in 3 weeks ago and she might not have missed any school! Now we have to see her psychiatrist again because we have to have a recent evaluation and it's been a whole 2 weeks since we saw the psychiatrist last! Are you kidding me?! *sigh*



This has been a long journey. We've had Kitty with us for almost 3 years - since she was 11 years old. She is diagnosed with RAD, complex PTSD, bipolar disorder,ODD, ADHD, learning disabilities, and was abused and neglected...

We had to put her biological half-brother, 13 at the time, in residential treatment within 6 months of the time he moved in with us because he was violent, suicidal and at 5'9" and 200+lbs he was dangerous. He was out 6 months later with new diagnoses and new medications - and for the one and a half years since we've mostly been able to feel safe with him.

So here's my dilemna, maybe because I think of kids needing residential treatent as extremely violent like my son was, I'm not always sure it's right to send our daughter to residential treatment. I want her to get the neurological assessments this treatment center is known for, and to get her medications in order. I do not expect the turn around that we got with her brother, but I think she would benefit from 4-6 weeks in this treatment center.

She constantly talks of vengeance and threatens us with physical violence (although she doesn't follow through). She was hospitalized in January for unstable mood fluctuations and again in April for suicidal threats. Her meds have been mucked with substantially. We're in the process of removing it, but one of her many mood stabilizers makes her sleepy. She naps for 3-4 hours a day.

We have removed as much stress as we possibly can. I'm working from home so I can be there to help her regulate and stay calm. We've stripped her room of all but the essentials, and she's always under direct adult supervision, and we rarely do anything more stimulating than Sunday school once a week (she tends to be an aide in the 2 year old room instead of hanging out with kids her own age. Even though chronologically and intellectually she's 14, emotionally and developmentally she's closer to 4-6 years). It's working. Her meltdowns are less frequent, milder, and she recovers quicker.

Right now anyone looking at her might see her as stable (or at least too stable to be in residential) and think it's because her meds are working. To write the referral for residential, her psychiatrist will be asking how she's doing, and at the moment she's "OK." I can't protect her forever though, for one thing, school starts in less than 2 weeks and that will trigger all the stress that's boiling below the surface. She never acts out at school - she'll be saving it all up to vent at home.

My daughter can honeymoon for weeks and weeks, and because of her RAD may never allow them to see a meltdown. Even when she was raging at home, the school system and the partial day hospitalization program she attended never saw it. This residential treatment center knows little of RAD.

So do I stretch the truth with the psychiatrist? Do I stop protecting her and allow her stress levels to increase back to the way they were? Do I wait until she starts school when there's nothing I can do to about the stress? And what about the interview with the residential treatment program? Should I bring up something I know will upset her so they see how close to the edge she is or just hope that they take my word for it from all the paperwork we've filled out?

Residential Treatment - aka drowning in paperwork

We have decided that Kitty will most likely need to go to residential treatment. In particular one that will do neuropsychological assessment. This has been a long time coming. Medication does not seem to be helping, and she seems to be escalating.

I am getting very concerned for Ponito. Kitty has not physically hurt him, but she calls him "that evil little boy." She is beligerant, oppositional and threatening to him. Calls him names and screams that if he hurts her she will hit/kill him. She feels totally justified in this response.

The other day they were arguing over the TV remote and he tried to snatch it from her, accidentally scratching her cheek. She slammed the remote in his chest so hard I heard it thunk. Luckily I was sitting near by trying to stop them so it did not escalate. She could not be convinced he did not hurt her deliberately.

He is understandably responding to her threats and escalating his response to her behavior. It's tough to be a 10 year old boy in a house dominated by teen girls (Bob will be 13 next month). He's reacting like most little brothers, but Kitty doesn't seem to have any understanding of this concept. In her mind younger siblings should be "dancing monkeys."

So Friday, I spent ALL day searching for a copy of the adoption subsidy paperwork so I could figure out who to contact for pre-authorization for residential treatment from the state of Nebraska for when our private insurance runs out.

I was inspired by another blogger who has been decluttering her home. She has even been keeping a Hefty Bag count. I went through every room of the house looking for paperwork.

I discovered that every time we sign up for a new program, start a new school, or whatever, we put everything in a folder, take it to wherever, usually end up with multiple copies as things are faxed or given to us out of order and in duplicate, and then apparently never put the stuff in the folder away. These folders get left in the car, or my study, or he entry hall table, or wherever the files got dumped when someone decided they needed the box they were in - not to mention all the new stuff.

I found at least 6 copies of 20 page documents. 15 page documents every 6 weeks for the two kids getting special services. The 3 inch thick stack of every meeting since the kids entered foster care (with all identifying info blocked out). Most of that again with all the identifying info not whited out. Every time someone goes to a new school, program, new therapist, is hospitalized... Every time the kids have a writing assignment, get an award, write poetry or stories, draw pictures... you get the picture.

8 hours and I still didn't find the document! Most of it was organized though. I threw out 2 Hefty bags of papers, and the 3 stacks I have left to file are only about 3 inches thick, and need more file folders before I can finish organizing. Oh well, I've got all weekend, right?! Maybe the document is in all the files in the garage I didn't go through yet.

I did find some interesting stuff though.

Residential Treatment?

At this point we are strongly considering the residential treatment center (RTC) that Bear did so well at, for Kitty. There are some major differences between the two kids that might effect the outcome though. Kitty is sick so Hubby and I went to therapy without her. We had a good talk, but I'm still torn.








We broke down the advantages of the RTC based on our experience there with Bear.

• This RTC is well-known for it's neuro-psychological assessments - which our insurance won't pay for outside the RTC. However the AT did mention that while our personal insurance won't pay for it, Medicaid will - if we can find an excellent neuropsychologist who takes TX Medicaid.



• Unlike other programs, this one is fully paid for by Nebraska if our insurance or state won't pay for it. For as long as we need it (Bear was there 6 months). Our insurance would most likely pay for a MAX of 6 weeks. TX Medicaid doesn't pay for RTC.



• Bear's meds were adjusted until he finally received what apparently was the right cocktail. However her current psychiatrist actually consults on a regular basis with the RTC, so he could easily do what they would - if he had the neurological assessments.



• When they "muck with" her meds she won't be home to take it out on the family.



• The whole family will get a break from her increasingly frequent verbal abuse and meltdowns, and it might "break the habit" for her.


• After the trouble with the PDH (unsafe environment that triggered her PTSD, fight, flight or freeze reaction), I'm feeling guilty about sending her away to another facility - even though I know hindsight is 20/20. I worry if the RTC environment is similar she will think I don't care enough to keep her safe. (I hear so often that she thinks I don't care about her, I guess I'm starting to believe it). However this is NOT the facility that asked if we were "OK" with our son getting beat up.


• Poor Kitty already has major abandonment issues, and obviously feels that if we send her to an RTC we are sending her away forever (like when Biomom sent her to foster care and then terminated parental rights). The AT reassured me that she doesn't think Kitty will hold it against me.


• My biggest concern is that sending Kitty to an RTC would damage the "anxiously attached" relationship we have. This facility appears to have no experience with RAD or other attachment issues. Therapy there seems to be pretty much a joke. However, now we know that we can complain, and if we really hate the therapist or have concerns, we can complain to her supervisor (didnt figure this out with Bear until the last week).



• This RTC is semi-nearby so frequent visits are fairly easy.

During her meltdown at the grocery store this evening I realized that Kitty's issues with jealousy over Ponito and need for his childhood to be as miserable as hers, are not going to be easy to ignore. She hates Grandma for loving Ponito and treating him as "special." She accuses Hubby and I of loving our biokids more than her, and giving them things, letting them go to friends' houses, not punishing them when they do something wrong.... I know this is her perception and not reality, but just like you can't make someone believe you love them, I can't convince her that she's wrong, while still protecting the other kids.

Have I been an ostrich?

This is an e-mail I received from Kitty's EMDR therapist. Am I prepared for this? I guess we've been progressing so far and so well that I want to think this is a glitch, something that will blow over. I've got a call in to the AT therapist hoping she'll tell me something different, but this was a real wake up call.

Mary,

My thoughts are these. I will be happy to do any configuration with biomom; I don 't want her here at the house. I will only see her at the south office. I do think you have to consider actual inpatient treatment for her; and I hate saying that because I am not crazy about anything but this can't go on. See if ___________ (RTC Bear went to) has a place for her; check with _____________ (local girls-only RTC I used to work at many years ago) and see if she is appropriate for them. There is a place in (about an hour away) called _________; I had someone there several years ago. I am not super crazy about anything except the kind of treatment I was trained in; but I don't know myself anyone else in the area who does that kind of work.

Now why I am suggesting that you find out about these placements is--if she sees biomom or not we have to be ready to have a safe place with adequate staff to contain her. If she sees her it can be awful as you are clearly aware of; if she doesn't and knows Bear does see her, it will be horrific. My personal preference is to not delay the inevitable; force the issue; but have your ducks lined up before you make the decision which way to move.

She will ask (biomom) to take her "home". We know that can't happen. She will melt down or attack her in some way--maybe just verbally. But it won't be pretty, and your home will get the fall out either way. She is out of control, and you are getting too tired. It won't help anyone if you get sick because of this child who has so many problems. Right now I think she needs more help than you and (Hubby) can provide in the home and keep your home environment healthy for you. She ties up so much of your energy.

I have worked with many kids like her; and the one hour office visit really isn't enough. I think she would have a better chance with a 24/7 contolled environment for a long period for her to get other professionals (plural) to do what you are trying to do with so little help. But I am here for the long haul. I will do whatever you are ready to try. I believe you are both wonderful parents and you got much more than you signed on for. No decision you make will be wrong. As I learned many years ago, you can't damage these kids further. The damage was already done by the time you got them.

See you tomorrow.
(EMDR therapist)

Bear, then and now

Bear came to us in November 2006 (picture on left). He was a very angry kid who kept everything bottled up inside - until it exploded (almost monthly). When he was stuffing things inside, he showed no emotions at all (not happiness, fear, or anger). He was like a volcano though - you could see the emotions - turned to anger - seething underneath. He told everyone he loved them, but had no idea what that meant. Bear came to us with RAD (Reactive Attachment Disorder) and a list of other diagnoses - some of which we've discovered since were inaccurate. His symptoms overlapped so many possible diagnoses and he was a very damaged "little" boy. At 5'9" and 200+ lbs he was very scary and intimidating most of the time.

The picture on the right is Bear the day after his adoption on his 15th birthday.

After 8 months of hurting himself, attacking Hubby, and scaring/intimidating the whole family so much that most of us had symptoms of PTSD. In one last attack on Hubby, D was accidentally given a minor injury, causing an investigation of Hubby for child abuse. While they were investigating BOTH Bear and Kitty were removed from our home and put in respite care. I can't tell you how much this set back Kitty's attachment therapy - even though they were only out of our home for one week, because their amazing Nebraska caseworker threw everything she had at Texas. It was the fastest investigation anyone had ever seen! The kids were back in our home in less than one week.

We didn't know what to do with Bear though. We were not allowed to restrain him, even if he attacked us. We were not allowed to let him escalate at all, which since he needed to escalate to vent off the pressure of all that seething anger - was an almost impossible task. We ended up basically medicinally restraining him until an opening in a residential treatment center opened up. Bear began taking mega doses of Depakote - which basically turned him into a zombie. At one point we asked him if he wanted to have his medications reduced, and he said No. I think Bear was afraid of his anger too.

Bear went into a residential treatment center with a strong neurological component. They took him off several of the medications he was on (not the Depakote!), and changed his diagnoses from RAD, PTSD, Conduct Disorder and Mood Disorder to

Bipolar Disorder
PTSD
Cerebral Dysrythmia (which for him is brain damage that effects his memory and learning)
ADHD
and they left the RAD on there.

They almost released him while he was still on the Depakote, but we insisted it be removed before he was released. This let some more of his issues come out and he ended up staying another couple of months. When he finally did leave Meridell he was on so many medications that it was pretty overwhelming. He was even on some medications to deal with the side effects of other medications. However, he was a changed kid.

We were afraid to trust it right away, but the lava was gone. He still has tons of issues, is rough around the edges, and is a teenage boy with a horrible past, but he's no longer out of control. We waited another six months to be sure, but this was a boy who could be part of our home. We adopted him one day before his fifteenth birthday. He's now MY pink loving, Superman cape wearing, goober. Just as weird as all the rest of us.

Mary