Work with me, please.

Posts tagged ‘cognitive behavioral therapy’

Winding Down

It’s been so long since I’ve been here! The clouds are breaking. Work has lightened up, at least for now. We have a new staff member, which I hope means that my workload will stay reasonable. Homework is decreasing as the end of the school year gets closer. Whew! I’m convinced that 3rd grade has been harder on me as a parent this year than it was when I was a student myself some 30 plus years ago.

20130522-072907.jpgI finished my cake decorating class. If grades were given, I would have been lucky to get a C. For the last class project, my cake leveler broke and I was unable to get the nice, smooth surface I wanted. I made cream cheese frosting, which the instructor recommended against. I’m a hardhead.  I could not bring myself to put butter cream icing on a red velvet cake, and I didn’t have time to make two frostings. I took my chances. As a result, my frosting was too soft to make the pretty flowers I saw in my head. At least the cake tasted good (or so I was told). You couldn’t tell by looking at the final cake, but I actually learned a lot.  I need practice, which means that I need to bake, which I haven’t had time to do. Well, this weekend I will have time as well as a reason to celebrate. Yesterday was the birthday of Albert, Jay’s favorite stuffed puppy. Albert has birthdays every few weeks. Jay decides the theme and plans the party, including the type of cake and how it should be decorated. He gave Albert three birthday gifts yesterday, including a sleeping bag that looked like a sock. So, we’ll top off the celebration with a special cake for Albert.

Mae is done with social skills training until the fall while the therapist takes a summer break.  I definitely plan to return to the social skills playgroup.   I had a nice, long talk with the  therapist during our last visit.  She talked about helping the kids recognize “unlikeable” behaviors that make it difficult for other kids to stay friends with them.  I’m convinced that there is value in structured play time with interventions or corrections as necessary, both in being corrected and seeing others corrected.  A teacher told me recently that kids need to see or hear something at least 17 times to master it or make it habitual.  So, I’m going with that.  The cognitive behavioral therapy is on hold because we couldn’t get a regular slot that worked for our schedules.  If Mae asks to go during the summer, it may work out better since we won’t have to worry about homework.

This weekend I’ll also be working on travel plans for a vacation in June.  Sooo looking forward to that!  The vacation, that  is, not the planning.

Spread Thin

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I would have written this post days ago were it not for Ruzzle, that addictive word game that has become my go-to mental break.

Work was on fire the past two weeks. I gave away hours of personal and family time in the evenings and weekends to keep up with the demands. I went to bed exhausted and woke up groggy and still exhausted.

Mae went back to therapy and social skills training last week, after a break of over one year. Overall, the school year has been great compared to past years. This is still a critical time. She’s made some friends and she seems to have a lot of fun with them . . . until someone doesn’t want to play tag. Then, the crying begins and then the teasing about the crying begins. Last week, she decided to give an upper cut to some boy who wouldn’t stop mocking her crying. She told me that night that no one likes or wants her anymore because they won’t play tag with her.

It’s the self-degradation and the hitting that worry me. I’m afraid that her classmates will stop wanting to play with her at all because of how she reacts when they want to do something other than what she wants to do.

So, we’re continuing to work on how to play what others are playing or learn to move on and play with someone else, and how to handle disappointments and disagreements.

Before tonight’s appointment, Mae said, “Today is a perfect day to go to Dr. [M]. I have a bunch of stuff to talk about. Last time, she did most of the talking. This time, I think I should do most of the talking.” And talked, she did.

I was unsure that more one-on-one therapy would be beneficial, but I’m glad we went. I think it’s good in the long run that Mae has a practice of going to safe places and people when something is troubling her. Unfortunately, we have a scheduling issue. Our choices now are 5 pm or 8 pm appointments. So, we’ll have to postpone more sessions until the therapist has different openings or I can change my work schedule.

Mae thinks social skills training is fun because she gets to play with other kids. The group meets on Saturday mornings, so the scheduling is working for us right now. She is the only girl in the group, which sucks. She seems to have more trouble playing with girls, and I was hoping for some practice in that area.

In better news, Mae and I had an awesome time for her birthday in NYC. It was a fun-packed two days. We got to do everything on our list and we made a new list of things to do on the next trip. We’ve already made a photo book, which is a birthday tradition, for the trip. She asked to add the captions this time, which took some letting go on my part. I had to tell myself, “She’s nine. Let her tell her story in her own words (and edit it before ordering :))”.

I started a 4-week cake decorating class. I didn’t do too bad on my first cake. The kids recognized it right away as an Angry Bird, and that’s all the validation I need. I thought it was much better than the “my family” foursome of mini cakes I made for Mae’s birthday. I thought Jay should have been easily recognizable with his two missing teeth and Mohawk. Hubby said that his cake should have had hair although he doesn’t wear any in real life. Oh well, I’m learning.

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Unmasked

A couple of weekends ago, Mae watched BrainPop movies on ADHD and autism as we were driving home from somewhere.  The short video on ADHD, or ADD, described the characteristics as inattention, impulsivity, and hyperactivity.  The narrator said that people with ADD can’t concentrate sometimes no matter how hard they try and get bored easily.  He described children who call out answers to questions out of turn and have trouble sitting still and difficulty interacting with others.  In the autism video, the narrator explained that someone with autism has a strong interest in a particular topic, difficulty communicating and relating to others, and problems interacting with family and friends.

As we came into the house, Mae asked me if she has ADD.  I said no.  Then, she asked if she has autism.  I said no.  Then, I remembered that the video talked about autism spectrum disorders, of which Asperger’s is considered one.  Though the video didn’t specifically mention Asperger’s, I realized that I should change my answer.

I began, “Wait, do you remember meeting Dr. Mike and taking a lot of tests?”  I told her that the outcome of the testing was that Dr. Mike said she has Asperger’s Syndrome.   Mae asked what that means.  I started with, “Sometimes, you’re impulsive” and explained that sometimes she speaks and acts without thinking first of the consequences or impact on others.  She recognized that and said, “Oh, yeah.”

I started to talk about a second characteristic (I don’t remember which) but she went off on a tangent and started describing one of her classmates that she thinks has ADD.

I realized this was an opportunity to talk about one of our cousins who has autism.  We only see Jaden once or twice a year, and I’d wondered when Mae would notice and ask why Jaden seems different from other teenagers she knows.  I wanted to help Mae connect what she show on the video with real life and develop more sensitivity.  I told her that I think Jaden is the only autistic person in our family, and I talked about Jaden’s fascination with spoons, her monotone way of speaking, and need for routine.  Mae, ever focused on herself, asked if she’s the only person in our family who has Asperger’s.  I said yes, I believe so.  Mae clapped and said “Yay!” with a big ol’ smile.

I’ve heard Mae mention Asperger’s only twice since that conversation.  Once to tell Jay that she has it, in a tone that sounded as if it were a badge or at least something that made her unique and special.  On the other occasion, I was reminding her to focus on her homework and she said, “It’s because I have Asperger’s.”  She didn’t press that point because I’m a stickler about homework.  She’s gonna get it done no matter what and she knows it.

It’s interesting that she recognized herself in the BrainPop videos.  Of course, we and her teachers have spoken to her many times about blurting out in class and staying focused.  I try to keep her to a routine, especially on school nights and she’s gotten help from a therapist, which the videos also discussed.  And, my goodness, she knows that she has trouble making friends, or at least the friends she wants to have.

I told Mae this morning that she will be moved to a new homeroom class when she returns to school this week.  The school sent home a form letter on Friday announcing that, based on test results, 3rd grade homeroom class makeup is being adjusted to better match the needs of students.  Mae fell into a funky mood right away.  She’s worried that she will be separated from the one friend that she’s made, and I understand.  Frankly, I’m worried about that too.  Mae has consistently been complaining about the general rudeness of the kids and requesting to go back to her old school.  On top of that, she continues to complain specifically about Gigi.  Mae said this morning that she has been trying to steer clear of Gigi because she continues to be mean and bossy.  Gigi, according to Mae, insists on sitting with her at lunch and trying to play with her.  Yet, Gigi says that she doesn’t like anything about Mae.  Two weeks ago, at aftercare, she gave Mae and another student the middle finger and said, “F*ck you.”  The aftercare director says that she called Gigi’s parents and sent a note home.

I’m so hoping this homeroom change doesn’t place Mae in the same class as Gigi.  I’ve been communicating with the school guidance counselor as well as the aftercare director about the girls’ interactions.  Both women have been very understanding of my concerns.  This past week, they both thought that things were mellowing out between the two girls.  I’m not sure what to think because Mae paints a different picture.  I do know for sure that it would be a setback for Mae if she is separated from the classmate who has become her friend and placed in the same environment with Gigi for several hours a day vs. just seeing her at lunch, recess, and aftercare.  One of those things would be bad.  Both?  I don’t even want to think about it hard.

School is closed tomorrow because of Hurricane Sandy.  When it reopens, my top priority is to see the class rosters.

National Minority Mental Health Awareness Month

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This post is in support of National Minority Mental Health Month and No Shame Day, a day of awareness promoted by The Siwe Project, a non-profit that promotes mental health awareness and education among people of African descent throughout the world.

I debated with myself on whether to participate. I am woefully underqualified to offer any creditable information or guidance in this area, and my support is generic at best. Though my daughter, Mae, was diagnosed last year with Asperger’s syndrome, I have still many unanswered questions and gray areas. My focus has been on better understanding, accepting, and working to her strengths and weaknesses, and less no on the label itself and larger questions about mental health.

Is Asperger’s a mental illness?

Yes . . . no . . . maybe.

There is considerable debate about the exact classification of Asperger’s, a disorder on the autism spectrum that is evidenced by high intelligence, poor social skills, impulsiveness, and inflexibility, among other traits. The characteristics are somewhat easy to identify; however, you’ll find differing professional and personal opinions on whether or the degree to which it is a mental illness.

What I do know is that Mae had been presenting my husband and I and her school teachers and administrators a host of behaviorial challenges that seemed beyond average for a child her age. At the start of first grade, she was still having emotional meltdowns that one would expect of a toddler, though her verbal skills were phenomonal. She would lose control of her emotions, especially during play, and cry for 20-30 minutes. The thing that scared me the most was her tendency to declare that nobody wanted or loved her. It would take a lot of coaxing to bring her out of that place. I didn’t think she suffered from depression; however, I feared that she would or could one day.

She is an incredibly social creature. She would introduce herself to complete strangers, children and adults, and invite them to our house to play within minutes of meeting them (including grown men). She would run off and leave us in public places if there was something interesting within viewing distance that caught her attention. Her impulsivity and strong desire to touch soft things like skin, hair, and ears made us fearful that she was vulnerable to abuse or kidnapping or both.

When she was six, we took her to a pediatric neuropscyhologist for an evaluation. Among other interventions, he recommended cognitive behaviorial therapy to help Mae learn skills to manage her emotions, control her impulses, and be more flexible.

I don’t know if Asperger’s is a mental illness. I do know that the therapy, which I view as a mental health solution, and additional supports given by her teachers and school administrators have been helpful to me and her. Mae knows that there has been a ring of support around her and safe places for her to express herself. At eight, she is more mellow and flexible. I believe that better, more informed parenting skills on my and my husband’s part and just plain old maturity have played a role and will continue to be important factors.

Mae hasn’t seen the therapist in over two months. However, she will if I think it would be helpful again. I’d like to set her up for success in every aspect of her life, and if there are solutions within the mental health community, then that’s where I’ll be.

Does Mae even have Asperger’s syndrome?

Yes . . . no . . . maybe.

At the appointment to discuss his findings, the neuropsychologist said that Mae is “borderline” Asperger’s. He could have gone either way with the diagnosis. She could just be intellectually gifted, social and “quirky.” Other professionals had offered a similar opinion.

Here’s where I have to acknowledge an immense privilege I know many others lack in treating mental (and other) illness. Rejecting or declining a diagnosis would have meant losing the opportunity for insurance coverage for therapy and legally required accommodations if we switched from private to public school. The mere fact that we could have walked away with a “no thanks” belies the advocacy that so many individuals and organizations engage in to de-stigmatize and promote greater attention to and support for mental health issues.

The other aspect of privilege here is that we were able to pay out-of-pocket for therapy visits, $150 each, which were weekly, then bi-monthly, and then monthly. Fortunately, our insurance company reimbursed us for most of the cost. It is no surprise to me that even folks with awareness or a diagnosis are untreated.

My family has been fortunate in so many ways. I know that others struggle with more complex and pervasive mental health issues and fewer resources to address them. I do believe, though, that I can share in a common resolve to better understand and support those who have or love someone who has a diagnosed or undiagnosed mental illness.

Namaste.

Moving Up and On

20120403-102450.jpgIt’s Spring Break! We’re free! We’re free!

Yesterday, I was talking to a girlfriend whose 2-year old is on Spring Break this week too. My friend was talking about her plans for events all around town. I felt bad. I have plans for all around the house. The kids and I were in the yard yesterday afternoon. Jay said, “I like pulling up weeds.” I thought to myself, “. . . until you go back to school and hear your friends talk about their trips to Disney or other exotic places.” Oh, well. We did have a play date today at an inflatables place. The kids ran, bounced, and slid for two hours straight. I felt better. I reminded myself also that they have had several busy weekends in the past two months. We’ve been to the National Building Museum twice, the Chesapeake Children’s Museum, Maryland Science Center, and the Natural History Museum. That’s in addition to birthday parties, field trips, and park visits. They get around. The father of the little girl we met today spoke of an article he read recently about how we schedule our kids’ time such that we deprive them of opportunities to use and develop their own imaginations. Instead of learning to plan and organize and be creative, they look to us to tell them what to do and play. And, on that note, while I spend the reminder of the week cleaning and organizing, Mae and Jay will be free to figure out what they want to do.

Last night, Mae had her last appointment with the therapist for what will be a while. During the visit, we talked about improvements she’s made and how it seems that the gap between her emotional and intellectual development has narrowed significantly. She has better self-control, and Hubby, her teacher, and I know better how to anticipate and head off triggers. Things have been relatively quiet on the school front, and issues she’s had — like losing time off recess for talking during class — are typical 8-year old behaviors. She rarely complains about not having anyone to play with or feeling left out. I think she’s accepted that she is not a part of certain circles. She doesn’t like it, but she doesn’t obsess about it. Right now.

The last quarter of school will be more challenging academically, and that will take extra coaching. When she doesn’t breeze through her work, she gets down on herself, saying that she can’t do anything. I have to coax her out of that frame of mind by reminding her of past success, which can include getting the previous 19 problems on the page correct with no assistance, and giving constant encouragement. I expect that transitioning to summer camp will take some special coaching as well. The therapist and I agreed that I’ll give her a call in early to mid-June to talk about how that transition is going.

I’ve given up on finding another social skills playground. So much effort, so little results. If she continues to have play dates and other social events where we can monitor her interactions with other kids and intervene as necessary, I think we’ll be fine. For now.

Jay had his follow-up appointment with the gastroenterologist today. I think his heartburn issues resolved shortly after our first visit in February. He continued to complain about more general stomach pain for a few weeks after, until about a week ago. Hubby and I became skeptical after we noticed a pattern of complaints after lights out on school nights. His stomach seemed to be pain-free on weekend nights and also at certain special times, such as when he had his blue comforter instead of his brown blanket, or when he listened to soft music at bedtime. There were many nights that I wanted to put my nose to his and say through clenched teeth, “Will you please just tell the truth?” That would work with Mae. Jay is my sensitive one. When I use a stern tone with him, he ignores the message and focuses on telling me he doesn’t like “that voice” and asking me to apologize. The conclusion is that his stomach did hurt sometimes, most likely due to constipation. So, we’re on to more fiber, water, and exercise.

My new job has gotten off to a good start. I swear this was a good move for me, and not just because I’ll be working from home two days a week. It’s going to be more intense and focused on employee relations (ER). After spending the past 6 years splitting my time between ER and other areas, I feel as though I finished my undergraduate degree and now I’m in graduate school. I’m excited about the new skills I’ll develop and new relationships I’ll build. It’s not that I wish for people to have problems at work or that I enjoy basking in other people’s problems. It’s just that problems are bound to happen because we’re human, and I like helping to solve them. So, I’m looking forward to talking to the supervisor of the “creepy old guy” who keeps putting his hand in his pants, much to his cubicle mate’s dismay. Ha’mercy!

“Tell Your Troubles”

20111220-003153.jpg Mae was in one of her talkative, insightful moods yesterday evening.  When I picked her up from aftercare for her therapy appointment, Mae told me about a website that she learned of from one of her classmates. She told me that she wants to join and that she will have to check it out to make sure it’s ok for Jay. She listed the criteria for him, top of which was no chatting.  It was funny that she gave herself the responsibility of screening a website for her brother.

As her therapy appointment was ending, Dr. M asked, “Is there anything you want me to think about before we meet again?”  While I was thinking of an answer and trying to write a check at the same time, Mae responded, “self-discipline.”  Huh?  It’s so easy to forget this child is 7 years old.

Dr. M said, “Okaaay. . . . What does self-discipline mean to you?” Mae said it means doing the things she’s supposed to do.  Check.  I believe strongly that Mae knows and understands what’s expected of her and wants to do the right thing. She needs help and she is open to receiving it. That’s more than I can say for a lot of adults I know.

As I was backing out of the parking space outside the therapist’s office, I asked Mae to turn off the overhead lights because they distract me when I look in the mirrors or over my shoulder to change lanes.  I said that it’s safer for me to drive with the lights off.  She turned them off right away.  (The backstory is that she knows I like those lights off; I’d just never explained why in detail.)  Mae then began one of her disclaimers — she’s become really good at disclaimers.

“Mommy, I want to tell you something and I don’t want you to get upset. I’m not trying to scold you or be mean or anything.”

Deep breath.

She went on to tell me that I should tell my troubles before they upset me.  If I tell my troubles right away, then people can help me and I’ll feel better.  She had a lot more to say on the subject, but the gist was that instead of feeling annoyed about the lights and snapping that they should be off, I gained her cooperation by explaining what it was about the lights that bothered me.

I get her point.  Still, I flip between being grateful that she is articulate and expressive and feeling bothered that she expects instructions with explanations about why.  Oh, she could not have been my mother’s child nor my grandmother’s child.  Ha’mercy!

Our play date on Sunday was a success.  Both the girls I invited showed up and Mae was surprised and thrilled.  We moms were 4 with 6 kids between us in an inflatables place that had about 4 birthdays going.  Chaotic, but the kids managed to keep up with each other.  At one point, I heard Mae tell one friend to stop following her.  I pulled her aside and reminded her that having a play date means playing together and being around each other.   I told her that if she wants me to continue planning play dates and expects her friends to say yes and invite her back, she’ll have to be kind and play nicely.

We left the play place and, even though I had a hefty to-do list, the other Moms talked me into going to dinner with them.  It was my first restaurant experience with a gaggle of kids, and it wasn’t bad.

The play date was a good experience for me in that it increased my confidence that Mae can manage herself with her classmates at least some of the time, and parents from the school see her as a suitable playmate for their kids.  I hope it was affirming to Mae that she has friends she can play with outside of school.  This is something I can remind her of if she says again in the future that she never has play dates or that her classmates don’t like or want her.

I’m thinking more and more that there is greater value in getting Mae out with other kids than in meeting with a therapist.  Being able to monitor her in social situations allows me to  give immediate feedback, acknowledging when she’s doing something right and intervening to correct or guide when she’s not.  I’ve been emailing another school parent to set up a play date after Christmas.  Her daughter, F, is a third-grader that Mae met during summer camp a couple of years ago.  They clicked instantly.  They are both non-stop talkers with room-filling personalities.  Both have spent time with the school guidance counselor working on social skills, and at my request, the guidance counselor passed on my name and number to F’s mom.  My hope is that Mae and F can get together regularly, including sometimes with other kids, and then we’ll phase out or cut back to occasionally meeting with Dr. M.

My brownies should be cool by now.  I baked a double batch of red velvet brownies for my family’s Christmas Eve celebration next week.  I did the same thing last night, and it was a disaster.  I will never, ever, ever double the vanilla again.  I had to start over tonight.   I now understand why people start holiday baking so many weeks in advance.  I’ve learned my lesson for good.  I’m off to cut and freeze the brownies, and then get a few zzz’s before hitting the office for my last day of work this week.  Yippeee!

Back to Cruel

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School hasn’t started yet, and it’s already not going the way that I planned.  Ms. J, who looked after Mae after school last, including making sure her homework was done, informed me last week that she hadn’t yet received commitments from any other families for her at-home after school program.

As her youngest child is a sixth-grader, she knows, and I agree, that he and a second-grader are not ideal playmates.  Ms. J shared with me that she thinks that Mae needs a smaller, more structured program than that offered by her school, where Ms. J works and has seen some of the trouble Mae has had in her interactions with other students and some teachers.  Ms. J remembered that I’d approached her originally about help with finding transportation to an aftercare program in our neighborhood, and offered to drive Mae there.  So, that was good news.  I also appreciated that Ms. J called me and asked to talk face-to-face.  She didn’t want to email me or talk in detail over the phone.

Fortunately, there is still space in the neighborhood program.  It costs about an additional $100 per month over Ms. J’s place, plus whatever we’ll pay Ms. J for transportation.  In total, we’ll pay per week what Mae’s school charges per month for aftercare.  All for a child who is quick to complain that we don’t take her enough fun places and all our vacations seem to be in SC.  Oh, I wish I had started adding from day one.

And, I’m wondering if we should be doing more for her social skills.  Playgroup sessions again?  An aide to be with her during recess at school?  At her last appointment with Dr. Laura two weeks ago, she had a meltdown right smack in the middle of the session.  Jay was with us because Hubby was out of town.  He was playing with a plastic truck on the rug, and put it down to pick up another toy.  Mae and Dr. Laura had been discussing how camp was going, and Mae left the conversation and went over to pick up the truck.  She did so quickly and then jumped to the other side of the room.  Jay began to protest, and Dr. Laura insisted that Mae hand over the truck.  Mae did so reluctantly, arguing that Jay wasn’t using it.  The doctor pointed out the cues that Jay wasn’t done — he’d put the truck down  near him and he sounded upset when Mae picked it up.  She asked Mae what else she could have done to get the truck.  Ask Jay if he was done with it?  Ask for a turn afterwards?  Then, the tears started.  Then, the arguing — she could play with it if she wanted to because he wasn’t using it.

Jay and I went to the reception area and left Mae and Dr. Laura behind the closed door to try to work it out.  I don’t think it worked at all.  The crying continued except for a short break until the session ended.  By that point, Mae had decided that Dr. Laura was mean and she never wanted to see her again.  Frankly, I was a little surprised and disappointed that the doctor couldn’t turn the situation around.  I’ve seen this behavior at home, and I can intervene without a meltdown ensuing.  Maybe Mae was more dug in because it was her first such encounter with Dr. Laura.  I’m not ready to break up with the doctor just yet, though I did have a moment when I thought, “$150 for this?  I can do better for free at home.”  I should avoid judging too quickly.

So, one and a half weeks until school starts.  New teacher, new after school program.  Maybe the same social skills, maybe not.  I expect the beginning will be rough for Mae.  Hopefully, she’ll adjust and find a rhythm before too long.

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