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Posts tagged ‘neuropsychological evaluation’

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.

Get Up, Stand Up

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Hubby and I had a good meeting last Wednesday with Mae’s four teachers and the school’s talented and gifted Coordinator and guidance counselor. I requested the meeting to get a better idea of how Mae has been adjusting. I’m still trying to determine what intervention(s) to pursue next and what’s available through the school system now that we’re public.

The meeting went well. As it turns out, the teachers have been pleasantly surprised that Mae is not the kid I described in my introductory email to them. I was expecting a much tougher transition than we’ve had. I’m happy that I was wrong. They counted among them 3-4 meltdowns, and two of those were on the same day and may have been one extended meltdown. The teachers have observed some of the same behaviors we’ve been working on — not picking up on social cues, difficulty working in a group, frustration and withdrawal when others don’t accept her ideas, trouble making friends. They offered some supports that they think may be helpful with social, transition, and organizational skills.

I wasn’t aware that she had such trouble with organizational skills at school (though her neuropsychological evaluation report said that she would). For example, even though she began the school year with a well-stocked pouch for pens, pencils, colored pencils, etc, and the pouch stays in the backpack that she carries from class to class, she’s caught the devil keeping up with the items. And, I check the pouch regularly to restock as needed. Students are actually graded on work habits, and can lose 20-25% of a daily work habit grade for forgetting to take crayons to math. One of my friends asked if the emphasis on organization creates too much pressure at this age. Right now, I think the teachers are being reasonable. The school’s stated goal is to make them “college and work ready,” even though it’s an elementary school (2nd through 5th graders). Working in human resources, I see how a lack of organizational skills can hamper career success. Once I receive the first grade report, I’ll know if I should change my attitude.

I brought up during the conversation that Mae has become more anxious about her relationship with one student in particular, Gigi, which may eventually lead to problems in class. Mae’s homeroom teacher offered to monitor them when she has recess duty and she said that she would suggest to Mae that they try peer mediation. She did just that later in the afternoon after our meeting. The guidance counselor agreed that peer mediation may be appropriate.

Mae has been talking about Gigi more and it seems that they are becoming less and less friends. Mae has said that she’s afraid not to do things that Gigi tells her because Gigi may gossip about her to other students who have been friendly and then those friends will stop liking her. There is one girl in particular that Mae admires and enjoys being with, and she’s afraid of loosing that budding friendship. I swear, this is the first time in her eight years that Mae has shown any inkling of being unwilling to stand up for herself.

I started reading Don Miguel Ruiz’s The Four Agreements to Mae last week, mostly because of the second agreement, ‘don’t take anything personally.’ I thought the concepts would help her understand the importance of protecting herself emotionally and build up the confidence to do so. On Wednesday night, we read agreement one, ‘be impeccable with your word.’ This requires using words for good, not evil.

When I picked Mae up from aftercare on Thursday, she asked me, with urgency, “What’s the second agreement?” I told her we’d read it later and asked why she needed to know.

Mae: “I told [Gigi] to be impeccable with her word.”
Me:  “Did you tell her what it means?”
Mae: “No, I told her to figure it out. We were about to switch classes.”

And, just like that, she was ready to give the kid the second agreement and she hadn’t even explained the first.

Ironically, I met Gigi and her dad that same day. Hubby was right about her — she reminds me too of my child!

I’d asked Mae to introduce me to Gigi, and I was glad the opportunity came.  I’d like to get to know this child who is the first person — big or small — I know of that Mae has been unable to stand up to and defend herself against. Mae had her own agenda; she walked over to Gigi.

Mae: “My mom wants to talk to you about being mean to me.”
Gigi: “I’m not mean to you.”
Mae: “Uh huh. You called my baby brother annoying and stupid.”
Gigi: “No, I didn’t.”

Gigi followed Mae back to me anyway, and I asked about her day. She seems friendly and outgoing. We walked down to where her dad was waiting for her. I introduced myself as Mae’s mom and told him that the girls ride the bus together to aftercare and sometimes do their homework together. He was friendly too. I asked him if he was aware of any of the “friendship drama” between Mae and Gigi. He looked confused and said no. I thought to myself, ‘I guess that’s Mom’s domain.’ Mae said to the dad, “She’s been mean to me. She said she’ll be my friend Monday through Thursday, but not Friday, and that’s just wrong. Wrong.” Without taking a breath, Mae then went off on a tangent about having swim lessons on Fridays and not liking having to swim in the deep end of the pool.

Gigi’s dad went with that line of conversation and asked questions about swim lessons. I would have liked to talk to him some more about the girls. However, since he made no attempt to explore what Mae and I meant about “drama” and “mean,” I decided that I would postpone that conversation until I have an opportunity to meet Gigi’s mom. Hopefully, she’s a reasonable person and open to having a candid talk about her kid. We chatted for several more minutes about swim and I don’t remember what else.

When it was time to go, Gigi began hugging on Mae and refusing to let her go. Gigi said she wanted to come home with us. She held Mae’s hand as we walked out of the building, and walked with us in the direction of our car instead of with her dad in the opposite direction. Finally, when I teased that she would have to help clean and cook if she came to our us, she gave Mae a last tight squeeze around the neck and kissed her on the cheek three times before she went off with her dad. It reminded me of the same clingy type behavior Mae had towards her friend K at her old school, towards whom Mae was often bossy and possessive. I wonder if Gigi displays that same sort of possessiveness and becomes “mean” if Mae tries to play with someone else or wants to play or do something different from what Gigi wants.

I think Mae and Gigi do have the potential to be friends. They need guidance on how, and with help from teachers and parents, maybe they can figure out ways to get along. Or, they may decide not to be friends at all and leave each other alone or just be homework partners in after care. It’s my mediation training, I’m sure, but I’m optimistic and hopeful.

On another friend-related note, Jay’s old pal that pushed him around last year didn’t return this year. Yay! It’s such a relief. He’s such a nice kid and was just unable to assert himself with that little dude. His kindergarten teacher has described him as “quiet and unassertive.” He’ll have reading and computer technology with the first grade class, and I am concerned that he may be too uncomfortable with the older kids to participate in class. I think he’s the only kindergartener reading at his level and so there is no kindergarten reading group in which he can be placed (and still be challenged). I’m sooo hoping that he will test into Mae’s school for second grade. This year, he’s playing soccer for the first time, and loving it. As he develops interest in doing more things outside of home and independent of his sister, I hope more assertiveness and leadership will come.

Jay has brought home his Good Day stick practically every day (a couple days, he forgot to take it back to school). Mae said to him last week, with wonder, not envy, “You’re such a good kid, better than I was in kindergarten.” She even told him that he’s cuter. When he began bringing home the stick, I thought she would make some comparison and feel bad about having taken so long (relatively) to earn the opportunity to bring home her Good Day stick in kindergarten. Instead, she’s been happy for him and encouraging. She still likes to help him with his reading and anything else where she sees a need. That’s a relief too. It reminds me that she’s a good kid too, in a different way from her brother.

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.

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