Trauma Effects vs. Mental Illness

Since Dr. F gave his opinion that many of Taz's issues are related to early childhood trauma, I've been doing some reading up. But first, here's some background.

Taz spent almost his first year of life with a very loving kind older woman who fostered babies until they went home or to pre-adoptive families. When Taz was about to turn one, two very traumatic events took place.

One, he had his palate surgery, which is a big operation. And two, he moved from the only mom he ever knew to a pre-adoptive family. So, as he was healing from his surgery, he was also transitioning to a new family. One that included a mom, dad, and 6 yr old brother. Oh, and an entire farm.

Taz went from living in a quiet environment with one caregiver in a small home to living on a farm with a family of four. All the while, healing from a major operation.

He had just turned one, which is significant in my mind. A lot of developmental growth happens just before and after 12 months of age. Most are exploring how to use their legs for walking instead of crawling. Many babies are also beginning to communicate with words or gestures. They are also in the throes of stranger anxiety and making significant relationships with other adults outside their family. They are quickly developing fine motor skills like feeding themselves and drinking from a cup. There's a lot going on for a one year old!

Taz should have been going through all these stages, but instead he was dropped from one traumatic event, surgery, to another, a complete change in environment and losing the one caregiver he felt safe with.

(Taz right after surgery)

So, he was supposed to be healing from surgery, meeting major gross motor and language skills, all without the support from anyone he knew and trusted. We know from Maslow's Hierarchy of needs there can be no growth or development if safety is not first achieved.

Taz did not feel safe, therefore he did not learn to walk or talk when he should have.

We also know how important bonding and attachment is to a child. Studies have shown that attachment within the first year of life is crucial to the development of most social skills (and sometimes even survival as the case of overcrowded orphanages with high infant death rates). This pre-adopt family didn't understand that. I believe that for the three months that Taz was in this pre-adoptive home, he had no bond or attachment with anyone.

He was lost.

Taz's speech therapist had visited Taz at the pre-adoptive family's home during this time. She said Taz sat in the middle of the room with his back towards everyone and didn't smile at all, as if he were depressed.

This family probably had all the best intentions in the world, but they had a farm to attend to. Taz was a very high needs baby. He needed someone to be with him ALL the time. To hold him, rock him, feed him, sing to him, carry him around constantly, for at least the first few months.

I think this family expected Taz to fit into their world instead of going into his.

They expected him to be a typical one year old. Actually, I think they expected him to be better than a typical one year old.

I received a letter when Taz came to us from this mother, mostly about his schedule and what kind of foods he liked. But there were several parts that jumped out at me that I've written below. Now remember, this is a very traumatized one year old we're talking about.

"Taz is selfish and thinks the whole world revolves around him. He needs to learn to wait and that other people have needs too."

"Taz is lazy so you have to hold his hands and make him walk everywhere. We are also making him use sign language to communicate."

Think about this for a minute.

Taz is one. All one year olds are selfish and think the world revolves around them! Not just that but he really needed someone to give him extra attention and extra love and meet his needs extra fast so he knew he was safe.

Also, they didn't seem to recognize that this was a fragile child that needed lots of time to acclimate to a new living environment and a new family. Instead they pushed him into the developmental stages they felt he should be doing way before he was ready. Before he knew he was safe.

Here's the sad part. When Taz came to us (I'll get into that trauma in a minute), any time we tried to stand him on his feet while holding his hands for balance he would start screaming bloody murder. When we stopped, he would stop. I think he had negative feelings associated with being on his feet. No wonder he didn't walk until almost 18 months!

(He did eventually learn to walk and talk)

He was also in no place to learn to communicate. He needed to know he could depend on his new family to meet his needs no matter what.

I've been told by an unnamed source that there was a referral on this couple called in for possible abuse and neglect. I don't really know what happened there. I don't think they abused him but I don't think they were particularly good to him either. They may have left him in his crib crying for long periods of time. At least that's what I heard. But before social workers could investigate the family called to say they wanted Taz out of the house by the end of the week. Their reason was because "he cried too much".

So the department of children and families had an emergency meeting to pick out a new pre-adoptive family for Taz. That's when we entered the picture. With two days notice, they told us about Taz. Then the social worker picked him up from the home he'd been in for 3 months, dropped him off at our house, then said goodbye and good luck, all in one day.

Trauma number three. Even though Taz didn't bond with the last family, it didn't do him any good to dump him with yet another family he didn't know within mere months of the last move. All he knew was that the last two sets of caregivers had disappeared and (even though we ultimately turned out to be pretty cool people) again he had to navigate a new environment and more strangers. New sounds, new smells, maybe new types of foods, new pets, new routine, etc. How scary!

If we had neglected his needs for nurturing and instead pushed his development like the last family, Taz would probably have RAD (reactive attachment disorder). But we didn't. I quit my job to stay home with him. We didn't let anyone babysit for several months. We held him all the time. I carried him in a sling. We rocked him to sleep every night. We spent tons of time with him, playing peek-a-boo, bathing, massaging, cuddling.

We didn't push him to walk or talk. We met all of his needs for him whether he was able to on his own or not. We made him depend on us for everything. Gradually he learned to trust us. And only then did he start meeting his milestones. Very late. But late is better than never. And late is better than RAD.

(Taz and Daddy, a special bond)

I've been reading a book by a psychiatrist who specializes in childhood trauma. I've learned a lot.

First, trauma, no matter how small, impacts the brain. The earlier it happens the more devastating the effects are. Taz certainly shows some effects from his early trauma. For one, I believe this triggered the bipolar symptoms. Two, he's very anxious. Three, he has the survival instinct that kids with traumatic backgrounds do. Four, he has trust issues.

I think trauma does account for some of the "fight or flight" response we see.

BUT. I don't think it's everything.

Because Taz did have his first foster mom who nurtured him and loved him and took care of him, I think he fared better than others. The first twelve months of life are so important. I hate to sound so drastic but the first year could possibly be the difference between becoming a sociopath and being able to heal and have significant relationships in life.

Two stories in the book I read are perfect examples of this.

One 16 year old boy was in maximum security prison for violently murdering and raping two young girls. He came from a loving hardworking family with high morals. None of his siblings had any criminal history. This boy was deemed to be a sociopath, meaning he had no feelings for anyone but himself and couldn't empathize or connect with other people, and ultimately would spend his life in prison.

A 6 year old boy was found living in a cage with the dogs his caretaker had a business breeding. His basic needs were met for food, clothing, and water but his caretaker (an elderly man with no experience with children) treated him like the dogs he bred. The boy could not walk or talk. But once he was put in a home with a loving patient family, he very quickly began catching up developmentally to his peers and was able to have lasting relationships with others.

What was the difference?

Well, the first boy, the sociopath, after investigating his background had found his mother (who had a low IQ) had become overwhelmed caring for two children (he had an older brother) and left the infant home alone most of the day while taking the older son out for long walks and errands. His father worked long hours and also did not interact with the infant much. He had little to no human interaction the first year of life. Once he got older and they found he was delayed and acting out they got him specialized services and he went to special schools. His parents were very loving towards him and tried to help him the best way they could, but it was too late. The damage was already done.

The boy raised by dogs, however, had been nurtured, cared-for, and loved by the dog breeder's wife for the first year of his life before she died. After she died was when the neglect had started. But he was already able to associate human contact with pleasure by that point.

Two extreme stories of course, but you get the idea.

Taz had major trauma early in life that contributes some what to his current (and probably lasting) issues. But his infant experience of nurturing essentially saved him from even more devastating problems than Bipolar Disorder. And for that, I'm thankful.



Trauma vs. mental illness:

- Taz is able to have significant deep relationships and attachments (Nana, Grampa, daycare teachers, friends, etc)

- Taz's behaviors are mostly dictated by his mood, not by fear or by the need to control a situation. He is fearful, but that doesn't account for his behavior. He is afraid of many things but he tells us and we reassure him, like a typical child.

- Taz is not a sociopath. He is compassionate and can empathize with others (when his bipolar mask isn't in place)

- Taz's behaviors are not triggered by situations that relate to his trauma (at least not most of the time) as the doctor said. He is in an internal battle, it's often within himself. That's why one day he can handle getting himself dress, and the next he can't. One day the battle is calm, the next day it's raging.

- Taz is not manipulative

- Taz allows himself to be loved and can love others





Now if I could only make those know-it-all professionals see.

Home. For Now

Taz is home today.

He slept like crap. He kept waking up wanting to go in our bed. Or afraid he was going to pee in his bed, even though he wears a pull-up. Dh wonders what nighttime was like at the hospital.

Taz is pretty much back to where we left off. He's calmer but mostly because he's tired. The meds are making him really drowsy and groggy. Dr. F assures me that will wear off within the week.

He's not manic like he was when we brought him to the hospital more than a week ago. But he's irritable.

And still aggressive.

Perhaps not as often. But when things don't go his way, he is still throwing chairs at me, scratching and biting.

I don't know what I was hoping for. A miracle? A cure? I know there isn't one but I've seen Taz do really well on certain medications. Until they wear off.

Now I'm wondering if there is no drug that can halt his aggression. And since he can't predict consequences, where does that leave us?

Maybe we need to be really creative about management strategies. We need to make him a calm down room where he can't destroy anything. Maybe we need more than one person in the house all the time.

I don't know.

If the tiredness doesn't stop within a few days we'll have to take him off the Intuniv. Maybe that will help with the crankiness. I don't know what to think anymore. I don't know what to expect. I don't know who to believe. I don't know what to do.

Like our outpatient psychiatrist said over the phone yesterday.

"Taz is a kid with a lot of problems."

ADHD with a Little PTSD and GAD on the Side

I need to change the name of my blog from "Battling Bipolar" to "Battling Acronym Disorders".

I was pissed today. Really pissed.

I had a phone conversation with Taz's psychiatrist at the hospital, who is also the director of the hospital program. Just like I said in my last post, I told him that I could get any doctor to prescribe ADHD meds, no one is disputing he has that, but what we came for was a mood stabilizer or some other medication used to treat bipolar. And that I wasn't happy with the Intuniv results, Taz has still been aggressive and irritable at our visits.

And then it all came to a head. Dr. F started going on and on about Taz not having bipolar and that he was getting older and learning how to push buttons and test limits. Again, I did not put my child in a psychiatric hospital because of ADHD and button pushing!

I said that if the hospital is supposed to be teaching me behavior management they are doing a pretty crappy job because so far, no one does a damn thing when Taz attacks me during visits. He said they were still observing the "interactions he has with his mom and dad" and the behavioral stuff will start soon.

I said, what? Time-out? Do you think we haven't thought of that in the last two years!? I'm not an idiot! (I probably shouldn't have said that part, I'm sure it didn't help my case for not being a crazy parent)

Then Dr. F proceeded to tell me that he asked Taz why he hits us and Taz said because we're dumb. Then Dr. F asked me where he would get that language from?

Umm....let's see. Daycare, his older cousin, TV, friends in the neighborhood, everywhere! We certainly don't talk that way so it's not from us. I'm still not quite sure where he was going with that.

I reiterated again that Taz doesn't have a behavior problem (are you getting tired of hearing this yet?), that he has a disorder that's symptoms are behaviors. We have done everything imaginable to change Taz's behavior... and it just doesn't work.

Taz is not able to connect an action to a consequence.

We've had this reiterated by professionals over and over. Then Dr. F asked me what usually happens when he gets aggressive and out of control.

This is what I explained. When Taz gets aggressive it's hardly ever just a smack here or there. It's usually a meltdown that includes destruction, aggression, and complete loss of control. It becomes all about calming him down. We can't use logic or reason because he's not "there" enough to process that. The only thing that works to calm him down is to remove him from people and things that he can destroy.

I described how in our old house we cleared out a room for him where he could sit on a bean bag chair and calm down but couldn't hurt people or break things. And it worked. He would calm down then we could process through what happened.

Now. Here's the catch.

We could put him in that room 20 times in one day and process through the event 20 times. But the next day, the next week, the next month, the next year, he will make those same 20 mistakes over again.

He doesn't change. He is not learning.

That's when the conversation changed. He agreed, over the phone still, to start Invega (a new form of Risperdal that is extended release). He started it today.


So...about an hour later I had an appointment at the hospital where the therapist was going to facilitate an interaction between Chica and Taz. Taz was sleeping, which apparently is happening a lot during the day because of the meds, but should wear off after a while, so the therapist listened to my concerns then brought in Dr. F.

Now. Here's the weird part. For some reason, Dr. F did a complete 180.

Is it because of something I said? Is it because I so eloquently stated my case which was so intelligently thought-out? Let's just go with yes.

Dr. F said that Taz may have bipolar and is likely to end up with some mood disorder but he can't diagnose that now at his age. He does not believe Taz's behaviors are planned or controlled and they are not a result of anything we are or are not doing. Thank you!

So. Bottom line from Dr. F: Taz has ADHD. He has developmental delays. And the rest of the issues we're seeing are due to early childhood trauma and anxiety.

Dr. F explained that the first 12 months of life are imperative for emotional development. If Taz endured an enormous amount of stress as an infant/toddler, which he did, the cortisol (stress hormone) levels in his body were probably elevated enough to cause damage to the brain. It causes people to get stuck in a hyper-vigilant state where they are constantly on guard for danger.

Basically, when Taz is frustrated, feeling challenged or threatened, he immediately loses higher brain functioning (logic and reason) and only uses his lower brain (fight or flight). Which is why sometimes it seems as if Taz is literally fighting for his life.

Dr. F felt like the on/off switch Taz has for meltdowns is more consistent of a child coming from a traumatic background than a child with Bipolar. What we see as depression he thinks is really anxiety. The violent thoughts and ideas he also says is common for people with PTSD.

This is something I can buy into. At least for now. Do I think Taz has some mood issue that will come to a head at some point in his life? Absolutely. Do I think he has bipolar now? Yes, I still do. But since we can't seem to get a mood stabilizer going to find out, I'm willing to try the Invega and Intuniv instead.


Now for the big news!

Taz is coming home tomorrow!!!

I told them I was taking him home. The psychiatrist would have liked to keep him one or two more days but agreed to let him get his vitals checked outpatient so he could come home. I feel like we're at the limit for keeping our attachment secure. He needs to come home now. He's asking more consistently about going home and tonight he asked me to stay overnight with him. He's increasingly more anxious when I visit. And he says he doesn't like the hospital. He's definitely ready.

And of course, so am I.

I think I have a greater appreciation for what Taz brings to my life. Even when it's hectic and crazy and aggravating.... I still need him. I need to be able to hug him before bed and know that I'll see him first thing in the morning.

I just love him so much.



So what should I rename my blog? Raising Complicated Kids is already taken. I'm kind of mad she thought of it before me :)

The Blame Game

The hospital Taz is in boasts a family centered approach to treatment. So far most of the nurses and staff have a guilty until proven innocent mindset about the parents. And since Taz has yet to exhibit any behavioral problems, the thought is that we, his parents, are to blame.

But what they don't seem to understand is that Taz is a survivor. His early childhood trauma has created this little being inside him that says to survive at all costs. That means until he knows he is safe and will get his needs met no matter what he does, he will comply. Until we get there. Then that big ball of pent up emotion comes to the surface and it can very much look like we are the ones with the problem.

But we're not. Obviously.

And I'm tired of being treated as if I am.

So tired that I am heading into the hospital tomorrow morning to give the therapist a piece of my mind. They need to tell the staff to back off. They need to know that there are sick kids in this world and that most of the time, it's no one's fault.

I asked one of the staff during my visit a couple nights ago why many of the other parents don't visit every day. He said that a lot of times the kids are there because of relationship strains with the parents. He said, "I don't want to say it's their fault or anything...but...the parents need a break and the kids need to reflect."

Reflect? This isn't meditation camp. Kids need their parents. Especially young ones.

This was after he told me that Taz was "showing off" because I was there because he's never seen him like that. Great. You've known my kid for 4 days and suddenly you know what's normal for him and what's not?

Another nurse told me that Taz seems calmer since starting the Intuniv. Great, he's calmer. But we're not here for calmer. We're here to stabilize his disorder. Disorder. Not a discipline problem. A real disorder.

I told her that I don't think it's enough because he is still aggressive and unstable on our visits. She said that because they haven't seen any of that it must be a behavior problem and that he just needs a consistent behavior program.

Sigh.

I told her I needed to speak with the psychiatrist about my concerns with the medication and she said that kids Taz's age can't be diagnosed with anything because it's too hard to tell how much of the hyperactivity is just because he's four and how much is ADHD.

Excuse me? Did I just hear you right? You think I put my son in a psychiatric hospital for being four? Or because he's hyper?

And enough of this ADHD crap! They are obviously not reading his file because it explains in black and white that Taz is in the hospital because he has attacked us with a screwdriver (as well as other dangerous objects) and is extremely aggressive with his younger sister. It also says his diagnosis is Bipolar, but apparently everyone just ignores that. And that he has severe mood swings and can't cope with his strong emotions.

They must have also missed the part where he was born addicted to cocaine and methadone. He is a recipe for disaster!

The bottom line is that Taz needs a mood stabilizer. Probably an anti-psychotic as well. And then maybe Intuniv. But I can't deal with the hyperactivity without dealing with the moods first. That is what dictates his behavior. His moods are what dictate his life (and ours).


Monday morning I'm going in with my game face on. I'm going to get an answer about starting a mood stabilizer and I'm going to complain about the implication that I have something to do with Taz's behavior. If they don't listen, we're leaving. I'm not going to waste our time and continue to traumatize my son. They are either going to do what we came for or it's not worth staying.

To Hell With Everyone! I Want My Kid Back!

First of all. Visiting my child one hour a day is simply not enough. I called the therapist this morning and told her I was going to visit in the morning as well as in the evening (which are the usual visiting hours). I can't be away from my 4 yr old all day like that. She agreed.

I miss him. I miss everything about him, even his anger. I just want to go home. Half my family is at my mom's (me and Chica because it's closer to the hospital), my son is in a hospital, and my husband is at our house more than an hour away. I want my normal life back. Even the chaotic crazy version of it. I want to be the one getting Taz up in the morning. Getting him dressed. I never thought I would say that because that's one of the times he's so difficult but I don't care. I want to feed him meals. I want to give him a bath and brush his teeth and watch movies with him and have him in my bed first thing in the morning being goofy.

I don't want an hour with him each day in a noisy hospital with no privacy. It feels like prison.

I hate this. It's torture. I hate everything about it. The only reason I'm not pulling him from the hospital and taking him home right now is because everyone is convincing me it's in Taz's best interest to be there. I don't believe it. I think he needs his family. I think he needs his mom putting him to bed and waking him up every morning. Not some stranger.

I've been crying off and on all day, especially at night. I've resolved myself to go pick Taz up and bring him home half a dozen times now but Dh convinces me otherwise.

I just want my life back. My completely abnormal, chaotic, frustrating, sometimes dangerous life back. To hell with everyone else. To hell with medication. To hell with behavior programs. To hell with doctors and therapists.

I want my kids. I want them with me.





P.S. I posted twice today so read the post below to catch up on medication issues and current frustrations with doctors.

And Hope Comes Screeching to a Halt

Everything was looking up. The treatment plan, the doctors, the behavioral program, hope was the sweet smell filling the air I breathed (poetic right?). Then yesterday it came screeching to a halt.

It started when the psychiatrist intern (we'll call him Dr. Dork cause, well, he is one) called to say he spoke with our outpatient psych Dr. S. He agreed to start the Intuniv (and ADHD drug used that works well for kids born addicted to drugs as it inhibits impulse) so they started a small dose yesterday. He happened to slip into the conversation that Dr. S wasn't confident in the bipolar diagnosis, which is news to me because he never mentioned that. He has always referred to Taz as bipolar.

Why do doctors do that to us? It's so confusing.

Anyway, I said, "you're not planning to change his diagnosis right?" To which Dr. Dork replied, "nothing has been changed as of yet." Which is a round about way of saying "we're considering changing it". I felt a little suspicious so I went to the wonderful and knowledgeable world wide web and looked up everything I could find on Intuniv, especially on how it relates to bipolar disorder.

Well, imagine my surprise when most reports say it works to control ADHD symptoms when used in adjunction with mood stabilizers and when the bipolar mood swings are under control. Many kids get irritable or depressed after several weeks of taking it. So, in a nervous panic (because I thought we were going to the hospital for bipolar meds or a mood stabilizer) I called back Dr. Dork and voiced my concerns. He said they are trying the Intuniv because it is used to treat the types of symptoms Taz is showing. I said I would go along with it but I'm concerned we'll end up back there when it wears off and what he really needs is a mood stabilizer.

Then Dr. Dork asked why I thought he was bipolar (alarm bells started going off in my head). I said,

well, if you give me a list of symptoms of bipolar, Taz has all of them. And I didn't just put my kid in a psychiatric hospital for ADHD (cause I know that's where they're going). Last I knew kids with ADHD don't threaten to cut their parents fingers off, blow up the house, shoot their sister to make her dead, and threaten to cut all our heads off. They don't cry for long periods of time for no reason. They don't throw themselves in front of traffic then laugh about almost getting hit my a car.

He said that yes, there does appear to be more going on than ADHD but that many kids have comorbid disorders.

So...basically....like all professionals, they don't want to use the big bad "B" word. They are going to tiptoe around it labeling every other condition they can other than bipolar. He's ADHD, ODD, GAD, Explosive Disorder...oh, and he also has mood swings. But not bipolar. No, of course not. We don't want to put that label on a kid. Just another five hundred labels instead.

Seriously, does this make sense to anyone else?

But Dr. Dork did make sure to tell me he's not saying that Taz doesn't have bipolar. They are just thinking about it very carefully.

Whatever.

Then he stressed a behavior management program at home and that Taz isn't have any behavior problems at the hospital. Yeah, well great. It's been 3 days!

I told him very firmly that I didn't just put my kid in a hospital to have him labeled ADHD and then tell me it's my parenting. I have done everything every professional has told me to do with him. I have a background in special ed. We are smart resourceful people. We have already fought with professionals who've told us it was our fault. I'm not playing the blame game anymore and I will take him home if that's what's going to happen.

I can get any doctor to prescribe an ADHD medication. One look at Taz and no one would deny ADHD.

Well I don't think Dr. Dork has ever dealt with a parent like me. He backed right up and assured me that's not what's going on and they just want to try Intuniv because we haven't tried anything like that yet and it's the simplest to try. If it doesn't work they will consider other options, maybe mood stabilizers.

Which brings me to my next issue. Behavior management.

Sigh.

Next post I'll continue my rant.




Oh, and I miss my son immensely. I have had multiple emotional breakdowns these last couple days. More on that next post too.

Round Two: Hope is Still in the Lead

My mom and I visited Taz at the hospital last night. He was bouncing off the walls, which is generally how he's been at home, but usually he's more subdued in new places. But no, he was talking a mile a minute, dancing around, barely able to focus on anything. He's definitely still manic.

But he was happy to see us. He even gave Chica a big hug and kiss. He wanted us to stay in his room. He didn't want to show us around or tell us what he did that day. He just wanted us to watch him play as he danced around and blabbered away. Even my mom noticed a huge difference from how he usually is. She didn't believe me at first that he needed to be in the hospital but on the way home she told that now she does because Taz is just not "there" right now.

Pretty quickly he started having trouble with Chica. I ended up getting a nurse to come in and help us because that's one of the main issues at home and I wanted to be consistent with whatever behavior program they're using with him. When the nurse came in she brought the psychiatrist assigned to Taz along. The nurse asked Taz what was going on. He said he wanted to crash us with a big monster truck. Then he said very quickly that he wanted to go home. It broke my heart. I couldn't respond right away because I was afraid I'd start crying.

Then the psychiatrist (Dr. F) pulled me aside while my mom played with Taz. Dr. F told me he had a chance to do some observation and testing with Taz. He said he definitely can see some pretty big delays. He had to do the testing in short 2 minutes bursts because of his attention span. He didn't dispute the bipolar diagnosis like I thought he would. He did say that we probably needed a strong behavioral program at home when Taz is released (I know that's a bad word but I can't think of a better one).

Dr. F sounded very experienced and knowledgeable about treating kids with mental illness, especially kids with similar issues to Taz. I asked him if he sees a lot of kids like him. He said, yes, a lot. He said that Taz has a lot of things working against him; born addicted to drugs, developmental delays, early childhood trauma, and genetics. But that he has things working for him too; a stable home environment and good advocates getting him the best treatment we can. That's the first time a professional has ever acknowledged the work we do. I like him already :)

Dr. F wants to try Intuniv, which I believe is an ADHD drug. I'm sure Taz qualifies for that diagnosis but Dr. F thinks he has the bipolar as well. The reason he wants to try it is because they've found that with kids born addicted to drugs, the non-stimulant ADHD medications inhibit the fight or flight response that's the main driving force of the behavior. When he said that I said, "yes, let's have that please!" Because Dh and I noticed that Taz seems to be almost in constant flight or flight mode.

Dr. F also mentioned trying a new form of Risperdal that they've found doesn't wear off after a few months like it has been for a lot of people. He also mentioned the possibility of a mood stabilizer. It all depends on how the Intuniv works.

He told me he sees the kids every day to monitor how the medication is working. That's the good thing about being inpatient is they can raise the dose much quicker. So while we're adjusting the meds Chica is safe from him, and hopefully after 10-14 days Taz can come home. While I know there's no miracle cure, I think the combination of new medication, our in-home program (which is going to start right away), and the structure of school starting in the fall, will make a huge difference. I asked Dr. F if he felt like it was good for Taz to be there and if he felt it would harm him. He said it was good. I'm worried about attachment but I'll get into that in another post.

So...hope is still out there my friends.




Oh, and after I went back to the visit with Taz he had calmed down a bit and agreed to take us on a tour, then gave big hugs as we said goodbye.

What Not to Say

So I totally stole this post. Read it if you haven't already. It's not only forcefully honest, it's also pretty funny. I couldn't have written it better myself.

I have an update from the hospital I'll write out tonight as well as my ER stories. Stick with me.

Hope?

We checked Taz into a wonderful inpatient hospital program this afternoon (after 24 hours in the Emergency Room). It seems like a great place. The staff was warm and friendly. They are bending the rules a bit by letting us visit extra and putting a different behavioral system in place for him since he doesn't understand points and levels.

Taz has his own room, which I prefer because he's so little. I don't ever want him to be a victim of another sick child (although there's plenty of supervision, I'm just paranoid!). There's a wonderful recreation/play room with video games, movies, toys, and a sensory table with sand (Taz will love that!). They go outside every day. The wing is bright and cheery.

What won me over was the staff. They appeared happy and to really enjoy the kids, not like other places where everyone looks like they hate their job. The kids were all happy (in the moment, I know they're there for a reason). There weren't any big violent kids (also a little paranoia of mine) because they only accept kids to age 13 since they specialize more with the younger ages. There were a few kids with autism and neurological disorders so I'm glad the hospital is used to that because that's sort of part of Taz's bag. He's not straight behavioral/emotional. He has neuro stuff going on too. They seemed to understand that.

I think that we'll be able to consult with a neurologist while we're there too, which is something we've been pushing for. Unfortunately there's a shortage of children's neuros in my state so the ones we have aren't seeing kids for developmental issues, only for seizures. The wait list is 6-12 months long! I think at this hospital we'll at least get a consult while he's there!

The Emergency Room, however, was a whole different experience. We went back to the same hospital as Friday. Now this is a children's hospital mind you. Like, a very well-known, highly recommended children's hospital. We've been here a thousand times for medical issues and have been treated wonderfully. The psych section (or behavioral health as they call it) of the ER felt like a whole different place. I just wanted to scream these kids are sick, they're not criminals!

Tomorrow I'll write out some pretty depressing stories about how "behavioral health" patients are treated in the ER. It made me worried for Taz's future. But if any of those kids were mine, you can be sure I would have told off a few nurses, EMT's, and security guards (they were the worst!). I'll write tomorrow. It was surely an interesting night.

Right now I'm feeling satisfied that we found him a good program. But I have to admit I've cried almost every tear my body could possibly produce today. I held it together in front of every professional and in front of Taz. But I fell apart in between, mostly in the car. When we left the unit after getting Taz settled in I lost it in the elevator. And I cried through the hallways of the hospital and out to the car. Poor Chica was so concerned she kept patting my face and kissing me. Everyone I walked by must have thought someone died.




I remember another mother of a child with bipolar wrote she felt empty after her child was hospitalized. I totally agree with that feeling. Empty. Like part of me is missing. My baby is away from me. He's safe and well taken care of, but still....away. I just want to scoop him up and bring him home. But I want him to be well. More than anything to be able to healthy and functioning.

I know the little boy that exists inside him. The happy-go-lucky, funny, charismatic, compassionate, sweet little guy that is buried under all that rage and confusion and fear. I want the little boy I know and love back. That's why I'm risking the hospitalization. I know it's not ideal for a 4 yr old. But I'm risking it because I think it's better for him to get the short term, intense "fix" (as in medication change) under the safety of professionals then hang around in this terrible state of limbo.

I have hope. And I have pain. Maybe hope will win. Maybe it will all be worth it in the end.

Brief Update from DH

DH guest blogging for all of the followers:

Things are no better now than Saturdays post below. We took Taz back to the ER this afternoon. They weren't able to do an initial eval until this evening. Taz is spending the night in an exam room in the ER waiting for a bed to open up in an inpatient facility in the AM. Even if it does, 2 of the 3 options involve J staying at her Mom's house an hour + away with Chica for the duration of the hospital stay. Consequently, we're hoping for a good outcome in the AM. I'm sure J will be back in a few days with a new post. In the meantime, we continue to lay siege on the Bipolar Battlefield.

To Sum Things Up

The EMPS (Emergency Mobile Crisis Team) clinician came to the house yesterday. This was promised by the ER clinician because there were no beds for inpatient and we needed a plan. We'll call this lady Ms. W.

It was clear she had a lot of experience with these types of situations and she agreed (as did everyone) that Taz does seem dangerous to have in the house with a 1 yr old who constantly sets him off. Speaking of, he's been home all weekend with Dh and I while Chica has been at my mom's. He hasn't been perfect. He still falls apart at the slightest stress. And he is still spewing angry violent thoughts for no reason. But he is much better than when Chica is here.

Now I can't very well get rid of Chica. Or Taz. So they have to learn to live with each other. And Taz has to learn some self-control and stop hurting her.

So Ms. W didn't have the miracle answers we were hoping for. There may or may not be such a thing as therapeutic preschool. I can tell you I've been around and have never heard of it but she is going to make some calls first thing tomorrow Monday to find out.

She recommended DCF voluntary services, which we've been told already. Yes, this is great idea. But, it is also a lot of paperwork and time. And like I explained before, I can't hold off of keeping everyone safe until these things can happen. I can't hold on for weeks until the in-home program starts (which is only 10 hours a week anyway), DCF does all their paperwork and get a parent aide and a child mentor.

I need help now. As in tomorrow when Dh goes back to work. I'm home alone with the two kids 10 hours a day, 5 days a week, for 7 weeks until school starts. And when school starts, it's only 2.5 hours a day.

I explained this to Ms. W and she completely agreed we needed help. Unfortunately there's just not much she can do. I can keep calling 211 to get an EMPS worker out there. But they can't stay the whole day. If I need someone the whole day to keep the kids safe, then he needs to go to the hospital. And that's that.

If there are no beds, you just have to keep coming back over and over until they get sick of seeing you and make a bed. Well, I don't really know what they do at that point. But that's what I've been told. You have to keep trying. But maybe by the time that happens we'll have found a good med combo and things will be better. Well, I can hope, right?

The Hospital

Here's the full story I referred to in my last post about the ER.

So you all know this has been a long period of instability and even more importantly, increased aggression towards our daughter Chica. I have been fighting hard against the hospital route because I don't want to traumatize Taz by sending him somewhere overnight without us. It's a lot for any kid especially one so young.

But everyone kept telling me that's what had to be done, professionals included. After talking with our psychologist yesterday to get her opinion on it (she's known us for a year now and is also experienced with adoption issues) I felt more confident about the possibility of impatient if we really needed to keep Taz and Chica safe. Dr. B had worked in that hospital and knew all the ins and outs and it does truly sound like a remarkable program. This has been repeated over by several people.

When I picked up Taz from a drop-in daycare after the appointment he was already wired. Like I said, he's been escalating for a couple weeks now. He can usually hold himself together for other people but was even having a rough time with the childcare provider (had hit other kids, been defiant, yelling, etc). When we got home it spiraled downward immediately.

First he was just shouting, calling names, telling me to shut up, even though I wasn't doing anything to him. Or my favorite, he asks me a question, I answer it, and then he screams to shut up. Gotta love that logic huh?

I started getting lunch ready during this verbal attack. This is not unusual for him but it is a sign that worse things are coming. Then he escalated to kicking anything in his path and throwing random objects around. Not exactly at me but just around.

I was changing Chica's diaper and that's when he threw a toy directly at me. DH feels that Taz has absolutely no concept of the consequences for his behavior, be it natural (throw a toy and it breaks) nor controlled (hurt someone get time-out). So after weeks of consistently enforcing a negative consequence for every act of aggression and seeing absolutely no positive result from it, we decided to make a change in our technique. Instead we were going to keep everyone safe by shadowing him to stop an aggressive act before it happens and talk him down verbally by using a calm voice and trying to find out what he needs.

So I attempted that. I followed Taz while he threw things around trying to catch them before they did any damage. I tried to figure out what he needed and calm him down. This did not work. I think he was just so out of control of himself that it didn't matter what anyone said, he could not stop himself from being destructive.

The destruction was so imminent that I couldn't even leave him long enough to clean up Chica who had apparently grown bored of eating yogurt and threw the cup of the floor (which the dog licked up) but not before using it as a lovely hair moisturizer. So poor Chica had to sit there with raspberry yogurt all over her until I could get Taz sequestered somewhere safely and attempt to clean her off.

I tried to keep Taz in the playroom, which he destroyed, throwing toys around, ripping up mail, then finally coming out to attack me. I just stood in his way and blocked him whenever he tried to throw something or hurt me. Then he wanted his pants changed cause they were wet so I told him to go to the laundry room and I would help him. On the way he knocked over a stool, then swiped everything off of one of our counter tops. Then he attacked me while I attempted to change him. I stepped back and told him I can't help him when he's hurting me and he was able to maintain control just barely enough while I changed him. But as soon as he saw Chica coming towards the room we were in, he was full force attack mode. I used my body as a shield but she kept getting in the line of fire so I had to lock her out of the room until we were done. I felt so bad for her crying for me in the hallway and I couldn't comfort her.

After that point things are a bit blurry. I remember trying to call Dh to see if he thought Taz should go to the hospital. I was on the phone with Dh when Taz suddenly jumped on Chica, laid on her back and shoved her face into the floor while trying to scratch her head. I grabbed him of course so he wasn't on her for long, but it can happen in an instant. I tried to hold Taz back while he clawed and kicked at me while talking to Dh about what to do.

Finally I just realized this was ridiculous. Taz obviously needed something that we just couldn't give him. And I think he still does. But I'll get to that. The fact that I had to stand in front of him blocking his every move for so long that I couldn't even clean up my daughter in her high chair (the yogurt is still on the wall by the way) is just no way to live!

So I decided to take him to the ER. My initial plan was to get them in the car and drop Chica off at a friend's house. I couldn't even get to the door. I was trying to let my dog out while holding on to Taz (who was still being destructive) and Chica followed me to the door (probably cause she was scared), and Taz got a good swing at her. I realized I couldn't even get him to the car in the state he was in. I put him on the couch and stood in front of it so he couldn't get off. Chica, luckily, got busy playing somewhere else (I don't know where. She was probably eating sand or something).

So with Taz on the couch I called the 211 number for Emergency Mobile Crisis Team. I was a little more than shaken at this point. I was trying really hard to keep myself together. But I must have sounded like a wreck on the phone because coupled with Taz screaming in the background the operator told me to call 911.

I wasn't about to send my 4 yr old on an ambulance to an ER for the first time by himself. So I called Dh to come home. Of course, by that time Taz had calmed down. But I knew it wasn't over so I pushed Dh to drive him into the city to try to get him admitted.

Our first option we would have liked to happen was to be admitted to the special cares unit which is a little bit like a regular hospital room and the parent can stay with the child while the doctor's and clinicians change medication (which Taz desperately needs). But they wouldn't take a child under 5 there. There are 3-4 hospitals in our state that will take a 4 yr old (if absolutely needed) but all of them that take state insurance were full.

The good thing is that the ER saw Dh and Taz right away. Apparently if you say your child is unsafe they take you immediately into the back of the ER (there's a special corner) where there are observation rooms and special psychiatry staff. Dh and I are calling it the "crazy corner" because apparently that's where they hide the psych patients so they don't scare the others.

Oh, yeah, and you can't wear shoes, bring a bag or toys, food or drink into the room. I understand because of kids who are at-risk for suicide but he's only 4, you'd think there would be an exception. BUT THERE ARE NO EXCEPTIONS. Apparently. Honestly, a hospital is no place for a young child. But unfortunately, neither is in a home with an even younger child.

So after a few hours of intake and observation (in which Taz was slightly anxious and agitated) the clinician said she understood the severity of the violence and danger but didn't really want to admit him impatient and there were no beds available anyway. Dh asked how to get a bed if we really needed one and she didn't seem to hopeful about that. There are never enough beds for kids who need them. They are always full. You have to just keep coming back over and over and hope one opens up while you're there. There was a child in the ER who had been there for 4 days waiting for a bed. Yikes.

While Dh and Taz were there I had driven Chica to my mom's for the weekend so I was only involved over the phone. Now let's face it....sometimes.... in some families....the moms are the fighters. At least in my family. I have no problem being "that mom" once in a while. So I wasn't going to accept that there were no beds, go home, it's not our problem. Not when my child needed help. So I made Dh tell the clinician that he wasn't going anywhere without a plan or we would just be back on Monday.

Now...here's what's going on with the psychiatrist. Dr. S is not around until Tuesday. So the earliest that we can see him for a med change would be an emergency appointment possibly Tuesday night. To some people that doesn't seem too far away. But what most people don't understand is that come Monday, Dh is back at work and I have both kids by myself all day again. Think about that. Eight hours of total instability trying to keep both kids safe. I literally have to shadow Taz's every move. How can I possibly do that while also parenting a toddler, feeding kids, letting the dog out once in a while, and even using the bathroom myself a couple times (I know, imagine that!)?

Since no one else seems to be thinking through all of this, I have to! I'm living it. I'm the one who is going to be right back in the ER when things go down the same way first thing Monday morning. Even if we could hold out until Tuesday afternoon...what chance is there that whatever new medication Dr. S is going to prescribe is going to work the next day anyway? We've already exhausted most of the quick acting AP's. Dr. S said himself that we needed to get more creative with medications and start trying different combinations because Taz is very hard to treat. So even with a med change, this is going to take time. Time that costs a lot. With Chica's safety being the highest price.

The clinician at the hospital didn't think it was a good idea to admit Taz under any circumstances but everyone we see in the community thinks it is appropriate. The ER clinician (we'll call her Dr. Er) was very concerned about Taz's issues and the level of aggression so she came up with another plan instead of admission. By the way, she did speak with our psychologist who confirmed the safety issues we were having so I know Dr. Er believed us.

The plan at discharge stood that EMPS (Emergency Mobile Crisis Team) would come today (which they did and I'll update that too) to make a plan for getting us in-home help and possible enrollment in a therapeutic preschool immediately. At least that's what I was told.

I'm going to post this so people can catch up then I'll write out what the EMPS clinician said.

The ER Visit

Dh took Taz to the ER today to be admitted into the psych hospital. I'll write out the whole story tomorrow. Here's the condensed version.

No beds. He's home. Chica's at my moms for the weekend. Emergency Mobile Crisis Team clinician coming tomorrow to put programs in place in the home and enroll him in a therapeutic preschool. I know of no such thing but that's what they said. I really hope they weren't shitting me.

...to be continued...

Homeschooling: My Temporary Moment of Insanity

So you all have been reading my last few posts right?

So you know that we've been out of school now for about a month?

And you also know that it hasn't been going so well?

Yeah, that about explains it.

Homeschooling? Hell no!

It sounded nice. It still does. Maybe I'll do it for Chica. But at the stage we're at now, there's just no way.

My entire day is spent keeping Taz away from Chica. There is absolutely no room for learning. All my wonderful plans of recreating my glorious childhood summers have been washed away by the bipolar tsunami.

I wanted to live at the beach this summer. Turns out Taz doesn't even like the beach. Well, he likes it when it's not hot or crowded. And I'm not taking him to the beach at 10pm.

All Taz really wants to do in life is ride his powerwheels car, hunt for worms, and fill water balloons.

So how do I explain my original plan of homeschooling Taz in the fall?

I plead temporary insanity.

Answers

No, no, mostly no.

Okay, I'm being dramatic. But that's what the day felt like. For real though. It was a no for the partial hospital program, which I'm really bummed about because I think it would have been really good.

I have childcare for at least one child for the rest of the week but after that I'm at a loss.

I called DCF voluntary services to see if they can hook us up with a camp or something. They can't. But they can give us a mentor for a couple hours a week. That's a start.

We've already been on the waiting list for the Intensive In-home Psychiatric Services Program, which would be really great but it's a long list. DCF might be able to get us pushed up on that list. It's worth a shot.

I called Dr. S and he said finding the right medications is going to be tough. We're going back to twice a day with the Abilify since that was better before. Then he'll add an anti-depressant next week when we see him. He said to bring him to the hospital if he gets really dangerous.

What exactly is really dangerous? As opposed to just regular dangerous?

I'll give you some examples.

Taz has attacked me with pointy objects, but not Chica, yet. But like I said in my last post, he made her bleed twice yesterday. He threw a wooden train at close range as hard as he could at her face and now she has a nice purple bruise on her forehead. Is that really dangerous? He's kicked her in the head and stomach. He's scratched her on her face. Is that too dangerous or just regular dangerous? Or not dangerous at all? I don't have any normal standards to compare to. Anyone? Anyone?

He hits and kicks and bites us. But that I can take. I'm worried about Chica. I'm worried she's going to have PTSD from living with her brother. She already flinches and hits the ground whenever he goes near her, good mood or not. She's scared he's going to knock her over or hurt her. It makes me cry just thinking about it.

I'm trying to get a home health aide through insurance but I highly doubt they'll pay for it.

The best thing that happened today is when I wrote a facebook message to my church pastor and his wife about Taz and asking if they knew anyone in the church who wouldn't mind babysitting once in a while, they literally called less than an hour later. And get this...they were on vacation! How amazing is that? The wife is a teacher at a school for kids with behavior and emotional disorders so she gets kids like Taz. She said they will think of how to help us. She also assured me that the local psychiatric hospital we would send Taz to if we had to is an excellent place. That she's dealt with them here and there and they are kind caring staff. And that sometimes they can pick up on things outpatient facilities can't because they are more intensive in their assessment. Just her phone call alone made me feel so much better about our situation. So thank God for them today!

As for tomorrow, we'll see what happens.

Hospital Day Program? Any Better Ideas?

Quick update then I'll post more tomorrow after I get some answers.

Emergency psych appointment last week wielded a raise in Abilify dose. Taz actually got worse after. We went back down to the regular dose right away. Taz was still going haywire.

We took him off the Abilify entirely. No difference, maybe even slightly better off of it in some ways. He's completely manic. He ran into traffic yesterday, almost got hit by a car, then laughed hysterically and tried to do it again. He's more hyper than I've seen in a long time, laughing at everything.

He woke up yesterday saying he wants to fight us. He was going to blow up our house and destroy everybody. He wants to shoot us and make us dead.

After he made Chica bleed twice in one day (nose bleed from ramming his bike into her and mouth bleed from yanking her face into a metal table leg), I realized I literally can not handle him by myself while caring for our 16 month old daughter. So we decided to call the local psych hospital day program to see if we can get him into the partial program during daytime hours during the week.

I'm calling tomorrow morning. I'll update after. The website says ages 5 and up so it's a bit of a stretch since he's only four. I don't know if they'll take him but I'm hoping if I sound desperate enough they can make an exception. I think the structure would be good. But I don't have a back-up plan if it doesn't work out. He can't be home with Chica. I don't work and can't afford full-time daycare. I have nowhere for either kid to go.

Anyone have ideas if the day program won't take him?

Violence

Taz told my husband while I was away that he wanted to shoot Chica, put her in the garbage can, and the garbage men to take her away.

Okay...it's not really funny but it is a little funny....that Dh then asked Taz what garbage can he wants to put her in so that we know where to look should she go missing.

He has also started using the k-i-l-l word. Yikes.

Emergency psychiatrist appointment tomorrow morning will hopefully bring us something to help with these violent thoughts.


On a more positive note, here is a favorite picture from our mini-vacation last week. You know, the one I posted about where we left early cause no one was having fun? Yeah, well, here was one good moment from our trip.