Tuesday, January 12, 2010

Steps. Maybe forward.

Last week I told you about having a helpless feeling about Ben's recent struggles with aggression and impulse control.

In the midst of that helplessness, a thought occurred to me.

The first incident that was unusual in its intensity and duration (relative to his behavior in kindergarden so far) happened not long after Ben started taking some daily asthma medication. It's a corticosteroid called Flovent.

After his hospitalization for an asthma attack, the doctor suggested that he remain on this daily low-dose preventative over the holidays when catching a cold - his asthma trigger - was likely.

While behavior changes aren't part of the official list of side effects for this medication, I found a convincing amount of of anecdotal information (hey, it's the internet, after all) about children behaving more aggressively and impulsively while on the medication.

The next morning we skipped Ben's "puffs" in the morning and have kept him off the medication - with this pedicatrician's approval - ever since.

And Ben has had six good days in a row.

(Please don't jinx it. Please don't jinx it. Please don't jinx it.)

I don't mean to suggest that Flovent was causing Ben's challenges of the several weeks. He was on a low dose - less than half the normal amount. I do wonder, though, if it was an exacerbating factor. He seemed more anxious, high strung, and prone to switching into flight or fight mode at the drop of a hat.

Several times at school, when given a chance to chill out, he would appear calm and give all the right answers to the questions that one uses to assess whether the storm is over. He appeared to be a kid who was ready to control his behavior and rejoin the group.

Then, as soon as he would return to the classroom with all its unpredictability, the anxiety spikes and resulting aggression quickly returned.

But, this week, he seems to have his emotions under more control. He still has moments of anxiety and acting out, but they are so much milder and he is able to think his way out of them.

Case in point: This week, Ben has learned what it means to "ignore" another child - in a good way. I gave him the suggestion and he's used it three times this week to overlook annoying behavior by his peers.

We still need to work on the nuance. He loudly and dramatically announces, "I'm going to IGNORE you, [child's name]!"

At least he's getting the idea.

And in fight or flight mode, he isn't able to make that kind of choice. Not by a long shot.

Trying to reason with Ben once he's in that mode is like trying to reassure someone with a deathly fear of heights who is standing on a tall ladder, "Just relax. You're not going to fall. Pull yourself together."

(Which is why his challenges are different than the manipulative or attention-getting behavior of typical peers. But, ho nelly, that is a whole other post.)

So we've agreed that the Flovent will come out only when he has a cold and we'll watch and wait and to see what patterns might emerge.

Tuesday, January 5, 2010

So this must be the one step back

I normally don't write when I'm in the midst of an emotional situation. This isn't designed to be my diary or a place for me to process my feelings in public view.

I tend to write after I've had some analytical distance from an event, hoping to provide some Big Insight that might also help one or two of you, or maybe just validate some Big Insight you've had yourself.

I tend to write after something good or funny has happened, so I can celebrate with a community who understands that a small step forward can feel like a leap.

And I tend to write for that mom who is frantically googling Hyperlexia or Asperger's at 2 a.m. looking for answers and reassurance that the world has not actually ended. Maybe that mom will find a story about Ben telling me "I love you" on Valentine's Day and feel better, or read about a particularly creative use of echolalia and get a good laugh.

But right now, I'm In The Middle Of It.

And I'm going to write anyway.

After a stellar start to the school year, Ben has had several discouraging days at school. Not that many: a string of them before winter break and then on the first day back.

Many, but not all, of the episodes start when he misses out on something the class is doing. He explodes, and can't seem to pull himself together.

He's bolting out of the classroom.

He's shouting insults and teachers and students.

He's hitting, shoving, and even in one case, biting other students.

That one landed him the principal's office for the first time. (How's that for a milestone?)

It's not like he doesn't have support at school. There are good people who are on his side, trying to figure this out.

And he's able to talk about the episodes with us at home more than he's ever been willing or able to do in the past.

Some of his reflections sound like he gets it and that he's sincerely sorry, but then in the midst of reflection, he'll say something like, "I never want to be anyone's friend anymore." "I don't want to be YOUR friend anymore either." "I'm going to be SO naughty that I crash the WHOLE WORLD.""I"m going to teach [insert child's name here] a LESSON!"

My worst fear is that these self-defeating thoughts simply create a vicious, inescapable cycle in which he doesn't believe he can do well.

My second worst fear is that these behaviors will stamp out the tiny, green shoots of real friendship that have started to grow with some of his classmates this year.

At our parent-teacher conference last month, his teacher told us that he is doing well academically. He's doing the work, mostly unprompted. It's the lack of impulse control that causes the struggles. He doesn't want to take breaks because he doesn't want to miss out on what the class is doing.

I know so many of you have faced this and so much more. So many of you have looked at your phone every five minutes waiting for The Call From School. So many of you have waited until your child wasn't looking to let the tears come.

Anne Lamott says there are just two prayers:

"Thank you, thank you, thank you." and

"Help me, help me, help me."

So, this is where I am right now, this moment. Saying a lot of the second one, and hoping that today is a good day.