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.


Natalie said...

So glad things are looking up. Keep us posted on how Ben's doing.

jaki said...

My God you amaze me... how you are so very tuned-in to Ben's thinking/feeling process!

pixiemama said...

I hope that was the trigger, and that the medicine is an "as needed" instead of a daily.

Anonymous said...

Makes perfect sense, really.

Charlotte took Nasonex once (2 doses) and had strange behavioral reactions as well. Her pediatrician assured me that could not be the case, but I found lots of anecdotal evidence online as well. Stopped the Nasonex and the negative behaviors stopped.

I'm glad to hear that you may have found the reason!

Anonymous said...

Your blog brings back memories. My son displayed the verbal aggression that you describe from about age 8 until about age 12. What started out as anger and outrage based on other children violating his very set standards of right and wrong turned into a lovely sense of social justice and compassion for the underdog during adolescence. At 19 he is much more tolerant, but still likes to talk it out and have the validation we all need when we have to deal with social behaviors and difficult people.

Diane said...

But, does "as needed," mean, "Hey, things are getting boring and I'd really like my child to have an unmanageable outburst, perhaps followed by hurting another child and at least a phone call or two?" When the docs say, "as needed," I think they should say, "If you think you absolutely have to and think you can deal with the side effects and oh, if you're Mother Theresa, then go ahead! Give him a puff!"

Kate Stillmean said...

I have been checking in on your blog. It really is encouraging to know there are other moms searching for answers to their child's difficulties. I have two children with Sensory Processing Disorder and struggled with asthma as infants. We have been able to end the cycle of asthma and infection with natural supplements and remedies, building the immune system. I would like you to read my blog. Keep blogging!