We approached the triage nurse with Max in tow. He'd been oddly quiet on the ride. Nothing was thrown, he even kept his shoes on. I wanted it to be unnecessary, and we second-guessed ourselves the whole hour there. We parked in front of the pediatric emergency room. I was shut down inside, feeling nothing, but on the outside, I was the perfect mommy. We approached the triage nurse, and I suddenly realized I didn't know what to say. Was I supposed to say that Max had a “fit”, that was Max called it, or did I say a “tantrum”? An “event”? No one had told me what to say. Dr. E. had said that Max was "ruling in for bipolar". She loved the technical lingo.
First they took our name, and then asked why we were there. “Um, my son has bipolar disorder, and...he's out of control, and his doctor thought we should come.” She smiled kindly, asked for his meds list, and had us take a seat. We got in quickly and were led into one of their special psych rooms, where they can close off the wall, so that there's no access to medical equipment or anything a suicidal child could use to hurt himself. It was room nine, and we spent 6 hours there.
A social worker came to take the history before anybody else. It was a screening, really, which as a nurse I recognize might be necessary, but as a mom...I'm certain that it doesn't matter how many drinks I have per week. My kid was sick, with a biological illness that lives in his head. Probably I was having too few drinks per week. My one to two glasses of sauvignon blanc were not the problem here. But I knew not to joke about things like this, knew that, if I did, the social worker would write it down, write down her concerns that maybe mommy drinks. I got through it, pretending to be solemn and take it seriously. I thought that maybe it I acted like this was normal, it just would be.
We met a nurse, smiling brightly, “how are we doing?”. I didn't say “I'm in the fucking emergency room because my kid has huge fits that are tearing my family into bits. How the fuck do you think I am?”. I said, “fine, thanks for asking”. We met a psych fellow, an Indian woman who mentioned her own kids. Max watched endless episodes of Sponge Bob while Dave and I just stared at each other, silently.
Eventually, it was agreed that Max needed to be admitted to the unit, known as Winchester One, or “Winnie one”. The fellow went over to make sure there was a bed, and to give report on max to the nurses. She came back an hour later, reporting that the acuity on the unit was high, and that, for our child's safety, she recommended that we take him home. She felt that she couldn't guarantee Max's safety if we left him on the unit. There were many older kids acting up, and the staff was stretched thin.
It was impossible, this offer. It was everything we wanted to hear. Of course, she wasn't saying that Max wasn't sick, which was what we still wanted to believe, but we didn't have to hospitalize Max. We were being told to bring him home with us. We were drained, deflated, we'd been wondering if this was the right choice for our 5 year old for hours, now a doctor was telling us to bring him home. So we did. We'd eventually get a bill for the ER visit. We had to pay because he wasn't admitted. Insurance wouldn't cover it. I called and explained what had happened, but they denied that we were told they couldn't keep him safe. They said no one would ever tell us that.
Showing posts with label child psychiatry. Show all posts
Showing posts with label child psychiatry. Show all posts
Monday, April 12, 2010
Thursday, April 8, 2010
I Win
The first helpful diagnosis we got for Max was pediatric bipolar disorder, but it didn't come from any of Max's doctors; it came from my doctor, Fred. In June, when Max was starting at Prospects, I was trying to take care of my basic needs by actually having a physical. I was wiped out. I was an emotional wreck, I'd developed asthma that required three different medications, and any free time I had, I spent wandering around our house. I'd go upstairs, looking for a book I wanted to read. I'd fold some laundry, then turn on the TV, and spend an hour watching an episode of NCIS that I'd already seen. Then I'd wander downstairs and stand in front of the refrigerator, staring for minutes at a time, and finally gulping something down without noticing it at all.
I dragged myself to my internist, patting myself on the back. Fred and I talked for a while about my physical health, he did a thorough physical exam, and then we talked again in his office about the other stuff. He knew Max had some issues, but, like us, didn't really know what they were. He asked if Max had a diagnosis. I took a deep breath, "I don't know...he seems to meet criteria for everything, ADHD, mood disorder, anxiety, oppositional defiant disorder. I don't know." Fred calmly said, "He may have pediatric bipolar disorder. A lot of kids do, and it's really underdiagnosed".
I finally had something I could google. Pediatric bipolar disorder. Which let me not only to the terrific book by Papalos (The Bipolar Child), but also to the Child and Adolescent Bipolar Foundation, where I found a whole community of people like me with kids like Max. I read Bipolar Child in a night, and went to my next meeting with Dr. E.
"Max has bipolar disorder Why do you keep saying 'mood disorder'?", I was furious. By not calling it by a name that meant anything, she held all the power. But with a real name to it, I could do something, read something, help myself. Dr. E responded carefully, bright-eyed and smiling, "Well, let's just call it a mood disorder. We don't need to label him."
A common excuse, the "labeling". It's bull, really, because labels are an important part of communication. Dave once pointed this out to me, "There's this thing outside that I drive. It's made of metal, and it has four wheels. I don't want to label it and call it a car, but it gets me where I'm going." The real issue with labeling is that many of these health professionals don't actually believe in this disorder.
Doctors like Dr. E. suffer from a terrible liberal bias which prevents them from seeing mental illnesses for the biological disorders that they are. Dr. E's clientele is mostly poor, black or hispanic. They are under-privileged by every definition. They are often referred by their school district for their acting out in a public school that just doesn't know what else to do. Dr. E. sees their situations as so painful, she grants them such latitude because they lack social, community, and family support. Their parents are mostly single mothers who work incredibly hard just to keep their families' heads above water, and Dr. E. knows that this has an effect on children. So she imagines that if she can hook those families up with community support and some "parenting skills", the kids will improve and not be so problematic. She's right about some of this: these kids would benefit from better nutrition, more time to play and be kids in a safe space, and from a cadre of adults around them who can guide them to good decision making. But that doesn't mean that they don't also have mental illness with a biological basis. She doesn't want to label them because maybe in a different environment, they could do better. And they're labeled enough, these kids, right?
So what does she do with me? I'm a member of a close-knit Jewish community. I have the support of my synagogue, my kids have 2 sets of local grandparents whom they see all the time, my husband and I have a close marriage untouched by alcoholism, infidelity, or financial stresses. But my kid is among the sickest of these kids, and that shakes her belief system.
So she just blames me, anyway. I give in too easily, or I'm emotionally distant, or both. She confidently states that I have anxiety, which is like telling a four-hundred pound woman that she has a weight problem. I do have anxiety. I have a kid who bites me, and throws things at me while I'm driving. He takes off his seat belt and tries to take his younger brother's seat belt off, too. Every day at 3 PM, he becomes completely uncontrollable, running around in circles, chanting nonsense words, like "api-ceca-gabi" or saying the same word over and over for half an hour. So, yes, I had anxiety. But Max was causing it, not suffering from it.
From then on, from the moment that Dr. E. denied that Max has pediatric bipolar disorder, I knew he had it. I was downright smug about it, in fact. This was something that I could control, research, advocate for. I wished there was a damn ribbon to put on my car, because I suddenly KNEW that this was not a parenting problem.
I dragged myself to my internist, patting myself on the back. Fred and I talked for a while about my physical health, he did a thorough physical exam, and then we talked again in his office about the other stuff. He knew Max had some issues, but, like us, didn't really know what they were. He asked if Max had a diagnosis. I took a deep breath, "I don't know...he seems to meet criteria for everything, ADHD, mood disorder, anxiety, oppositional defiant disorder. I don't know." Fred calmly said, "He may have pediatric bipolar disorder. A lot of kids do, and it's really underdiagnosed".
I finally had something I could google. Pediatric bipolar disorder. Which let me not only to the terrific book by Papalos (The Bipolar Child), but also to the Child and Adolescent Bipolar Foundation, where I found a whole community of people like me with kids like Max. I read Bipolar Child in a night, and went to my next meeting with Dr. E.
"Max has bipolar disorder Why do you keep saying 'mood disorder'?", I was furious. By not calling it by a name that meant anything, she held all the power. But with a real name to it, I could do something, read something, help myself. Dr. E responded carefully, bright-eyed and smiling, "Well, let's just call it a mood disorder. We don't need to label him."
A common excuse, the "labeling". It's bull, really, because labels are an important part of communication. Dave once pointed this out to me, "There's this thing outside that I drive. It's made of metal, and it has four wheels. I don't want to label it and call it a car, but it gets me where I'm going." The real issue with labeling is that many of these health professionals don't actually believe in this disorder.
Doctors like Dr. E. suffer from a terrible liberal bias which prevents them from seeing mental illnesses for the biological disorders that they are. Dr. E's clientele is mostly poor, black or hispanic. They are under-privileged by every definition. They are often referred by their school district for their acting out in a public school that just doesn't know what else to do. Dr. E. sees their situations as so painful, she grants them such latitude because they lack social, community, and family support. Their parents are mostly single mothers who work incredibly hard just to keep their families' heads above water, and Dr. E. knows that this has an effect on children. So she imagines that if she can hook those families up with community support and some "parenting skills", the kids will improve and not be so problematic. She's right about some of this: these kids would benefit from better nutrition, more time to play and be kids in a safe space, and from a cadre of adults around them who can guide them to good decision making. But that doesn't mean that they don't also have mental illness with a biological basis. She doesn't want to label them because maybe in a different environment, they could do better. And they're labeled enough, these kids, right?
So what does she do with me? I'm a member of a close-knit Jewish community. I have the support of my synagogue, my kids have 2 sets of local grandparents whom they see all the time, my husband and I have a close marriage untouched by alcoholism, infidelity, or financial stresses. But my kid is among the sickest of these kids, and that shakes her belief system.
So she just blames me, anyway. I give in too easily, or I'm emotionally distant, or both. She confidently states that I have anxiety, which is like telling a four-hundred pound woman that she has a weight problem. I do have anxiety. I have a kid who bites me, and throws things at me while I'm driving. He takes off his seat belt and tries to take his younger brother's seat belt off, too. Every day at 3 PM, he becomes completely uncontrollable, running around in circles, chanting nonsense words, like "api-ceca-gabi" or saying the same word over and over for half an hour. So, yes, I had anxiety. But Max was causing it, not suffering from it.
From then on, from the moment that Dr. E. denied that Max has pediatric bipolar disorder, I knew he had it. I was downright smug about it, in fact. This was something that I could control, research, advocate for. I wished there was a damn ribbon to put on my car, because I suddenly KNEW that this was not a parenting problem.
Wednesday, April 7, 2010
How Not to Find a Shrink
The new headmaster convinced me that the school could do it. A big, bearded guy with a long career in education, he was exuberant about getting a kid with some issues. He showed me every room in that school, spreading his arms wide, booming "Doesn't it look like we can do everything here? We can do everything but a self-contained classroom." He adjusted his blue and white knit kippah and gave me a goofy grin. I was sold; that was before we knew.
Max's entry into kindergarten was okay. His teacher, Mrs. M., had a quality that Dave and I can't quite describe. Sometimes we meet someone, and we tell them about Max, and there's a look they get; they know what we're talking about. They don't say anything that would tell us that, they don't have to, Dave and I can just tell. Sometimes they say less than most people do when we talk about Max. But Mrs. M. had that quality.
Prospects was part of our weirdo routine. Max's notebook from Prospects traveled everywhere with him now. He had goals for school, goals for home, goals for Prospects. He got points for doing things he was supposed to. He never understood that some rules are the same everywhere. If he wasn't allowed to scream obscenities at home, then that wasn't allowed other places, for instance. max could make no sense of that. He was transitioning poorly. When recess ended and the kids came inside, Max would stay riled up for hours. He couldn't just settle down and listen. Things were deteriorating as October approached, and somehow, Prospects rushed him into a graduation. I know now that September is always a good month for Max. I don't know why, although lots of kids with bipolar have a seasonality to their symptoms. So Max graduated, and we were done. But things were getting worse, not better.
We needed a new psychiatrist. We had been able to continuing seeing Dr. L. because Max was at Prospects. Now that Max wasn't at Prospects, we had no shrink. And Dr. L. had no advice on where to find one. I think he knew that most of them are awful, and that Max was totally out of their league. in an extreme cop-out, he proclaimed, "Max is not a private practice kind of kid". He was right of course. Dr. L. was always right. but my kid needed a shrink.
I called all over. The Yale Child Study Center was going to be seeing kids at Greenwich Hospital, where Dave works. But they didn't know when that might be, and never called me back when I left messages. The Child Guidance Center of Stamford felt that Max was "too sick" for their agency. Thus began an inter-agency battle between Prospects, hosted by the Norwalk Child Guidance Center, and Stamford's center.
I had a hard time understanding that Max was too sick. I mean, they offered psychiatric care, right? To whom? There were un-sick kids who saw a psychiatrist? I couldn't read between the lines yet.
Max's entry into kindergarten was okay. His teacher, Mrs. M., had a quality that Dave and I can't quite describe. Sometimes we meet someone, and we tell them about Max, and there's a look they get; they know what we're talking about. They don't say anything that would tell us that, they don't have to, Dave and I can just tell. Sometimes they say less than most people do when we talk about Max. But Mrs. M. had that quality.
Prospects was part of our weirdo routine. Max's notebook from Prospects traveled everywhere with him now. He had goals for school, goals for home, goals for Prospects. He got points for doing things he was supposed to. He never understood that some rules are the same everywhere. If he wasn't allowed to scream obscenities at home, then that wasn't allowed other places, for instance. max could make no sense of that. He was transitioning poorly. When recess ended and the kids came inside, Max would stay riled up for hours. He couldn't just settle down and listen. Things were deteriorating as October approached, and somehow, Prospects rushed him into a graduation. I know now that September is always a good month for Max. I don't know why, although lots of kids with bipolar have a seasonality to their symptoms. So Max graduated, and we were done. But things were getting worse, not better.
We needed a new psychiatrist. We had been able to continuing seeing Dr. L. because Max was at Prospects. Now that Max wasn't at Prospects, we had no shrink. And Dr. L. had no advice on where to find one. I think he knew that most of them are awful, and that Max was totally out of their league. in an extreme cop-out, he proclaimed, "Max is not a private practice kind of kid". He was right of course. Dr. L. was always right. but my kid needed a shrink.
I called all over. The Yale Child Study Center was going to be seeing kids at Greenwich Hospital, where Dave works. But they didn't know when that might be, and never called me back when I left messages. The Child Guidance Center of Stamford felt that Max was "too sick" for their agency. Thus began an inter-agency battle between Prospects, hosted by the Norwalk Child Guidance Center, and Stamford's center.
I had a hard time understanding that Max was too sick. I mean, they offered psychiatric care, right? To whom? There were un-sick kids who saw a psychiatrist? I couldn't read between the lines yet.
Life in Basket C
Dr. L was our first psychiatrist. He seemed surprised that the dog lady had referred us to him He didn't have room in his practice, not really, but was willing to evaluate Max and give us an opinion. We'd later learn that if you find a child psychiatrist who has room in his practice, he probably sucks. Better to see someone without room, and then beg for their mercy.
My husband and I both went to that first appointment, I think. Dr. L. asked lots of the same questions that the dog lady had asked. He was thoughtful, tall, good-looking. A nice Jewish psychiatrist who would meet with Max 3 times, and then meet with us again to discuss...something. I'm not sure I ever knew what to expect. I always felt that I had to be on my best behavior. Proper mommy outfit. Not too much makeup, but not too casual. I had to look like I cared, but not too much. Always hard to tell who they're looking at, the psychiatrists.
He met Max 3 times. The third time ended prematurely, Max ran out, giggling hysterically, crashing through the office, down the hall. I could barely get him into the car, into the car-seat. It was a common site for problems, the car. By problems, I mean...problems. Like taking off his shoes and throwing them at me on the highway. Like taking off his seatbelt, climbing out of his car seat, and grabbing me from behind while we were speeding across the Tappan Zee Bridge. I'd be desperately trying to control him with my right arm while I drove with my left, screaming, crying. Sometime later a preschool teacher asked where Max learned the word "fuck". I told her he learned it on the Tappan Zee Bridge.
But back to Dr. L. He would turn out to be ALWAYS correct. Never wrong. Everything he ever said turned out to be truer than we could have imagined. Not always right away, but eventually. And there were things he said that no one else ever told us, and that we still say to one another to this day. The first one he said when he met with us after those three meetings with Max: "Don't talk to other parents," he said. And he was right. We didn't realize how different we were. We'd been dropped into a cold pan of water, and then the water was brought to a boil, so we didn't even know how bad it was. If we'd been dropped into the boiling water, we would have screamed for our lives.
Dr. L. said Max had a "mood disorder", and we started down a long medication road right there. He gave us an abbreviated version of a lecture he gives to medical students at Yale. I still have my notes from that meeting, and sometimes I even still refer to them, but mostly I've memorized the whole damn thing. We started with a tiny dose of stimulant medication, "just in case" this was "just a really bad case of ADHD". I didn't know that I was supposed to be hoping it was just ADHD. It wasn't.
The next medication was Abilify, an atypical anti-psychotic medication you can see advertised during the 5 AM news. The lonely woman walking in the forest, and then it turns sunny. That's Abilify. In tiny doses, it helped right away. For 3 weeks, life was incredible. Max was manageable, and did what I asked. He stayed calmer, and could process requests. There was no violence, and I imagined that life would be normal. But then it stopped working, and Dr. L. sighed, "I've seen this happen". But none of the drug reps knew anything about this possibility. It was devastating.
Dr. L. suggested that we read The Explosive Child, a book by Dr. Ross Greene, who's at Massachusetts General Hospital. The book isn't about diagnosis, but about managing kids "like Max," who are exceptionally angry, and whose families have to run around in circles to manage them. Using a method called "collaborative problem solving", the book was radical, suggesting that we can choose to stop fighting about all sorts of things, placing many of those things into "Basket C," where we realize that we can't invest time in them. Truly important things are "Basket A". Basket A was about safety...the rare things about which we just have to impose our will against our child for everyone's good. Basket B was supposed to be a place where we started genuine negotiating with your child, in an effort to teach them skills, to help them catch up where they were developmentally lost. What resulted was what Dave called "life in basket C". Max couldn't negotiate anything. He got stuck on an idea, and was totally unable to give it up. He would decide that he needed something....a matchbox car, a certain kind of waffles, and demand that we immediately go to the store to buy it. He could focus on something for days. If we bought it, it didn't help, he just moved on to something else. And if we didn't buy it? He would talk about it incessantly, sometimes raging through the house, throwing every solid object he touched: toys, crayons, chairs. Wooden toys became forbidden in our house, as the walls became more and more distressed with the evidence of our child's rages.
Then Max began going to a summer program called Prospects, allegedly for kids like him. Dave and I constantly called it "Promises", after the celebrity drug rehab in Malibu. Mostly it was really poor kids who suffered from tremendous under-parenting, as well as their psychiatric disorders. I had to sign a contract that I would participate in therapy, and that I'd go to a parent group. I thought it might be helpful. That's when we still had hope, when I thought that I could do what these experts told me, and things would get better. But the experts had already turned on me.
Prospects used a behaviorist model: kids got points and could use them to buy things in the store. No one told me that a behaviorist model is the OPPOSITE of Ross Greene's baskets. Mostly, I think the professionals we came in contact with underestimated how closely we were listening to them. Far from the "non-compliant parents" they were used to, I took it all to heart, hopefully implementing everything. Eventually, the psychologist in charge at Prospects, Dr E, told me that using collaborative problem solving was the opposite of Prospects. Oh. So, I don't know what I'm doing, and I don't know what you're doing, and why does my kid act like this?
Prospects introduced Max to all sorts of clinical lingo that he still uses: he calls other children "peers" and he might describe a child having an outburst as "testing limits". It sounds ridiculous when Max says it, and worse when a clinician is impressed by Max's use of these idiotic words. Prospects also had bizarre lingo unique to their program. When a child starts to act out of line, the staff members would say "That's a prompt". I think it was supposed to mean that the staff was prompting the child to improve his behavior, but I"m honestly not sure. Max knew that getting a prompt was bad, but he could never really understand why he had gotten one.
Slowly, Max moved up their level system...he made it to level two, Hooray! Then he'd throw a marker, or a chair, and be down on "restriction," meaning he couldn't go to the Prospects store and spend his points. Secondarily, that meant two hours rages at home where he angrily tore the room apart when I denied him any points. Points became a new focus of his rage, and his rage only seemed to get bigger as he grew. By July, Dr L and Dr E started discussing something new: psychiatric hospitalization.
My husband and I both went to that first appointment, I think. Dr. L. asked lots of the same questions that the dog lady had asked. He was thoughtful, tall, good-looking. A nice Jewish psychiatrist who would meet with Max 3 times, and then meet with us again to discuss...something. I'm not sure I ever knew what to expect. I always felt that I had to be on my best behavior. Proper mommy outfit. Not too much makeup, but not too casual. I had to look like I cared, but not too much. Always hard to tell who they're looking at, the psychiatrists.
He met Max 3 times. The third time ended prematurely, Max ran out, giggling hysterically, crashing through the office, down the hall. I could barely get him into the car, into the car-seat. It was a common site for problems, the car. By problems, I mean...problems. Like taking off his shoes and throwing them at me on the highway. Like taking off his seatbelt, climbing out of his car seat, and grabbing me from behind while we were speeding across the Tappan Zee Bridge. I'd be desperately trying to control him with my right arm while I drove with my left, screaming, crying. Sometime later a preschool teacher asked where Max learned the word "fuck". I told her he learned it on the Tappan Zee Bridge.
But back to Dr. L. He would turn out to be ALWAYS correct. Never wrong. Everything he ever said turned out to be truer than we could have imagined. Not always right away, but eventually. And there were things he said that no one else ever told us, and that we still say to one another to this day. The first one he said when he met with us after those three meetings with Max: "Don't talk to other parents," he said. And he was right. We didn't realize how different we were. We'd been dropped into a cold pan of water, and then the water was brought to a boil, so we didn't even know how bad it was. If we'd been dropped into the boiling water, we would have screamed for our lives.
Dr. L. said Max had a "mood disorder", and we started down a long medication road right there. He gave us an abbreviated version of a lecture he gives to medical students at Yale. I still have my notes from that meeting, and sometimes I even still refer to them, but mostly I've memorized the whole damn thing. We started with a tiny dose of stimulant medication, "just in case" this was "just a really bad case of ADHD". I didn't know that I was supposed to be hoping it was just ADHD. It wasn't.
The next medication was Abilify, an atypical anti-psychotic medication you can see advertised during the 5 AM news. The lonely woman walking in the forest, and then it turns sunny. That's Abilify. In tiny doses, it helped right away. For 3 weeks, life was incredible. Max was manageable, and did what I asked. He stayed calmer, and could process requests. There was no violence, and I imagined that life would be normal. But then it stopped working, and Dr. L. sighed, "I've seen this happen". But none of the drug reps knew anything about this possibility. It was devastating.
Dr. L. suggested that we read The Explosive Child, a book by Dr. Ross Greene, who's at Massachusetts General Hospital. The book isn't about diagnosis, but about managing kids "like Max," who are exceptionally angry, and whose families have to run around in circles to manage them. Using a method called "collaborative problem solving", the book was radical, suggesting that we can choose to stop fighting about all sorts of things, placing many of those things into "Basket C," where we realize that we can't invest time in them. Truly important things are "Basket A". Basket A was about safety...the rare things about which we just have to impose our will against our child for everyone's good. Basket B was supposed to be a place where we started genuine negotiating with your child, in an effort to teach them skills, to help them catch up where they were developmentally lost. What resulted was what Dave called "life in basket C". Max couldn't negotiate anything. He got stuck on an idea, and was totally unable to give it up. He would decide that he needed something....a matchbox car, a certain kind of waffles, and demand that we immediately go to the store to buy it. He could focus on something for days. If we bought it, it didn't help, he just moved on to something else. And if we didn't buy it? He would talk about it incessantly, sometimes raging through the house, throwing every solid object he touched: toys, crayons, chairs. Wooden toys became forbidden in our house, as the walls became more and more distressed with the evidence of our child's rages.
Then Max began going to a summer program called Prospects, allegedly for kids like him. Dave and I constantly called it "Promises", after the celebrity drug rehab in Malibu. Mostly it was really poor kids who suffered from tremendous under-parenting, as well as their psychiatric disorders. I had to sign a contract that I would participate in therapy, and that I'd go to a parent group. I thought it might be helpful. That's when we still had hope, when I thought that I could do what these experts told me, and things would get better. But the experts had already turned on me.
Prospects used a behaviorist model: kids got points and could use them to buy things in the store. No one told me that a behaviorist model is the OPPOSITE of Ross Greene's baskets. Mostly, I think the professionals we came in contact with underestimated how closely we were listening to them. Far from the "non-compliant parents" they were used to, I took it all to heart, hopefully implementing everything. Eventually, the psychologist in charge at Prospects, Dr E, told me that using collaborative problem solving was the opposite of Prospects. Oh. So, I don't know what I'm doing, and I don't know what you're doing, and why does my kid act like this?
Prospects introduced Max to all sorts of clinical lingo that he still uses: he calls other children "peers" and he might describe a child having an outburst as "testing limits". It sounds ridiculous when Max says it, and worse when a clinician is impressed by Max's use of these idiotic words. Prospects also had bizarre lingo unique to their program. When a child starts to act out of line, the staff members would say "That's a prompt". I think it was supposed to mean that the staff was prompting the child to improve his behavior, but I"m honestly not sure. Max knew that getting a prompt was bad, but he could never really understand why he had gotten one.
Slowly, Max moved up their level system...he made it to level two, Hooray! Then he'd throw a marker, or a chair, and be down on "restriction," meaning he couldn't go to the Prospects store and spend his points. Secondarily, that meant two hours rages at home where he angrily tore the room apart when I denied him any points. Points became a new focus of his rage, and his rage only seemed to get bigger as he grew. By July, Dr L and Dr E started discussing something new: psychiatric hospitalization.
Subscribe to:
Posts (Atom)