sick of the anti-meds lunacy!

Just browsing through the stuff that comes up on google on a search for "zoloft and irritability" or "zoloft and violence" is . . . depressing, pun intended. What in the heck is wrong with people? FAR from increasing violence or irritability with my son, it has DRASTICALLY REDUCED his violent actions and speech, his awful threats, his irritability, to the point that the child is now functioning in a nearly normal way much of the time. You'd have to know N to know what an amazing statement that is. And it's no placebo, no fluke: It's been too great a change, for too long a time now, to be a flash in the pan. No doubt about it: Zoloft has made my son stable, and that is a miracle, knowing how out of control he was. M has told me not to blog on the most horrible things he's done or said, knowing it might come back and haunt us one day, in one way or another, but I can say with certainty that the child's violence was gettting out of hand, and I don't use that phrase lightly. It was unbelievable.

update on the big move

Despite still living at my in-laws (though we sign the lease for a great rental house today), things are actually going really well with N and the other kids. Pre-Zoloft, this would have all looked very different. I've been amazed at his ability to handle this major life change with very little in the way of raging, aggression, or general obnoxiousness. There's still some cognitive inflexibility left over, some general glitches in interpersonal communication, and of course, the ADHD stuff, but it's all pretty manageable, really, particularly since we've seen so much worse over the years.

when one door closes . . . the wisdom of my oldest son

Blessings abound. Seeds planted in most unfavorable conditions surprise and delight us years later by bearing good fruit. In the worst of it, while we hardly dared to hope, strong roots were taking hold. 

Translation: We're leaving Skokie in just a few days for a new life in Maryland. We were worried about how N, in particular, would handle the transition, remembering how hard it was coming from Texas to Illinois. By now, we expected the fallout to have begun, in anticipation of leaving his best friend, his school, this house, the neighborhood. Instead, this morning at breakfast at Annie's, a wonderful pancake house we will actually miss, one of the few Skokie restaurants memorable enough to miss, N. looked up from his DS for a few seconds and said:

"When one door closes, another door opens. Did you know that, Mom? It means even though we're leaving here and that's sad, a new, happy life is waiting for us in Maryland."

"Huh?" M and I looked at each other. Wow.

Thank God for that little green pill. Thank God for Merck and the people who developed Zoloft and researchers who discovered that human brains need ample serotonin to behave normally and achieve happiness and pleasure. That's what it is, and there's no doubt. Actually, since being out of school the past few days, there's been a striking lack of anxiety and craziness, crazy talk, cursing, negativity, hostility, snarling. There've been a few fairly mild isntances, and two weekends ago it was kind of nasty, but everything is still SO much better. Maybe the fish oil is helping too, at just over a gram a day of the high EPA to DHA ratio, the amount that's been shown to be helpful in the clinical studies. 

Besides the obvious joy at seeing our son happy and more normal, it feels darn good, no, it feels damn great, to see that all the seeds we planted over the years--meaning Matt and me, his teachers, our family, his counselors and doctors, priests, therapist, everyone--actually weathered the storm. It actually DID mean something, he actually WAS learning, there actually IS hope, once the brain chemistry is straightened out. As I really knew all along, it wasn't our fault. Hell, it wasn't even his fault. Only God knows how much work and teaching and effort we have put into that child over the years, and to see with absolute clarity, over and over again, that it wasn't all for nothing, is a deeply gratifying thing, and that's an understatement. 

One door closes and another opens, when God closes a door, he opens a window. Amen. 

three monkeys

No special theme here, just wanted to post the latest photo, taken a couple days ago, of my bunch.

routines -- tyranny or liberation?

A pattern is emerging: Either of these two things sets disregulates and unwinds A to the point that we have to go back to square one in terms of attachment, security, regulation, obedience, and definitely falling asleep in a peaceful state: a) sleeping somewhere else b) having others sleep here. And the worst of all possibilities, sleeping overnight without me there with her. Last week, she and Matt went to Ma and Pa's in Frederick, Maryland, simply because Matt had to be on site for a few days with his new job and I knew there was no way in hell I could manage the three of them alone for four days. So she went with him, N and S stayed here with me.

Every night, she called me crying. She wasn't able to fall asleep until 10:00 or later. The past two nights home, she's needed me lying down with her until she falls asleep, which might not be so bad if she could just SETTLE. But she's twitching, chattering, twisting, wide awake and, dare I say, hyper, for an hour or more. If I try to leave, she freaks out. I'm talking screaming, flailing, clutching, mad hyperventilation, completely wild-animal type freak-out. The simple truth is, A is anxiously attached to me, I'm sure of it. She loves me like crazy, and we have a very close, adoring relationship, but she is definitely terrified of losing me. Add to that the predictable acting-out for attention, though I give her as much as I possibly can and reassure her several times a day that I love her, proud of her, glad she's back, etc. She's like a sponge that can never be saturated with maternal love. Kind of reminds me of someone else I know. I've said the same about him, though with him it's much more extreme and desperate, to be sure.

Now, three weeks or so, we make the big move to Maryland. I'd wanted to stay in Matt's parents downtown row house about as much as I'd want surgery without anesthetic, but we still haven't sold this place, and we can't be foolish enough to turn down a rent-free place while we still have this mortgage. It's a nice place, very nice, too nice, filled with antiques, each room meticulously designed and arranged by his --- let's just say very DETAILED father. It's his baby, a labor of love he's spent years fixing up, and it's nice enough now to be a b and b. It's nowhere near kid-friendly, but maybe moving out some of the nicer stuff into storage, or sticking it in the basement, taking up the persian rugs, will get us by. I'll be holding my breath the whole time, waiting for one of the kids to barrel into something, spill, stain, break. Add to this the fact that the man has made plain on more than one occasion that he thinks our children don't have adequate "discipline" (which is a whole 'nother thing I won't even get into. Let it suffice to say he has a hard time accepting that good ol' Army-style discipline ain't necessarily gonna work with a mentally ill child.). But anyway . . .

the routines are so important for my kids. There's exquisitely sensitive to a change in environment, to the least bit of stress. It's going to be tough.

But with A, at least, a couple of weeks of my sameness and presence, my reassurance, and she falls back in line, relaxes, becomes much plug-and-play. I know we'll get there again.

Another diagnosis . . . just what we need

Yawwwwwn. That was my reaction when Dr. Whoever, one of the ones in charge of my son when he did a week of day treatment in the psych department of a nearby children's hospital, told me he suspected my son might be somewhere on the autism spectrum. I didn't even go there with him, not really. For one thing, every kid and his dog is getting diagnosed autistic spectrum these days, and for another, it didn't ring true. Finally, I just didn't have the mental space to deal with yet another disorder. Bipolar, ADHD, yada yada, that's enough for now, thanks. I'll let ya know if we ever need any MORE letters.

One thing I know about autism is that it's a communication problem, and my son doesn't, on the surface, seem to have one. He's very verbal, and in the right circumstances, communicates extremely well, is very interested in what others have to say, can reciprocate in conversation, can be genuinely sweet and affectionate. When things are stable and he's in the right environment, he's an awesome kid, and you'd never dream there was anything wrong with him. Of course, if something rocks his boat, watch out. Oh, well, all these brain systems and disorders are related and overlapping, anyway. He has symptoms of just about all of these disorders, and serious enough to cause impairment.

So his psychiatrist, his regular one, tells me today she thinks he's on the autism spectrum, Asperger's. His bizarre thoughts and so forth, she attributes to having too intense an inner world and being unable to successfully navigate between that world and the regular world. She says he doesn't communicate on a deep emotional level with people. Okay, I don't get that part, though the crazily vivid imagination and obsession with certain things -- police and cars -- makes sense. When we get to Kennedy-Krieger in Baltimore, she wants him to be assessed formally for Asperger's. She says the outcome, expectations, etc., are different than those for other disorders. She didn't say he doesn't have Bipolar, exactly, just that there are other things going on, as well.

This is what I know: The SSRI is working, well. His stimulant works. Lithium made him fat and after a while, didn't seem to be doing a damn thing else. Risperdal seems to help some with the aggression, but doesn't make a huge difference in him. Therapy has never, never been able to improve or change his behavior in any way.

Now that the anxiety and behavior problems and aggression, the worst of them, have been helped some by Zoloft (though not eliminated), the weirdo stuff is what remains--the bizarre things he says, the weirdness in his head, the silly-violent, crazy ideas that are still around. The intense and constant need for emotional reassurance, the constant "You don't love me" stuff.
He's been cursing more, talking about body parts more, talking more negatively about himself. But she says he's not psychotic, just needs to learn how to manage his emotions.

I don't know what to think anymore. I'm just really thankful for that little green pill. If we up the Risperdal and the weird ideas don't want to go away, does that mean it's not psycho stuff, but his Asperger's? That's what she says.

Damned if I can sort it all out. Truth is, a while back she thought he had Tourette's. Well, he did have tics, but they were stimulant-caused, and now they're gone. ADHD, Bipolar, Tourette's, ODD. What else can you come up with? Okay, autistic spectrum. Might as well throw that out there, too. Oh, yeah, she also thought he was playing me with SOME of the weirdo talk and stuff, pushing my buttons for attention. Whatever. Sometimes, he's just off his rocker.

Skokie Festival of Cultures

Last Saturday was the annual Festival of Cultures. It's a pretty amazing event, in a pretty amazing little city, if you ask me. This place gives meaning to the word diversity, seriously. On our block, let's see, the cultures and ethnicities represented? China, Romania, France, Ireland, Iraq, Latvia, possibly Estonia, central America--and those are only the ones I know, on a fairly dense city block. A's preschool class is full of beautiful little brown-skinned children from around the world. It's one of the main reasons we chose Skokie when we moved to Chicagoland. Historically, it's a very Jewish city, but in the last decades, it's become much more global. N's best friend is Chinese-American, his mom from China and dad from here. I'll hate to leave them, and I feel awful about separating N from his friend, and A from their family. The woman dotes on A, took them both to the movies last weekend. It breaks my heart to take her away from a Chinese "auntie" who loves her and would like to see her grow up. I don't know that Skokie is somewhere I'd really choose to live forever, and it's not perfect, but the large Asian presence is one of the things I'll hate leaving, for A's sake. And the Russian? Well, you hear it everywhere you go. This place is full of Russians. 

I learned a lesson the other day: I was in Walgreen's, and becoming impatient with the checkout lady, an elderly woman who was very, very slow. "Oh, no, not her again!" I muttered to myself. When she finally got to us, she asked if A were from China. I sighed a bit impatiently and said yes, expecting some stupid question or comment about how smart the Chinese are or whatever. Instead, this:

"I used to live in China, for ten years. I love the Chinese people."

"Really? Where did you live in China?"

"Shanghai. It was the only port in the world that would take us with no papers, no passport, nothing. We had no money, you know. A charitable group gave my mother money to get us there."

"Where did you come from?" (my historical ignorance showing itself)

She gives me a look.

"I'll give you one guess. Before you were born." Pause.

"Ever hear of a guy named Hitler?"

"They took everything, you know, we had no money, nothing."

I asked her a couple of more questions. She learned Chinese there, and during the Japanese occupation, learned Japanese. She was one of the lucky ones who made it out of Germany, must have been very young at the time. 

I felt so humbled and ashamed of myself for the way I'd put this woman down in my mind, looked right through her, saw her as just another daft, slow old lady who should be in a retirement home and not behind a cash register. 

Skokie has the largest concentration of Holocaust survivors in the country. How many times have I been humbled like this, learned not to judge a book by its cover? 

I'll miss Skokie, though it still feels foreign, to tell the truth. 

I hope my kids benefitted, if only briefy, from living here. 

a worrying couple of days

N had his last appt. with his psych before we move to Maryland next month, and of course, she was very pleased with his "progress." I use quotation marks not to disparage her or him, but only because I know very well the only thing that has made this progress possible is the tiny green Zoloft pill I convince her to let us try with him. She didn't really want to, but agreed to let us try when I told her I really thought he had some significant depression and it was sloppy thinking to rule out that entire group of (very helpful) meds based on one dose, years ago.

When I say the progress was only possible because of Zoloft, I don't mean to belittle N's role in his more positive behaviors, or the role of all the people who have worked with so much in socialization, therapy, behavior training, etc. What I mean, and what I explained to him on the way home, was that the correct medication gives him the CHOICE to be the person he really is, make the decisions he really wants to, and act more "like himself." The meds alone can't make a person do anything, but they can normalize the chemicals in his brain so that it's much more possible for him to follow rules and use his self-control, things he understands but has trouble actually doing when he is not stable. I do give him great credit for demonstrating his desire to behave as society expects and have good relationships with others.

The past couple of days, though, have been a bit disturbing. He's been sort of manic-y and weird the past couple of evenings, mouthy, difficult, hyper. Also, he's been talking a lot about Russia and expressing sadness. I'm not too worried. I know the Zoloft is working, but that doesn't mean there will never be any dips or cycles again.

On a more positive note, I heard back from the director of the pen pal project in the orphanage in Saratov, in the same region as Samara, where N was born. She's arranging for a couple of boys, Kirill and Vova, to become pen pals with N. I hope this will help him process and deal positively with his emotions and question about Russia.

Daring to hope, or hedging my bets?

M and I were talking last night about how our lives have changed so dramatically since N became stable, relatively speaking, on Zoloft.

"Enjoy it while it lasts," he says. He's always been kind of a glass-half-empty guy, too quick to cover up and protect himself by "I didn't think it would work out, anyway," or "I'm not even gonna get my hopes up."

I responded to him that I know very well a mood disorder, by definition, can't be stable forever, and there will be peaks and valleys. I also know very well that this Bipolar or depression or low serotonin, this mood disorder that's helped by the SSRI, is not this child's only challenge, and even on Zoloft, he still has difficulty. I know all that. But still, I WANT to . . . oh, not exactly pretend, per se. I want to let go of the fear and air of inevitability, stop protecting myself by not getting my hopes up, stop hedging my bets and allow myself to believe and enjoy this period for what it is, without worrying about the next plunge into the abyss, the next manic period or whatever. Why? Because it feels too good to relax, breathe, enjoy. I can't spend my entire life, or his entire childhood, miserable and shell-shocked, covering up in anticipation of the next blow. I have to be happy and carefree sometime; otherwise, I'll be the next one in the psych ward. (I'm being slightly facetious.) But really, that's exactly what I am doing: I am enjoying it while it lasts, truly---and for me, enjoying it means I'm not worrying about next year or next month, and I'm not holding myself in check. I want to believe, and I will enjoy thinking about that family camping trip that hovers in my imagination. I'll picture my kids sitting around a campfire eating s'mores and looking up at the constellations. I choose to.

Enjoying it while it lasts. Yes, I am--not in the sense M. meant by the statement, but enjoying it, nevertheless. I'm actually looking forward to the weekend. Thank you, Pfizer.

Parenting . . . fun again!

I was struck by this thought late this afternoon, sticking frozen enchilada casserole in the microwave while M. held baby S., A. played nearby and N. ran around outside with the six year-old from down the street. It was an odd moment--joyful, of course, but a little sobering, too. When was the last time I would have described parenting as "fun"? I couldn't recall. Not drudgery, stress, insanity--but fun. FUN! A. has been delighting me with her insatiable desire to learn basic math and reading. At four, she's already working written addition and subtraction problems, and she's absolutely driven, and I mean EATEN UP WITH THE DESIRE to learn to read, to learn everything she can. I have never seen a child so consumed with "seatwork." I guess I'll just try to keep giving her material and teaching her, as long as she is up for it. Actually, I'm not the one pushing it, at all. It's her.

I took N for a "date" this afternoon to Starbuck's, picked him up early from his after-school program. He was pleased as punch, of course, and we had a nice chat. I think I've found him a Russian pen pal from an orphanage in Saratov. A university program is coordinating the translation and such. He said he'd like them to address his e-mail to Kolya. Pre-SSRI, this wouldn't have come up, wouldn't have entered my mind. We were white-knuckling it every day, just to get through the day with him with our sanity intact. Who in the heck had time to think about pen pals, Good Grief! Or anything else but safety, for that matter. I swear, I think we have PTSD just from living with that child. Now, the idea of a pen pal seems natural. It is natural. It's normal, is what it is, and we ain't seen much of that around here for quite a while, baby.

The craziest thought, maybe the scariest thought, is that I know very well where this happiness and "fun" comes from. I know who I have to thank: It's Pfizer or whoever makes Zoloft, generic name Sertraline. And it's not for me. It's N, of course. What a revelation: Parenting can actually be FUN, ENJOYABLE, when it doesn't suck. When you don't have the joy and humor slowly extinguished by day after day after endless day, for YEARS, of nonstop hassle, argument, frustration, hair-pulling, maddening, unbelievably draining and frustrating and tedious hell courtesy of one lil' ol' boy. Chinese water torture.

That one, tiny green pill. Amazing.

laughter, remembered

Baby S. laughed today. Really laughed, for the first time. He's almost five months, and of course has been cooing and ooing and gooing for quite a while. He's the sweetest, happiest little thing. But today, it was a real laugh. A. was here with me on the bed while I moved his arms up and down, as if he were doing jumping jacks, while making a very silly high-pitched sound at him. He thought it hilarious, obviously. Quite a moment.

I remembered, too, that when we adopted A., and for a few weeks afterward, maybe even several weeks, she was physically incapable of really laughing. She tried, but it was so weak. She didn't have the muscle tone and breath control to do it. That's how low her muscle tone was, at 13 months when we brought her home, all fifteen pounds of her. What a long way she's come, and how thankful I am she's ours: bruised, scarred, sick, waaaaay underweight, one side of her head flattened from lying in the crib, couldn't sit without support or even roll over, scared to death, freaked out and traumatized. But she clung to me like a baby koala, and it's made all the differen

I am so blessed and thankful, and right now I feel like the luckiest mom around.

quick thoughts on therapy and self-monitoring

Now that N is more stable on the Zoloft, I see the self-monitoring skills that we and his therapist and teachers have been working so hard to teach him for the past three years or so, start to kick in. If he's not stable in the chemical sense, he cant' seem to make use of any of it. Maybe if he stays stable over time, it might be worth starting therapy again. It isn't that the therapy wasn't valuable. It was, and is, to a person who is in a stable enough mood and state of functioning to be able to implement anything taught or discussed in therapy. When he arrives home from SPACE afternoons, he needs to unwind a few minutes berfore being able to join the family for dinner. This will usually involve some goofiness, yelling, hyperactivity, agitation, just letting go of the tension, I guess, at the end of the day. After a few minutes of "me time," he's generally okay. He now heads straight to his room or the basement for his "me time" every afternoon--often without any reminders.

This is N taking responsibility for himself, being a responsible person. I am so proud of him when he does this. For some kids, being responsible might be not yelling or acting out in the first place. With N, he is what he is. For him, being thoughtful, proactive, and responsible enough to monitor himself, try to keep himself and others safe and preserve relationships, etc., well, THAT''s what I call responsibility. And maturity. Way to go, N.

full dosage zoloft, update

N has been on the full prescribed Zoloft dosage, 24 mg. daily, one tablet in the morning, and we continue to see even more improvement. It's a real revelation to us, seeing his personality seem to actually change into the person he should have been, could have been, is, and perhaps can be. He is so much more easygoing. The prickly porcupine is showing up around here less and less frequently. A calls these animals "poking pines," but I digress.

Another observation: He and A play "baby" (house) quite a lot. He is playing police and bad guys/violent fantasy play much less. Not that it's vanished altogether, and in extreme moderation, I think it's okay for him, when he's thinking straight and his mood is normal. Particularly when he's with other boys, it's comes with the territory, no problem. But he's playing non-violent, non-emergency dramatic play probably, oh, seventy percent of the time, with A, maybe even more. Hmmmm . . . coincidence? I think not.

I believe the SSRI's are actually very, very good at reducing anxiety, and obviously, this was a big part of the problem--the fight/flight thing. And he's so happy! Man, that low serotonin is, apparently, a real bitch. Some study in Finland on murderers revealed that ALL the murderers they autopsied had low serotonin. Seems to play a big, big role in aggression.

Yesterday was a really good day, a trip to IKEA!! Normally, this is one of those I'd-rather-have-a-root-canal-with-no-anesthesia things with N and the other kids (because of him, not A and the baby). But it was actually not too bad. And last night we had a good laugh, all of us, over Drumstick ice cream cones, before the kids went to bed. He was laughing at himself a little, even, and able to let Matt be silly without freaking out and yelling at everyone and calling his father an idiot, a freak, or a jack---. He just laughed along. It was great.

Lying in bed, I said to Matt something along these lines: It's amazing the damage a mentally ill person, a brain-disordered person, whatever, a child who is dysfunctional, can do to a family. It's really tragic the way they can warp the family and take the fun out of everything. After a while, you think, why even bother to try having a good time? Just grit your teeth and try to keep everyone safe, try to keep him out of the psych unit this time.

I don't know how long it will last. But we are enjoying the ride, that's for sure. We all are.

early maternal rejection causes lower serotonin levels

Very interesting and relevant study, for those of us whose children came to us through adoption after being separated from, or abused/neglected by, birth mothers. This will be of particular interest for those of us raising post-institutionalized children. Infant monkeys whose mothers were abusive or rejecting ending up having lower serotonin levels as adults, lower than those monkeys whose mothers were more accepting and non-abusive. This low serotonin level, in turn, led those monkeys who were rejected by their mothers, to be rejecting and abusive to their own infants. This study is concentrating on the theory that it's caused by low serotonin, rather than some kind of imitative behavior.

Here's the link:
http://www.sciencedaily.com/releases/2006/11/061102092229.htm

N and A, still together

The lovefest between N and A continues. There've been a few spats, sure, but overall, they're stilll doing very well together. This afternoon, N read three books to her. They spent at least an hour, probably more, playing "baby" together this morning, taking her dolls' temperatures, giving them shots, etc. They have an imaginary pet called "Dogbot," part robot, part dog, I guess. No doubt about it, N is functioning better-- FUNCTIONING better--on the Zoloft. That's the bottom line, I guess. It is making him more functional in life, everywhere. It has not solved the problems, but he's just easier to manage these days, and the blowups are milder. There's some low self-esteem talk, still, but not so much. He does get into the wacko violent talk a little, still, but there's much less of it. We are slowly, very slowly, increasing his dosage of Zoloft to try and get the maximum benefit possible without pushing him into mania.

article -- serotonin and judgement

N continues to improve on the Zoloft, an SSRI, which boosts the level of serotonin in the brain. Tonight at dinner, he said "Every day is a gift from God." This doesn't sound like the N from the last couple of years. He has been playing, and playing WELL, with his sister almost constantly. Just a few weeks ago, we had to basically keep them apart most of the time because he was so volatile and would strike out at her for almost anything, with absolutely no warning. He said the most horrible things to her and threatened her terribly. He didn't even want to play with her most of the time. He seems much more relaxed and less irritable. It's really quite a striking change.

Now, things aren't perfect by any means. He is still N., and he is still difficult. But I'd say there's probably been at least a fifty percent overall improvement in his mood and behavior. That's remarkable. I know it's the Zoloft. Anyway, here's an article that describes N's problems to an uncanny degree, and links it to low serotonin, which is remedied (usually) by an SSRI.

Dinner tonight was weird--so peaceful. He even LOOKED different. I guess if you're not scowling all the time, and you're not always on the verge of blowing up, maybe your face might look more pleasant, normal, and relaxed. And if you're not so tense and hypervigilant, you can actually look NORMALLY happy and ok and peaceful, so that when you are in a good mood, you're not bouncing off the walls and acting like a caged monkey on speed. I don't know, he just looked . . . normal, when his eyes met mine. He wasn't his usual roller-coaster self, but not zombied out, either.

Anyway, here's the link: It's from the Society for Neuroscience.

http://www.sfn.org/index.cfm?pagename=brainBriefings_serotoninAndJudgment

great research site for FASD

Here's a site I found -- NOFAS (National Organization for Fetal Alcohol Syndrome) with TONS of links to research studies showing the devastating effects of alcohol on a fetus, and later on the child and adult, as well. It is linked to ADHD, severe behavior problems, lowered iq, school failure, violence, incarceration.

A study on FASD rate in a Russian baby home in Murmansk is available on this page. The rate of facial feautures consistent with prenatal alcohol exposure was MANY times higher than in the general population, and that's only the babies with the facial features. Many more will have problems just as severe, though they may look perfectly normal. There was also a study of a Russian internat school, basically an orphanage for older kids, and the rate there was also, expectedly, very high.

It's hypothesized, and there's even some emerging evidence, that very intense early intervention in the form of constant stimulation, interaction, and nurturing can greatly improve outcomes for kids with FASD--but here's the catch: It has to be done in the FIRST TWO YEARS OF LIFE. Obviously, a child in an orphanage won't be getting this in their infancy and toddlerhood. Does it suggest that the damage from FASD could be even greater when the opposite is true? When the baby and toddler does not even receive the basic nurturing that any child needs? When their mother is unavailable, which is just about the worst thing that can happen to a human infant?

Those of us parenting Russian adoptees will not be surprised with this research. Here's the NOFAS site:

http://www.nofas.org/news/FASDnews.aspx

update on zoloft

N. is still on a super-low dosage of Zoloft, and it's definitely working. Hasn't improved his impulse control, self-regulation or any kind of behavior, but it's doing what it's supposed to do, which is make him happier. WAY less morbid talk, and in general, his mood is brighter. He's as difficult as ever, but seems happy, anyway. He sees the endicronologist tomorrow about his awful weight gain, and I'm hoping she might order us, more or less, to take him off Lithium again. Last time, we ended up putting him back on, but this time, who knows? He is erratic and difficult on meds and off, so perhaps we can try again.

clinical study--Zoloft helps kids, too

I found this link describing a clinical study of 376 -- that's a fairly large sample--children, who improved over a ten-week period on Zoloft. It's an SSRI, which means it regularizes serotonin levels in the brain. More on this later.

Here's the link:
http://www.usatoday.com/news/health/2003-08-26-depression-children_x.htm

zoloft, miracle drug?

I had this feeling . . . just a hunch, just intuition, Mother's intuition, maybe, but I had this nagging sense that we should try an anti-depressant again for Nik. I knew we had to be careful, since anything "up" can send this kid into screaming, lunatic mania-land quicker than you'd believe. Actually, he doesn't even need a stim or anti-depressant to end up there. But we'd only tried ONE dose of Prozac ONCE, about three years or so ago, and since he became very agitated and aggressive just a couple of hours later, we thought maybe we shouldn't try the ad route, again. Many kids along the Bipolar spectrum can't take anti-depressants for exactly this reason. The lift in mood sends them into mania, increased agitation, anxiety, etc .

So, to sum up, I asked his p-doc if we could try another anti-depressant. Just seemed like sloppy thinking to rule out an entire class of very helpful meds based on one small dose, one time. So she suggested Zoloft. Lately, we'd been hearing more of the morbid, "kill me," "I deserve to be shot" kind of talk, and beyond sympathizing with him for feeling so low, I'm beginning to wonder about the effect on Anna of hearing this ultra-violent, morbid, wacko, very disturbed talk all day long. So the doc agreed, said Zoloft might be less activating than Prozac.

We started off at a very small dose, 12.5 mg. once a day. And yes, he did become more manic-like, and yes, things went south at school. He became even more difficult, swiped at a teacher with his open hand, opened a door into another teacher's body so it was a contact type of thing, definitely aggressive, went back to level 1 on their level system (he had been at four or five), and I started getting the phone calls throughout the day again. But I didn't want to blame it on the Zoloft (though it probably was due to this) too quickly, said let's hold tight and just wait a few more days, weather this storm. Sometimes, the initial reaction to a med doesn't last.

I had a talk with him about the word "assault" and informed him that teachers have been known to press charges against bigger kids who attack them. He sobered up. He lost his lunchtime stuff, and had to spend a morning in the time-out room. And---Matt gave him Tenex and put him back on Risperdal, and I know that helped. The next day was better.

And most encouraging of all, the kid is noticeably HAPPIER, and his mood is brighter--most def. Matt and I agree. It's one of those things you can't quite put your finger on, but it's different. He's talking purposefully about the future, talking less about death and killing and being devil's spawn. He is really, really happier. God BLESS the evil pharmaceutical industry. More later.

worth the pain, morning reflections

At this moment, I'm doing something I never would have dreamed possible even a year ago: I'm watching my three month-old baby boy kick and punch the air like a tiny boxer, trying to reach small dangling birds, cows, and plastic beads from his baby gym. His eyes are still blue, and hair still quite reddish, and I'm sure this can't last. Both Matt and I are blonde, with greenish hazel eyes. Still, I can hope that, through some miracle of recessive genes, he will keep the blue eyes, maybe even the red hair. He is a miracle. After many, many years of infertility and no need to even bother with contraception, along comes this baby just when I was sure nothing like this would ever happen. He is a ray of sunshine in my life, as my Mom predicted. He is a miracle, as his Dad has said more than once.

It's reassurance of some kind, I suppose, some kind of bulwark--or distraction, maybe--against the sadness and discouragement I feel this morning, thinking of my oldest son. He starts a new medication today, and by now I know not to get my hopes up. But they're up, anyway. I can't help it. Maybe I don't want to help it. Maybe I want never to stop hoping we'll find the "thing" that lifts him out of his sadness, his darkness. How could anyone be depressed, truly depressed, and so troubled, at only nine years old? Actually, I can remember him talking about hating himself much younger, as young as four or so. He feels like he messes up, does the wrong thing all day, every day, again and again, and concluded long ago that he doesn't like himself much, that he's a bad kid, that only someone "pure evil" (his words) would do the things he does. His impulsivity is so hard to overcome. His self-regulation is so very poor. Yet he also has a conscience, the ability to feel and express love, and he knows many of the things he does are just plain wrong. Yet he does them over and over again, then feels so guilty about it all and so hopeless about himself that he is filled with darkness, blackness, morbidity, and he feels alienated from all that is good in the world. And the thing is, no matter how hard I try and wish and pray, no matter how much I yearn for him to just FEEL BETTER, be happy, be content, not hate himself, I don't seem able to change it, change him. How many nights have I held him, telling him again and again how precious he is, how much he is loved, that no one is a mistake, that God loves him just the way he is, as do we. I tell him no one is all bad or all good, that we're all a mixture of the two. I try everything, say everything. And sometimes he feels better, but it's just a band-aid, just for the moment. Apparently, I can't change him from sad kid to happy kid, no matter how I try. It's humbling, the limits of a parent's influence and direction in a child's life.

The big question is, is he depressed for more psychological reasons--guilt and despair over himself and his impaired functioning in the world? Or is it a more genetic destiny kind of thing, in which he would feel depressed anyway, more from a chemical imbalance resulting from genetics or early environmental factors? If it's the latter, maybe an anti-depressant can help, if he can tolerate it, which is far from certain, since he also is diagnosed wth Bipolar Disorder. Many people with Bipolar cannot take anti-depressants, or if they do, they're so activating that they become manic. I shouldn't have my hopes up. Maybe one day I'll learn not to.

But if I lose hope, I guess I've really lost him. Maybe I can hold onto hope for improvement while not putting so much of myself into that hope, that I'm destroyed when it doesn't materialize.

working memory, the new iq?

Found this article on yahoo yesterday. Seems researchers are concluding that working memory is the most important factor in how well a person learns academic material. It attracted my attention because N's testing revealed deficits in working memory; this is very common in people with ADHD, FASD, and and other neurologically-based problems. Put very simply, it's the ability of a person to remember several things simultaneously, holding one in place while incorporating other bits of info, without losing the first bit. So if you're reading one of those reading comprehension passages on a standardized test, you'll do pretty well if you have good working memory. If, on the other hand, you don't, then you might have forgotten the point of the first two paragraphs by the time you get to paragraph # 5 or 6. It also probably explains why so many of our kids have problems with daily functioning--it explains one piece of the puzzle, anyway. Sometimes, it isn't that they're disobeying or being lazy or whatever, just have trouble remembering what they're supposed to be doing. N., for instance, routinely blows up if you give him more than one or maybe two instructions at a time. We've learned to break things down and only tell him one thing at a time.

Anyway, here's a link to the article on working memory:

http://news.yahoo.com/s/nm/20080302/sc_nm/memory?learning

"What You Pawn, I Will Redeem"

I've been reflecting lately on a wonderful short story I read a few years ago, by Sherman Alexie. It's called "What You Pawn I Will Redeem." I believe it was published in The New Yorker, and later won some awards. It's the story of a middle-aged, articulate, native American alcoholic man living on the streets of Seattle. In the story, the man (who calls himself Jackson Jackson) walks into a pawn shop with some friends one day and sees his deceased grandmother's regalia headdress in the window, for sale. He tells the owner it's his grandmother's, to no avail. The man wants a thousand dollars for it, period. He says he will hold it for twenty-four hours, and if Jackson can bring him the money, he'll sell it to him. He even gets him started with a twenty (or maybe ten) dollar bill. So Jackson Jackson sets out on his quest. He believes for a moment that if he can get that headdress back, he might bring his grandmother to life again. He is a man on a quest.

The problem is, he's an alcoholic. He manages to make a few dollars selling the local homeless newpaper, feels pleased about it, closer to his goal, and then promptly goes out and spends it on booze for him and his friends. He does this over and over again, never giving up on his quest, but each time, ending up drinking the money away, then picking himself up and starting again. At the end of the story, he shows up at the pawn shop with five dollars in his hand, all the money he possesses in the world, showing up regardless of what he has, to claim the regalia. The pawn shop owner looks at him and asks one question: "Did you work hard for this money?" Jackson says yes. The owner walks over to the window and gets the regalia and hands it to him. Jackson walks out of the pawn shop with an ecstatic shout:

"Do you know how many good men there are in the world? Too many to count!"

Then he puts on his grandmother's regalia and goes out into the street and dances, blocking traffic but not caring because for a mystical moment, he achieves some kind of union with his grandmother and feels her presence again.

This story resonates with me not only because it's a beautiful statement of perfect grace, but because Jackson's seeming helplessness reminds me of the pattern experienced by those with FASD, in particular. They wake up with the best intentions, most likely. Then they spend the rest of the day doing the wrong thing, over and over and over again. They feel guilty. They might resolve to try to never do the thing again. But before the day is over, maybe before the hour is over, they'll do it all over again. And they'll feel like dirt, feel like they're bad beyond redemption. And every day, this is repeated over and over, the cycle. It's hell.

I see this so much in my son, and it is absolutely heartbreaking. You feel so helpless and frustrated, try to keep hope and not give up, try not to show how disappointed you are. But sometimes it comes through because we're only human. My son does the wrong thing all day long, most days. He asks me, "How can I be a good person if I do bad things?" "Why do you love me when I'm so bad?" I know beyond any doubt that he would love nothing better than to have more "self-control." If you ask him one thing he could change about himself, he'll say ADHD. ADHD is what we use to explain his disability to him, the way his head works. Of course, there's more than ADHD going on, and psychological problems on top of that.

It brings to mind a fundamental dilemma: How much personal choice does he really have? Can someone who is obviously impaired in the areas of impulse control, memory, self-regulation in general, be held to the same standards as non-impaired people? Yet accepting that he will be unable to control himself means giving up on him, in some sense, giving up on the idea of his ever living any kind of normal life. Should I not make him feel guilty about taking things that don't belong to him, or lashing out physically? If not, or if we dont' try to change him, that means without a doubt he will end up in a jail or some sort of mental hospital or residential facility. That seems unbearable. How do we protect him from the consequences of his actions, impaired or not? Of course, the obvious and cliched answer is that we can't. I know that. But it's a hell of a predicament. When we talk about changing him, we're talking about trying to fix a computer that's broken, and I don't know how. It isn't that he has NO control. When the stars align, meaning when he has an adult person or some very strong limiting factor RIGHT THERE two inches from his nose, he can choose -- sometimes -- to do the "right" thing. Sometimes the right environment can make this possible. But when he's not getting immediate feedback, reinforcement, control, whatever, all bets are off. And if he goes into fight/flight too quickly, the environment or management won't matter much.

I don't know the answer. I don't know how to balance "He's got to learn somehow not to break the law" and "He has to learn to function in society" with "I know there are certain things about him that can't be changed, and I know he doesn't have the same capacities for control and self-regulation that non-impaired people do." Would it do any good to try to teach a kid with a sprained ankle to keep up with the rest of his classmates in a fifty-yard dash, or to run without a limp? Staring me in the face is this frightening and crushing fact: At nine years old, after YEARS of giving it our best shot--reward and punishment, lectures, therapy, counseling, various parenting techniques, even a few mild spankings when he was younger (until it became clear they didn't help the problem), basically giving it everything we had--he is often as violent and defiant as he was at three years old. That same kid who threw his little plastic chair at the window at three is the same one who threw his notebook at me and hit me in the arm yesterday. And it's the same kid who felt so bad and guilty and low about his behavior that he called himself "pure evil" and "idiot" a few hours later and couldn't stop making references to killing and death. 

Something in this cycle reminds me of Jackson Jackson, of his doomed life and the futility of wanting to be a  better person. Maybe someday he'll be dancing in the street after someone redeems his pawned treasures, lets him off the hook in a moment of pure grace and pardon. Or maybe it really is hopeless. That's more how I feel today. 

A Good Day!

Nik's teacher made my day by writing in his daily planner that he had a GREAT day and worked VERY hard. Wow! She also said he wanted to talk to me regarding a playdate. Wow again! Maybe he's settled into the routine of the new school or they've learned what makes him tick and how to handle him. Or just as likely, he's just having a good day and I should leave it at that and just enjoy the feeling. Is it possible all that fish oil is actually doing something for his nervous system?Whatever the reason, I'm one happy mama right now.