This may seem like an odd title for a post, but that's the way I feel right now. I feel like one of those acts where the performer is trying to keep a bunch of plates on poles spinning at the same time and make sure they don't all come crashing down.
Thus, a forewarning: This blog post may be a bit rambling and all over the place as I try to touch on the various spinning plates in my mind right now.
In most cases, these are actually good things. I've gotten the ball rolling on a lot of issues on my long-term to-do list for myself and the kids.
Hmm, maybe it'll help if I break down the topic going by each child. I hope they will forgive me for putting all their personal business out there, but if Mommy doesn't share some of these thoughts piling up in her head, the pressure's going to cause an explosion.
Let's go oldest to youngest.
Andrea
Something changed with Andrea the year she started school. Until she was 4 years old, she always seemed like a very content, happy, outgoing child. Suddenly, she developed a lot of anxiety. Every year since, this anxiety had grown exponentially. It's the only issue the teachers ever have with her. She's intelligent, responsible, hard-working, reliable, kind, a good helper, and a good leader. However, I inevitably get the calls and the parent-teacher conferences about Andrea's anxiety in the classroom. The sudden breakdowns into tears. The frustration. The defeatist self-talk.
It's not just at school, either. Well, yes, there is the related breakdown during homework pretty much every night. But she is also extremely sensitive. Any constructive criticism and she's upset. If you talk about anything medical, she becomes a panicked hypochondriac. If I even raise my voice slightly, use a stern tone, or be sarcastic, I'm "yelling" at her or "being mean" (and consequently, she's in tears). She also panics over things that seem unreasonable to the rest of us. And when I say panics, I mean basically has an over-the-top-nervous-breakdown-type-reaction with raised, high-pitched voice, anger, tears, and she will not listen to reasonable suggestions for solutions. In terms of the anger, in her panic state she lashes out at whoever may be nearby. Kevin usually takes the brunt of this. He'll come to see what's going on and she'll start screaming, "Go away!" and trying to shove him or threaten him. Does Kevin act the instigator sometimes? Yes. But lately, he's actually been there genuinely trying to cheer her up or offer suggestions of the type we give him when
he's upset.
Andrea and I have had some serious talks lately about what's been troubling her. Her focus seems to be school. She feels she is too shy and can't make friends (but she does have a best friend, and generally gets along well with others). She feels like she can't keep up with the class work and the teacher will be mad at her. She says she's the only one in her school who gets upset and cries so much. (None of these things are true, but I can't convince her of that.) I also know she's dealing with a lot at home. Being the older sister of two brothers on the autism spectrum must totally suck (although she does sometimes mention the positives, like getting to go to the Autism Ontario picnic). Occasionally she'll show her true feelings with an outburst like, "You treat Kevin like a king!" and "You love them [the boys] more than me!" and "You don't care about me!" and "You don't understand me!"
We're doing our best to help her. She goes to the sibling group at Summit Centre each month, and she really enjoys this special gathering just for kids with brothers and sisters who have autism. We've also signed her up for a second round of Sibshops this fall. That's a sibling group put on by Autism Ontario that lasts about 8 weeks, one night a week. We did that last winter and she got a lot out of it. She thought it was really fun, too.
As for the school issue, we've tried to teach her some relaxation techniques and encouraged her to voice her concerns to her teacher. Unfortunately, she's too wound up and too afraid to speak to her teacher. All of Andrea's teachers have been kind. We haven't had one yet that we've had a problem with, that we didn't like, or who didn't try to help Andrea with her school anxiety. It's on my to-do list to have a good chat with this year's teacher about what we can do for Andrea. But first . . .
I've finally taken action on getting some psychological help for Andrea. Anxiety and anxiety-related disorders run in my family. It's been on my to-do list for a few years now, and about 2 weeks ago, I finally called the Regional Children's Centre and put in a referral for Andrea. They offer free, individual counselling services with a child psychologist, as well as group therapy sessions for children with high anxiety. There is a waiting list, of course, but as Andrea's anxiety-related issues have continued to become more intense with each passing year, I'm glad I've at least got that in progress.
Andrea's an early bloomer, too, so puberty is going to hit within the next year. I see the physical and emotional signs. And emotions are only going to get more wild with puberty. Her ups and downs are so erratic right now, I've honestly had some concern about manic-depression or bi-polar.
Anyway, as I mentioned, Andrea and I have had some deep discussions lately and when I explained what anxiety is, and how it runs in our family, and how I've put in that referral for her, it was like a huge relief came over her. I think it actually comforted her to know it has a name, she's not alone, and we're seeking help.
Kevin
Let's keep the mental health theme going, why don't we?
This summer, when Kevin came up for eligibility in the Thames Valley ABA services program again, the greatest need was once again in the area of emotional regulation. Of course, it had to be the toughest issue to tackle. We tried this the last time he had services (over a year ago!) with no appreciable changes resulting. Anyway, in the course of doing his assessments for this round of ABA intervention, the coordinators expressed a great deal of concern over Kevin's violent outbursts (hitting, throwing things, screaming) and his high level of crying and anxiety.
Consequently, they set us up to see a child psychiatrist at Maryvale. I know, Maryvale has a reputation for dealing with "bad kids" or "troubled teens." Let me dispel that myth now. Please visit the Maryvale page for more information:
http://www.maryvale.ca/ It is a wonderful community resource which helps children and teens with mental health issues on both an in-patient and outpatient basis.
Anyway, back to Kevin. We had an assessment at Maryvale with Dr. Ahmad, a child psychiatrist, last week. She was very kind and did her best to get Kevin to open up and talk to her. I tried not to interfere too much except to prompt him for answers a few times and explain some things he said which she didn't quite understand. Overall, she said his emotional regulation/behavioural issues are totally consistent with his autism diagnosis. She was extremely supportive of the ABA therapy program we are currently doing with Thames Valley focusing on Kevin's emotional regulation. She basically said she would have suggested the exact same strategies as them, so she's not going to interfere in that. As for Kevin's anxiety, after looking at our family history, she offered medication if I was interested. Yes, I was! I had been debating the medication route for Kevin for some time, but to have the validation of a specialist made the decision much easier for me. She decided to put him on Prozac, at a very tiny dose, once a day. It is in liquid form, so it's easier for him to take. We are very slowly increasing the dosage each week until he's up to a possibly 2.5 ml per day. She said it will take about 4 weeks before we actually start seeing any effects, as the medication has to build up in his system.
So far, there have been no side effects. If anything, we've already seen an increase in the times he's been thoughtful and helpful towards others, and a slight decrease in his negative behaviours. He's also making great progress with his three ABA programs to help with emotional regulation. Well, it's one ABA program with three target areas: waiting, tolerating "no", and following a schedule to decrease his time spent playing video games. In our baseline data, we found these were the three things that usually triggered his negative behaviour. He has difficulty waiting for things he wants or things he wants to happen, so we are slowly increasing the time he has to wait and using different prompts and reinforcements to aid in that. He is doing excellent; we're already up to waiting for 10 minutes (we started at just 3 seconds!). For tolerating when he is told "No," he is also doing great. We're up to Step 3, where he simply accepts the "no" and moves on to something else. We started at him accepting "no" in exchange for something he might want even more. Then we moved to accepting something equal to what he wanted. Now, he's just working on accepting the "no." Finally, and the toughest one, is decreasing his video game time. The reason behind this is that it is well-documented that playing video games increases agitation and anxiety. However, since this is Kevin's "happiest thing" (in his words), we knew we couldn't completely eliminate video game time. The idea behind the program is to let him play for designated amounts of time, and schedule other activities in between video games. It's good because the less time he plays, the less likely he'll get frustrated when the game doesn't go the way he wants; also, it encourages him to try new activities or at least spend time doing other activities he enjoys. Right now, we're at a half-hour of video games with a ten-minute break for something else. Being back in school has really helped this program because he's not at home so much and busier with school-related things.
Speaking of school, it's not all roses, but he had a very good start. There was some anxiety, but he got the teacher Andrea had last year, who is a very kind lady and familiar with Kevin. Still, on Friday, I got TWO calls from his teacher. Ugh. She had "some concerns" to discuss, which unfortunately, are things we've dealt with in the past. Kevin has been helping himself to his classmates' lunches, snacks, and drinks again. He's so impulsive; he sees, he wants, he acts. He doesn't take the time to think of alternatives. The teacher doesn't like to isolate him, but she suggested he sit at a separate desk for now to avoid temptation. I agreed. It's not a permanent move; he'll get to try eating at his own desk again soon. He's also had a few incidents of lashing out at people who accidentally hurt him at recess or gym class, or bumped into him in the hall or coatroom. We just can't seem to get the idea of, "If they hurt me, they need to feel my pain," (his words) out of his brain. The difference between accident/on purpose is meaningless to him, and the concept of forgiveness is lost on him.
The second call was because Kevin took another child's agenda and hid it. Did we have it at home? No. Did Kevin know where it was? "No . . . I put it back on his desk." Um, nope. It ends up Kevin had put it in another student's desk. Probably the one closest to his. Kevin is all about selective hearing and shortcuts.
We're also struggling with him lashing out at Andrea at the end of the day. They are both dismissed a bit early, so we can pick up Ryan on time. Now that Andrea's in a new area of the school (junior), their coatrooms are separate and they don't come out together like last year. Kevin has this obsession with "being first" and "beating Andrea." His teacher says he's agitated for about 15 minutes before his dismissal time, eyeing the clock, anxious to leave so he can get to mommy first. On the days when he sees Andrea reach me first, he either shrieks and/or threatens to punch her. We discussed a plan to get Andrea to meet Kevin like they did last year, so they can come out to me at the same time. On Friday, although they came out the main doors together, Kevin still ran across the hallway yelling, "I'm first! I beat you!" Sigh.
But somehow, he still manages to win everyone over. Because he's so darn cute. And funny. And smart! He's got an explanation and a story for everything . . . of course. His teacher just loves him and has nicknamed him "Mr. Math" because he is doing the work she's giving the grade 3s (he's in a split grade 2/3). She also says his literacy is excellent. In terms of the way autism was diagnosed before the
DSM-V came out, I think Kevin is definitely an Aspie (
Asperger's Syndrome). Actually, Dr. Ahmad suggested we look into having Kevin re-assessed within the next year or two as he has changed quite a bit since his original diagnosis of Mild Autism about 3 years ago.
Ryan
Oh my little Ryan, always so much going on . . .
Let's start with the biggest event on the horizon: on Monday, Ryan starts junior kindergarten at H.J. Lassaline School! It's the same school his sister and brother attend. It is fully integrated. He will be attending full days on Monday and Wednesday this year, and will still be at Summit Centre for the other weekdays.
At least, that's the plan. And plans can change. Here's a good example:
The other JK's started in a staggered entry from September 2 to September 8. We decided to wait for everything to settle down and everyone to get settled in before bringing Ryan into the classroom. That's why we chose September 22 for Ryan's start date. Well, I got a call on Friday afternoon from the Board's Spec. Ed. Coordinator telling me there have been changes at Lassaline. Two new teachers have been added to to the staff (good for the school), but that means that some of the children will be changing classes on Monday, so there are going to be some upset/re-adjusting JK/SK's in the room. So, would we mind cutting down Ryan's first day to just until first recess? Or maybe lunch? What do we think?
Well, I think WE PURPOSELY DELAYED HIS ENTRY TO AVOID THIS. NOW HE'S GOING TO BE IN A CLASSROOM WITH AGITATED/ADJUSTING KIDS WHICH IS EXACTLY WHAT WE DIDN'T WANT. YOU ARE ALSO INTERRUPTING HIS FIRST FULL DAY AT SCHOOL. IT'S NOT GOING TO MAKE AN EFFING DIFFERENCE WHETHER HE'S THERE A FULL DAY OR NOT.
I said, "I'd like him to stay at least until lunch."
Then, he asked, "What time are you thinking of bringing him in? It might be better if you brought him later in the morning."
Well, I think WE'VE PLANNED ALL ALONG TO DROP HIM OFF AT THE SAME TIME AS HIS SIBLINGS SO HE CAN BE WITH FAMILIAR PEOPLE AND I DON'T HAVE TO CONFUSE HIM BY MAKING TWO TRIPS. ALSO, WOULDN'T IT BE MORE DISRUPTIVE FOR THE CLASS FOR ME TO BRING RYAN AND ALL HIS GEAR IN AND GET SETTLED ONCE CLASS IS IN PROGRESS?
I said, "I planned to bring him in when I drop off my other two children, before class starts."
He hesitated, but said, "Okay, I understand, since you're already there for the other two children."
[Picture me, mentally giving him the finger.]
Let's just say, I'm very much like my autistic boys in not adjusting well to unexpected changes of plans, especially in a situation that is already new and already extremely stressful. :p
But let's look at the positives of this. I know Ryan is getting a good teacher. I know they are prepared for his arrival because we've had meetings, they've observed him, and Summit Centre and I have sent the teachers and students all kinds of things to help them understand autism and get to know Ryan. I know there will be an EA to focus on Ryan (one in the morning, one in the afternoon). I know at least one of the EAs has worked with a severely autistic child for a few years and the other I know from seeing around the school, and she's met Ryan. I know a person from the Board's Spec. Ed. team was at Summit on Friday to observe Ryan, and that same person will be spending the day with Ryan at Lassaline on Monday. She will make sure they have everything they require to meet his needs, and may start making recommendations for what his school program will look like (
IEP).
I'll be honest: every time I really let myself think about Ryan starting junior kindergarten, I start to cry. It is terrifying! Parents are always nervous and excited and emotional when their little ones start school. But this is so much more. I want him to have this experience. I want him to have this opportunity. I want him to be surrounded by dozens of children his own age so he can learn and imitate and socialize and have fun. But at the same time, it's like putting a baby in a JK class. [By the way, I cringe whenever Andrea or Kevin refers to Ryan as a baby, and I even hate it when my brain makes the comparison. I feel like we're underestimating his abilities or belittling him. I know we're not, it's just . . . Sigh.] He can't speak. He's in diapers. He can barely feed himself. He doesn't understand concepts like ABCs and 123s. He can scribble, but he has no idea how to use a pencil for writing. He is still
learning how to learn. He can cry, but how will they know what's wrong? I'm his mom. I can usually figure it out because he's my little guy. How will they be able to help him? Will they be able to teach him? Will the children be kind to him? ignore him? overwhelm him? or hopefully, love him? So many unknowns.
Thank goodness he's still with Summit Centre for 3 days a week. That is my rock. That is my comfort. I guess that's why we did it this way. I know Summit Staff will be there to support Ryan's transition 110%. THEY know Ryan. THEY know how he learns best. THEY know his strengths, his weaknesses, his motivations. And they'll be there to help Lassaline get to know Ryan over the next year, too. Summit staff are so excited for Ryan's new journey. They keep reassuring me, "He's ready." Maybe it's just me who's not ready. It's so hard to let your little one go into the hands of strangers, and trust those people will love and care for them as they deserve to be loved and cared for.
Especially when that child has special needs, and does not have a voice of their own, and it is your responsibility to be their voice. But a big difference between Summit and Lassaline is how involved the parent can be. Summit is all about parent involvement: I can walk in any time I want and ask to observe what they're doing with Ryan. In fact, it is
mandatory to do that for
at least 2 hours a month. On top of that, they're doing programming at home every Thursday. Not only do I get to watch and listen for the whole day, I'm also
expected to do an hour of active parent coaching each Thursday. I love this. I know exactly what's going on with Ryan's programs, how he's progressing, and how his day has been. I also get detailed, daily reports in his communication book from Summit. On the other hand, Lassaline is a regular school where parents are discouraged from visiting the classroom (it's disruptive, and they want to foster independence in the children), and the teacher has 30 other little people to worry about, so communication is spotty and not particularly informative. Not knowing what Ryan's day-to-day at Lassaline is going to be like will probably kill me. Or at least turn me grey.
Okay, deep breath. Stop thinking about Ryan starting JK and mention some other things.
In my last blog update (in July!), I mentioned Ryan's uncontrolled crying outbursts and the possibility of some medical investigations to try and sort out that situation. The good news is that the uncontrolled/unexplainable crying had decreased dramatically since the end of August. It still happens occasionally, but it has gotten much better. [*knock wood*] We finally got in to see his regular pediatrician on September 3. Again, the good news was, after a thorough examination, the doctor couldn't find any obvious causes for Ryan's distress. He's in perfect health (besides autism and developmental delays). The doctor suggested it might be behavioural/psychological and likely related to autism (duh!). So, the bad news is, we sill don't have any answers. The next step--it's on my to-do list--is to try and get a referral from one of our doctors to see Dr. Morgan. She's a highly-recommended pediatrician who specializes in children with autism . . . but also has a long wait-list. I've heard she might make an exception for us considering our circumstances. We'll see.
Ryan has so much he's working on right now in terms of programs that I don't know where to start. I'll mention a few highlights. At Summit, they've started his toilet training program (yay!). He will sit on the potty for a few minutes about 4 times a day and has even peed a few times. :) This week we tried it on his Thursday at home for the first time. He didn't pee, but he cooperated well and didn't seem too fazed by the change from school to home. He is also doing well on riding a tricycle at Summit. They have moved him from the smooth hallway indoors to the parking lot outside. It stumped him at first because the uneven pavement took more effort, but yesterday his therapist said he took off and rode away like a pro! :) We are also noticing he is making a lot more sounds lately, like "deedee, tick, shh, mum, ch, oh, ga," etc. I encourage and repeat every little sound he makes. He is doing great with his PECS, although he still almost always requests Ritz Bits cheese crackers. ;) We're at a point though where we've got two items on the picture board, one preferred and one not, and he usually picks the picture of the (preferred) item he wants and gives it to us. His pointing gesture had improved dramatically, and when he's in the mood, I've seen him do song actions during circle time that he didn't do before. So yes, there is always progress, but it's on Ryan's slow and steady timeline. We have to be patient.
At home, Ryan is also working on an ABA program through Thames Valley. Ryan's program focuses on food expansion, since that's an area Summit hasn't focused on. His program, like Kevin's, has three target areas: watermelon, bread, and food play. We chose to work on watermelon and bread because they are foods he showed an interest in this summer, and they are healthy (a fruit and a grain). The food play program is basically designed to expose Ryan to new scents and textures, and also activities that will get his mouth/tongue/teeth working together to help chew and swallow food properly. Ryan's food programs are going . . . meh. We had a bunch of progress with watermelon until about 3 weeks ago when he caught a bad cold. After the cold, he had a set-back, dropping from step 4 (eating tiny, thin slices of watermelon) to step 1 (totally puréed with me holding the spoon). In the bread program, he was at step 2 (ingest a tiny piece of bread with pureed fruit on it) and dropped back to step 1 (lick pureed fruit off a piece of bread). Recently, he's been completely refusing both at Step 1. :( We tweaked it a bit, and I have Andrea to be a cheerful food model for Ryan. We've made it back up to step 2 with watermelon, but no luck with the bread.
For food play, Ryan usually cooperates with handling new foods and squishing them and smelling them. The toughest part is trying to get him to imitate the oral motor activities (smack lips, stick out tongue, tap teeth together, blow bubbles, etc.). He doesn't understand what I'm asking him to do and usually gets really frustrated. There has been a little progress, though. I've seen him try to purse his lips and blow bubbles, and he also puts his hands on his cheeks sometimes when I do "fill your cheeks with air and pop with your hands." I'm trying to find ways to make it more fun. He's usually more interested when I can get Andrea and Kevin involved (they like making the silly faces), or when I use bubbles as a reinforcement (although that usually ends up becoming a session of him signing for "more" bubbles).
You've probably seen my complaints on Facebook about all the data I'm taking for Kevin and Ryan's programs. It is a bit insane. But I know if I'm dedicated, it will eventually make a difference. We are seeing a little progress in Ryan and lots of progress in Kevin.
Eye Doctor
I put this one at the bottom because it involves all 3 kids. A few days ago, I finally took Kevin and Ryan for a follow-up to see Dr. Moussa, their eye specialist. We last saw him 3 years ago! I let it go because it's about that time that they received their autism diagnoses, so we've been focused on dealing with that, and I felt the eye doctor wasn't a priority. Neither of them had a significant eyesight issue at the time and haven't seemed to develop any issues to date. Anyhow, I figured it was way past time to see that doctor again, so when his office called to book a follow-up this time, I agreed.
I took all three kids because the appointment was right after I picked up Ryan from Summit. They (doctor and assistant) examined Kevin first. They said he has a slight prescription but does not need glasses. His eyesight is fine. However, they did note he still has that weak left eye muscle, and the left eye occasionally turns. It doesn't bother him or affect his school work at all, so we decided not to proceed with any treatment. There are therapies, but they would NOT be covered, so if they're not necessary, then no thank-you. He'll see Kevin for a follow-up in 6 months to make sure no issues have developed in the meantime.
For Ryan, it was much the same. Ryan has a slight prescription, but no need for glasses. His eyesight is good. However, Ryan has issues with his eye contact and tracking (clearly related to autism). They also have therapies for that. These therapies are also NOT covered. So, we decided to book a follow-up appointment for Ryan in 6 months. Ryan's appointment will be special, though. The doctor has specifically-scheduled slots for his autistic patients which make sure the waiting room is quiet and there are minimal sensory distractions, so the patient is calm and focused as possible. (Good idea: Ryan was obviously neither calm nor focused at this visit. But he hates doctors, in general. And elevators terrify him. We had to take one on the way up to the office.) Hmm . . . I mentioned to his secretary when we booked the follow-up that Ryan was moderate-severe autistic, but she didn't book a special appointment then. *Shrug*
Finally, I asked the doctor if he'd be willing to see Andrea as a patient. It's something I probably should have done years ago. You should've seen the doctor's face when I said, "She's 9. No, she's never had an eye exam." However, she's never had any eye problems (no infections, no problems reading or seeing the board at school, etc.). Actually, I just asked him because
she wants to get an eye exam because she read about one in a book, and she thought it would be fun. I didn't tell him that, though. LOL So, Andrea will see Dr. Moussa with Kevin in January.
Overall
Between the kids and I, we've had 10 appointments in the last 17 days. Yeah, I'm kind of over it. That doesn't even count school meetings and such. But like I said at the start of this post, it's all really things that needed to get done, or put into motion, and there's
still more to do. There's always more to do.
I haven't even bothered to get into everything that's going on with me (don't worry, nothing major, female stuff, TMI). ;)
Just more appointments and paperwork and phone calls and research and therapies and so on . . . as per usual. ;)
***
So, the next big update will be about Ryan's first day of JK! EEK!