Wednesday, June 01, 2011
Aggressive Spring
This time of year is always so crazy because there is so much going on with the kids schedule. Every extracurricular thing wraps up. The school crams in a bunch of field trips. Kevin takes off for a week for work. I take off for a weekend to meet my girlfriends. All the rained out Little League games need to be made up. And then the twins have their birthday right around the last day of school. No wonder I'm a stress monkey.
No wonder M is acting up.... hmmm.
Her aggression has really taken off. If there's something she doesn't want to do and we try to get her to do it, she just immediately goes for the hair pull, or scratching, or biting. She lays on the floor and kicks. And these things I can take in stride and work with (through many hours of parent training, and many more to come) when I don't have to get her out the door somewhere -right now -, or we're out in public. Ugh. I hope it's just a phase. She's not talking yet and this creates much frustration for her. She's really good now at letting us know what she wants. She comes and gets us when she realizes she needs something. She's also too good at getting things herself, so we're constantly training her to not grab, but point. But she can be so impatient sometimes that if you're not completely "ON" and paying attention to her... anticipating what she's going to do, then she takes advantage, which is very reinforcing. It's exhausting.
Somehow the aggression is being reinforced too... and we're scratching our heads. She doesn't get away with anything as a result of being aggressive. But there's always the battle to get her pants on, or keep the shirt on, or to hold our hand. The therapists see the aggression a lot during her sessions because when she decides she doesn't want to work they have to continue the work by doing the hand over hand actions. Sometimes she's passive aggressive and sits there like a ragdoll. Sometimes it ends up being a brawl. They are constantly changing their tactics to see what will work best with her. And she constantly changes too... she used to cry to get out of working. Now she goes for the hair pull.
I consider what it would be like if we just relaxed a little with the therapy.... but then I remember what she was like when we started. She was completely shut down. Her eyes closed to avoid anything too stimulating. She couldn't track. She wasn't listening. She would not imitate. Absolutely no attention for anything. And if you tried to sit her down and play with a toy she would cry and squirm away. You couldn't teach her anything. She would still be like this if we didn't push her through the hard parts. It was hard on all of us. Now see where she is... She's imitating. She's paying attention. Her listening and receptive language is great. She values toys and will play with them, almost appropriately. She enjoys watching us play with her toys. She will sit at the table with me and do little tasks that I ask her to do (I've been working on fine motor skills). Her attention span, while not great, is so much better. I think the ABA therapy has given her these gains because I certainly haven't. And she was perfectly content in the beginning to hide out with the shoe basket sucking on shoe laces or fingering plastic bags.
The ABA director is constantly changing her program to maximize what works for her and to make sure she continues learning. Sometimes they push hard, and then they have to back off. She is getting lots of exercise breaks. She has play time on the floor and work time at the table. She comes downstairs and does work around the house, outside and even some play time outside. They are trying to teach her how to ask for a break by using a 'break' card between each work period.
My job is to keep her fed. Most of her outbreaks are when she's hungry. She goes ballistic if she's being asked to do something she doesn't want to do and it's right before meal time. It makes me wonder if some survival instinct is being triggered and her ability to fight increases because she's unconsciously reminded of not having her hunger needs met when she was in the orphanage. It's like she's fighting to stay alive.
It's tough... we try to meet her needs the best we can. And yet, we can't reinforce the behavior when it occurring because that would just strengthen it. Not the usual parenting. At. All.
No wonder M is acting up.... hmmm.
Her aggression has really taken off. If there's something she doesn't want to do and we try to get her to do it, she just immediately goes for the hair pull, or scratching, or biting. She lays on the floor and kicks. And these things I can take in stride and work with (through many hours of parent training, and many more to come) when I don't have to get her out the door somewhere -right now -, or we're out in public. Ugh. I hope it's just a phase. She's not talking yet and this creates much frustration for her. She's really good now at letting us know what she wants. She comes and gets us when she realizes she needs something. She's also too good at getting things herself, so we're constantly training her to not grab, but point. But she can be so impatient sometimes that if you're not completely "ON" and paying attention to her... anticipating what she's going to do, then she takes advantage, which is very reinforcing. It's exhausting.
Somehow the aggression is being reinforced too... and we're scratching our heads. She doesn't get away with anything as a result of being aggressive. But there's always the battle to get her pants on, or keep the shirt on, or to hold our hand. The therapists see the aggression a lot during her sessions because when she decides she doesn't want to work they have to continue the work by doing the hand over hand actions. Sometimes she's passive aggressive and sits there like a ragdoll. Sometimes it ends up being a brawl. They are constantly changing their tactics to see what will work best with her. And she constantly changes too... she used to cry to get out of working. Now she goes for the hair pull.
I consider what it would be like if we just relaxed a little with the therapy.... but then I remember what she was like when we started. She was completely shut down. Her eyes closed to avoid anything too stimulating. She couldn't track. She wasn't listening. She would not imitate. Absolutely no attention for anything. And if you tried to sit her down and play with a toy she would cry and squirm away. You couldn't teach her anything. She would still be like this if we didn't push her through the hard parts. It was hard on all of us. Now see where she is... She's imitating. She's paying attention. Her listening and receptive language is great. She values toys and will play with them, almost appropriately. She enjoys watching us play with her toys. She will sit at the table with me and do little tasks that I ask her to do (I've been working on fine motor skills). Her attention span, while not great, is so much better. I think the ABA therapy has given her these gains because I certainly haven't. And she was perfectly content in the beginning to hide out with the shoe basket sucking on shoe laces or fingering plastic bags.
The ABA director is constantly changing her program to maximize what works for her and to make sure she continues learning. Sometimes they push hard, and then they have to back off. She is getting lots of exercise breaks. She has play time on the floor and work time at the table. She comes downstairs and does work around the house, outside and even some play time outside. They are trying to teach her how to ask for a break by using a 'break' card between each work period.
My job is to keep her fed. Most of her outbreaks are when she's hungry. She goes ballistic if she's being asked to do something she doesn't want to do and it's right before meal time. It makes me wonder if some survival instinct is being triggered and her ability to fight increases because she's unconsciously reminded of not having her hunger needs met when she was in the orphanage. It's like she's fighting to stay alive.
It's tough... we try to meet her needs the best we can. And yet, we can't reinforce the behavior when it occurring because that would just strengthen it. Not the usual parenting. At. All.
Wednesday, April 27, 2011
Symbolic Play
M's symbolic play is really picking up.
She loves her dollhouse with the furniture. Yesterday at speech M brought some little people figures with her and her therapist brought out a chair. M put them in the chair and pushed them up to a little table. Then the therapist handed her a tiny plastic piece of cake and M fed the people cake. Then she held it up to the therapist's mouth... then she held it up to herown mouth (never putting it in her mouth). I was blown away. She had a smile on her face the whole time...
As her ABA therapist noted yesterday, M is playing with her toys more and more appropriately, and she's taking pleasure from it. It's not a mechanical response.
This morning she's running around the house with the little plastic play knives from the kitchen (sounds bad, right? They're really dull and small). But she was trying to cut things ("No... not the table. No... not the cabinets.) I was cutting onions so I had her cut onions with me. She loved it. I guess she sees me chopping food for her all the time.
Yesterday we had a train video on for her... then she disappeared and ran upstairs and started messing with C's lego trains. I brought out the Brio trains this morning and while she doesn't have the patience to just sit and watch them go around the track she couldn't leave themcalone and worked well for them during her ABA session.
She's pushing cars, putting people in the cars, and running figures down her bath toy slide.
It feels like she's starting to catch up. Can I let out a big sigh? There are still moments when she's spacy or not listening. There are moments when she's tantrumming and being aggressive because she wants her own way. And there's the whole speech issue where she's not saying a whole lot. But a small step in one area gives me hope that she'll be making small steps in all areas eventually.
She loves her dollhouse with the furniture. Yesterday at speech M brought some little people figures with her and her therapist brought out a chair. M put them in the chair and pushed them up to a little table. Then the therapist handed her a tiny plastic piece of cake and M fed the people cake. Then she held it up to the therapist's mouth... then she held it up to herown mouth (never putting it in her mouth). I was blown away. She had a smile on her face the whole time...
As her ABA therapist noted yesterday, M is playing with her toys more and more appropriately, and she's taking pleasure from it. It's not a mechanical response.
This morning she's running around the house with the little plastic play knives from the kitchen (sounds bad, right? They're really dull and small). But she was trying to cut things ("No... not the table. No... not the cabinets.) I was cutting onions so I had her cut onions with me. She loved it. I guess she sees me chopping food for her all the time.
Yesterday we had a train video on for her... then she disappeared and ran upstairs and started messing with C's lego trains. I brought out the Brio trains this morning and while she doesn't have the patience to just sit and watch them go around the track she couldn't leave themcalone and worked well for them during her ABA session.
She's pushing cars, putting people in the cars, and running figures down her bath toy slide.
It feels like she's starting to catch up. Can I let out a big sigh? There are still moments when she's spacy or not listening. There are moments when she's tantrumming and being aggressive because she wants her own way. And there's the whole speech issue where she's not saying a whole lot. But a small step in one area gives me hope that she'll be making small steps in all areas eventually.
Monday, April 18, 2011
All of 5 minutes
I've left myself only 5 minutes today to blog, so quickly...
M was playing with K's dollhouse with all it's pieces and parts... we are seeing symbolic play!
M is beginning to act shy when she is around adults she doesn't see often. Now that's a huge social step.
Monday, April 11, 2011
What IS it? Part 2
I'm practically jumping out of my skin!
This morning M's ABA case director came to the house to observe some of M's difficult behaviors. M qualified for continuing help through our regional center for additional treatment for "challenging" behaviors. These are classified as behaviors that cause harm to herself or others, or harm to property. For example, running off in parking lots or the street, biting, or putting inappropriate objects in her mouth. Our program addresses these behaviors already but now we have extra dollars being contributed that will help take the stress off our own pocketbook.
For two hours I tried to stress M out so that she would have a tantrum and show frustration with me. M was in such a good mood I couldn't incite anything but a whine! I had her performing all her dog and pony tricks.... nothing. The only thing I could visibly show was her putting stuff in her mouth outside. Occasionally she would pat a little too hard for some attention or put her mouth on the case director. I even took away balloons, gummy bears, fruit rollups... she gave them all up without a fuss.
What was truly amazing was that Kat was threading large beads on a string. She was putting small rings on a tippy pole/base. She was building a conic puzzle. I whispered to her to go get her baby for the stroller and she ran to the back of the house, found the baby and ran it back out for us, putting it on the table. This blew away our case director. She said that was "huge!" I think M's program is going to get some new changes because M is beginning to follow multi-step instructions which involve items that she has to search for far away.
Now the clincher... we were outside walking around, giving M the opportunity to run into the street, get messed up in the creek or eat nature. We succeeded in the nature eating part. But the case director said to me that she and the head director of M's program were both discussing M and they both agreed that they didn't think she had classic autism. M was just too social. Most of M's behaviors were attention-driven and this doesn't happen with kids with classic autism. She's too aware of her environment and when things (like her nose running) bother her.
What an unbelievably awesome thing to hear this morning. I can't express the rush of hope that I have coursing through my soul. Yes, M hasn't changed. She still the same challenging little girl. But to have that monkey off my back is ... is... a long overdue relief.
I'll be spending the day trying not to cry.
This morning M's ABA case director came to the house to observe some of M's difficult behaviors. M qualified for continuing help through our regional center for additional treatment for "challenging" behaviors. These are classified as behaviors that cause harm to herself or others, or harm to property. For example, running off in parking lots or the street, biting, or putting inappropriate objects in her mouth. Our program addresses these behaviors already but now we have extra dollars being contributed that will help take the stress off our own pocketbook.
For two hours I tried to stress M out so that she would have a tantrum and show frustration with me. M was in such a good mood I couldn't incite anything but a whine! I had her performing all her dog and pony tricks.... nothing. The only thing I could visibly show was her putting stuff in her mouth outside. Occasionally she would pat a little too hard for some attention or put her mouth on the case director. I even took away balloons, gummy bears, fruit rollups... she gave them all up without a fuss.
What was truly amazing was that Kat was threading large beads on a string. She was putting small rings on a tippy pole/base. She was building a conic puzzle. I whispered to her to go get her baby for the stroller and she ran to the back of the house, found the baby and ran it back out for us, putting it on the table. This blew away our case director. She said that was "huge!" I think M's program is going to get some new changes because M is beginning to follow multi-step instructions which involve items that she has to search for far away.
Now the clincher... we were outside walking around, giving M the opportunity to run into the street, get messed up in the creek or eat nature. We succeeded in the nature eating part. But the case director said to me that she and the head director of M's program were both discussing M and they both agreed that they didn't think she had classic autism. M was just too social. Most of M's behaviors were attention-driven and this doesn't happen with kids with classic autism. She's too aware of her environment and when things (like her nose running) bother her.
What an unbelievably awesome thing to hear this morning. I can't express the rush of hope that I have coursing through my soul. Yes, M hasn't changed. She still the same challenging little girl. But to have that monkey off my back is ... is... a long overdue relief.
I'll be spending the day trying not to cry.
Wednesday, March 30, 2011
Wednesday
After hearing from the speech therapist that she thinks that M definitely has speech apraxia I did some poking around to see what more I can do to help with it. From the little bit of reading I did it appears that the treatment for it is varied and that there is no data-based clinical approach to it. I was surprised at this since with autism the ABA therapy has been statistically proven to make an improved difference. I did read that kids with apraxia should be getting speech therapy 3-5 times/week. We are at 2x/week plus what she gets in her ABA therapy. I'll have to check with the speech therapist to see if that's enough. We are missing speech this week because the incredible rains we have had in the past week caused flooding in the town where her office is and they are mopping up the mess.
It has finally stopped raining but that still hasn't stopped the power from going out. Our road had two good-sized slides blocking us in and pulling the power lines down both times. Since the last cleanup we have lost power again twice.
With the rainy weather and sitting in this coffee shop enjoying the scones, bagels and breads I am starting to accumulate the fruits of my eating without the time to burn it off. I have to increase my activity level. I assumed that chasing M around would be enough to keep me trim but I've been hungrier than usual lately. Maybe because it's spring? K has been eating like crazy too. She joined a running group a few weeks ago and I think the increase in exercise for her from nothing to 4 days/week has her growing and eating. It's good to see because she's on the smaller side and she doesn't eat much. She's almost 10 now and yesterday she said, "I don't understand why sometimes I feel so angry and frustrated for no reason." It really seems like it's too early for those hormones to start kicking in but I wonder. No physical signs yet, thankfully. But K has been complaining that it seems like C is growing up and leaving her behind. He won't talk to her and isn't interested in playing with her like they used to. Then it occurred to me, when K said that C answers her with grunts and groans when she tries to have a conversation, that it wasn't C that was growing up. It was K. She's starting to mature faster than her brother... to even be so aware of them drifting apart and to comment on it. It makes me a bit sad to see my babies growing up but it's a good thing. I just need to remember to stay in the moment so I can enjoy them as much as I can.
Which is hard when the challenges M faces weigh on me every day. Maybe I just worry too much. I try to reckon with God about this whole process by thinking, "We're doing everything for M that we can. M seems smart. M must have some miracles waiting ahead or some grand purpose for her life that we are contributing to." And then I realize how selfish that is... it's still about me. I'm sure God is shaking his head and saying, "What if I have nothing grand planned for M? What if I just need you to love her and take care of her? Can't that be enough?" Yeah, I suppose. But it's difficult. And when life is difficult I think we all look for some greater meaning to help us get through it.
Another friend who adopted her two children from Russia said to me, "You can't compare M to any other kids to measure her progress. You have to only measure her progress with respect to her own gains." Or something like that. If I think about it that way I'm pretty content that we are on a good path because she makes progress daily, albeit slowly. But when I think about it, she is imitating now. Her biggest hindrances at this point are 1) she can't communicate w/ us and 2) she's not paying attention much of the time. I'm trying another thing... the enzymes have helped us the past two months with regard to her attending and giving us some freedom with her diet. I just read that EFA (fish oil, Omega fatty acids, etc.) supplements are helpful for people with speech apraxia. Gets the brain functioning. So I'm trying that and have heard more attempted sounds lately.
Anecdotal, of course.
It has finally stopped raining but that still hasn't stopped the power from going out. Our road had two good-sized slides blocking us in and pulling the power lines down both times. Since the last cleanup we have lost power again twice.
With the rainy weather and sitting in this coffee shop enjoying the scones, bagels and breads I am starting to accumulate the fruits of my eating without the time to burn it off. I have to increase my activity level. I assumed that chasing M around would be enough to keep me trim but I've been hungrier than usual lately. Maybe because it's spring? K has been eating like crazy too. She joined a running group a few weeks ago and I think the increase in exercise for her from nothing to 4 days/week has her growing and eating. It's good to see because she's on the smaller side and she doesn't eat much. She's almost 10 now and yesterday she said, "I don't understand why sometimes I feel so angry and frustrated for no reason." It really seems like it's too early for those hormones to start kicking in but I wonder. No physical signs yet, thankfully. But K has been complaining that it seems like C is growing up and leaving her behind. He won't talk to her and isn't interested in playing with her like they used to. Then it occurred to me, when K said that C answers her with grunts and groans when she tries to have a conversation, that it wasn't C that was growing up. It was K. She's starting to mature faster than her brother... to even be so aware of them drifting apart and to comment on it. It makes me a bit sad to see my babies growing up but it's a good thing. I just need to remember to stay in the moment so I can enjoy them as much as I can.
Which is hard when the challenges M faces weigh on me every day. Maybe I just worry too much. I try to reckon with God about this whole process by thinking, "We're doing everything for M that we can. M seems smart. M must have some miracles waiting ahead or some grand purpose for her life that we are contributing to." And then I realize how selfish that is... it's still about me. I'm sure God is shaking his head and saying, "What if I have nothing grand planned for M? What if I just need you to love her and take care of her? Can't that be enough?" Yeah, I suppose. But it's difficult. And when life is difficult I think we all look for some greater meaning to help us get through it.
Another friend who adopted her two children from Russia said to me, "You can't compare M to any other kids to measure her progress. You have to only measure her progress with respect to her own gains." Or something like that. If I think about it that way I'm pretty content that we are on a good path because she makes progress daily, albeit slowly. But when I think about it, she is imitating now. Her biggest hindrances at this point are 1) she can't communicate w/ us and 2) she's not paying attention much of the time. I'm trying another thing... the enzymes have helped us the past two months with regard to her attending and giving us some freedom with her diet. I just read that EFA (fish oil, Omega fatty acids, etc.) supplements are helpful for people with speech apraxia. Gets the brain functioning. So I'm trying that and have heard more attempted sounds lately.
Anecdotal, of course.
Wednesday, March 23, 2011
Speech Apraxia
In February I started taking M to speech therapy twice a week for an hour at a time. She can't sit still so she has to sit in a little high-chair type contraption so that the speech therapist can keep her attention. The speech therapy is mixed with a lot of different activities including oral and motor stimulation, pretend play, turn-taking, motor and vocal imitation. The speech therapist also tries some sensory things like using weighted vests and one time M had to sit inside a blow-up peapod that looked like an inflatable canoe for babies. It was quite appropriate because it was the morning of the tsunami and therapy is down by the coast. I had to drive through road blocks to get to it... but I was determined. She needed that therapy!
As the months have passed it has become apparent to me that as M has made sounds for items, or just randomly, that she understands that vocalizing for objects is necessary however she is unable to put the right sounds together for whatever she is requesting or referring to. For several months everything was "buh". Her current sound-du-jour is "ohhh". She is capable of making the correct sounds on a random basis. She just can't put those sounds together when we ask her to or even when she knows she wants something.
The speech therapist said that this is speech apraxia, a neurological problem where words or even correct sounds can't be put together when needed for speech. M also has poor muscle control and tone in her mouth and is learning to form her lips and move her tongue to make the sounds she needs to make. I don't fully understand the treatment for speech apraxia so I expect I'll be spending some time on the internet researching it. Has anyone else had any experience with this?
As the months have passed it has become apparent to me that as M has made sounds for items, or just randomly, that she understands that vocalizing for objects is necessary however she is unable to put the right sounds together for whatever she is requesting or referring to. For several months everything was "buh". Her current sound-du-jour is "ohhh". She is capable of making the correct sounds on a random basis. She just can't put those sounds together when we ask her to or even when she knows she wants something.
The speech therapist said that this is speech apraxia, a neurological problem where words or even correct sounds can't be put together when needed for speech. M also has poor muscle control and tone in her mouth and is learning to form her lips and move her tongue to make the sounds she needs to make. I don't fully understand the treatment for speech apraxia so I expect I'll be spending some time on the internet researching it. Has anyone else had any experience with this?
Wednesday, March 16, 2011
A Little More on Attachment
I feel like I had to cut the previous post short due to time, but at least these coffee shop posts are coming out.
Things that have helped with attachment with M:
The "Beyond Consequences" book and reading FB posts from Heather Forbes.
Skin to skin contact.
Singing. M loves to be sung to.
Patience.
Remembering that it's my job to help M understand that she is safe.
Tickling.
Encouraging her to acknowledge when she's physically hurt and reminding her, "Yes, it hurts. I know it hurts. Let me kiss it to make it feel better."
Positive reinforcement, over and over again.
Picking her up when she asks with arms up.
Talking to my friends who have also adopted kids internationally.
Things that have troubled me during our process:
The philosophy of ABA is based upon positive reinforcement, but there are times when M just can't rally to do the work and they pretty much continue working her until she responds, at which point she receives lots of praise. I have tried to educate the team about the stress/fear model and also give constant reminders of M's background but they are firm in their methodologies.
Wondering if her lack of eye contact is a post-institutional problem or autism, or both. ABA therapy treats this as an autism problem and works on establishing more and more eye contact through positive reinforcement. So the corrections are all behavioral and not rooted in any emotional-psychological way. (Does that make sense?)
My lack of patience, at times. I am surprised at the challenges of mothering this child who is so different from the other two. I am not the mother I thought I was. M is making me better, though.
I have to wrap this up now because my battery is dying and M's nearly done with school.
For more information on attachment, Lauri has a great post on March 10th, 2011 titled "You've come a long way Baby."
Things that have helped with attachment with M:
The "Beyond Consequences" book and reading FB posts from Heather Forbes.
Skin to skin contact.
Singing. M loves to be sung to.
Patience.
Remembering that it's my job to help M understand that she is safe.
Tickling.
Encouraging her to acknowledge when she's physically hurt and reminding her, "Yes, it hurts. I know it hurts. Let me kiss it to make it feel better."
Positive reinforcement, over and over again.
Picking her up when she asks with arms up.
Talking to my friends who have also adopted kids internationally.
Things that have troubled me during our process:
The philosophy of ABA is based upon positive reinforcement, but there are times when M just can't rally to do the work and they pretty much continue working her until she responds, at which point she receives lots of praise. I have tried to educate the team about the stress/fear model and also give constant reminders of M's background but they are firm in their methodologies.
Wondering if her lack of eye contact is a post-institutional problem or autism, or both. ABA therapy treats this as an autism problem and works on establishing more and more eye contact through positive reinforcement. So the corrections are all behavioral and not rooted in any emotional-psychological way. (Does that make sense?)
My lack of patience, at times. I am surprised at the challenges of mothering this child who is so different from the other two. I am not the mother I thought I was. M is making me better, though.
I have to wrap this up now because my battery is dying and M's nearly done with school.
For more information on attachment, Lauri has a great post on March 10th, 2011 titled "You've come a long way Baby."
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