Antidepressants Are a Beautiful Thing

Our boy has done a complete 180 degree turn during the past week. He has gone an entire week without a single tantrum (by which I mean no hitting, punching, throwing things, threatening to hurt himself). That is probably the longest he's ever gone since being with us. He's been happy, smiling a lot, telling us he loves us a lot (unsolicited statements like "I love you, Ima..." or "I love spending time with you, Mama..."), and totally fun to be around. He's earned new privileges, he's talked about his feelings instead of acting out, and he's been pretty much like a "normal" kid with fairly severe ADHD. He's had no aggression or violence or angry outbursts. It's pretty incredible.

Family life has been a total joy lately, which is such a relief from the constant struggling of the last 4 months. There have been difficult moments, things are far from perfect... but they are so, so much better. I think the Prozac is working, and allowing the therapy to be more effective... which is giving credence to our belief that Big Guy's violent tantrums were not just behavioral but instead were due to a combination of anxiety, depression and PTSD. He's only been on Prozac a few weeks, and just this week we upped the dose, so it's possible things will get even better from here. I can't help feeling like I'm waiting for the other shoe to drop - How can this be real? How long can it last? But I'm also starting to let go and just enjoy these times... and giving him loads of positive feedback about how awesome his behavior is and how much fun he is to be around.

Big Guy told us last night that he's being good so the judge will let him go home. It broke my heart to hear him say that, because it means he really still thinks he was removed because he was bad and he can go home when he's good. But it was a good opportunity to let  him know that being happy and being well-behaved will help him in every aspect of life, no matter where he lives. Whether he goes home or is adopted, he will have a better life and more privileges if he can behave respectfully and he feels good inside. We reminded him he isn't in foster care because he is bad, that he's in foster care because mommy has problems parenting (problems she is working on right now), and that we can't promise that good behavior will mean he gets to go home.

At first I was worried that raining on his parade like this might make him start acting out again, but my dad reminded me that there's no way that Big Guy was able to keep up such amazing behavior for an entire week purely out of willpower so he could go home. If that was the case, he'd have been on perfect behavior from the beginning of his time here. I think he just had an easier time behaving the way he'd like to behave because he's less depressed and anxious, plus he's been working in therapy on internalizing that hurting us isn't going to make him be able to go home. When he saw his behavior being so positive, it may have renewed his hope that now he can have enough self-control that he can behave well at home so that mommy will want him back and the judge will send him back. So I don't think he's going to regress simply because we are giving him reality checks about his power to make the judge send him home to mommy. He looked so deflated after I corrected him, I wanted to cry.

We knew from the beginning that "Oppositional-Defiance Disorder" and "ADHD" didn't fully encapsulate what was going on with this child. I'm so glad we finally found professionals who agreed that we needed to dig deeper into the psychiatric issues. Big Guy is happier, calmer and so much more focused. I feel like a weight has been lifted off of me. Even if it's temporary, it's a huge gift. Times like this remind me that all this hard work is worth it. And you know what? In the (unlikely) change that he does go back home to mommy, who is so limited in so many ways, I think it would be great to send him back as a happier, less aggressive, more well-adjusted kid who is easier for a cognitively limited mom to parent. I finally understand what foster parents mean when they say that they get satisfaction out of reuniting with their families a healthier kid who's done a lot of healing and learned new coping skills.

What's goin' on.... and a plea for help.

Oh dear, it's been a while since I've updated, huh?

Did you think maybe I stopped posting because we threw in the towel and our boy got placed in a therapeutic foster home? Rest assured, we're still hanging in there with Big Guy and don't have any intent to stop.

It's partly the Jewish holidays - Rosh Hashanah, Yom Kippur, Sukkos, Simchas Torah... They have taken up a huge part of my time for the last month. It's also partly that there's so much to say and I know I'll never be able to update you on everything that's going on.

Here is a bullet list of just a few of the many things that have happened since I last posted:

• His team (case workers, etc) decided if this placement fails he will be placed not in a therapeutic foster home but in a Residential Treatment Center. Holy crap, talk about pressure on us! We feel so strongly, as does his therapist, that at this point he does not need an RTC, he needs a family. It's one thing if we adopt him and then he needs RTC, because he'd have a family to visit him all the time and then to eventually come home to. If he went to RTC right now we'd have no rights to even visit him and at most he might get a weekly visit with mom and an occasional visit from a social worker. 

• His therapist asked me "So, how does it feel living in a residential treatment center?" Because he acknowledged what everyone else is coming to realize, which is that we are basically providing a residential treatment center and therapeutic foster home without the training or compensation.

• Big Guy's therapist is excellent and Big Guy is starting to talk about his anger, why he takes it out on us, his sadness, etc.

• Big Guy has been revealing more abuse history. I'm feeling so angry I just want to kill everyone who hurt him. I have to laugh that I told people when he was first placed with us, "He doesn't seem to have any kind of major abuse history, at most maybe a little emotional neglect." Warning to first-time foster parents like us: Never, ever believe that the story you think you know during the first month or when a kid's placed is anything near what the full truth is.

• We found a great psychiatrist who is starting him on an anti-depressant! Hallelujah! She actually gets that it's not just ADHD and Oppositional Defiance Disorder that are happening here, and she diagnosed him with PTSD after we had been increasingly feeling that some of his behaviors are trauma reactions.

• We have been talking to Patty (Big Guy's mom) a lot and learned from her more about her own and her mom's mental health history which has helped us understand the situation better and also helped us inform the psychiatrist. We have an awesome relationship with her...

• ...Which makes it so frustrating that CPS has decided we shouldn't be allowed to supervise visits. Because an outside agency that CPS contracts with is now doing visits at their offices and doesn't allow any contact between birth families and foster families, we cannot see her, and Little Guy (Big Guy's baby brother who we had for the first week that Big Guy was with us), at all. She literally enters through a different door than us, we think, so we can't even "run into her" in the waiting room. It's awful. So much for our dream that we could help mentor and support her. Basically CPS has made it clear they want to build a case to terminate her parental rights, even though she is parenting her baby and her older kid has only been in foster care 3 months with us. They have a foster family who is very competent and has a good relationship with the birth mom, a birth mom who never hurt her child directly, and a foster child who isn't traumatized by contact with his birth mom... The perfect situation to allow a mentoring relationship between foster and birth family or at least to allow more casual visits outside a clinical setting. Yet they don't want to make more work for themselves or risk her actually getting help from us, so they're screwing everyone in the process. Nice.

• School started and life became much more manageable because of everyone having a set schedule, so we no longer feel we're living in constant crisis mode...

• ...However, around the time school started Big Guy stopped sleeping through the night. He woke us up no less than seven times last night. He simply cannot and will not sleep without a grown-up in bed with him (please, spare me the lectures and horror stories about how foster parents should protect themselves from abuse allegations by never ever laying down with a child. It's the only way to keep from multiple violent meltdowns at night right now, and if those meltdowns are hard to deal with during the day they are impossible to deal with when half-asleep). His anxiety is so out of control. Usually I go lay down with him when he wakes us up, but end up falling asleep and waking up hours later in horrible pain because his bed sucks and I have a bad back. If anything is making my life feel unmanageable right now, it's not his tantrums or violence... it's the lack of continuous sleep and how we're held hostage by him at night because he wakes up multiple times and is terrified to go back to sleep without us with him. Have I mentioned I have idiopathic hypersomnolence, and am therefore supposed to get 9 hours of sleep a night in order to safely drive? Haha.

Any suggestions on how to deal with the sleep issue, experienced mamas and papas? He's already on 3mg of Melatonin and is taking his Risperdal at night as well. He has nightmares but frequently he wakes up without having nightmares. I hope the SSRI will help. I feel like the parent of a colicky infant, who feels ready to kill someone due to weeks and weeks of interrupted sleep.

Dear G-d

Please let the new psychiatrist we are taking Big Guy to today be kind, good at listening, and full of ideas. Ideas about what is going on with him and what to do about it. Please let her take seriously the fact that he was up for 1.5 hours last night afraid that he was dead ("can kids be half-dead?" he asked my partner), that he'd have nightmares if he went back to sleep, and that we were going to die (he kept saying "I love you, mama. I really love you, mama" in a scared voice over and over to my partner... which is not normal for him). He said his heart was pumping blood really fast and "beeping" really fast (he thinks his heart beeps, not beats). He was a wreck. Please let the new psychiatrist take seriously the fact that our house is in danger of being destroyed during his rages and that we are in danger of being hurt. Please let her understand that he has a gentle and sweet soul, which is why he gets so depressed when his behavior is out of control. If she has more clarity about diagnoses, great. But I care less about diagnoses than that she can do something to help take the edge off for him so that he can work more productively on changing his behaviors and coping better with his feelings. A kid who is so anxious they are refusing to go to sleep (or waking up 10 times during the night like he did Sunday night) and is so out of control that they fly into physically violent rages is not in any place to be doing productive work in therapy. We aren't big on medicating kids, but this child is clearly not on the right meds right now and he is suffering. So please let this woman be compassionate and insightful, and have some idea of where to go from here. My sweet boy deserves this.

The good bad news

Today's "good bad news":

The psychiatrist finally returned our phone calls. Sarah spoke with him and said he sounds good, was respectful, took our concerns seriously, and said that he is absolutely not discharging Big Guy this week and without any med changes, contrary to what the social worker had told us yesterday. He thinks Big Guy will probably come home towards the end of next week. This makes me really sad because I miss him and don't want him to have to be away from us for that long. But it is also a HUGE relief because the idea of them sending him back home with nothing having changed whatsoever was terrifying, and I couldn't believe they weren't taking seriously our concerns about his depression (which he's not being treated for currently), his dissociation, etc. Sounds like they are now taking those concerns more seriously, and they do indeed plan to start med changes today or tomorrow. Some of what happened yesterday was likely miscommunication - Social workers are often not filled in by psychiatrists on what their plans are. But some of it may also be the additional info we provided the social worker yesterday about the abuse history that Big Guy has been talking about increasingly, the dissociative-seeming episodes he has after some of his meltdowns, etc.


I'm sad Big Guy will be in the hospital for so long, but I'm glad there's some hope that some change can happen while he's there. In particular, they'll have time to see if med changes make any difference for him. Explaining to him each time we visit why he's not home yet despite his good behavior is going to be hard.

Update.

Big Guy is still in the psych hospital. We made peace with our decision once we saw that the unit is really quite fine and the staff is really nice, and though Big Guy refused to see us the first time we visited (he was really angry), he's seen us each subsequent time and seems to be doing well. Yesterday he said "it's fun here." Um, psych hospital FAIL. It's not supposed to be fun, buddy! But I'm glad he's not miserable, I certainly don't want him to be suffering.

So Big Guy is okay, but I still have steam coming out of my ears right now. They are refusing to alter his meds because they haven't seen the behaviors that we hospitalized him for yet. They say "we don't want to rush things, it might take a while for us to see them" but when we asked them how long they keep most kids for they said "7 days." Um, it's already been 4 days. So basically they are making it sounds like they're going to discharge him on Thursday, with no med changes, no aggressive or self-destructive behaviors observed, and basically it'll just return to business as usual at our house. They said something like "Well, a lot of times it's behavioral issues that need to be dealt with in the home, not psychiatric issues." Seriously? So in the meantime, while we deal with the "behaviors", it's totally normal that we spend hours wrestling him to keep him safe? It's totally acceptable that he's trying to run into traffic, and that he sobs for hours on end, that he can't stop his outbursts and then feels horrible about himself and asks us to beat him, and that he becomes dissociated after his tantrums? We can fix all of this with good parenting?

Even if we could fix all of this with good parenting, we need to keep ourselves and our belongings and this sweet little kid SAFE while we get more services in place to help with behavioral interventions in the home. We are approved for 2 hours of therapy and 2 hours of behavioral assistance each week, but he couldn't even make it to his next appointment last week! The neurologist said he needs to be under the care of a psychiatrist, but he couldn't even make it until his psychiatrist appointment! Even if these issues were more behavioral than psychiatric, if he can't behave safely while we continue our behavioral interventions, nothing is going to change.

BTW, the psychiatrist hasn't returned our calls and didn't show up to the meeting. So the only info we have is filtered through a social worker, who's not the one who makes any of these decisions. I've had it up to here.

How we ended up in the psych ER

Yesterday neither Sarah nor I could work because it took two of us to keep Big Guy safe, and even then he was hitting and trying to jump out the 2nd story window, and things like that. This is after a week that included him running into the street and refusing to come back to us (once on a street that had little traffic, once on a street that has a lot of speeding traffic)... Having tantrums every day... and saying things like "Do you hate me? Do you want me to die?" in a sad little voice while in the bathtub. His tantrums just escalated and escalated. He broke a lamp and threw a lot of our (and his) belongings across the house. He cried, he yelled, he threatened. He refused to leave the house every morning. But the worst part was that he is so, so sad. And so, so frustrated with himself.

For a kid with ODD it can take a LOT of sadness for it to come out as child-like (i.e. appropriate) tears and sobs rather than just angry wild-animal tantrums. But we've had a lot of both recently, and we knew something was not right. Obviously we don't know what "right" is with this boy, since he's only been with us 2 months so far. But we knew something was different than usual in the way he was acting. The difference was that he was excessively sad and even his acting out seemed to stem from that instead of just from testing. In addition, he was unable to stop his tantrums, or recover from them. Instead, I think as he'd start to come down from them he'd start to realize what he'd done (in other words he'd perceive that he had physically hurt the people he loves, destroyed his room, made us upset, exhausted himself, etc) and then feel so bad about himself that he thought he deserved to be punished... So he'd act out even more, seemingly trying to get us to punish him. We have gathered that he thinks he deserves to be beaten, kicked out, or have the cops called on him. So "punishment" means one of these extremes, which are the things he is accustomed to. When I have told him during his tantrums, "Baby, you deserve to feel good. You deserve to be happy. Please stop punishing yourself,"... his response is things like "No, I deserve to feel bad. I deserve to lose all my privileges. I deserve bad things."

I called Big Guy's care manager, and said that our rope was really fraying and we needed help, pronto. I explained that being held hostage by this child, and having him continue to try to harm himself or us, was not an option for us... but that we did NOT want to give up on him, and didn't want him to think we were going to abandon him when the going got tough. I said I didn't know what to do. She quickly recommended that we take him to the psych ER for an evaluation. He hasn't had a psychiatric evaluation in quite a while and when we tried to make an appointment, we couldn't get one until the end of September. We have tried to convince his doctors to tweak his meds, but they hemmed and hawed over it. What the care manager explained is that in the psych hospital he can stay for a few days while they change his meds. It's easier and safer than going through med changes while living with us, as they can observe him carefully.

I really didn't want to do this. I was so fearful he would hate us, that it would set him back in terms of his progress emotionally, that it would undermine his trust in us, that things would be worse when he got back to us instead of better. But I called all the people I know who have professional and personal experience with this stuff, and they all reassured me that it was the right thing. As I said to the caseworker "This really isn't about his behaviors. His behaviors are unmanageable right now. But it's really about the fact that he deserves to feel better than this." It is physically painful to see your child hurting and unable to talk about it, and unable to stop themselves from acting in ways that get them further into trouble emotionally and in terms of family consequences.

The horrible part is they don't have visiting hours today, so our boy is going to think even more that we're abandoning him. We're trying to get through to the psychiatrist to fight for an exception to the rules due to his history of abandonment issues and his being in foster care for only 2 months with us, because we think not seeing us every day would be very damaging for him. But they haven't returned our calls.

I wish I could stop feeling like I've failed him somehow by needing to take him to psych hospital. I wish I could stop feeling like a bad mom because I couldn't magically handle his behaviors and help him feel better. I know better than this. But my brain hasn't yet convinced my heart that we did the right thing and that he'll be okay, largely because he has two dedicated foster moms who can't wait for him to get out, who will advocate for him to no end, and who would do almost anything to help him continue to heal and grow.

I broke my own heart last night.

The hardest thing I've ever had to do was to leave my screaming, sobbing, scared, sad little boy at the psychiatric hospital.

We spent 9.5 hours in the psych ER last night, listening to mentally ill and drug-withdrawing folks screaming and talking delusionally (the guy in the next stall kept yelling things like "Why does everyone keep ignoring me? What am I, a criminal? Did I murder someone? I don't remember!") Oy. Anyway, they ended up admitting him. The psychiatrist was very nice and explained that she really felt that he needed to be there for a few days and they needed to look at his meds. She agreed with our suspicions that he is on too much ADHD medication which is making him more aggressive than he would be otherwise, and that it might not be good that he's not being treated at all for depression. We'll see what the child psychiatrist thinks.

I am so, so sad. I miss him terribly. This hurts so bad. I feel like I betrayed him somehow. I will never forget his despair when we left him last night. I pray that he can get some help feeling better. As I will continue to remind him, we cannot wait until he is home. We are not abandoning him, though I'm sure it feels that way to him because of his life experience. But we cannot allow him to be in danger and putting us in danger, and he needs professional help in feeling less out of control.