Tuesday, October 27, 2009

(Almost) Three Years In...

I'm gearing up for Blink's re-evaluation. It's hard to believe that it's been 2.5 years since his Asperger's diagnosis. Last time, we did a straight autism evaluation. This time, we're doing a neuropsychological evaluation. There's a good deal of overlap between the two (both have iq tests, for example), but the neuropsych is more comprehensive. And, I've been told, is the way to go so we can suss out what role ADD might be playing in his challenges. He doesn't have this dx now, but over the last year it has come up a few times as a possibility for him. (And once by someone whose professional opinion I really, really trust.)

And honestly, he has gotten much more distractable and spacey lately. I cannot tell you how many times I've tried to talk to him only to have him say, "Huh??" (though maybe that is more of an auditory processing issue?? Someone who knows more, I'd love your thoughts on this...it was brought up as a potential concern but never really explored with him.)

Anyway, I had to have his teacher fill out a form about his challenges/strengths. It's the same form his preschool teacher filled out 3 years ago. Kind of interesting to see the differences between them. Some of it due to progress/maturity, some of it I'm sure due to the fact he's in a special ed setting now and not a Montessori preschool, plus the different perspectives of different teachers. It was interesting to see confirmed that his attention issues seem more of a concern now.

Just to get my head around it, here are the areas marked "very much" (the highest category) by his teacher:
* often acts without thinking
* frequently calls out in class
* has difficulty waiting turn in game or group activity
* quarrelsome, argues, or debates
* Acts "smart" [ugh, i hate this wording!]

And those marked "pretty much" (3 out of 4 on the scale)
*is easily distracted
* has difficulty concentrating on school work or other tasks requiring sustained attention
* shifts excessively from one activity to another
* has difficulty organizing work
* needs a lot of supervision
* has difficulty staying seated
* restless or overactive
* fights, hits, punches, etc.
* frequently interrupts other children's activity
* is bossy, always telling other children what to do
* teases or calls other children names
* refuses to participate in group activities
* loses temper often and easy
* excitable, impulsive
* disturbs other children
* fails to finish things he starts -- short attention span
* cries often and easily
* mood changes quickly and drastically
* temper outbursts, explosive and unpredictable
* uncooperative

Just for the record, he didn't get a single trait marked "not at all" either time. What a litany of complaints, huh? But I'm not complaining. It's accurate. Overall, his "problems" were rated moderate this time, again (3 on a 4 pt scale).

I'm really feeling like something is changing/has changed with him. His medicine (prozac) doesn't seem to be helping him any more. He is often unhappy, unfocused. A month or so after the neuropsych we will go see his neurologist. I'm strongly considering asking about ADD-type meds if we end up with that diagnosis, which I strongly suspect we will. I like that we could try them out and know if they're working quickly, and change course if not.

I'm working with a new therapist who is coming out to the house each week. I like her a lot. She suggested I try out the Explosive Child book by Ross Greene. I happened to have that, having read it about 3 years ago. It made a lot of sense to me back then but implementing it in a household with my former husband was impossible. I think it's a great time to revisit. Greene suggests that kids have meltdowns, etc., because they have a very low tolerance for frustration and are highly inflexible. Ding, ding, ding! That's my boy. He says they are delayed in acquiring skills in these areas. Much like a learning disability, they need direct instruction and extra practice to acquire them.

I like that the author is highly compassionate about challenging kids. I'm just going to level with you here and say that I dislike that he advocates taking consequences for explosions totally off the table. I'm not going there again. I realize my reluctance here stems from my incomplete and flawed implementation with Blink three years ago, but I just spent the summer trying to take the control back as the head of this family and I'm not willing to step away from this approach. I'm still trying to figure out in my head what that means to me and how it will work with the book. (It's always been hard for me to take what works and ignore the rest in a model.)

But I believe Blink is now developmentally ready to understand there are consequences to his actions and if you act like an asshole, guess what, you go to your room. (And that's as much for his sister's and my sanity as it is to teach him anything.) I also honestly believe that Blink is so ego-centric that he does not realize what he is doing is wrong and he rarely expresses remorse, so in my mind it is appropriate for me to be doing this. (And let's face it, it's helping. There's that.)

But! The good news is hopefully there will be less need for consequences if we defuse the situation first using what he calls a Cooperative Problem Solving model.

So my task starting out with this is to log all of the things that frustrate Blink for a week. Whee! It's going to be a long list...