Saturday, August 31, 2013

The aftermath of the diagnosis

Since my last post I've spent a lot of time reading about bipolar, talking to various agencies and organizations, working with school to make a plan for her, etc.  It's been busy.  The behavior therapist came out last week.  Although her mood and behavior is still up and down, even with the Risperdal added in, Oksana is emotionally stable in our home at this time.  I talked to the behavior therapist about the few issues we still have and how we handle them.  The decision was made that we do not need her at this time.  I appreciated her honesty.  We are on their radar now so if anything changes all we have to do is make a call and we will pick up where we left off.  It's good to know that option is there. 

We are still looking into things like respite and various programs we can have access to through grants and such.  There is a lot out there but not all of it is the right fit for our family.  The biggest recent changes are in Oksana's schooling.  We had an IEP meeting last week that was pretty incredible. 

I know I have mentioned here before that I have felt for awhile that Oksana needed to be pulled from the regular classroom.  I could see that it was a source of stress for her, as were many other aspects of school, and I felt that in order for her to learn we needed to reduce stress where possible.  While our team agreed with me to some degree, they also had been reluctant to give up on the regular classroom.  We compromised last year.  She was still in there more than I wanted but less than they would have probably wanted.  By the end of last year it became apparent that Oksana being in the regular classroom was a joke.  It became a major issue just to get her through the door at points. 

I don't know if it was that, the behaviors, the bipolar disorder, the fact that she has made no educational progress at all since Kindergarten, or a combination of all of those things but when we walked into the meeting this week we were all 100% on the same page!  Not only have they pulled Oksana almost entirely out of the regular classroom, but they have recognized that she is not going to benefit at all from a traditional academic curriculum.  It was time for everyone to be honest and realize that Oksana is never going to college.  It is time to prepare her for life.  Because of that we are transitioning her to a functional curriculum.  I didn't know much about that, but when they presented it to us I almost did backflips.  This is just what Oksana needs.  If you aren't familiar with it, the basic concept is that Oksana will still learn but she will do it in a way that helps her to function in society and her learning will all be done through real life skills.  Here are a couple of examples they gave:

-Oksana will still learn sight words but while other second graders are learning words like "green", "these", and "what", Oksana will be learning "men", "women", "exit", etc.  That certainly doesn't mean that when the word green comes up in a situation she won't be learning it but her education takes a different focus now.

-Oksana will still learn math but it will be done through "jobs" for the school.  An example I was given is that if the nurse needs 10 bandaids put in each baggie she would be given that "job".  She would even have a work station where she would sign in, do her job, and sign out.  Through that job, which gives her education meaning, she will be learning counting and one to one correspondence.

-Oksana will no longer be required to write anything but her name (so she can sign documents although she still can't spell or write her name).  This is a place where it is just time to be honest.  The chances that Oksana will ever spell and write are slim to none.  So now the focus is on finding out how to give her the power to "write".  This will be done through technology.  To make it functional she will "write" things like birthday cards, thank you notes, party invitations, etc.  She will still be learning through all of this but it has purpose and the focus is on preparing her for life, not college.

Does that make sense?  This is new to me so if you know more about it I'd love to hear from you.  We also now have a behavior plan in place as well as a crisis plan for when she "snaps".  I think this was one of the most positive and exciting things I've done regarding Oksana in a LONG time.  We are all hopeful that this will help her finally start to learn and thrive in school.

Saturday, August 24, 2013

The latest in the saga of Oksana....we finally have an answer

Sometimes I wish this blog was private.  I'd love to be able to type out every little detail here because I know it would be therapeutic but I can't.  Still, I'm sharing far more here than on Facebook where I've been completely silent on the subject.  Somehow sharing this with the handful of people who actually read this is a lot easier than posting it for hundreds of people to see.

I've alluded to the fact that Oksana was very challenging this summer.  Actually "very challenging" doesn't begin to describe what we have been through.  Now I'll pick up where I left off......I guess it was the first days of school.  I mentioned that the psychiatrist got us in on Monday.  Our appointment was after yet another nightmare day of school.  We were the last appointment of the day.  By the time we left there the lights were out and the doors were locked.  In the past I had debated leaving our psychiatrist.  On Monday I was SO glad we didn't.  She was wonderful to our family.  She sat and listened to me spew what had happened over the summer and at the start of school.  She told me to tell her EVERYTHING because she didn't want me leaving her office feeling as if I had not been heard.  She asked how I was doing, which was so refreshing since many doctors just focus on your child.  She listened to all of my questions and fears and never said "Oh that won't happen" or "You don't know what will happen in the future".  Instead she gave me an answer or suggestion to each thing I was worried about no matter how ridiculous.  I think I was with her for about 45 minutes.  In the  meantime Larry was in the lobby with the girls.  At that time she already knew what was going on with Oksana but it was time to bring her in.

Oksana came bounding into the room.  She got a teddy bear off of the shelf and sat on the couch.  She squeezed the bear, bounced on the couch, rattled on about various things, etc.  The psychiatrist started asking her questions "Oksana, how are you?  What did you have for dinner tonight?  How is school?  Who is your teacher?  You are doing such a great job pooping on the potty!  Do you get angry sometimes?  Tell me what makes you angry."  As Oksana talked, the psychiatrist pointed things out to me.

"Erin when you look at her right now what do you see?" 

"Ummm...should I see something?"

"She is very elated at this point" (a nice way of saying the child is so hyper she is bouncing through the roof)

"Oh, yeah. That's Oksana."

"No.  This is worse than I've ever seen her.  This is not normal for Oksana and certainly not for an 8 year old girl.  Do you hear how she is talking to me?  That is called compressed speech."

During Oksana's conversation with her about the recent events at school I honestly was creeped out.  As I watched her the psychiatrist turned to me and said "What do you see as you watch her talk to me about this?"

"She is getting joy from it.  She is smiling while she talks about what she did."

Disturbing, because what she did was very violent.

There was so much more to this appointment.  I'm really just giving  you the highlights to help you understand how our psychiatrist worked with us to make the diagnosis.  It is one that Larry and I have been suspecting all summer.  We've done our research.  We knew she fit so it didn't come as a shock to us but it's still not what a parent wants to hear.

Oksana has early onset bipolar disorder.

Early onset means that it is very likely genetic.  It manifests itself differently than bipolar in adults.  The mood swings are more frequent and the depressive part tends to come out as aggression rather than depression.

She was in a manic phase in the office.  Once we understood what that really is we could point out clear times throughout the summer when she was manic.  Times that we looked at each other and said "What is up with her?!"  Early onset bipolar is often misdiagnosed as ADHD because of this manic phase.

What seems to have happened is that at some point while Oksana was on Risperdal the bipolar disorder set in but it was masked by the Risperdal.  Seroquel is not as strong of a medication as Risperdal so when we started to pull off of the Risperdal and move onto the Seroquel we got to see what was hiding underneath.  The Seroquel just wasn't sufficient to hide it.  It was bad enough at home but when we changed everything on her and sent her to school everything got kicked up a notch....or 50 notches....because she just couldn't cope with it.  The doctor decided to try keeping her on Seroquel because it has a component that reduces drooling, and then add a small amount of Risperdal back in since Risperdal was so effective in the first place.  On the way home we got our prescriptions and had them in her before bed that night.

The next morning we could already see a difference.  She had much better days at school and we saw a difference at home too.  She still struggles, but the behaviors come much less frequently and they are more easily controlled.  We will go back in a month to reevaluate.

We have a behavior therapist from the Center for Autism Education coming to meet us on Tuesday and we are in the works with a number of organizations and mental health centers to get our family help.  We believe that if all of this had happened in a couple of years when she was bigger and stronger she would have been dangerous and ended up hospitalized.  We are preparing now to either avoid that, or at least know what to do in the event that she would need inpatient care. 

While I am very sorry this all had to happen, Larry and I are very relieved that our family is now getting support.  We aren't doing this alone anymore. 

Saturday, August 17, 2013

The start of the school year....2 very different stories

I guess I'll start with the good news.  Anya is a Kindergarten rock star!  That child has already won the hearts of the entire staff.  She loves school, and besides a look of concern and a whimper when I dropped her off the first couple of days, she has been awesome.  The best part is that every time I pick her up she sees me, shrieks with joy, jumps up and down, and throws herself in my arms.  My heart could honestly explode.  Speaking of my heart, I cried my eyes out the first day I dropped her off.  I even managed to wait until I walked out so that she couldn't see me which was an act of God.  Her special ed teacher hugged me and said "We will treat her as if she were our own."  I told her that I had no doubt about that and it was the only reason my child was sitting in that classroom!  Anya has her fair share of behaviors and she really drives me insane sometimes but boy did I miss that kid!

This is the part where I debate what to share about Oksana's first days.  I won't give details.  Here is what I will say.  It has been bad....really bad.  So bad that the school has totally changed their tune.  They are really seeing her as a mentally ill child.  Her diagnostician thinks that this is the RAD coming out.  What ever it is, I don't care...all we know is she is getting worse and not better.  That has kind of changed everything.  They are now seeking outside help to help them with her.  Seriously, it was that bad.  I asked them what is the worst case scenario.  They said she will go to an alternative school where the most disturbed children in the district go to learn to manage their behaviors so they can be put in a regular school again.  I asked if we were to that point.  They said not yet. We all feel like her meds are a big part of this.  The new med just isn't working.  I called the psychiatrist and when I told them the things that were happening our appointment went from being in November to being Monday.   She was finally finding success at the end of the last school year on Risperdal so we know that with the right medication she can function better not just in school, but in life.

This isn't only a school issue for her.  The second day of school she got pulled out early for her private therapy.  I think she believed that we would not let her go to therapy if she misbehaved in school so she held it together.  The teachers were so excited because they thought maybe it was just first day jitters.  Well a child in this state can only hold it together so long, so the result was that the therapists got to experience her wrath.  The third day at school was awful again.  Now we are on the weekend and I'm curious to see how she does.  I'd be tempted to think this was because of school except that, as I've indicated, summer got extremely bad.  School has definitely put her in fight or flight more often though.

Again, in the end I think this is 90% about meds.  I've mentioned before that my biggest fear is what will happen when she is older and bigger.  If we don't get this figured out now she will be able to really do some damage.  There is good news in all of this.  Because she has gotten to this point and now school has seen it too, we are finally getting some help.  On Monday morning I have an appointment with an organization that is going to get us set up with a number of resources to help our family, including some respite and the funding for it. How awesome is that?  We desperately need this help.  This has really taken it's toll on us.  A wise friend who is a therapist to some very severely disturbed teens told me that the mental health of our family can not trump her mental health.  We have to keep our family healthy to be able to help her.  We haven't been doing that but things are about to change.

In the end I'll say what I told her special ed teacher in response to the email that explained the train wreck of a day she had yesterday....."I know this isn't a fun way to start the year but I assure you that if....no WHEN we get Oksana stable you will see the joyful, sweet child that is in there.  I promise that she's worth it!"

.

Sunday, August 11, 2013

Oksana's school placement

2 days until school.....after the summer we've had I'm literally counting the minutes!  When I went to Kindergarten orientation with Anya I stopped to talk to Oksana's new special ed teacher and I was SO impressed!  She is young, like right out of college young.  One of the first phrases out of her mouth was "I love behavior kids".  Well praise God because if that's the case she is going to LOVE Oksana!  She also talked to me a bit about how we will communicate, how she will keep Oksana motivated to have good behavior, and the fact that she will not reward Oksana for good behavior but will find many other ways to reward her through her day.  Hallelujah! 

So her IEP meeting is coming very soon.  I already had a talk with her diagnostician.  She is amazing, by the way.  I told her that I am very concerned about Oksana.  Her behaviors, of course, are an issue, but she is really not progressing much academically either.  I can't decide if it is a brain thing or if it is a stress thing.  Obviously kids under stress can not learn well and school is a stress for her.  The regular classroom has been a trigger for her for a long time now.  In Kindergarten she was fully included and it was a nightmare.  I pushed them to increase her time in the special ed setting in first grade but they still kept her in the regular classroom some because they felt she could do it with the meds on board.  Well she couldn't.  That classroom continued to be an issue all year last year.  I think we are finally to a place where we are going to consider that Oksana needs a small environment full time to reduce her stress, manage her behaviors, and help her to learn.  I think there are some on our IEP team who will not necessarily agree with this so I'll be curious to see how it all plays out.

For the record, I've also expressed my concern about her lack of academic progress to her neurologist.  She feels that if we don't see some good progress in the next year or so we might need to do some genetic testing to see if there is something else going on that we don't know about.  I can tell you one thing....she has many people working hard to help her so it is not for lack of effort at all!

Another small change we are making this year is in her para support.  In kindergarten she had a full time one on one para.  In 1st grade she had 2 paras, one in the morning and one in the afternoon.  This year we are going to try not giving her an assigned para at all.  There will be many people in the classroom and anyone who is available will help Oksana whether it is to answer a question, write her name, or take her to the bathroom.  We had some issues last year with her freaking out if she didn't have the para that she thought she should have and demanding that they were with her at all times, even when the teacher was trying to help her with independence.  If they didn't meet her demands she would blow.  I'm going to be very curious to see how this new set up works for her.

While I am not sure that Oksana will be in the regular classroom much I was also told that her regular ed teacher was arranging her room with Oksana in mind just so that she can move freely through it.  How cool is that?  She has some really incredible people ready to help her this year.  I have a lot of hope! 

At one point in my conversation with her diagnostician, as I expressed my concerns about her meds, behaviors, and learning, the comment was made that there may come a point when their school is not going to be the best place for her.  That is my biggest fear.  I can't think that far ahead right now.  Let's just get her through second grade and try to make it so that thought doesn't have to enter anyone's head again!

Saturday, August 10, 2013

My baby is going to school!

Last year, when Oksana was in first grade, Anya often made trips to school with me for various things.  Towards the end of the year those visits became for her as they evaluated her for various therapies, etc. to see how to best serve her in her kindergarten year.  Anya was NOT  happy about that.  She would scream and yell "NO!" at anyone who came near her.  Once she settled in she would cooperate for them but she was definitely on edge.  Because of that I dreaded this orientation.  In our orientation the parents take the kids to their class, introduce them to the teacher, and get them settled before leaving.  The parents then go to another room to hear about policies, procedures, etc. while the kids visit with their teacher, get a tour of the building, and get a chance to go through the cafeteria line to get a snack.  I was prepared for this to be a royal disaster.

When we got there Anya was definitely apprehensive.  She had a furrowed brow for quite awhile and didn't really want anyone talking to her.  I took her over to the carpet where all of the kids would sit with the teacher when the parents left.  Luckily that carpet had the alphabet on it and Anya LOVES to sign the alphabet so that got her interested in something.  The paras and teacher from her special ed class came in to see her and she came over and got very close to me because I think she sensed I was going to be leaving.  She cried for a minute when I left but got over it quickly and did AMAZING!!!  She got to help the teacher pass out name tags and they said when she got hers she was SO excited!  She stayed with the para the whole time and participated in everything the kids did.  She rocked kindergarten orientation!  At the end she ran up to me and jumped into my arms...which is pretty huge and totally warmed my heart!  Everyone was amazed by her and the change in her since they all met her last school year.  This girl is blowing us all away!  Of course they'll get to see her true colors in time ;).  Anya still has a fair number of behaviors but I think with the great staff they have, the great structure they provide, and the many activities that will challenge her, she will do great.

Many people ask me if Anya will be fully mainstreamed.  The answer is no.  Of course she will have a regular classroom teacher and will be in there for a small portion of her day and any special events.  Anya has very poor receptive language and still has many areas to catch up in considering she has only been home 9 months.  Thankfully she has the MOST INCREDIBLE special ed teacher.  There will be 7 kids in her class and the majority of them have Down Syndrome.  Her teacher knows DS very well and the kids in her class absolutely thrive.  I honestly could not be more thrilled about Anya's placement.  She is going to grow so much in this setting!  School starts on Wednesday!  I didn't take a ton of pictures but here are a few:

Her special ed room has a sensory bin and this was in it. It is a Ziploc bag filled with a smooshy gel.  She played with it the whole time we were in there.

This is in her regular classroom.

This is in her special ed room.  They had to find her a teeny tiny desk :).  She is easily the smallest kid in the class.


I'll do another blog later on Oksana's placement and new teachers soon.  Before I go I just want to touch on my last blog.  Oksana had to be taken off of Risperdal because of some side effects and we transitioned her to Seroquel.  I never could have imagined what a transition like that would do to her.  We saw things in her that quite frankly made us scared for her.  These are things that are one thing at 8 and a whole other at 16 or even 13.  We have had to make some significant decisions about how to build supports around our family so that we are prepared if some very hard decisions need to be made regarding her mental health in the future.  Let's just say it was eye opening but it was good in the sense that we avoided a catastrophe and will be prepared for anything like this in the future.  I will not delve deep into this publicly but I will say that Oksana is doing much better now and she is as ready as she can be for school.  I have many positive things to say about the year she has ahead of her......

Friday, August 2, 2013

Where I've been

I really enjoy blogging.  It's kind of therapeutic for me, however, it serves another purpose too.  Back when we were in the process to adopt Oksana I read MANY blogs.  I'd sit up at night reading beautiful story after beautiful story and awaiting the day that one of those stories would be mine.  Well as many of you know our story was not what I thought it would be.  I was shocked and I felt alone.  Why had all of those other families had wonderful experiences and we were suffering.  Then I joined some online groups and guess what I learned?  Those families were suffering too!!!  I couldn't decide if I felt more relieved or betrayed. 

I've always wanted to be honest on this blog.  Sometimes I get comments saying how people appreciate that I don't sugar coat things, but the truth is that there is really only so much you can put on a public blog.  Obviously I don't share everything, just enough to let anyone else struggling know they are not alone.

Then there come times in our life when things happen that I don't even know how to begin to share.  And so I say nothing.....

The fog is clearing a bit and so I'll just say

There are some things love can't fix

There are some hurts that change a child in ways we never could have imagined

....and mental illness sucks......but there is hope......