Oksana update

I can not believe I haven't updated since Oksana was put in the residential center.  Wow......I have plenty to share.  First of all she is still there.  We are still waiting on a bed to open up at the psychiatric hospital but that hasn't happened yet.  We've been close to having insurance kick her out of there twice.  The closest we came was this past Monday.  Her behaviors were definitely better (because she was a zombie on her new meds) and they told me that they didn't think insurance would let her stay if she wasn't having behaviors.  They contacted insurance on Monday, and after reviewing her case they were told that it would go to peer review.  I don't do insurance stuff so I had no idea what that meant.  Apparently it's basically that it wasn't a clear yes or no so they sent it to a higher up who called the residential center for more info to make a decision.  That was going to happen Tuesday morning but I was told to be prepared to pick her up Tuesday.  They told me that they have never had a case go to peer review and get more days.  So I told my contact person at the residential center that I wanted her to tell the insurance company that the psychiatrist planned to remove her lithium.  If that was still the plan they can go ahead and book her a room at the hospital the next week because she can not safely do med changes in our home.  I had so many people praying and on Tuesday morning I learned that we got 7 more days!  I couldn't believe it!

This coming Monday will be the next insurance review.  I am praying that a bed opens at Hawthorne soon because I don't know how long insurance is going to keep allowing this.

Let me share a bit more about the residential center.  I've been very pleased overall.  The staff has been very friendly.  I have no doubt that Oksana is being well cared for.  Their visiting hours are very relaxed so that has been nice compared to the hospital.  Oksana is very content there.  Possibly too content.  I don't think she really cares if she doesn't come home.  In fact sometimes when we visit her she ends our visits early to go back to the cottage with the kids.  She loves on the staff members and doesn't really care if we don't visit.  I had feared this would happen.  This is the closest she has ever been to being in an orphanage, this is the longest she has ever been away, and this is the least she has seen us.  This place is 45 minutes away from us so we can't go daily.  We see her every 2-3 days.  She is reverting back to some old RADish behaviors that we spent years trying to reduce.  She's peeing her pants to get them to focus on her and they aren't making her do anything for herself.  Unfortunately the price we are paying for her mental health is in her attachment to us and her physical health since her CP also isn't being cared for like it is when she is home.  Of course a psychotic aggressive kid isn't exactly one that is ready to attach or receptive to therapy so there isn't much we can do.

Another update to give is about her testing.  You may recall that awhile back her psychiatrist wanted to send her to another psychiatrist who would do extensive testing on her and give a second opinion on her diagnoses.  Yesterday I went in to get the results of that testing.  I loved the psychiatrist.  This is someone that Oksana's regular psychiatrist is one of the few people whose opinions she highly respects.  I can see why!  She came in with the DSM V (the "diagnostic bible" that gives all of the criteria needed for each mental health diagnosis), all of the forms we filled out, and her own testing.  She came with a good idea of what she felt Oksana had based on the testing results but she sat with me and looked for my input on all of them.  I've never had a doctor do this!  I find psychiatry fascinating and I had a great time answering her questions to clarify things and digging through the DSM with her to make sure we were finding the most accurate diagnoses.  In the end her report will suggest the following diagnoses:

Schizoaffective disorder, bipolar type
ADHD
ODD (oppositional defiant disorder)
autism
Disinhibited Social Engagement Disorder

Just a bit about Disinhibited Social Engagement Disorder.  In the DSM IV Reactive attachment disorder had 2 subtypes, the disinhibited and the inhibited forms.  An easy way to say it is the inhibited form of RAD is the kids who don't attach to anyone and the disinhibited form is the kids who inappropriately attach to anyone.  In the DSM V they changed it so they are 2 different diagnosis.  RAD is now only the inhibited type.  The disinhibited type is now called Disinhibited Social Engagement Disorder.  While Oksana definitely shows signs of RAD she more clearly falls under DSED.

 I'd be lying if I didn't say we are exhausted and worn down.  We are trying hard to make the most of the time that we have while she is under their care but it isn't as easy as it sounds.  I'll try to do better about updating from here on out!