Christmas Eve at the Shrink

It wasn’t in the plan to spend Christmas Eve talking to a psychiatrist. Not even one teeny bit. But as fate would have it, that was the only day they had an opening that worked well. So that’s where I spent my Christmas Eve afternoon…

I debated about whether I should post this, since there is certainly a stigma attached to mental-health issues. But I hate that there’s a stigma to it, and if I hide it, then I’m simply enforcing an existing stigma…which certainly seems counterproductive.

So why was I at a psychiatrist? No, not for me, though I’ve been to counseling myself in the past. This time, it was for Theo. And let me just state here for the record: He does not have a mental-health problem that we know of. He is, however, struggling in some ways, and the developmental pediatrician that we saw earlier this month suggested that we ought to do two things: (1) have him re-screened for autism and (2) talk to a child psychologist to get some ideas for coping strategies for him.

We were fine with doing #1, but we weren’t so sure about #2. Did we want to go there? Well, not really. But he continued to struggle, and we finally decided that we weren’t doing him any favors by not exploring what the doctor had suggested.

The way counseling with kids works in our medical group is, the first appointment is with the parents only. And then treatment is jointly with parents and the child. It’s not a typical “go once a week and talk to a therapist” kind of thing; rather, it’s a “here are some ideas to try and work on; after you do that, we’ll regroup” kind of thing. So, for that first appointment, we needed someone to watch the boys. Only we don’t really have anyone close by, so instead we decided Chris would watch them while I went to the appointment. And it seemed wise to do that while he was already off work, so he wouldn’t have to take extra time off. And that’s how I ended up talking to a psychiatrist on Christmas Eve, of all times.

But I noticed something oddly uplifting when I was there. I used the bathroom before the appointment, and I noticed graffiti all over the wall. I expected it to be complaints and angry rants—after all, I was in a psychiatrist’s office, and generally people in there aren’t overly happy with life, right?

Wrong. The graffiti on the wall was made up of messages of support and hope. It gets better…keep smiling…you are loved… All kinds of messages of hope and support. It was really cool—maybe I was just feeling emotional, but it brought a tear to my eye. People supporting other people who are hurting…you just don’t always see that anymore. I like it.

The meeting with the psychiatrist was actually less depressing than I expected, too. Let’s face it: It’s not fun to have to go talk to someone about how your kid is struggling. That was not something I wanted to dwell on, particularly on Christmas Eve. But the psychiatrist was very nice, and after interrogating me about Theo, she sat back and frankly said, “You need to get that autism evaluation done.”

“We are,” I said. “Why?”

“Because this all sounds like autism to me. And once you get that evaluation and it comes back showing he’s on the spectrum, which I’m nearly certain it will, you’ll have access to more services for him. And I think behavioral therapy is going to be a huge help for him.”

I expressed my concerns about behavioral therapy, which she acknowledged but then repeated that she thinks we’ll find behavioral therapy very useful for Theo. (Click here to read an explanation about applied behavior analysis (ABA), which is what she means by “behavior therapy.” My concern is that I’ve heard some adults with autism express that ABA made them feel like every instinct they had was wrong, and it was hard on their self-esteem to feel that way. I do not want that to happen to Theo. On the other hand, many people swear by ABA, so I suppose we’re cautiously willing to try it. The good part is that we would be present for absolutely all of it, as it takes place in our home, so we can quickly put the brakes on anything that we feel is detrimental. And I think we both feel that it’s preferable to any sort of medication route, which is where we’re afraid things will eventually head if we don’t help him learn some coping strategies to deal with challenging situations.)

Interestingly, both the psychiatrist and the developmental pediatrician seem convinced that we’re looking at autism here, and not ADHD. And I wondered why they were so certain, given that the two have very similar symptoms in a lot of ways. I got the answer when I read the report the developmental pediatrician sent us: If he had ADHD, he would be unlikely to be able to control it in the classroom. And he’s actually doing fairly well in the classroom. His attention and focus aren’t great, and he requires extra time to complete work, but he holds it together and remains respectful and reasonably cooperative with his teacher. It’s when he comes home, where he feels comfortable, that he just falls apart and becomes a mess of stimming and much more unable to control his emotions. And evidently that is more characteristic of autism than of ADHD. Interesting…I had no idea.

I hate to see him like this. I’m proud to see him working so hard at holding it together in school, but I hate to see him come home and fall apart. I hate to see him constantly tense and wound up because of all he’s working to control. I want to see him more at ease, more able to function outside of our home but still come home and relax, rather than just losing it. And I fear that his ability to cope will get less and less as he moves into more challenging schooling. First grade is a big jump from kindergarten, but the expectations are still not terribly taxing. They will get much, much harder as he moves along, and we’re both afraid it will just be too much for him if we don’t find a way to help him manage this stress.

In a way, though, I was relieved to hear the psychiatrist state so emphatically that she felt this was all part of his being on the spectrum. I was in a cycle of frustration—wondering what on earth I was doing wrong in my parenting, how I was failing him, but also getting frustrated because he has been acting out so much…for a sustained period of time. He’s been on a hair-trigger, and I feel like it’s put us on one, too. But somehow, hearing that this is “normal” for someone on the spectrum makes it easier to take a deep breath, recognize that I’m not a failure as a mother, and recognize that my kid is not always just trying to get under my skin.

I think that’s the biggest challenge for us, really: When Theo has a bad day…or a bad hour…or a bad moment… we wonder if it’s just him being six, if it’s just his temperament, if it’s autism, if it’s something we’ve done, etc. It’s very hard to know how to handle something when you don’t have any idea what’s causing it or whether it’s an expected behavior for the age/gender. Because he’s our oldest child, the age of six is new to us. What’s typical behavior and what’s not? It’s hard to know.

And it’s hard not to question yourself, too. Were we doing something to cause the issues? Could we be doing something differently? We’ve heard a lot of advice over the years; some people think we need to be strict disciplinarians with him, and others think he needs to be given a lot of leeway. Which leaves us wondering, what is right? We’ve tried to go with our gut, which I think most parents do, and parent in a way that feels comfortable to us. For us, that means having some general rules that are consistently enforced, but not micromanaging on the small things. As I explained it to the psychiatrist, our general parenting strategy is somewhat like this: If we take Theo to the park, we have a general expectation that he will not put himself or anyone else in harm’s way. He knows that, and he knows he needs to stay away from the street, not throw rocks, etc. But that’s about it in terms of the rules: As long as he keeps himself safe and respects the safety of others, he is free to do what he wants. We don’t insist that he stay on the playground, for example. If he’d prefer to go wander around collecting rocks or climb a tree or play in the grass, we’re fine with that. And that is a pretty good overview of our general parenting: We have certain rules that are fixed for every situation, mostly involving respecting and being kind to others, and ensuring safety. But we choose not to micromanage on the little rules. So given that, I think we’re pretty middle-of-the-road—not totally permissive, but not totally strict, either. That’s a comfortable place for us, and it seems to work well for Sam…but we began to question ourselves about Theo. Were we somehow causing his issues? Should we be parenting him differently? If so, how??

I felt like a huge weight had been lifted off of me when the psychiatrist listened to what I had to say and then said, “You don’t need to beat yourself up here. You’re doing a lot of things right. People with autism just don’t process things in the same way others do, so we need to use different strategies to help them. There’s a reason why he isn’t understanding what you mean when you tell him he needs to show respect, for example. That concept isn’t concrete enough for him to comprehend in the way that you’d expect. We’re going to need to work on it in a different way to help him understand what’s expected of him. It just takes time.”

And instantly, I flashed back to teaching younger Theo “please” and “thank you.” It took forever. We started with the signs for the words, and then moved to the actual words when he started talking. It took nearly three years to get him to use the words without prompting, and I do not for a second believe it’s because he isn’t a polite child. Because he actually is a polite child by nature; he just seemed utterly clueless about applying those words to everyday conversation. I’d see my friends’ toddlers using “please” and “thank you,” and I’d think, “What am I doing wrong? Why doesn’t my son do that? I keep teaching him!”

Well…maybe I wasn’t really doing anything wrong after all. Maybe I was doing the best I could, and so was he. And he got there eventually, but it took a while. And maybe that’s not something either one of us could help.

I’m taking comfort in this. I had begun to doubt myself as a mother, and I’d ask Chris, in tears, “Am I bad mother? Because Sam responds well to our parenting! If I was so bad, wouldn’t Sam be having trouble too?” I was perplexed. I couldn’t figure out why I could easily parent one child, and I couldn’t seem to get through to the other one. I felt like a total failure some days. It was a pretty bad feeling. So I’m taking comfort in the fact that the psychiatrist said, “This isn’t your fault, and it’s not his fault either. We can work on this together. Let’s get that reassessment done and get started.” It makes me feel hopeful—that I can better learn how to help him, and that he can start to feel more comfortable when things are challenging.

Let me wrap up by saying that the psychiatrist emphasized that it’s very important we tackle one thing at a time. Right now, the biggest issue is temper tantrums, which aren’t terribly frequent but have gotten intense enough that when they do happen, they’re disruptive to the entire family. So we are to focus first on those, possibly for a couple of months, before tackling any further issues. So when you hear my six-year-old mouth off to me, and you see me grit my teeth, take a deep breath, and say nothing, know that it’s not that I’m condoning his attitude; rather, I’m ignoring it because that’s what I’ve been instructed to do. One issue at a time…and we’ll handle the next issue when we get to it.

And we’ll get there. Much as I hated to go to a shrink on Christmas Eve, she made my holiday better by giving me some much-needed hope that things will improve for my favorite six-year-old…and for all of us.

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