Bipolar Children and Poo Smearing

I've read through a number of books on bipolar children. They all seem to have one brief paragraph somewhere in the book that says something about bipolar children urinating in inappropriate places and/or smearing feces. That's it. One brief statement and they're done. The really comprehensive books may say something like "Little is known about this." That's about all they say on the subject.
Yes! I know he does that! Why?! and more importantly HOW DO I DEAL WITH IT?!!
Well, after much research, I'm still coming up empty handed, so here's what we're doing. Maybe this will be helpful to someone else out there dealing with the same thing, or maybe one of you will post here about a good technique you've tried. I should probably also mention that it isn't just poo. He also pours urine in his heat vent, on the carpet, on his bed, in the window sill, etc. Poo he hides, plays with, or smears on carpet, walls, bedding, windows, curtains, and toys. At this age he rarely has much on his body. It's everywhere else.

Poo smearing can be for 4 main reasons: sexual, attention, sensory stimulation, or defiance. I'm lumping anger in with defiance for the sake of simplicity.
The approach to treating the first 3 is much more straightforward, so I'll touch on them because it makes sense to consider those strategies first. I believe Pajama Monster is the last category.

Sexual: In some cases a child who has experienced sexual abuse will act out with elimination issues such as fecal smearing, soiling themselves, bed wetting, etc. In these cases it's obviously the abuse and not the elimination concerns that you want to be addressing. In these cases the behavior is often also accompanied by other symptoms such as sexualized behaviors, tantrums, nightmares, and possible avoidance of the person abusing them. If you think this could be what you're looking at go see a therapist, and prevent unsupervised contact with anyone who had the chance to abuse, at least until you've had a chance to figure out what is going on. This is a case where discipline isn't the answer. This child needs protection and safety to talk about what has happened. Seek the help of a professional and be sure to avoid planting any ideas in your child's head about what you suspect might have happened with leading statements. Not all poo smearing has anything to do with abuse, but I thought I should mention it because it does sometimes happen.

Attention: This one is just straight up behaviorism. Don't provide any response (I know, I want to scream too!) and provide lots of praise and attention when the behavior is not happening. Have the child clean up as much as is developmentally appropriate, but don't clean with him/her because you're trying to minimize attention. Provide a consequence for the behavior but don't comment on it more than to assign the consequence, and make it clear that there are rewards to be had for those who do not do this behavior. It usually extinguishes fairly rapidly once you're not reinforcing it. The reinforcement is your big reaction. ("Rapidly" meaning about as long as you've been reinforcing it, plus a week or two.)

Sensory: These kids are doing it because the texture, feel, smell, etc. is very reinforcing. It feels great to them to squish things between their fingers or smear it on the wall. For these kids you want to provide a sensory appropriate outlet. Painting with shaving cream on the shower wall or a big piece of paper, washing plastic dishes with lots of gentle soap, play doh, finger painting, paper mache, water play, etc. Continue to do your best to limit chances for poo play and provide appropriate alternatives/redirect. Offer sensory play often, and coach the child on ways to ask for sensory play so they don't get the idea that smearing poo is the way to get to play with shaving cream.

Defiance: This one is where we are, and where I suspect most of the bipolar children are. Pajama monster uses a sock or cloth to grab the poo so that he doesn't have to touch it. He also doesn't always smear it. Sometimes he puts it in his dresser, or in a toy, or in his shoe. This tells me it's probably not sensory. He isn't left alone with anyone except daycare, and I've interviewed children and parents from the daycare, and can pop by at any moment to check on him. He also isn't showing any sexualized behaviors, so this tells me it's not sexual abuse. I've tried and tried with the behavioral route. The behavior doesn't respond at all to rewards or consequences. I can literally offer him a choice between pooing on the walls and having a day of scrubbing his walls, or just playing with his toys during quiet play time and then having a treat and going to the park. He picks poo almost every time. There's no lack of consistency with the rewards and consequences. they simply don't seem to have any impact on his behavior. Since I can't make him stop, and this has been going on for several years now, here's what our coping strategy had been, followed by a discussion on our new strategies and the role of anger in this behavior:

1. We stripped his room of everything but a washable toddler mattress and blankets and a couple easily washable toys.
2. I got a carpet shampooer. If I had the choice I'd just have linoleum in his room.
3. I painted his room in high gloss paint (He got to choose the color...light blue.)
4. I tied his ability to choose his own food and have treats to whether he'd smeared poo/urine in the past 24 hours. (I hate to use food as a reward/consequence, but I'm kinda desperate and I wanted to show that he could have more control if he's made good choices.)
5. When he smears poo I calmly remove any remaining large pieces and give him a scrub brush and a couple of wet cloth diapers and tell him he may come out when the room is clean. Without saying anything else I then shut his door and return periodically to check progress. If progress is made, I praise the effort and leave again. If no progress then I just shut the door. Once the room is clean (anywhere from an hour to a day and a half so far)to 4 year old level of capability, I have him sit in a chair till I finish cleaning. He doesn't get to sit with me or interact with me or play during this time. Once I've shampooed out any bad spots from the rug and wiped off any residual from the walls, he may wash up and return to normal life. Obviously he gets to come out for meals and school and doctor appointments whether he's cleaned up or not.
6. We have a toddler potty in his room so that he doesn't get creative in the main bathroom/ hall/ rest of the house after bedtime. It also prevents the "I have to go potty" every 5 minutes battle we used to have at bedtime. He'd spend 20 minutes playing in the bathroom and then would announce he needed to potty as we were putting him back in bed. If we didn't let him return to the bathroom he'd poo or urinate on his floor, despite having spent the last 20 minutes not using the toilet in the bathroom. If we did let him, the cycle would just continue over and over.
7. I keep a small jar of the paint for his walls and a paintbrush handy to do touch ups when he manages to damage the wall.
8. When he was younger we used several strategies to keep him in a diaper. We would put him in footy jammies that were pinned shut with a diaper pin, not a safety pin. Diaper pins have plastic covered heads that are less likely to come open on their own and poke the child. When the pin didn't work we moved to cutting the feet off the jammies and pinning them on him backwards, or even wrong side out and backwards. These helped for a little while, but my son can disable any childproofing device and nothing will stop him from getting out of his clothes now.
9. I explain the natural consequences of his action, such as no friends can come over because the house smells like poo, or we can't go to the park because Pajama Monster needs to clean, etc.
10. Minimize his chances to do it. Lots and lots of supervision seems to decrease his opportunity. I am especially careful when he uses the bathroom or at bedtime. This doesn't always prevent it because I can't be there all the time, but it does reduce it somewhat.
11. I put a cotton cloth about 2.5 feet down his heat vent. He can't reach it there but it will soak up any urine, etc. that gets dumped down there and prevent it from getting deep into the heat ducts where I can't clean it but will have to smell it every time we run the heat.
12. I make sure that the process of cleaning Pajama Monster isn't reinforcing. He gets any soiled parts of himself rinsed off with cool water from the shower sprayer, then quickly dried off and back in his jammies. We don't do the usual long toy filled bubble bath that he enjoys so much or else the smearing behavior just becomes a way to get a bath, thus reinforcing it.

The new strategy: We're using many of the same techniques with two noteable exceptions. We're no longer having him clean alone over whatever length of time it takes him, and we're no longer tying other consequences after the fact. I'm still expecting him to clean, but if he's not cleaning then I hold his hand and guide his cleaning till everything is done, then we wash up and move on with our lives. I'm not sure if this will work yet, but at this point all I know is that what we were trying wasn't working and I'm not willing to spank him (and also don't think that would help) so that leaves us with this.

When a child behaves this way, and it isn't sexual, attention, or sensory related there is usually an underlying anger component. I know this from my years in the field, but what I don't know is why Pajama Monster is mad. Usually I see this when the parent is on meth and neglecting/abusing the kids or there's some sort of extreme emotional abuse, but we have a pretty normal family, and I suspect most of you reading this do too. Pajama Monster is consistently praised and told that he is loved. He has toys and education and playdates and snuggles. The things that seem to make Pajama Monster angry always center around control, and they're unfortunately usually things I can't give in on. We give Pajama Monster age appropriate levels of control, and choices on almost everything else. I'm willing to problem solve and negotiate, but sometimes I just have to say "No." No, you can't take your sister's ice cream. No, you can't play with the electrical outlets. No, you can't have a sharpie. If I were my own client, the first thing I would be looking at once determining the anger issue is how to give Pajama Monster a sense of control, but in Pajama Monster's case there just doesn't seem to be enough control in the world to satisfy him. If he wakes on his own time and picks his clothes and breakfast and fun activities and lunch and generally has free range to make his own choices, he'll melt down because his sister got to pick the pink bowl and he wanted her to have the blue one (We have multiples of each color. He didn't want pink. He just wanted to make her choices for her.) If I structure his day so that everything is nice and predictable for weeks and weeks at a time, he still gets mad every time a choice isn't his, and doesn't seem to care about the routine at all. I feel like I'm trying to fill a bottomless pit of need for control, and as long as it isn't full there will be anger bubbling out of it. I'm hoping that by switching to a "fix it and move on" strategy perhaps I can minimize the anger a little bit and also break the long stretches of time that Pajama Monster is dealing with poo.

Just in case anyone out there was wondering, I should probably also mention that there was nothing strange about Pajama Monster's potty training. We offered praise and rewards and never gave consequences around toileting. He was given a potty at about 18 months and allowed to use or not use it. It was just there in the bathroom when he felt ready. He was around 3 years old when he was done with diapers, but still wearing a bedtime diaper because he still wets the bed. He's never been scolded for bedwetting. We give him control over age appropriate things such as what he plays with, what he wears and what he eats (within limits of course-no marshmallow and chocolate dinners!). I truly don't know where this behavior came from, but it's been a long and very frustrating struggle.

The Heartbreak of Hope

Pajama Monster started Depakote on Sunday. We increased to 2 pills last night, which will probably be the final dosage. We do the blood test next Thursday or Friday to see if the levels are right. Today has been a great day. He soaked several cloths in his room with urine before I came to get him out of bed this morning, and he's had a couple very brief time outs for things like throwing things in the trash when he knew not to, but that's it so far. Other than that he's played in the yard and had lunch and gone for a "milk treat" at Starbucks, and played at the park, then ridden bikes with his sister. It's very very rare for Pajama Monster to have a day like this, and so I hope. I try not to, because I hope on every good day, and with every new med, and every new therapy or program. I hope and pray and then the next swing hits, and we're right back where we were, and I hurt. I'm trying not to hope this time. It's never brought anything but more pain, but I look into his smile and I can't help but hope, once more, that this time will be different.

ODD, ADHD, Fetal alcohol, and Bipolar, the laundry basket test

This is a little example I use to clarify the differences between the overall feel of these diagnoses. Every child is different, and severity of conditions also varies. This is meant as an example of the flavor of the diagnoses, not a set checklist sort of test. You can read all the checklists in the DSM IV, but really it comes down to feel, so here's how I think of the differences. Imagine you have 4 children. One child has ODD, one ADHD, one fetal alcohol syndrome, and one bipolar. You give each child a laundry basket full of their clean clothes and tell them to go upstairs, put their clothes away, and bring down their dirty laundry. None of the children bring the laundry back, but it's HOW they don't bring it back that shows what's going on. Just because your child didn't do as instructed doesn't really clarify anything about the problem. Here's the differences between the diagnoses as I see them.

The ODD child dumps the basket on the floor and stomps off, or goes upstairs and dumps it over the railing, but either way they're very clearly deliberately refusing.

The ADHD child takes the basket and goes half way upstairs. You find them sitting next to it 20 minutes later playing with a toy. They look at your irritated expression, see you staring the laundry and jump up, clearly surprised that they had forgotten to take the basket upstairs.

The fetal alcohol child will probably take the basket upstairs, assuming they were calm when you asked. When you ask them later why they didn't put their clothes away and bring you the dirty laundry they will look at you in confusion, as though there were no instructions after the first one you gave. Conversation around your frustration will likely skew on random tangents. Alternately they will refuse to take the laundry upstairs, but with reasoning that doesn't seem to line up, such as because her boyfriend is awesome and laundry is stupid and they're going to be super rich because they both want to be rich, so no, she won't do laundry today.

The bipolar child may do anything. Maybe they follow all the instructions. Maybe they throw the basket at you and start an hour long screaming/throwing fit. Maybe they politely take it upstairs, then poo in it. The response varies from minute to minute. The only thing predictable seems to be that something unpredictable will happen on a fairly regular basis.

These are stereotyped examples to show themes, not meant to be taken as a way to pre-judge someone based on their diagnosis. Sometimes by exaggerating the simplicity of the diagnosis you can more easily see which theme is happening within the complexity of daily life. I hope someone out there will find this helpful in avoiding a misdiagnosis.

Diagnosis: A little of everything

I'm sitting here with a copy of the DSM on my shelf wanting to rip my hair out. For those of you not familiar with the DSM, it's a book used to diagnose mental illness, etc. It has codes for all accepted diagnoses and has a list of accepted criteria for each diagnosis. When someone says they have a diagnosis, they mean that they meet all the criteria for that diagnosis listed in the DSM. I've heard talk that the next edition may contain both childhood onset bipolar and sensory processing disorder as new and accepted diagnoses. Here's the full current edition for anyone curious DSM Online

The frustrating thing about childhood bipolar is that because it's new, people are still agreeing on what it looks like. On top of that, it seems to have a very high rate of comorbidity (other diagnoses being present along with it). This muddies the waters in terms of what is generally seen in bipolar, and what is part of diagnoses often occurring along with bipolar. The childhood version doesn't seem to have nice clean cycles as are often seen in adults, and children often express depression through anger and irritability. As if that weren't enough, environmental stressors can make any child extremely moody and defiant as well. In short, it's a nightmare to try to diagnose.

I've hard many other parents echo this, and it's my constant lament: Any of the things Pajama Monster does could be seen as the far extreme of normal naughty behavior if it were the only incident. The thing is, it's not just one incident. It's hundreds, happening very frequently and seemingly without warning. Other kids show signs that they're getting frustrated and then lose control, but my little boy suddenly just smiles as though possessed and proceeds to destroy things.

I've tried so many different diagnoses on for size. He has a sampler platter of so many, but doesn't meet the full criteria for most. He's extremely active at times, but not as much as a child with severe ADHD, and he seems gleeful, not oblivious to the results of his actions. He is rigid in his thinking, but with social skills that clearly show he's not autistic. He meets criteria for ODD (Oppositional Defiant Disorder) but that's just a name for symptoms, not a cause. A diagnosis of ODD will get you insurance coverage in most cases, but is otherwise useless. It's the mental health equivalent of going to a doctor because your throat hurts and being given a diagnosis of "sore throat." You already knew your throat was sore. What you want to know is WHY and how to TREAT it. Before I launch into a list of what's going on with Pajama Monster, let me just give my gut feeling on bipolar childhood symptoms: If it looks like ODD, anxiety, sensory problems, ADHD, and a few autistic features just for flavor, you may want to consider evaluating for bipolar. It doesn't mean that your child doesn't have bipolar AND one or more of those other diagnoses, but it may help in gaining a clearer picture of what's going on.

So, that's my rant, and here's the giant pile of puzzle pieces I'm trying to put together over here.

Anxiety?: He seems to go "Deer in the headlights" when overstimulated or confused.

Autistic features?: He has trouble engaging in structured creative play, such as playing kitchen. He gets locked on certain ideas and can't readily change. He sits and draws patterns for long periods of time and doesn't like things being out of order.

Sensory?: He becomes frightened when upside down and will get stuck on play equipment unless he's done the exact motor activity several times. The school OT suspects poor motor planning. He runs into things and falls frequently and has trouble mirroring actions that are demonstrated for him, such as a jumping jack.

Mood disorder and etc?: Tantrums over seemingly trivial things, extreme defiance and need to control, destruction of property including his own favorite toys.

Just fooling myself?

There comes a time in any parent's life when he/she must make an honest assessment of their child's capabilities. This allows the parent to push for services their child needs, both in terms of providing chances to excel in areas the child is good at, and building skills where the child struggles. For the parent of a disabled child this also often involves grieving the potential we'd hoped our child would have. I've heard parents in denial around this step many times in my office saying things like "when we find the right med and he can understand things..." regarding a profoundly mentally retarded child for instance. That child may grow to be many amazing and wonderful things, but no medication in the world will change the retardation. Despite the need to be realistic, though, a parent must be very vigilant not to pigeon hole their child. I've met many a parent with charming and very verbal autistic children who were told early after the diagnosis was made that their child would never develop language.
I know it sounds noble to say that you're sure your child can do whatever he wants in life and you'll be there to cheer him on, but the truth is, this reality check isn't about settling limits for the disabled child. You should never tell a child not to try. This reality check is about letting go of your own dreams and expectations and accepting your child as they are, for who they are. It's hard to see all their real strengths if you're caught up in fooling yourself about the disabilities. The parent of the retarded child, for example, was so caught up in how things would be once the retardation was gone, that she couldn't advocate for the things she needed in order to function with the retardation. I wasted a lot of time thinking that I shouldn't bother to find a support group or research medications because surely we'd find some star chart or reward that worked and all of this would soon be nothing more than a memory.

My struggle is this: While being truly honest about Pajama Monster's disability and his many strengths, what does this mean for his future? What is the best case scenario? What does success look like? Could my son become a neurosurgeon, a CEO, president? Could my son be a computer engineer, or would just holding down any job be a success for him? It's not that I expect that he will necessarily want to be a neurosurgeon, but I'm wondering if his disability would stop him if he did. What sort of extra supports will my son need long term? Where will he be next year? The answer is, no one seems to know. Maybe the meds will work and next year I'll be pushing for the gifted program instead of working on the IEP. Maybe next year will look exactly like today, with me typing my frustrations out while my son refuses to scrub the poo off his walls. Even hope feels painful sometimes, because it always comes just before the new med sends Pajama Monster into mania or the next swing hits. I wish so much for a glimpse of the future, but even if I could look, I'm not sure I'd have the courage to do so.

A comic that sums it up.

I just thought I'd share this. It reminds me very, very much of life with a bipolar preschooler, expecially the part about potty training. http://theoatmeal.com/comics/tyrannosaur_crack

The Therapist in Me

I feel like I need to mention this, just because I've seen it so often in my practice. Bipolar disorder with childhood onset is a bit of a hot topic now, and is therefore getting more publicity. It's a fairly new idea that a child can have bipolar disorder, and this leads to a boom of diagnosis, hopefully mostly accurate, but because of the newness and lack of familiarity, some may not be accurate as well. Just because your child is acting out, even in the same ways you see listed in books you're reading, does NOT necessarily mean that he/she is bipolar, or has any mental health condition for that matter. Before Pajama Monster was diagnosed, the psychologist did extensive looking at my husband and my own parenting skills, our home environment, the possibility of abuse from home or another source, medical problems, family history of mental health problems and medical issues, major transitions or changes, and longevity of the problem, to name just a few. He did this because it is very often one or more of these factors. A child can appear to be bipolar as a result of poor parenting skills, or medical problems, sexual abuse inside or outside the home, trauma, etc. There are also many overlapping symptoms between bipolar, depression, anxiety, sensory processing disorder, OCD, ADHD, and ODD.
I'm writing this blog to talk about how I'm coping with life with a bipolar preschooler, and all the heartaches and joys and setbacks, but please, please, PLEASE, never diagnose your child yourself! I'm a therapist. I'm qualified to diagnose bipolar in a child, and still I would never have considered making the final diagnosis myself. I'm just too close to the situation. There's too great a risk that I'll see what I want to see and not see what I don't want to see. Beyond that, for the nonprofessional, reading a list of symptoms just isn't enough to make a diagnosis. That's why no therapist will diagnose until he/she has seen the child. It's how all the pieces fit together that informs diagnosis, not just a list of check boxes. We see supervisors and learn over time what the diagnosis really looks and feels like before we diagnose it in others.
I just want to make sure I don't give the impression, by jumping in with where we are today, that we skimmed over all the other steps of diagnosis. They are incredibly important, and unfortunately very time consuming. Be honest with your child's therapist. It's the only way to get an accurate diagnosis, and be willing to wait while all the information is being gathered. It may be the diagnosis you suspect, but then again it might not. I once met a little girl diagnosed with autism because of headbanging, screaming, failure to develop language, flailing motions, no interactive response to other's attempts to speak to her, etc. Autism? Everyone thought so, that is until someone took a look in her ears and discovered the horrendous ear infections she had behind both eardrums. She couldn't learn language or engage in attempts at speaking because she couldn't hear, and the rest of the symptoms were her frantic attempts to deal with the pain in her head and to express her needs without words. The diagnosis isn't always what it first looks like. Take your time and never be afraid to question.

How to Reason with the Unreasonable: An Attachment Parenting Dilemma

I suppose this is my way of saying, how does an attachment parenting Mommy reconcile her desire to reason with her child and avoid compliance through punishment with the fundamental lack of reasoning that comes along with bipolar disorder? Essentially, when Pajama Monster is feeling reasonable, everything is fine. I can explain and negotiate and compromise and life runs very smoothly. When, on the other hand, Pajama Monster is screaming and bashing into the wall in an effort to wake his baby sister, how do I take an attachment parenting stance and still be effective? He's loud enough to hear all over the house, so moving the baby isn't an option. He's beyond reason at that point. Believe me, I've tried every approach to trying to problem solve with him imaginable. He just wants to hurt people and wake his sister and destroy things and consequences and rewards and impacts on those around him are immaterial. He's simply out of his head.
I usually end up putting him in his room and waiting out the storm. I use his room because it's a safe place. We've nailed down the inside of the heat register and painted the walls with high gloss paint. We've filled every little nick or nail hole so there is nothing way to tear apart the drywall. All lighting and decor has to be high enough that he can't possibly reach it, and even the curtains had to be removed after I found him spinning in them till they'd formed a cord around his neck (not self harm, just lack of forethought). I'm afraid of what happens when he's older and can smash his window. As it is now, we often strip his room of all furniture and leave him with a mattress and bedding because we're afraid of him tipping things onto himself and pouring urine behind any furniture he can't tip. This means we have to unscrew the furniture from the wall to clean up the urine.
I've tried telling him after the fact how I felt about the behavior and what the impact on the family was. For example, we had planned an outing to the coffee shop and then to the park, but instead we all had to stay home, including Pajama Monster. When he's getting overstimulated or panicked, I step in early to soothe and help with coping skills, but nothing helps once he's got "the look."

The upshot? How do I reconcile Attachment Parenting with the unusually extreme need for safety? Firstly, I intervene early. I've heard plenty of "leave him be. He's fine. It's no big deal." but it makes the difference between spinning out of control and having a nice playdate. If I let him pour half the bottle of glitter out, then he's excited by the lack of limit and immediately it's 5 bottles of glitter, then he's screaming and trying to microwave the glitter and trashing the kitchen, so yes, I'm the mom who takes the glitter away at 1/2 a bottle puts half of the pile back. It may not sound very AP, but I see it as protecting him from something I know he can't handle, much as the mother of a diabetic child says no after one small cookie. She knows what happens after he has more and she's not willing to put him or anyone else through that. Moreover, she doesn't care if you think she should let him have more cookies. Her child is far more important than the opinion of someone who doesn't understand her child's special needs. My child needs more rigid limits when he's dealing with something new or he becomes unsure, then unstable and destructive. It's not fair, but it is reality.
Secondly, and this is the part I struggle most with, I try to view anything happening after I see "the look" as an involuntary action, beyond my child's control. I frame the time outs as a way of protecting him and the family while he is out of control, not a way for me to get back at him for being bad until I finally break him and he stops. I still expect him to take responsibility for cleaning up his messes, etc, in the way an adult would pick up items from a table he/she had accidentally bumped into. I still explain the impact of his actions, e.g. "You can't be alone with your sister because sometimes you lose control and hurt her." Ultimately though, I still view him as fundamentally good and worthy of unconditional love, and I let him know this. Yes, I still lose my temper at times, but this is my goal: to show him that I love him, fundamentally and completely, regardless of his behavior. He's likely to encounter countless negative responses to his behavior as we struggle with his illness. He needs to know that while his behaviors are often unacceptable, it is not him that is unacceptable. He is loved, just as he is.

The Medication rollercoaster

My husband and I didn't want to try medication for Pajama Monster. We were worried about the impact on his developing brain. What if things don't develop as they otherwise would because of the meds? What if he grows to be dependant on them? We stuck it out for a year of therapy before we finally broke down and agreed to see a pediatric psychiatrist. I should note at this point how lucky I feel that there was a pediatric psychiatrist available to us. They're not nearly as common as regular psychiatrists and there are a lot of nuances that they need to know in order to effectively deal with little ones.

What changed our minds? We finally decided to try medication when we felt we'd tried everything else available to us, and when we were certain that we were trying it for Pajama Monster and not to make our own lives easier. It's one thing to use medication to help a child and quite another to use it to avoid having to work hard at consistency, praise, setting limits, rewards, etc. We finally realized that Pajama Monster was starting to be the "bad kid" in different settings, and we began to look at what this would mean for his developing sense of self. What does it do to a person to try their hardest and still always fail, and fail so spectacularly that people don't even want to be around them? How does it feel to constantly elicit negative responses from those around you for something you can't control? I can't force him to live through that, and to begin to see himself as "bad" if there is something, anything I can try to help him.

It has been quite a roller coaster so far, and the ride just goes on and on. I can't tell you how much I want off this ride. The worst part is knowing that there may not be any "off" to the ride. It may be that no med or combination will work. Each time we try a new one we not only have to wait for it to build up to level in Pajama Monster's system, but also for Pajama Monster to be at level long enough for us to see if it's the med or just another mood swing that is creating the change. Our strategy has been to always choose the med with the least side effects that looks like it might work, even if another med might be more likely to work. It makes for slow going, but reduces the risk that we'll end up with a med that is stronger than we need. We've also drawn the line at anything that seems sedating. If Pajama Monster doesn't seem like Pajama Monster anymore, we're just not going to use that med, even if it does settle the fits and mood swings. We meet with the psychiatrist every 4-6 weeks with several e-mail updates in between. It's been a long and heartbreaking ride so far.

Here's our wild medication ride to date:

Prozac: Takes weeks to get up to level in his system. High hopes, but no results. It just didn't seem to make any difference at all, so we discontinued.

Adderall: This helped. It took some tweaking to get the dose right, but at least he seems able to process instructions and consequences. He's still moody, defiant, has fits, etc, but he's a little less wild about the defiance.

Zoloft: Never showed much of a result, but broke out in a splotchy, itchy rash, so discontinued.

Celexa: This seemed like it might help for a little while, then he went absolutely bonkers. we took him off it after a 4 hour stretch in which he destroyed several toys, ripped the ivory off the piano, smeared diaper cream and saline all over the house and his sister, ransacked the diapers, removed and emptied all his dresser drawers, took and hid his sister's food, scratched up the paint on the walls, and was sitting in his room excitedly and very rapidly talking to himself about all of this. I think that's when he used his heat vent to smash holes in the drywall too. not a good fit for him.

Lamictal: This one started out OK, but rapidly seemed to push him manic as well. We stopped this one after he stabbed his sister in the back of the throat with a fork.

Depakote: This one is sitting on my counter now. We're supposed to begin it Monday and increase in about 5-7 days. It does require a blood draw, which isn't going to please the Pajama Monster, but it seems like the safest med in line that we could try next.

Wish us the best with this one. I really hope, each time that we'll have found the answer. Prayers are always welcome.

What a Bipolar child looks like

Well, for starters I had to stop between the title of this post and the text to go see what the crash was. He had tipped over his dresser, breaking his cubbies because he was mad about being in time out.
The real answer is, everything! The bipolar child looks like everything. He is sweet and angelic, creative, funny, anxious, loving, charming, violent, destructive, malicious, and cruel. I brace myself in the morning before I open my son's door because I don't know what's on the other side. Every child is (*CRASH* It sounds like he flipped the dresser again. I'm not standing it up again this time.) different, but I think most parents of a bipolar child will tell you that they have one thing in common: THE LOOK.
It's a change in the eyes that is hard to describe. The look is the sign that your child is well beyond reason. He or she will not be swayed by reward or consequence and something very very bad is about to happen. In my son's case it's a sort of ecstatic grin with a crazed manic laugh. I love my son's real laugh. It's one of my favorite sounds in the world. This isn't the same sound. It's a frantic, crazed laugh and it means I have about 3 seconds to get him to somewhere safe before he starts world war III.
For the parent, we live in fear of the look. We watch for it constantly because we know that it can come at any moment, without warning and catching it early is the only way to minimize damage. If you're not familiar with a bipolar child this probably just looks like an overprotective parent making something out of nothing. It isn't. The look is very real and unmistakable. It means the little sweetheart who has been so nicely playing and sharing has left, and in his place is a child capable of almost anything. It means our child is about to have one of those moments that everyone says, "Oh no. He's such a good boy. I'm sure he wouldn't do something like that." about.
I hate running errands because I know that there is a very good chance that my son will flip while we're out. There's nothing like trying to pay for groceries while your son is emptying the contents of the cart onto the floor and shrieking with glee. Worse still are the times he starts smacking his sister because he knows it will take me a moment to get her safely out of the cart and away from him. What should I do? I have no one to watch him and we need groceries. I can't hold his hands while I'm paying, and I have to pay before we can leave. At home he'll smear poo on everything, pour urine into the heat vent and everywhere else, scream "Help! Help!" out the window, color on walls, hide dirty diapers around the house, trash the fridge, assault all of us, scream, destroy, and generally be as rotten as he can be. Except when he's not. Sometimes he wants to read stories and color and snuggle and play in the yard. It makes me want to scream and cry and tantrum right along side him.

If you want a glimpse of my life, I suppose Monday pretty much sums up life with Pajama Monster.

Monday we woke, had a nice morning, sent Pajama monster to preschool and then had lunch. Overall ok with only a few defiant acts, etc. Then Pajama Monster decided to feed Baby Peep a few bites of her noodles. It was nice seeing him being so loving toward her and I thought I had enough time to run downstairs and set a vase in the cupboard. I had just reached the cupboard when I heard the scream. Apparently Pajama Monster had fed Peep a couple of bites and then rammed the metal fork straight into the back of her throat. He later said he did it because he was mad that I had gone downstairs. When Peep calmed I could see two bloody punctures in her throat, and couldn't tell if there were more further down. We rushed to urgent care. While there Pajama Monster set about trashing the room we were in, throwing supplies in the garbage, yelling rude things at me, etc. I finally buckled him into one of the chairs. Angry, he hit his sister then cheerfully announced that he was going to wet himself, and did. After tipping any furniture he could reach and several more attempted assaults he announced that he was going to poo himself, and did. I rushed him to the bathroom where he danced around gleefully chanting about poo. He then spent the next 30 minutes pinching me and hitting me while we stood in line at the pharmacy for Peep's antibiotics. At one point he tried to it me, slipped into the wall and screamed for the world to hear, "You hit me so hard I'm going to die!!" We finally drove home. At home he then ate dinner and hopped into bed, kissed me goodnight and went to sleep like a little angel. Peep still has the sores in her throat, several days later, but they are healing nicely and aren't likely to cause her any further discomfort. Still, I'm haunted by the realization that becasue I left the room for less than 1 minute, my baby could have been killed. Since then, I never leave them alone for even a second. It's exhausting and I'm going out of my mind. I have to follow them if they leave the room and take them with me to use the bathroom, check laundry, grab my hairbrush, get something from the pantry, everything. That, I believe, is what it means to live with a bipolar child. Every moment is spent coping with their illness or planning for it. I fantasize sometimes about what it would be like to just let them play in the yard for a few minutes and know they're safe. I wonder if I'll ever know what that's like.

Drive-by parenting advice

I'm sure it's happened to most of us. We're struggling to deal with a tantrum or saying no to a cookie or just minding our own business while grocery shopping when suddenly we are the victim of a drive-by parenting attack! Whether it's the old lady telling me that I should put those bananas back because they're not organic and the pesticides will irreparably harm my son, or the woman telling me that I shouldn't tell him not to throw things because he's a good boy, they all go beyond bad manners and into the realm of dangerous.
Dangerous? Yes! The mother who is the victim of this parenting assault is one of two things. She is either a loving mother who is doing her very best to handle the situation, in which case the drive by criticism only makes her job harder and increases her stress, depleting her coping skills, or she is an abusive mother who really is a danger to her child. If she is an abusive parent then all you have done with a nasty comment is make her angry. She can't safely take that anger out on you, so guess who is going to suffer for your action? Rest assured that that child is going to receive much worse treatment as soon as she gets him alone. If a child is in danger do take action, but make it an action designed to help the child, not just make you feel high and mighty.
I've been thinking a lot about these drive-by parenting advice givers, and here's my fix:

1. If you are a drive-by advice giver: look at why you are doing it. Are you trying to help, or do you just enjoy making yourself feel big by putting everyone else down? If you just enjoy criticizing others, go find someone to slap you till you're over it, or go find a therapist, your choice. Let's assume you're not a selfish jerk and you really do want to help. Look at the situation. What do the mother/child actually need? If she's truly hurting the child, they may need child services intervention. In those cases a snide comment will endanger the child further and provide no positive change for anyone. It's probably time to look up the number for your local child services program and explain the situation to them. If, as is usually the case, the mom is just dealing with a tantrum, maybe she needs someone to help her push the cart out of the way while she restrains her little one, or someone to help her pick up the oranges he just threw out of the cart. If she's talking to her child and no one is getting hurt, maybe she just needs to be left alone. Only offer advice if you truly think you know something she doesn't. For example, there's a changing table on the other side of that clothes rack, or his foot is caught in the stroller. Advice like "organic is much better" or "that swaddle is too tight" doesn't qualify as useful info she isn't aware of. Next time you're thinking about offering some completely unwanted parenting advice, imagine how you'd feel if I suddenly appeared in your kitchen, chewed you out for your lousy sense of decor and poor cooking skills and then disappeared. Would you find it helpful? No. I thought not.

2. If you are the victim of unwanted parenting advice: Don't let them finish it. You can greet their "You know, boys like that need..." with a big smile and a cheery, "Oh good! Are you here to help?" Most people will look very surprised and murmur some kind of yes. Now is the time to give them a task. "Great! I need paper towels, and a 5 lb bag of potatoes. You can drop them off with me in the soup aisle." or "Great, you can push the cart to the checkout for me while I carry my son." (Obviously you never have them interacting directly with your child.) Any time they balk just repeat, "You said you wanted to help. This is what would be helpful." Eventually they will either slink away embarrased, or help you finish shopping. If they truly wanted to help, you have given them something helpful to do. If they didn't, maybe they'll think twice before offering their next piece of unwanted drive-by advice.
Ok, you've survived a drive by incident. The final step is to take a minute and honestly consider how things were going at the time of the criticism. Wait till you're calm and not feeling defensive. You know your child and all the factors at play. Do you think you could have handled things better? If yes, do your best to correct what you can and make a plan for next time the situation comes up. Drive by advice can be truly painful, especially when you're dealing with a disabled child who looks "normal" and everyone is sure it's just your incompetence leading him to act out. It hits every raw nerve and usually comes when your child is in the process of hitting them too. I've often had to restrain myself from saying, "Oh, do you have $130K of education in children's mental health? No? I guess it's just me then."
No matter what, remember to be true to yourself. When all else fails, I remember a story my mother once told me. Apparently, when I was about two I kicked her while we were grocery shopping. Shocked, mt mother said "Why did you do that?" Immediately she was beset upon by not one but two drive-by parenting experts. One woman laid into my mom for not spanking me immediately for my bratty behavior while the other chewed my mom out for speaking to me too harshly. It just goes to show you can't be what everyone expects, so forget about how they see you and just focus on being a good mother.

Rationally crunchy

I should probably fess up that in addition to all that is going on with my Pajama Monster and Baby Peep, I'm also slowly changing into a crunchy granola Mommy. I live on the West coast, so that's not terribly surprising. I belong to attachment parenting groups and am surrounded by organic eating, cloth diapering, baby wearing, extended nursing mommies. I'm also a cloth diapering, baby wearing, extended nursing mommy, but I've found that I have to do some things differently. I believe that the heart of attachment parenting is listening to your child and trying to meet their individual needs.
What I believe it is NOT, and what I sometimes see it twisted into, is a rigid set of rules for how to treat every child. For example: I believe that baby wearing is a great idea. I use a moby and a ring sling and love them both. My son loved to be worn and spent a huge amount of his time happily watching the world while nestled on my chest. Baby Peep, however, hates it. I've tried carriers, slings, wraps, etc. She hates it. From the time she was a couple months old she has wanted to explore and return for snuggles on her own terms. I believe that an AP mommy respects personal baby preferences like this and doesn't force the issue just because it's AP to babywear.
That being said, I belong to a wonderful group that is very flexible and willing to meet moms and babies where they are. I co-slept till about a year with both kids, at which time they stopped being able to fall/stay asleep if I was in the bed with them, so we transitioned to their own beds. I struggle to find ways to set limits with my son that don't feel punitive, but every day is an exercise in finding a new approach that will work. Novelty seems to be the only thing that is effective. Sometimes I need time outs just to give everyone a chance to calm down and prevent Pajama Monster from hitting anyone or breaking anything.

Things that have helped:

I hope this will be a list that is added to by myself and maybe by viewers, but here's a beginning list of things that have helped:

-Asking the doctor for help in writing. This seems to make them take an extra moment to consider whether or not there might be a problem.

-Request an IEP evaluation. These are free and you either walk away with peace of mind that everything is fine, or you walk away with help. Either way, things are better when it's over.

-Look for a support group, even if it's only online. Sometimes just knowing that someone else has gone through the same thing makes things feel a little less crazy. On top of that they often have good ideas because they've gone through the same things. I'm a fan of meetup.com, but there are many other places to look, and even a google search can go a long way.

-Ask everyone what services they have found helpful. From the other parents in your child's class to the counselor to people in your support group, sometimes there are programs that are a perfect fit that you may never have even heard of.

-Find an outlet. Blog, or talk to a counselor or call a few trusted friends, paint, journal or jog. Whatever does it for you...we all need a pressure release valve!

-Find a professional you trust. If you think they're not paying attention or just are uncomforable with their approach, ask for a second opinion/a switch of providers.

-Read. Books can be pricey, and taking an out of control child through the library is definitely one of the circles of hell. The public library here can be accessed online from home and you can place holds on any book you choose. This lets me pop in, grab all the books I wanted, and leave in less than 3 minutes. I also check amazon.com for book reviews to see which books might be the most helpful.

-Treasure the good moments. It's the "I love you mommy" and the silly running around pretending to be a dinosaur moments that make all the others bearable. Try to revel in those moments.

-Give yourself credit. This is HARD work. I know I fall into the trap of comparing myself to other mommies and wondering why she manages to get her nails done and throw a perfect dinner party while still baking cupcakes for the bake sale. Well, my life is different from hers. My children are safe, clean, played with and loved. I'm doing ok.

How it all started...the LONG version

This will probably be my longest ever post, but a coupld months ago I wrote it because I was feeling like maybe if I wrote it all down it would form some sort of clear picture and have a solution. I was mistaken, but here is the story of my little one. I've renamed him "Pajama Monster" because that's one of his favorite nicknames. Here's my story:

I started this journey like many moms. I wanted a baby. I had hopes and dreams for that baby and a vague but firm acceptance that he would still be his own person. I imagined myself as a mommy who would read all the books, or at least skim them, and breastfeed and make my own preservative free baby food while little birdies chirped away in the blossoming trees. I imagined myself taking walks in the woods and teaching my baby about all the things we see. In short, I imagined perfection. While I realized that things can never be this perfect, I was wholly unprepared for reality.

In preparing for pregnancy I ate healthy foods and took my vitamins and avoided all medications, cleaning chemicals, caffeine and alcohol. Once pregnant I continued these healthy habits and started walking for exercise. I talked to my belly and attended numerous classes on birth and babies with my husband. I was already a marriage and family therapist with a specialization in children’s mental health. I believed that I was prepared. We were going to breastfeed on demand and swaddle and introduce the pacifier at exactly one month and use a SIDS alarm and introduce solids at exactly 6 months. I had everything completely figured out in a way that only someone who has never had a baby can.

And then my son was born. He was 9 and a half pounds of adorable. He was really here and I was finally a mommy. I jumped in feet first with the skin to skin contact and the nursing on demand and lullabies. The first few days were wonderful, but when we attended our first well child visit we learned that Pajama Monster was losing weight rapidly. I was rushed off to a lactation consultant and told that I was producing almost no milk. Pajama Monster was sleeping so well because I was starving him and he didn’t have the energy to be awake. I was killing my son through what felt to me to be my complete failing as a mother. I was crushed. I was hormonal and sleep deprived and in pain and now I was sure that I was a failure as a mother. I would need to start pumping every 3 hours round the clock and would need to give Pajama Monster formula. The next weeks are a blur of weight checks, pumping, and several times per week lactation visits. I was averaging a cumulative 3-4 hours of sleep per day and would have been hard pressed to tell you my name at that point. Even if I had been able to tell you, I probably would have started crying. I was still certain at this point that the warnings of the American Academy of Pediatrics were correct and co-sleeping meant certain SIDS death for my son. My husband once found me crying and tearing the couch apart searching for the baby I was sure I was accidentally smothering in the blankets and pillows. Pajama Monster was asleep in his bed at this point and I was so emotionally wrecked that even asleep I was afraid that I was failing him. Eventually it was discovered that Pajama Monster had an issue with extreme jaw clenching. He clenched so hard at each nursing that he cut off the flow of blood and milk to my nipples, damaging the tissue and leaving my nipples cramped and bleeding. I was taught infant facial massage to add to my routine of pumping, tube-aided nursing and never sleeping. After about 3 months it finally all came together and Pajama Monster was able to go off formula completely in favor of nursing. I breathed a sigh of relief because I had made it through the big problem. Surely now I would be able to get some sleep and become the Betty crocker/Martha Stewart/Donna Reed mommy I was sure I would become. Things were easier, except for the screaming.

From the time Pajama Monster was a couple of weeks old he would scream in the evenings. Starting at about 6 PM he would scream. He would scream and spit up. I knew the formula was probably part of the problem, and it did improve once he was off the formula, but I had to feed him and simply couldn’t produce enough milk as long as he couldn’t nurse effectively. Once the formula was gone, Pajama Monster settled in to a routine of screaming when tired, being tightly swaddled and athletically bounced/shhhhhhed/danced with till he fell asleep. He would sleep for about 40 minutes and then wake up screaming. This would repeat from around 6 PM until sometime the next morning. After that he would be up for a few hours before starting the cycle for naptime.

Little by little I began to fall into a rhythm. Pajama Monster was cooing, babbling, smiling, and hitting his milestones very early, much to my delight. Despite these joys though, Pajama Monster began to go through “phases.” We viewed each phase as separate from all the ones before it. There was the taking off his diaper and smearing poo phase, the biting phase, the hitting phase, the chewing each bite and the spitting it on the floor phase, the throwing things in the diaper pail phase, the sucking water from the sippy and spitting it onto other containers phase, the sticking his fingers down his throat and making himself throw up phase, etc. At each phase there always seemed to be someone in one of my many playgroups who had had their child do something similar once. I didn’t explain at length all the horrible things that Pajama Monster did, so I just assumed everyone was in a similar situation and just didn’t want to focus on the bad. If someone mentioned that their child had taken a diaper off during naptime, I took this as reassurance that it wasn’t just my child, even though my child did it several times a day, even with the backwards jammies that were diaper pinned shut. I just assumed that their child did it frequently too, and they just weren’t mentioning everything, after all, who wants to make a laundry list of everything their child has done wrong.

By 6 months I was sure that parenting was much harder that I had expected, and convinced that the authors of all the parenting manuals I’d read were insane. My son was hitting developmental milestones long before the other children while remaining completely immune to all my attempts at correction and redirection. I decided that my pediatrician was obviously a sadist because she would say things like “Try to get some sleep when he sleeps” even though he never slept for more than 40 minutes and it took 10 to be sure he was asleep enough to set down, at which point I was supposed to use the breast pump. Her other gems were “set him down for a nap drowsy but awake.” and “Let him cry it out. Just check on him every 10 minutes but don’t pick him up.” I tried those last two, thinking she must know something about babies that made this magical notion possible. He screamed. He screamed as I hung, half conscious over the rail of his crib, singing lullaby after lullaby to his screaming red little self. He screamed and I sang for 3 and a half hours. I finally asked the pediatrician at what point I should give up and take him out of his crib. She said not until he had slept. I countered that he would at some point need breakfast and lunch etc., and it seemed unwise to leave him in his bed screaming for more than 3-5 hours without feeding and changing him. She looked very confused and told me he wouldn’t scream that long. I’m not sure she ever really believed that he did.

Pajama Monster grew and grew. He learned the alphabet in several languages and was beginning to master his numbers. He knew his colors and was already showing a blossoming creativity. In play he preferred to hang back and study the situation before joining in, but I was confident that this was just a natural part of his personality. As for the phases, I kept reminding myself of his developmental stage and the certainty that he didn’t really understand my feelings or perspective and so therefore couldn’t be doing any of these things out of malice. I was sure that he just didn’t understand the impact he was having and would stop as soon as maturity gave him the ability to understand that there was such a thing as outside perspectives.

When Pajama Monster was 18 months old I became pregnant again. This time we were going to have a little girl, my sweet Peep. We launched into preparation mode, expecting that things would go just as they had with Pajama Monster. We prepared Pajama Monster by reading him big brother books, reading his baby book to him and writing a special book with photos explaining what Pajama Monster could expect about the pregnancy, delivery and new baby. I bought a gift from baby sister for Pajama Monster and planned and planned to make things as smooth for Pajama Monster while lavishing him with attention and making him feel special. Toward the middle of my pregnancy Pajama Monster refused to sleep in his bed and began throwing screaming fits at bedtime. He demanded that he be returned to his crib and no alterations of the crib were acceptable to him. Bed time became a constant battle. I found a second crib from someone willing to pass it on for free, but Pajama Monster then began sleeping in the baby’s bassinette, though his head and legs stuck out onto the floor. He also often asking to be rocked while drinking from his sippy. I accommodated, believing that he simply needed a bit of time to adjust to the idea of someone else also being my baby. I reassured him that he would always be my baby.

As I grew larger, Pajama Monster became increasingly difficult to handle. He would hit and kick and bite me. I didn’t understand why all of this was happening, but was sure that it must be something I was doing wrong. I tried harder to be loving and patient and set clear limits and offer rewards. I lost my temper, but I was really trying. At one point, a month before my due date I ventured out to a thrift shop to find anything that would fit. I had outgrown most of my maternity wear at this point. I was a large, uncomfortable whale and Pajama Monster decided he didn’t feel like being in the store anymore. I tried playing a game with him, then tried a visit to the toy section, nothing was working. I even tried pulling the cart from the other end, but that only gave him free range to grab things off all the racks as we passed. At one point a woman came over to chastise me for daring to have another baby on the way when I was such a terrible mother to my son. At that time he was in the shopping cart screaming and pinching and flailing at me while trying to bite my hands as I pushed the cart. I had put one hand on his forehead to hold him at bay while I blocked my pregnant belly from being kicked. Apparently this woman was under the impression that as Pajama Monster lunged against my hand in his manic attempts to bite me again, it could put a strain on his neck which would do terrible future damage to his spinal cord. I asked her what exactly she thought I should be doing with my crazed son and she responded that I shouldn’t let him act like that but shouldn’t criticize his behavior or physically restrain him either. You may wonder why I hadn’t left the store at the first signs of Pajama Monster acting up. The reason is simple. Pajama Monster always acted like that. This was standard behavior and if I left the store over it I would quite literally have never ever bought groceries, maternity wear, soap, or any of the other items necessary for daily living. My husband worked on salary and was working ridiculous hours and often weekends at this point. I had no family living locally. There was simply no alternative and so I gritted my teeth and foraged on.

By this point I was beginning to realize that something wasn’t just like all the other parenting experiences I’d heard. If any parent I knew had had a behavioral problem, I’d struggled with a worse version of it. I didn’t understand. I thought I was doing things right, or at least as right as I could. What was wrong? Why was he doing these things? He never seemed to throw out of control tantrums, but rather seemed to be enjoying the behavior, smiling and laughing, even as his father and I struggled to restrain him or clean up his messes. He usually continued to smile through consequences and even asked for them at times.

I had to find a solution and I was sure that there couldn’t be anything really wrong with my precious boy. Maybe the problem was that Pajama Monster was having trouble expressing his feelings and desires. Pajama Monster had developed an extensive vocabulary, but most people meeting Pajama Monster believed that he had not yet learned to speak. Pajama Monster would fold his tiny hands before dinner and say something like, “ Dit-dou Dod bo be a be a be ah brus ae, Ma Mo.” For those of you who aren’t Pajama Monster’s mommy that probably sounds like gibberish coming from a child who cannot yet speak. I however knew that it translates to “Thank-you God for bean and bean and bean and milk and Amen.” I’m sure you’re wondering if this is just wishful mommy thinking, but I assure you that if asked to repeat any of those words he would say them in exactly the same way. They were completely consistent and almost completely unintelligible. It took three evaluations before I got a speech therapist who would listen. Each evaluator would run Pajama Monster through a list of sounds, check off that he could make all the age appropriate sounds and was even advanced in some areas and then send me on my way, with a note to wait 6 months before I could ask for a recheck. One even told me I was an “overly anxious mommy.” and that Pajama Monster was completely normal. On the third evaluation I put my foot down. Pajama Monster’s behavior was becoming unmanageable and I thought better communication might help. I refused their evaluation and bargained that I would go away and stop pestering them with my concerns if they would just close their test book and TALK to my son for 5 minutes and still tell me that everything was fine. Three minutes later I was told that Pajama Monster had a very severe and completely atypical speech impediment. We attended weekly speech therapy for a year before Pajama Monster became able to express himself with anything approaching age appropriate intelligibility.

After Peep was born things finally hit the breaking point. Pajama Monster seized every opportunity to claw at Peep’s delicate baby skin, leaving a couple scars on her chest which she will always bear. Without any seeming provocation he would hit her and tear at her hair whenever he had the slightest chance. We had to keep them physically separated which meant that I had to separate physically from Pajama Monster while tending to Peep. I spoke to his pediatrician and asked about the violence. She said it was perfectly normal for children to hit when jealous of a new sibling. A few weeks later in desperation I sent one last e-mail to the pediatrician stating that it didn’t seem normal for him to attack her multiple times per day and smear his feces over walls, toys and carpeting multiple times per day as well. As I had previously told her, he also seemed to be struggling in his gross motor skills, even though his cognitive and fine motor skills were exceptional. I received an immediate referral to a pediatric psychologist specializing in 0-4 year olds.

My husband and I waited the long 6 weeks until our appointment. We waited through Thanksgiving, my son’s 3rd birthday, Christmas, and New Year’s, hoping the whole time that this would be the end of the long march. Surely the psychologist would see the problem and tell us how to fix it. Soon everything would go back to the idealized future I had hoped for.

I should add at this point that in addition to smearing his poo and shredding things, hitting, biting and general destruction, Pajama Monster was a charming little boy. He was handsome, he was creative, he was funny, and he was very very bright. We delighted in Pajama Monster, until he turned on us, destroying the house and attacking family. I should be clear that Pajama Monster didn’t really wildly attack. He didn’t appear angry. He clawed and bit with the excited smile of a child swiping a cookie or playing a fun game. He appeared to be delighting in his destruction, dancing in his own filth and chanting “Poo! Poo! Poo! There’s poo! Poo!”

That should bring you up to date with the start of all our specialists. Feel free to weigh in with your opinions and suggestions and own experiences or even rants. I am open to considering anything at this point and certainly willing to provide some emotinal support to all you other mommies out there going through similar struggles.

Why this blog?

I started this blog because I have a wonderful, beautiful little son who is a gift from God. He is also disabled. I'm currently in the whirlwind of doctors and psychiatrists and occupational therapists, IEP evals, and speech therapy that so many parents of disabled children have fought through. The sad fact is that being surrounded by all these professionals has only called to light just how "different" my son is. I feel very alone. Right now it looks like my little one is most likely bipolar, with possible traits of anxiety, ADHD, and some autistic features thrown in for flavor.
Initially I was afraid to reach out to my friends because some part of me is still saying, "but soon we'll have the right medication or therapy and all this will be over." I wouldn't want playmates to label or judge him based on something that will be over soon. Now I'm afraid to reach out because people just don't understand. I can't count the number of times I've heard "boys will be boys." or "he just needs a good spanking." Can someone please explain to me how hitting him is supposed to correct a neurological problem?!
Well meaning people suggest that I try rewards and consequences and just "be consistent." I should probably specify at this time that I have a MS in marriage and family therapy and am a child mental health specialist with the majority of my training focusing on severely disturbed children. I also have a 2 year old daughter who is as well behaved a little teddybear as you could ever want to meet. This isn't an issue of poor parenting. I wish it were. I want so much for the problem to be me because then maybe I could fix it.
Sooo...This is the place I can talk about what is really going on in my journey to help my son, and all the frustration and joy and setbacks and triumphs that go along with it.