Thursday, March 10, 2011

teasing out understanding

Last December, I finally discovered a clinic that helps children with oral desensitisation. By a happy coincidence, we had just booked in to start sessions with a speech pathologist at the same place. Some discussion occurs, time goes by, funding options and qualifications cause a false start, but finally P was seen by an OT last week. I have barely been able to contain my excitement at the prospect of getting help with this. Looks like I'll have to hold it in a bit longer though. The session was disappointing in that the OT felt that he had "classic tactile defensiveness" and that we needed to start more generally rather than homing straight in on the food issues. Otherwise we wouldn't really overcome the levels of anxiety and avoidance that she feels are already present.

Well I said disappointing, but not unwelcome. This is why I try to keep him in contact with people who can help me see what might be missing for him, not just waiting for problems to manifest. So this is exactly the kind of information that I suspected that I would come across and needed to hear, it's just that the timing wasn't great, given how hard it is to live with a child who eats almost nothing, and a brother who therefore feels he can get away with a similar diet. It's pretty gut-wrenching, having your child's difficulties pointed out to you in detail. It has to happen, but there is always an emotional aftermath for me, every time I'm informed of a new detail in his profile of deficits.

In this mood, a few days later I watched another boy run enthusiastically up to P as he walked to class, place his hands on P's shoulders from behind and give him an affectionate shake. I didn't see P's complete reaction as he was a little behind me, but I think he basically shook the hands off, or at least shivered or physically withdrew somehow, perhaps briefly made eye contact and murmured something, then continued walking expressionlessly. The other boy looked surprised but took his hands away and fell in beside P.

I keep thinking about it. I think the other boy took the "rejection" well: he didn't get angry, or tease; he looked confused, but seemed to understand that his action was not eliciting the response he hoped for, and stopped; he didn't look as if he felt distressed, embarrassed at making a misjudgement, or anxious about the mis-match. On the whole he seemed to take it pretty well, although I can't know what he thinks of P as a result. Does he think that P still likes him? Does he think, "P doesn't like that kind of play, but we can do other things together?"

And what did it mean to P? He clearly registered the approach as unpleasant and made that clear. Did he understand that there was an emotional component in that approach too? I don't think so. Would another child have made a reassuring face as the other boy let go and walked next to him? Did P add this encounter to any other impressions of this boy, or did it just slip out of his mind as a random event? Such treacherous missed opportunities; how many similar episodes before a child gives up on him? So many things to learn, and how can it all be achieved? And is it asking too much for that to be the goal?

A few weeks ago I dreamt I was watching P recount an anecdote. He was confident and happy, and as a result many emotions flitted across his face with absolute ease, in synchrony with the events that he was describing. In my dreams I got to see the carefree, communicative child that I hope will develop as much as is possible. That would not only be gratifying for me, but a watershed for him.

Friday, March 4, 2011

from pillar to post

How many forms of turmoil can I take in a matter of weeks and still function? Since the "mini-assessment", with every day that went by, I became more sceptical, more relaxed, but keen to prepare S as best as possible and get the full assessment over with. That was until the psychologist cancelled about 90 minutes before the session; then I became considerably more agitated. This was compounded by her offhand acknowledgement that perhaps it was for the best, since she hadn't arranged for the paperwork that would allow us to get any kind of rebate for this assessment ... When she first brought that paperwork up 2 weeks ago, I asked her specifically to ring me if she had any difficulties so that I could make arrangements to see a pediatrician locally, & I also pointed out that I needed time to do this, so could she let me know as early as possible ...

So there was emotional suspension coupled with tedium and a dose of disappointment in the psych too. We were able to see a GP that afternoon to get a referral to the pediatrician who mercifully had a cancellation today. The GP did warn me that he couldn't guarantee that the pediatrician would agree to the assessment, so I then made calls & pulled together documents. So I sat last night, alone as Q is on an extended work trip, reading the point-by-point list of all the ways in which S resembles an ASD child. It was not good.

Then today we went to the pediatrician for what I thought was likely to be a rubber-stamping, with P in tow as well, home from school with a cold. I think partly from having him there, and partly because of the toy I told them they could have when we got home, we got pretty good cooperation from S. And so the pediatrician saw what I saw; that when he tried, S could do what was expected. Not only could he, but the Dr referred to the "richness" of responses, once he co-operated. But based on the history of angry behaviour that I'd given, the pediatrician announced that he thought that we were dealing with an attachment disorder and that we should see a pediatric psychiatrist.

Of course I was very business-like, but this was crushing. Finally, there it was; proof that I had in fact screwed my youngest child up. Attachment disorder. Luckily the babysitter I had organised for later that day (for S so that I could take P to an appointment) could come earlier. That meant that I could get away from my boys, I honestly felt, for their benefit, since I was so unfit. At least that didn't last too long. I took myself to a cafe for lunch & thought. And I soon came to the conclusion that I was not being dishonest, I was not dodging any bullets, but I didn't accept this theory. I know how stressed I was when I gave birth to that little boy with a newly diagnosed ASD toddler on my hands, but I also know that I mustered up my absolute best, and I know what he gave back. I know how much came from him, regardless of what we were offering. He has always been the same contradictory bundle of extreme clinginess and extreme independence. Some saint somewhere might have dealt with it better than me, but I didn't produce it, I know that.

And mingled in with this another huge wave of reservations. This is the pediatrician who diagnosed P originally. We did not go back for another session after that, partly due to his observations on P's "dependence" on me. He didn't like it. I foolishly mentioned that we co-slept, and he probably asked about breastfeeding (and I probably naively told him that P was an extended feeder, as I did of S when asked today). He felt it was therefore important to P to separate more from me, and gave us an ever-so-respectful dressing down about our co-sleeping. Any evidence of closeness seemed to suggest to him that I was holding my child back. We saw a specialist in ASD 2 days later and while waiting at the desk, I read his faxed referral, stating that the parents' concerns included "attachment". Well no, actually.

So in my distress it took a while for the reality to filter through that this man has some sort of attachment wheelbarrow to push. I really can't prove this, but I'm pretty sure that he saw my attachment parenting practices as something pathological. Once it hit home, I felt quite removed from the whole process. A few hours later, I managed an international phone call with Q who had listened to my earlier voice message and come to pretty much the same conclusion, bless him, not to please me, just his own gut instinct. We went back to this pediatrician today for convenience, and I can't say he's not doing his job as I think he basically got important things about both of these boys, but gee, you wouldn't want to ask him what you should do next.