Teacher's Letter to Doctor

I am Ben's Classroom Teacher, and I am writing this letter to you at the request of Ben's mother, Janine. Ben is a grade three student at "...." School. There are 19 students in his class.

At the beginning of the school year, Ben experienced a great deal of difficulty transitioning into grade three. He exhibited oppositional behaviors quite early in September. Ben required cues and redirection for tone of voice, refusal to work, talking back, and put downs to others. He connected with another student, and both were extremely disruptive to the learning environment of the other students.

Ben often blurts out silly, rude, and inappropriate comments intended to make the students laugh or make someone feel badly or uncomfortable. Cues, redirection and discussions about his behaviors, shows little to no emotion during these times, and does not accept responsibility for his actions.

Ben's interaction with teachers outside of the classroom has been quite challenging. Ben doesn't always respond to adults when they are speaking with him. Many times he refuses to answer them and avoids eye contact (ignores them). Quite often, Ben does not follow the rules of the classroom. He is quiet and sneaky about his defiance. Instead of asking for permission, Ben usually does what he wants to do when he thinks you're not watching him. Other times, he outwardly defies adults, choosing to ignore them when his behavior is addressed. Many times, Ben repeats the same inappropriate behavior over and over.

Ben experiences a great deal of difficulty when working with other students (partners, or groups). At times, he is silly, off task and disruptive. Ben also wants to have things done his way. If this doesn't happen, he usually leaves and sits at his desk, or asks to work by himself. Ben is quite rigid in his thinking, and unresponsive to problem-solving strategies which are modelled and suggested to him.

During recess, he was observed to walk around, not playing with the other students. Ben didn't like going outside during the winter months, and often stayed in to play with a few other classmates. He has been going outside with the other students since the nicer weather.

When playing with toys during Indoor Recess, Activity Time, or Free Time, Ben leaves if the students won't play his way, or if he can't "control" the situation. He often plays the same activity each recess (sets up 200 domino's in a snake pattern and tips them over to watch them fall). Ben shows interest in limited topics and really focuses on those specific areas. (tunnel vision).

Ben's behavior fluctuates, and sometimes depends upon the tone of the classroom. Please let me know if there is anything that I can do to help.

Sincerely,
Julie
Grade 3 Teacher

In like a Lion

So this month of March hasn't exactly started out lamb like, but just as the saying goes in like a Lion! I am not referring to the weather...
It all started last month with a decision to take Ben off of Vyvanse, a decision that needed to be made due to side effects that we just couldn't bear to see our 8 year old live through.

I really was hopeful that this was going to be the drug that was going to work for Ben's ADHD, it had great promise being that it was a long lasting stimulant. It seemed to give him the focus he needed to be able to pay attention in class and stay out of trouble. He rarely bothered anyone, and was co operative when asked to perform tasks. We had great conversations, asking deep thoughtful questions about life and why things work the way the do. Our lunch time breaks from school together where very enjoyable as he actually listened and obeyed simple requests to turn off the TV, or computer to eat or leave to go back to school. He gave me few arguments and went to school with no complaints. It seemed to good to be true. Unfortunately it was.
After taking the medication for 2 months the initial concerns seemed to wear off, most of all his insomnia. The lack of appetite although still present, didn't seem to be causing any weight loss and he did eat small portioned meals but along with multi vitamins seemed acceptable by the doctor.
The effects of the medication seemed to be wearing off sooner in the evening as we started into the 3rd month of treatment.  After school became very difficult for Ben to contain his hyperactivity. He was unable or just plain refused to do homework, often claiming not to know how to do the required tasks. He became very angry, picking up on any excuse to start a fight with his younger siblings. Then his anger and adjutaion turned into uncontrolled laughing and giggling, being loud and obnoxious, rude and belligerent.
At this point the school was also starting to see Oppositional behaviors starting to emerge once again. Refusal to complete tasks, unwilling to join in group activities, but still observing improved ability to complete assigned tasks and not getting caught up in the antics of others children.
I met with Ben's teacher around this time, and unfortunately we must have both been at our breaking points that day, because the meeting did not go well. We both lost our "cool" heads and said things that we both regret in the moment. That being said, one thing she did say about Ben will never be forgotten. She said that he was a liar and a manipulator. This is very hard to hear from a person that is with your son on a daily basis, and is suppose to be supporting you in the journey to help him with his disorder.  At the time it hurt me as a mother deeply, as it exposed a problem that really showed how a child with these complex issues can be viewed by others. As liars and manipulators.......the fact is that Ben is a very intelligent child and I can concede to say that he may at times manipulate to get things his way...in fact I think he does that on a daily basis as he rarely doesn't get what he wants....but a liar he is not. He never perceives his actions to be wrong...he always perceives that he is justified and that everyone else is to blame....and if he ever does tell an untruth he will admit to it...but NEVER will he agree to something he feels he has not done or is being accused of...as he rarely feels he is wrong.
After this meeting with the teacher, which led to also meeting with the principle of the school I was able to have a minor adjustment to Ben's educational expectations.  He was no longer expected to complete and/or hand in homework assignments.  We will encourage him to focus on the "important" things at school, and only ask that he continues reading when at home. We also got paper work in line to have the school physiologist and social worker observe and work with Ben to help him with any "issues" they observe.  We then made a date to meet again as a co ordinated group to discuss any further plans for him.  I also let them know that I was meeting with the doctor to discuss adjusting medications due to the behavioral problems we were having.
I met with Ben's Pediatrician and we decided to add Strattera back into his daily dosing, as the Strattera seemed to work best from Ben's ODD, and the Vyvanse on his ADHD. So his dosage would be 20mg Strattera (10mg in morning and after school)  and 20mg Vyvanse in the morning, hoping the Strattera would provide support for after school behavior.
After this addition to his medication I was hoping for some improvements, unfortunately I don't recall there being much change to his agreeableness or co cooperativeness, in fact now that I look back on the past few months it may have been the combination of these two drugs that maybe caused the side effects that brought us to taking him off Vyvanse.....hmmm....it's funny how until you actually reflect and write out your thoughts that connections can be made....

This combination therapy began just before Christmas break and over the past 2 months Ben's "normal" handicaps started becoming very debilitating. He has always been a little OCD about certain issues, like what he will eat and how it's to be cooked or prepared. This became very exaggerated to the point that he ate next to nothing because it wasn't prepared to his liking...either it was burnt or undercooked, even though I cooked to exact timing to ensure it was to his "normal" requirements. He would go an entire day on nothing but a Yop and a granola bar. He also became extremely anxious about so many things...lots of big "what if" type questions, he was ultra sensitive to what he thought his classmates or others thought of him to the point that he insisted on wearing deodorant because he thought he was being avoided in class due to being smelly. He also began cracking his knuckles in a uncontrolled manner similar to a tick (again something that comes up in different forms when he is dealing with anxiety). These issues all became almost unmanageable, arguments ensued between us, and all out refusals to go to school, to eat or even get out of bed in the mornings. He also started becoming very paranoid, started hearing things and seeing things in his bedroom at night keeping him awake to all hours with his lights on.
Near the end of February Ben didn't get out of bed on a Saturday morning till about 10:00am, knowing he had a poor sleep the night before I didn't question it. He finally came downstairs and almost immediately started causing problems with his brother and sister. He continued being unmanageable to the point where he needed to be given "time and space" to settle down and was sent to is room to give him this opportunity. Within a few minutes he began screaming at the top of his lungs, I ran to his room meeting him half way in the hallway. He was visibly shaken, white as a sheet and crying uncontrollably....he was unable to tell me what had happened until much later in the day. He began to describe a feeling that something was emerging from beneath the bed and was about to come out from under the blanket with a loud rushing noise, when he screamed he said it stopped and wasn't able to see what it was. He also told me how early that morning he didn't get out of bed because he was being held in bed by a skeleton and he was to scared to scream for help. Not knowing what was happening to him, I assured him that he was just dreaming and imagining things, not to worry. Later that night he was scared to go into his room for bedtime. I brought him into my bed and layed with him.  I could hear his anxiety, his breathing was quick and shallow and his eyes were as big as saucers. I asked him what was wrong, and he said he was seeing a snake with razor sharp teeth coming out of the ceiling at him. I held him in my arms and told him not to worry that Mommy was there and nothing was going to hurt him. I assured him that his mind was just imagining things and that he was going to be ok.  I repeated this several times before he was calmer, and it took hours and a Gravol to get him to close his eyes and fall asleep.
It was decided then that Vyvanse was the cause of these hallucinations, and he would no longer be taking this medication.  I continued the Strattera at same dosage.
I met with the doctor the following Monday, and he supported my decision to stop Vyvanse and would have done the same. We decided that we would monitor Ben's behavior and see if he is managable without trying anything new, but to continue Staterra.

So March has started rough, hoping that is will end more lamb like.

Daddy

I wanted to dedicate this post to my Dad. He is currently in the hospital recovering from Valve Replacement Surgery to his Heart, and is not recovering as quickly as expected. He has been in ICU for nearly a week now, when other patients would be on their way home by this time in their recovery process. Unfortunately Dad has developed several Pulmonary Embili, so has had to be put on blood thinners fearing additional clots traveling that could lodge in his heart. We are also hoping and praying that he doesn't begin to have internal bleeding, as both conditions could be fatal.

It's times like this that has you reflecting on the wonderful man that he is, and how empty our life would be without him.  He truly has been a wonderful Father, that would do anything for his Family.
I would like to jump up in his bed and snuggle down with him like I used to as a child, I remember the sound of his heart beating when I would lay my head on his chest watching tv, with his big arm draped around me. But with so many machines he has hooked up to him, I can barely get near to kiss his forehead and hold his hand.

It seems like yesterday that he was dancing with me at my wedding, holding my hand through the pains of labor, and being one of  the firsts to hold my babies.

I know that Dad will pull through and will be ok, it's just so hard to see him like this.  I love him so much, and I know that he loves us as well. When he was just coming out of anesthetic and barely able to speak, he was able to muster up the ability to tell us all he loved us.

He is one amazing Dad.   Butterfly Kisses

Perfect

So here is another piece of writing that I've been working on. I hope it helps those who read it understand what it's like to have a child with emotional disabilities.Unfortunately many fail to look at Attention Deficit Hyperactivity Disorder and Oppositional Defiance Disorder as disabilities, but rather something that can be handled by discipline and a change in diet. Please if you read this blog, also read my previous poem called "The Monster Inside" as this Disability is as real as any other.

Perfect

His first breath, first cry, first glance up into my eyes,

His first suckle, his first cuddle, these are the bonds that ties,

His ten little fingers, and ten little toes,

Cute little button nose.

How I love each part of you,

I stare at you day one day two,

Perfect in all that you do.

The first little giggle,

Rolling over with a wiggle,

Soon you will crawl,

I think I am going to bawl,

Is that your first tooth?

He’s been so hard to sooth.

Please don’t cry,

Mommy’s going to try.

To be perfect in all I do,

When it comes to raising you.

His first words, his first steps,

His first fall, when running down the hall.

He’s so upset, I cannot stop the tears,

Is he frustrated, upset or is this because of fears?

I try to help, make things right,

But now he’s trying to bite.

I try to keep him safe from harm,

Don’t want him to break an arm,

While he throws his little body into the walls,

Drags his forehead while he crawls,

Is this normal, is this right?

It’s just his personality, he’s alright.

You’re my perfect little man,

You’ll grow out of this I know you can!

The doctor says no problems, nothing’s wrong,

Like other’s his age, he’s growing up strong.

Children are all different, develop in their own way.

Don’t worry everything will be okay.

I remember those words and think of them every day,

But deep inside I wonder,

Keeping notes and I ponder,

That I may need to prepare,

For challenges to beware.

He sleeps through the night,

He always has until it’s light,

He wakes and demands to wear all his ties,

One will not do, or he gets tears in his eyes.

Then we must find him his rubber balls,

Look everywhere, put out the calls,

One in each hand, never will he part

Or he will cry like I’ve broken his heart.

Don’t worry son, I will take care,

To keep a good supply, as rubber balls aren’t rare!

I think to myself, this may be odd,

But he’s still perfect even though a little flawed!

As days turns into months and then to years,

There seems to be more anger and fears,

Temper tantrums turned to rage,

Not like other boys his age.

Needing things a certain way,

Especially when and how to play.

What he’ll eat and how it’s prepared,

It must be perfect, nothing can be compared.

He’s so impulsive, fearless and untamed,

Always feels he’s free from being blamed.

I’m being told he isn’t right,

Even though he is quite bright!

Is this just behavioral or something more?

Is my parenting very poor?

What should I do, where should I go?

How can this be?

Why did this happen to me?

Could my child have special needs?

I’ve done the research, and yes indeed,

He has something called ADHD, struggles with ODD.

The doctors access and they’ve agreed,

Perfect I say, now let’s start a plan

I promised him I would do all I can.

To give him every chance in life,

To live his days with little strife.

I am so proud of my little man,

He is so brave, I am his biggest fan.

How I love each part of you,

PERFECT in all you do!

I Do Not Know

So here I sit, another sleepless night. The kids are tucked in sleeping, and the sounds of my husband's snoring fills the air. Most nights I look back on the day and although I feel relief that the day is over, I feel somewhat assured that I have done a good job, and that all my efforts have not been in vain....but tonight I can't say this.
I feel so overwhelmed with confusion, I feel such a responsibility for the way my children turn out that I  wounder if I am steering them wrong.  All that they do lately is fight and yell and scream and cry. My efforts to regain the peace between them usually ends up in more fighting, yelling, screaming and crying, but usually involves one more person...me!  I don't know what I am doing wrong..my day is spent trying to keep the peace and keeping everyone happy. Lately it seems like it's having the opposite effect.
The stress of everyday life is getting to us all, but mostly Jeremy.  He has been working long stressful days to provide for us and to allow me to be a stay at home mom, I really admire and appreciate his dedication to his family. So when he comes home from work I want it to be a peaceful, relaxing evening for him, but instead it usually is the opposite. When he finds more comfort alone in our bedroom with the door closed rather then with us it makes me feel like a failure.

What more can I do? I do not know...How much more can I give?....I do not know....Can I do better???...I do not know....but tomorrow is another day, and I will try again, and again, and again cause that is what a Mother does....

The Bully

So this past week our school took part in Anti Bullying Week. The whole week was focused on this not being tolerated or accepted. We were encouraged to stand up to bullying, and were taught what to do in the case where we are being bullied or see someone else being bullied. We all took a Pledge and signed a paper committing to this.
So with that in mind, I was really not happy when Ben came home with 2 accounts of being bullied this week.
One of the incidents occurred on the playground and the other on the bus, and I am very proud of the decisions Ben made, as the outcomes could have been much worse.
The first occasion was a conflict with another child on the playground. The children like to play a game called Beyblades, which is a spinning top like game. Ben traded tops with another boy on the playground, who after playing a few spins broke a piece off of the top. He insisted that Ben trade back the top he just broke. Ben was co operative and traded back the tops, leaving him with the broken piece. Then the boy got up, kicked the arena and broke it as well and walked away.
I was really unhappy to learn that Ben had been a victim of bullying, however so happy that Ben didn't "strike" back, he handled himself really well.
The next day on the bus ride home, the younger brother to the other child already mentioned lost his temper with some girls that were sitting behind Ben. This boy started threatening Ben with a fist saying that he needed to bring a knife to school and stab those girls with it...Ben seeing how angry this boy was, didn't know what to do. He felt threatened, and yet out of the concern of others agreed to the boys demands just hoping to calm him down, then turned to the girls being threatened and told them that he would never do that, he just lied to the boy to calm him down.
This is not the first time this young boy has threatened with a knife, and so out of the concern for our children and his I HAD to call the Principal of the school. Bullying cannot be tolerated, no matter the age of the children involved. These two boys have serious problems that needed to be addressed, so I hope that it is.
In both cases though Ben did not over react and was able to think through whatever emotions he may have been feeling and he made good decisions. I was so proud of him, and made sure I told him so!

FYI

So this past week has gone very good with Ben. His emotions seem to have levelled out, as he is not crying as easily. His appetite is being greatly effected, often he only eats a few small items each meal. He also is having trouble getting to sleep at night, usually not getting to sleep until 11:00 or later.
His teacher has said he is much better then he was prior to Vyvanse, however still has silliness at times and needs to be told to settle down. However I am not getting the sense from her that he is as out of control as before....it sounds to me that he has the silly time but is able be brought back to task in a reasonable amount of time. So that is definitely an improvement.

I do have a new concerns though that I have seen in the past few days. I am beginning to see a bit of his rage return...out of control anger. Twice in that past week he has lost control and kicks and screams and destroys belongings as a result to being punished. I am unsure as to if this is because this new drug focuses more on his ADHD and less the ODD? As the old drug I found helped with his ODD and less the ADHD.  Every drug has it's strengths or what it works best for, so if this problem continues we may need to address this later on...perhaps in some further counselling on anger management??? Something I am definitely going to keep my eye on.
But in the meantime I am happy that he is more successful at school, I think any silliness he is displaying is more what a typical 8 year old would be displaying. Although there is a place and a time to be silly, I think he will never be the perfect quiet kid in the corner, and I am happy that he's not!