Binkies and Briefcases

We’ve all seen a child throwing a temper tantrum in the grocery store and thought, “What that child needs is….” maybe you think it’s a spanking. Maybe you think it’s a nap. Maybe you think the mom should ignore it. If you saw my son in the store throwing himself on the ground, screaming, punching me, and biting my legs you probably would not think “That mom needs to give in and give her son what we wants.” I wouldn’t be thinking that either, but we would both be wrong.

I debated posting this, but I know a lot of you like hearing follow-ups to Nicholas’ stories and I know it might be a help to some of you who are struggling with similar issues now and don’t have years (yes, years) to wait for an appointment. Plus writing it down will help me remember what he said and it’s easier for me to direct friends and family members with questions to this blog post rather than explain the same thing a million times. I want to make it abundantly clear, though, that these techniques apply only to our specific situation. If you think your child might have attachment issues, consult a psychologist as soon as possible. Yesterday we finally had the appointment we’ve been waiting for for about two years: the attachment specialist.

First, some background:
Getting an appointment with a specialist is complicated, apparently. We had to get a recommendation from the pediatrician to get a psychological evaluation from a regular ol’ psychologist. That evaluation happened about a year and a half ago. He was also evaluated for Early Intervention (the division of the school system that provides services for children with special needs before they reach school age) around the same time. He qualified for services in several behavior-related areas. After he turned three he had to be re-evaluated by the school system because he was going to be transferred to a different unit, which is a standard policy.

The first evaluation brought up some concerns, but the psychologist wouldn’t give a diagnosis because you need to be a specialist to do that when it comes to these attachment issues. He said he thought there was an attachment issue and so did one of his Early Intervention therapists. They told me to find another psychologist, which took forever because there are very, very few psychologists willing to work with a three-year-old and far fewer qualified for dealing with attachment. Finally, I found a play therapist who would see him. She has been working with him regularly and she is the one who recommended this attachment specialist. In the meantime, we also had to take him to several different doctors’ appointments, like a pediatric GI specialist, to rule out certain behaviors as biological in order to prove that they were in fact behavior problems.

Are you following? Basically, this is the 5th psych evaluation and the 11th specialist if I’m counting various doctors, occupational therapists, etc. that I have tracked down in order to help our son. Eleven different specialists, all of whom have required multiple appointments. There were several months when we had at least 3 appointments for Nicholas every single week. It’s my job to figure out what he needs by emailing old contacts and reading research materials, find out what steps we have to take in order to qualify for that, make hundreds upon hundreds of phone calls, schedule appointments and babysitters and work around Eddie’s work schedule or just go to those appointments myself with kids in tow. It’s been exhausting and it’s all been leading up to this.

So what exactly was this?
It’s the opposite of Super Nanny. Similar concept, opposite advice.

We had no idea what attachment specialists actually do, we just knew we needed to see one. It turns out they videotape you interacting with your child and then they analyze it. He taped me and Nick by ourselves for a few minutes doing various things like playing games or asking each other questions, then Eddie and Nick by themselves, and finally the three of us together. We did that a few weeks ago. (Twice actually, because the video didn’t record the first time) Yesterday was the day where we sat down with him to analyze it. Our play therapist cleared her schedule so that she could be there as well.

Yes, we actually paid to sit in a room and have our parenting critiqued play-by-play by not one, but two psychologists. Afterwards, it gets sent to Chicago to a whole team of psychologists for further analysis. I was really nervous. This did not sound like it was going to be a lot of fun, but they were really nice and they pointed out a lot of things we were doing right.

They would pause the video to get us to look at our body language and Nick’s posture and point out things like how often he was making eye contact. I always thought he refused to look at me, but in the video, he looked at me all starry-eyed every time I turned away, which was interesting. They showed us triggers we had never realized, like when he gets a certain sing-song quality to his voice the tension is already escalating and that’s when we need to change our approach, etc. We talked about how parenting him was going to be different than other children and why we need to limit his choices and show a calm display that we are and will always be in charge rather than the Love & Logic approach we had been trying to use. (I still highly recommend Love & Logic to other parents, it’s just not the right technique for Nick because he is overwhelmed by the idea of being the one who has to make the choices. He needs to see that as our job.)

We were told to always put a commanding twist on the end of our statements, even when it seems like we are giving him something he wants, such as “Oh, you’d like some ice cream? That’s a great idea! Use the blue bowl.” Not, “Would you like to use the blue bowl or the red bowl?” as would be recommended with a “normal” child. Just “use the blue bowl” to show that even when you are having fun and getting your way I will still be in charge. We are not to use time-outs or punishment of any kind for him. In his mind, following our commands is a consequence in and of itself so we are to distract him with various techniques they showed us for twisting what he wants by saying it in a way that puts us in charge of the situation. For example, if he is tantruming because he wants to keep playing hiding seek we are not supposed to ignore it or say things like, “I will be happy to play with you when you are calm.” like you normally would for a tantruming child. Instead, we are supposed to go with the resistance and do what he wants, but give him a command at the end to put ourselves back in charge and say something like, “Oh, you’re frustrated because you weren’t finished playing? I’ll tell you what, you hide one more time, but this time hide behind the sofa.”

I’m also not to leave the room, ever, without giving him some kind of structured task to do. I think that’s going to be hardest for me because I like to give him a little more freedom to be creative in his play, but with some practice, I should be able to get it down. Like, “I’m going to change Abby’s diaper. While I’m gone, see how many train tracks you can put together.” I do this sometimes naturally, but it will take some effort on my part to make sure I do it all day, every day. If it means no more poop smeared on the furniture or permanent marker on the tv that will be awesome.

I struggle a bit with the techniques for attachment-focused parenting because they are so fundamentally different from what I learned in all my graduate-level child development and educational psychology classes and all the techniques I teach to other parents while I’m at work. It’s hard to remember to phrase it one was for Nicholas and the opposite way for Abby, but hopefully, with more practice, it will just come naturally and I won’t have to spend so much time thinking about it.

The overall consensus was that while Nicholas does not have Reactive Attachment Disorder, he does have a lot of evidence of attachment issues that put him on the spectrum. This is good and bad. It’s good because he’s making a lot of improvements and the doctor thinks he has definitely formed strong attachments to us. It’s bad because it means we can’t get the diagnosis that would qualify him for services when he has to go to school.

We talked a lot about the potty training issue and basically every technique that was suggested we already tried to no avail, but interestingly enough we were told to stay away from sticker charts or any kind of reward system that would put him in charge. We’re supposed to try our best to make it fun if we can, by putting surprises like marshmallows or Cheerios in the toilet, but other than that we’re just supposed to ignore it.

We only have one more year before kindergarten starts. I can’t send a kid to kindergarten in diapers, smearing poop on walls and throwing temper tantrums without any consequences. I’m really hoping something clicks in that little head this year.

In the meantime, if you see me at the grocery store dragging a screaming child on my ankles saying something along the lines of, “Oh you are angry because you want a doughnut? (Identify the emotion) Well, they do look yummy. (Go with the resistance) Get the one with sprinkles. (Give a command)” kindly bite your tongue. I’ve got a whole army working on this kid. We’ve got this.

I’m linking to the Mental Health blog party.