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Oppositional Defiant Disorder

and the band played on

Apr 4th, 2013
by Zendette.
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Some days it feels like nothing’s changed. I’ve removed K from her afterschool program after she continued to have behavioral problems. Instead of getting better, her behavior seemed to get worse when we tried several changes to accomodate her there. I think she felt that the changes were rejections, and so things got worse. Luckily, I can have her in an alternate program by next week, but it brings back home the issue of her inability to control her impulses.

Just as I’m digesting the changes I’ll have to make as a result of the childcare issues, I receive notice from her teacher that she hit two of her friends at school. She claims it was “friendly”, but the girls are afraid of her, so clearly, it’s not.

True, she no longer exhibits the level of violence of last year, but she still pushes, and hits on occasion. She usually explains it as a misunderstanding. She didn’t mean to hit, she meant just to “lightly touch”. We’ve told her over and over again that she’s lost the benefit of the doubt, and there should be NO touching anyone else, for any reason. Then again, I see all the kids pushing and shoving, and feel sorry for K, because she feels she’s only doing what other kids do. She fails to realize two things:

1. She’s much stronger than the average child, and what may feel like a light push to her, is actually a forceful shove to someone else, and

2. She has an angry streak that scares people. When she gets really angry, even if she doesn’t raise her hands, she is capable of saying some really awful things to other people, both children and adults.  In any case, she’s mastered the art of scaring people. It’s almost funny how no one at home is afraid of her. Even Matan loves playing with her, and shows no fear, even when they fight.

She has such a keen understanding of these issues, and keeps telling me that she is controlling her behavior, it’s just that she’s misunderstood. I so want to believe her, but I know that she simply loses control and has no valid explanation. She insists she has control, even when I show her that she clearly does not. I do think she understands, but that she’s afraid of her own lack of self control. If anything, Karen is a control freak, and hates not to be able to accomplish what she’s set out to do. Often she has to reject something in order to let go of going for perfection.

The horseback riding didn’t work out. The fall sort of put an end to it. She’s afraid to go back. Now I’m considering emotional therapy with the help of small animals. I’m also considering a new therapist, one with whom we’ve spoken before. I liked her and I think it will be a more positive environment than we had with the last one. We’re also looking at some sort of workshop to help her with social skills. I’ve heard of two that sound ok, but I’m trying to hold off until summer when she has fewer activities.

People who meet her often report a charming and intelligent young lady. She can sound very mature when she so wishes, and enjoys holding conversations with adults.  She’s capable of being extremely polite when she’s trying to make a good impression. She knows how to behave, she just can’t always control her impulses.

What a difference a year makes

Feb 9th, 2013
by Zendette.
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Equine_therapyA year ago we were beginning to despair of finding anything that would help K behave like a normal first grader and stop the fits of rage that were ruining everything. I remember sitting up one night talking to her after weeks of hitting and acting out on an almost daily basis at school. She said, “Mommy, I don’t want to be like this”, in a sad, sad voice that seemed devoid of any hope. DH and I were also afraid to hope anymore. Her behavior, always a problem, had gotten steadily worse since beginning first grade. Two solid years of therapy and she only seemed more unhappy, her behavior more extreme.

Today it’s like we’ve scrubbed away a dirty film of anger and self hate to reveal an amazingly mature and empathetic eight year old. She has friends, does well in school, excels in sports and is becoming more social. I don’t really know how we managed to get from there to here, but a lot of things have changed. We “gave in” and put her on meds. That alone made a huge difference, but the anger was still there, it was just less extreme. We finally managed to end the relationship with a therapist we didn’t feel great about, and instead K is focusing her time on riding therapy. I’m not suggesting one is better than another, just that after three years of therapy with no breaks at all, perhaps the focus on a more physical therapy is what she needed.

We chose riding therapy because of the focus on animals. She’s hysterically afraid of animals. When we first went to the stables, she was completely on edge since chickens, dogs, cats and horses seemed to appear out of nowhere. I asked her if she wanted to go back to the car, but she said she wanted to “deal with the challenge”. She’s been going for more than a month now, enjoys it and is more relaxed around the animals. She still hates the chickens though.

The fear of animals goes back for as long as we can remember. I think it may be related to her first time ever seeing crowds of people walking and riding bikes, and dogs and children seeminly running in circles all around her.

When we first brought her home, we didn’t get any specific advice on integrating an orphanage child into our modern lifestyle. Today I know that both my children suffer from different effects of being denied sensory experiences. Both have issues related to sensory integration. Both dislike loud noises and crowds. When we adopted her, Karen had never been outside of the baby home grounds, and rarely left the single room that acted as both playroom, dining room and bedroom. She had never been in a car until we took her to get passport photos at age 2. She had never touched, or even seen a live animal.

We brought her back to Israel and our first full day home was sunny and warm. We made plans to meet up with another local couple who had shared our adoption journey. Both our families arrived home from Kiev on the same day. We were happy to follow their lead and meet them at the park with both our newly adopted children.

We met in a crowded Tel Aviv park full of people and animals, all moving faster than K had ever seen before. It must have overwhelmed her because after we got home she went into shock, refusing food and water, and lay on the floor with a blank look on her face. Our acupuncturist, Dr. Barak, advised me to put on a Russian language tv station so she would hear something familiar. Karen is a survivor and eventually snapped out of it. But it seems that the fear of dogs may be left over from that critical time when we exposed her to too much stimulation before she was ready for it.

Last year, when the phone rang, we always worried it was the school or an angry parent. “What did K do now?”. She still has fights with other children, after all, she’s still our strong-willed K, but today it’s always an issue of how she managed to turn the situation around, or at least to maintain self control. Adults who work with her often comment on how self aware she is for an 8 year old. She learned the hard way, but seems to have gained so much from the struggle.

in the summer time

Jul 11th, 2012
by Zendette.
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School’s out and K’s at camp. Every day M asks me when he gets to start his new pre-school and both of them are looking forward to babysitting a cat again for two weeks this summer, and perhaps going away for a few nights to a zimmer in the Golan.

K’s thriving at summer camp. Her Judo instructor runs the entire program so even though there are about 100 kids, K still gets her fix of attention from the top gun. She’s happy with the activities and is ready to sign up for a second session. I’m so grateful that she’s been able to maintain her behavior, even in a less structured environment. She’s investing a lot of effort to show me, and herself, how much she’s changed. Today at the pool a boy was acting aggressively towards her and a younger girl she was playing with. K first tried to move away and ignore the boy. I could see her heating up. She said something to him, it looked like she was trying to reason with him. Suddenly it looked like they were all friends, and no one was angry anymore. I was SOOOOO proud of my girl!

and back again

May 8th, 2012
by Zendette.
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Three days in a row, same story, different hour, each day, earlier than the next. The school called us on Sunday after 12, to pick her up after disturbing behavior. The next day, physical violence, and another call, this time around 11 am. Today, the principal called 30 minutes ago, at 10:15.

I’m on my way to pick her up. She’ll be grounded from all activities this week, including the L’ag B’Omer bonfire with her class scheduled for tonight, and a play date for tomorrow afternoon, as well as tennis and Judo.

We are doing everything we can. Like I said to the principal when she called, “tell me what you want me to do”. So we have a meeting scheduled in 10 minutes. Life goes on.

Wonder of wonders, miracle of miracles

Mar 28th, 2012
by Zendette.
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K’s anger seems to have nearly disappeared! She is currently in several new treatment situations, so it’s hard to pinpoint exactly what’s working, but the girl has done an amazing change job on herself.

I have rarely seen her angry at all in the last two weeks, and when she does get upset, she gets over it quickly, once I get her to see things rationally. In the past, she wouldn’t have listened to any attempt on my part.

She’s still super energetic, although she’s spent less, overall time doing sports activities in the last month, but that may be due to all the therapies. She still maintains her practice schedule, and has been responsible about doing her homework. She’s more polite, less abrasive, and uses more tact. While I know she still has a long way to go, the school has also noticed the marked change. The aggression seems to have withered up and is dying. But not quite dead yet, I’m sure.

Blessed breathing space, kind of

Feb 15th, 2012
by Zendette.
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Kiftzuba This week the kids seem to be on an even keel. Almost a sense of normalcy even with all the work we’re doing to help K, and with her stuff at schhool going on in the background. Both kids are in the process of getting all their evaluations so we know what direction to aim for in the coming school year.

Matan is continuing with psychological and speech evaluations to present to the municipality so he can get into speech school next year. He just restarted his speech therapy after a short break. He’s really come a long way but the benefits of the speech school go beyond just speech, and should help him close the gaps in his overall understanding of the world so he’s ready to rejoin his peers in kindergarten or first grade.

We’re now halfway thru the process of finally getting a full psych work-up on K to rule out any serious issues. The school wants it, and frankly, so do we. We need some advice “from above” about whether her therapy is doing enough good or whether we should change focus somewhat. Maybe we need to direct more attention, as so many have advised, to sensory integration treatment along with her existing therapy to work on emotional issues. K’s really an excellent student, and takes her homework responsibilities seriously. Her report card was excellent, except for behavior. We have no room to complain at all. That’s why it’s so hard for all the “professionals”, from school to private therapists, to understand why her behavior is so extreme. She’s going to incredible lengths to moderate her behavior during class time, but still loses it during “down” times like breaks and those small spaces before class starts. She also has few, if any, behavioral issues during the after school sports she loves. The coaches are tough and gruff women. K clearly responds well to a caring, but very structured environment. School is often neither.

Still Crying

Feb 6th, 2012
by Zendette.
3 comments

Paralysis is my reaction to the extreme pain I see reflected on Karen’s face each day, for the last few weeks. She’s been shut out by the girls in her class. The boys are willing to play football with her, but don’t want to be friends. And now, even the “nice” teachers and school admins are sick of her anti social behavior. She has only us and home as her refuge from the real world. Even the school principal came up to Karen and DH and told them it’s time to look for a different school. Karen was deeply hurt by the rejection of an authority figure who had, up until recently, done a lot to get Karen to trust her. Now the trust is gone, and a child who has already faced the ultimate rejection, is again abandoned by someone she was expected to trust.

I originally ignored the bizarre statistics I’d heard, that up to 60% of the children in our area are on psychotropic meds to keep them functioning as automatons of the school system. I thought the number was inflated by reactionary parents. But no, I met a teacher from a kibbutz school, traditionally considered “better” schools with smaller classes. She told me about half the students are on Ritalin or it’s relatives. Those numbers are completely crazy. It’s not our kids, it’s the molds they are being forced into by the modern world. It’s making me want to live off the grid…as I ever could!

The school wants us to take some sort of drastic action. We’re not sure what, yet. Meeting the whole crew from school next week to hear the principal’s verdict. They can’t force us to medicate her, but they can make her life, and ours very unpleasant if we choose not to. We suggested they transfer her to a different first grade class, one with a more experienced, and stronger teacher. So far, they’ve refused, but it may be the only option open to them at this point. Of course they wield the ultimate weapon. Apparently someone has mentioned it to Karen, because she’s terrified they are going to suddenly switch her to a different school. I did my homework today and found out it’s not so easy, but if the principal is convinced nothing can be done to turn Karen into a pliable student, like all ordinary, domesticated students, she has declared herself willing to force us out of her school.

Our plan, as parents, is to be as supportive as possible because she really needs to be reminded regularly that she’s not inherently “bad”. Last week, at bedtime, she told me, “I was already bad even before I was born. I’m bad from before I came out of the tummy”. All I can do is keep on pointing out the kind things she does. Her therapist started a book with her, where, at the end of each day, we list the times she was able to overcome her desire to do something to hurt someone else. We also list anything especially nice she has done for others. The point is to keep her focused on the positive actions she accomplishes. She already gets enough attention for the negative ones.

What next?

Jan 29th, 2012
by Zendette.
2 comments

Last week was a difficult one for Karen, and for all of us. Without going into the details, her school called us on Tuesday to pick her up at around 10 am after she behaved horribly and nearly caused a riot in class. I kept her home from some of her after school programs and she spent most of the week thinking about her behavior and how disappointed we are that she hasn’t been able to maintain a moderate level of equanimity regardless of what we and the school try. Almost 2 years of therapy, hard work on our part and on hers, and still, she lost control and continues to lose control when she thinks she’s being slighted or attacked. She perceives slights even if another student gives her a “look”.

In spite of the situation at school, she’s been a real joy at home. It’s almost as if she needs to get the anger out. Either she releases it at school, and then can be more relaxed at home, or else she holds it in all day, and then takes it out on me when I pick her up.

It’s so hard for her. She clearly made a huge effort to control her behavior for several weeks leading up to her birthday. She knew that if there were any major problems, we would cancel the party. Now that her birthday is over, it seems her incentive is gone. She is an excellent student and is reading well and even began doing multiplication this week. The school seems at a loss as to how to deal with her. I think they are also finding it very confusing to see a girl who excels at school, yet who sometimes reacts violently to the smallest slight.

Birthdays and report cards

Jan 11th, 2012
by Zendette.
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In between MY cold, MY laryngitis and MY flu, we celebrated Karen’s birthday in full pomp and style becoming to a young lady of seven years.

The gorgeous princess cake was created by my friend, and expert cake designer, Hagit Avital. The party was designed and executed by Maly Mivulbali, who brought decorations, giveaways and a sound system. The party was a huge success. Karen said it was her best birthday, ever. One of the moms told me her daughter told her, “mom, you wouldn’t believe it, but there was a REAL princess there!”.

Today we had our half year parent-teacher meeting. The report was as good as we could have reasonably expected. In spite of the behavior problems that seemed to me overwhelming at times, Karen is a very good student, and generous with her classmates, freely lending her coloring materials, pencils and other personal items to other students who may have forgotten to bring theirs. She writes very well and is exceptionally good at math. While her reading is still halting, she does read, and simply needs to improve the fluidity. She reads better than I did in first grade!

Overall, a good report card. The teacher reports communicating with our psychologist once or twice for guidance, and there has been a great overall improvement in Karen’s behavior. Most importantly, she now knows immediately that she’s acted inappropriately. She quickly recognizes that what she’s done is unacceptable, and she usually apologizes quickly. The school, and in particular her teachers, have been very understanding and willing to adapt to help Karen overcome her impulsiveness and control her acting out in anger. She’s also working with an animal therapist once a week at school. She’s managed to overcome her fear of small creatures and is enjoying the activity.

I see Karen maturing week by week, and I’m really impressed with her growing ability to accept and adapt to more socially acceptable behavior.

What idiot said childhood is the best time of our lives?

Nov 3rd, 2011
by Zendette.
5 comments

K is doing really well academically during her first semester of first grade. She reads, writes and does simple addition. She usually completes all her homework in her after school program so that she’s free to engage in other activities, usually sports, once she gets home. She’s doing well in both her tennis, 2x week, and her gymnastics, just once a week. This leaves her 2 weekdays when she can meet with friends or do something else. All good stuff that any parent would envy. The problem is friends. She has few due to her strong attachment and then aversion to any child she becomes close with. It’s cyclical with her.

We continue to get complaints that she pushes, hits and, most often, engages in annoying touching or destruction of others’ workbooks. One day she stood up in the middle of class and began going around the room kissing students. It proved to be very annoying to several students, and disruptive to the whole class. She has used kisses with me in the past to confirm love, but also at times she will aggressively kiss me or Matan. She seems to want to use an act that is supposed to be positive, in order to elicit a negative reaction. I’m not sure why, but I think it’s related to her grasping at, then pushing away friends. I believe aversion is partly due to wanting to test how much they really love her, just as she does with her parents. Testing a parent’s love seems to be a common behavior pattern with adopted children. Although most children test their parents to some extent, children adopted as toddlers tend to constantly test boundaries, hence the need for very clear ones.

I have posted in the past about K’s oppositional behavior. Wikipedia describes oppositional Defiant Disorder, or ODD behavior as, ” Children and adolescents with this disorder often annoy others on purpose, blame others for their mistakes, and are easily annoyed.” They also note that,”Common features of Oppositional Defiant Disorder (ODD) include excessive, often persistent anger, frequent temper tantrums or angry outbursts, and disregard for authority.”

While it is true that she has improved and is much less aggressive. I get the sense that she’s spending less time with other children for two reasons. First, she has few friends who want to meet with her after school hours and second, I believe she really doesn’t want to engage in behavior that will anger or disappoint us, or that will make children dislike her so she sometimes just goes off on her own to escape what we sometimes feel is the inevitable.

On the bright side, we have found the parents and the school to be much more willing to work with us than now. We even had a family field trip for her whole class last Saturday which was a lot of fun (See thumnail) But I saw K sitting on her own quite a bit. She did play with her friends, but she also seemed to want to play with DH and Matan. It was an interesting dynamic to see how much she preferred to be with friends vs. family. When they were hiking and playing, she was with friends. But during free times, and some of the games, she preferred to sit alone or hang out with family. Interestingly, she has such a strong attachment to the nuclear family that she has a hard time viewing even her grandparents as “real” family.

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