Can Someday be Today?

dressup

“Can we go to the candy store?”

“Not today. Maybe another day.”

“Can we go to the park?”

“Later, Sweetie. It is raining now.”

Fidget, fidget, scan the room.

“Can I have a phone?”

“Maybe one day.”

“Can we go to Disney Land?”

“Maybe someday.”

Sigh.

Another one.

“Can someday be today?”

 

 

 

For The Daily Post

Daily Prompt: Someday

Stuck on

He won’t let her have a quiet cup of coffee.

He won’t let her sleep.

He needs her when she bathes

Or pees.

He whines during any of her conversations

Cares little for her schedule

Her meetings

Her needs.

He requires constant attention

Won’t be left alone

Must come along.

That phone.

 

phone-getty-images

 

 

For The Daily Post

 

 

You going to have to wait…

stubborn
photo: pinterest.com/pin/339810734368459869/

 

She didn’t want to wait.

She wanted a treat NOW. Not later. Not after she finished her work. Not after session. Not after dinner.

No waiting.

NOW!

She was NOT going to move, or sit, or come, or go, or climb the stairs, or listen, or ANYTHING until she got her treat.

Which she wanted NOW.

No waiting.

Making her wait was “mean.” It was “not fair” and “not nice.”

She wasn’t having any of it.

None of her mom’s cajoling. None of her mom’s reasoning. None of her mom’s threats of consequence or punishment or loss of playdate or no TV or no iPad or no … something … unless …

I heard them argue. They were still at the bottom of the stairs. Two frustrated voices. Volume rising.

I could visualize the little girl. Arms crossed and foot stamping and lips pursed out in a pout, jaw forward in clear dismay and stubborn determination. I’d seen her do the ‘you’re not gonna make me’ before.

“Upstairs!” The mom ordered, fed up. “Now!”

“You not waiting EITHER,” the child accused, sounding vindicated. “You say go upstairs NOW. I saying go to the store NOW. I want my treat NOW!”

“Don’t be cheeky!” Mom’s voice went up an octave.

“YOU not be cheeky!”

This was devolving. I walked downstairs toward them.

Red faces, one large, one smaller, looked up at me. One in exasperation, one in challenge and a touch of “yeah … so what are you gonna do about it?”

I smiled. “Seems like I’m the one whose waiting…”

The child frowned. This didn’t quite fit her script.

“I’m not going!” she huffed.

“She won’t come up,” the mom accused.

“I want a treat NOW!” the little one dug her heels.

“Oh boy,” I lowered myself onto one of the stairs. “Mind if I sit down? Seems like you’re a little stuck. Can you tell me what’s going on?”

“She won’t get me my treat/She won’t cooperate” They spoke together.

“Are you hungry?” I asked the girl.

She regarded me suspiciously. She knew me well enough .

I raised an eyebrow in question.

“Yeah!” she raised her chin accusingly. “And mommy said we can go to the store and get a treat and now she say go up NOW. I’m not!”

“Hmm …”

“There was lots of traffic,” the mom’s chin was only slightly less raised… “I told her if there’s a lot of traffic we may not have time to stop at the store.” She turned to the girl, “maybe next time you get your stuff faster so we won’t leave so late …”

The child’s face grew angrier. Couldn’t totally blame her … this was a bit low …

“Traffic can be tough in the city,” I intervened. “We can think together about some better planning for next time but now … we have a hungry child and no snack. Good thing I have some snacks upstairs. Shall we?” I got up and offered a hand to the child, eyed the mother meaningfully.

She understood. Stayed silent.

The child narrowed her eyes at me. “What treats you have?”

Bargaining. We’re making progress.

“I don’t know. I’ll have to check upstairs. Let’s go see.”

Eyes still narrow. “What if I don’t like them?”

“I guess we’ll have to see.” (I get really boring when I’m not going to say much more…)

“But I still get a treat after.” This was demand, not query.

“This is between mommy and you, but for now, lets get something into your belly so it isn’t hungry.” I moved my arm closer and she took it. We began climbing, mom trailing a few steps behind.

“Na’ama says I can still have my treat later,” the child swiveled her head back and declared to her mother. A little victoriously.

“This is between you and mommy,” I repeated, not quite able to keep the amusement out of my voice.

“Mommy promised me a treat,” she insisted, but her legs were still climbing so I knew she was only half-combative now, making conversation.

“Yes, you told me. Too bad there was so much traffic.”

“Yeah …”

“I don’t like traffic much.”

“Me too,” she sighed.

“Me three…” Mom piped up from behind.

The child stopped, turned, giggled. “That’s not how you say it!”

“I guess Na’ama will have to help me say things better?” Mom smiled back.

“Yeah!” she liked that. She climbed energetically up a few more stairs. “But …,” she paused again. “You going to have to wait …”

 

 

Communication and Collaboration

Upcoming Webinar!

Communication and Collaboration: Multidisciplinary treatment of traumatized/dissociative children

Friday, May 20, 2016
2:00 PM – 3:30 PM Eastern Time

Registration now open! (please see disclaimer in bottom of post)

spacornerJuly12no5

Photo Credit: A.A.

Abstract
Treatment of traumatized and dissociative children is most often discussed in the context of psychotherapy. However, traumatized and/or dissociated children often come into contact with additional professionals. Like all youngsters, traumatized children need to manage everyday interactions with caregivers, educators, and routine childhood medical and dental care. Yet many also face clinical interactions with speech-language pathologists, occupational therapists, physical therapists, medical professionals, and more. This is because trauma places children at a high risk for developmental issues, and because children who already have developmental and/or health issues are highly vulnerable to trauma. In addition to clinical care, many traumatized children encounter legal personnel, forensic evaluators, child protective services, foster care staff, etc.

Posttraumatic and dissociative reactions are not limited to the therapist’s office. Just as communication issues aren’t segregated to speech-language pathologist’s office, asthma to the doctor’s, or sensory integration issues to occupational therapy. Various issues can complicate children’s presentation and behavior, and traumatized youngsters are often judged as difficult, aggressive, manipulative, immature, unpredictable, and inattentive. This can result in painful consequences (e.g. loss of placement, shaming, treatment failure), which further increase stress and reinforce the need for dissociative coping. In addition, caregivers routinely face challenges that can affect course of treatment, and professionals do not always ‘speak the same language’ when it comes to describing, assessing, and treating the child (and/or family). Even when professionals are trauma-aware, coordinated care is not always easy to achieve … and yet is essential for effective stabilization, minimizing compartmentalization, and carryover.

This webinar will look into the often complex realities of caring for traumatized/dissociative children and adolescents, the tapestries of clinical encounters many face, and how these may shift throughout infancy, childhood, and teen years. The challenges (and potential) of coordinated care and communication will be discussed, as would logistical and ethical limitations and suggestions for managing them. Clinical vignettes will serve as a window into ways for improving communication among child/family professionals, and will provide examples for practical solutions for increasing regulation and decreasing posttraumatic activation in all involved. The role of caregivers and the child as part of the team will also be examined.

Objectives
Upon completion of this webinar, participants will be able to:

  • Identify the connection between trauma and care utilization in children and adolescents.
  • Describe three challenges to coordinated care
  • List five strategies therapists can apply to improve communication and coordination in the multi-disciplinary treatment of traumatized/dissociative children

For more information and to register

Disclaimer: I volunteer my time and expertise for this webinar, and do not receive any financial gain from it. Registration fees are collected by ISSTD, which hosts the webinar, is responsible for all fees and/or refunds, and provides an option for CEs for attendance.

“A Bandaid for my heart”

She asked me if I knew about dying.

I said I knew it hurt when someone we love died.

She nodded and fiddled with the pencil, poked the tip against her finger, poked again. Again.

I wondered if she was trying to make the hurting take a form she understood through the pinprick of a just-sharpened pencil. I gently put my hand on hers.

She looked up at me, thankfully without embarrassment or worry of judgment. Feelings weren’t easy for this child, whose very early years were filled with much that couldn’t be expressed and had no wording. Her grandfather passed away right before her birth and a hue of grief lingered many months, adding to her mother’s post-partum depression. Her mother has recovered since, and the home was generally caring, but unspoken early patterns of if-you-are-quiet-you-won’t-overwhelm-mom and waiting for another’s space to open so you can have your needs met still played out often. The girl, not yet ten, was more likely to attend to others’ feelings than her own; more likely to dismiss her anguish to not distress others.

I smiled at her and she smiled back shyly. Her eyes glistened and she sniffed.

“My dad told you?”

“Your mom did.”

Her eyes flew to mine, surprised at being thought of. She took another breath. Tears slid down her cheeks.

“I’m sorry, Sweetie.” I handed her a tissue and snuck a bit of extra affection into the gesture. Just because. She noticed. Smiled the sad smile again.

Her great-grandmother died two nights before. Her father’s grandmother was a fixture in the child’s life. A rock. The one who filled the gaps, stepped in, held, held on. An elder in the best sense of the word. There was a love there that spanned generations. A special bond with this child.

It was a gentle death, the mother said. Doctors believed the grandma had passed away peacefully in her sleep. No pain. No long decline. That was a blessing, but for the child this loss still hollowed.

“I didn’t get to say goodbye,” she whispered.

“I know. I’m sorry.” I moved a strand of hair off her cheek. “You can still say it. Maybe not in the way you’d have wanted, but still …”

“Yeah,” she sniffed. Dismissed. Reconsidered. Looked up. “How?”

“Any way you can think of, almost.”

She pondered. “Dad said she can hear me. In my dreams. In my thoughts.” Her eyes probed. She wanted to believe it.

“I believe that’s possible, yes.”

“How?”

“I don’t know exactly. I just feel it. In my heart. About people I love and passed away. It feels right to me that we are still connected, that in some way they can hear me.”

Her eyes overflowed again but her face softened. “I think I’ll talk to her. Tonight, maybe. You know, just me and her.”

I nodded, smiled.

She sighed. Drew in a shuddering breath. Sighed again.

“I miss her,” she whispered. “It hurts. I wish I had a Bandaid for my heart.”

hands-and-heart

 

On The Matter Of Monsters

Angelika Scudamore - monsters under bed scene

http://www.angelikasillustrations.com: “monsters under bed scene”

 

Zane’s mother looked exhausted. I asked her if all was well.

“He won’t go to sleep unless I’m with him, he is taking forever to fall asleep and waking me up several times every night,” she sighed. “It is exhausting.”

“How come?” I asked, looking from the preschooler to his mother.

“It’s the monsters,” he chirped to clarify.

“For the hundredth time, Zane,” his mom exasperated, “there is no such things as monsters and there are certainly none in your room!”

“Is too!” his lower lip tightened in determination then began to tremble.

Zane’s mom took in a long breath and mouthed a silent “help.”

I smiled gently. The matter of monsters comes up often. Many young children–especially between four and six years of age–go through a period where they fear monsters. Under the bed, in the closet, behind the curtains/desk/wardrobe/chair, camouflaged among the stuffed animals on the top shelf … At the age where imagination and reality can merge and the veil between what’s real and what could be is thin, many children find the dark ominous and fear the parting with parents for the night and being left to their own thoughts and imagination. They are often too young to verbalize what it is they fear, exactly, but the feelings are still there: scary, dark, sneaky; the territory and making of monsters.

Scared or fearing to become so, they plead, coerce, and cry for their parents to stay and make sure they are okay.

Some are reassured by the adult checking under bed or dressers. For others, securing the closet door closed can suffice. However, for many, the fear remains in the ‘what if’ category: “what if the monster comes later?”, “what if the monster opens the door?”, “what if it is invisible and you can’t see it?”, “what if it just pretending to be my shoes but it will scare me later?”

Perception, reality, and belief make a sticky trio; and declaring monsters nonexistent rarely helps. To many children–as with Zane–this only makes the fear grow further and adds frustrated loneliness onto it, making nighttime doubly scary.

Zane’s mother needed her sleep. Zane needed his to feel safe. It was time to bring out the ‘big guns.’

I looked at the boy. A messy head of curls, brown piercing eyes under thick brows, a smattering of freckles on a button nose, wide lips, and a tongue that likes to slip out during speech and activity regardless of whether its presence is required (the tongue thrust being the main reason he sees me for speech-therapy).

The little boy regarded me. He needed to ascertain whose side I was on. “I have monsters,” he announced, “under my bed.”

“Yikes,” I replied. “This sounds scary.”

He smiled and turned to glare victoriously at his mommy.

She looked at me with uncertainty.

“You also see monsters!?” he checked, suddenly a bit wary of the possibility. Monsters being real is one thing. Monsters being REAL is quite another.

“Nah,” I shook my head. “But you say you do, so maybe they are there.”

He nodded quickly.

“What do they look like?” I wondered aloud.

“I don’t know!” he exclaimed. “They are hiding under my bed and it’s dark.” He followed that obvious fact with an ‘adults-can-be-so-thick’ look.

“Oh.” I demurred. “What if you turn on the light?”

“You can’t see them in the light. They do magic.”

“Hmm…”

“If I go to sleep by myself they will come and get me,” he warned. “Mommy says they not there but they are.”

“Well then,” I breathed. “I’m not in your house and I haven’t seen them, but just in case they are there, have you tried telling them you don’t want them there?”

“They don’t know English,” he responded.

“They don’t?” I let my voice rise some.

“No!” he explained, “they only speak Monster.”

“Hmm…”

He nodded sagely.

“…and they eat children,” he added for emphasis, then his eyes grew big with fright at the possibility of his own words and he backpedaled, “…um, maybe … if they really hungry.”

“We can’t let that happen,” I said.

He nodded again, reached for my hand.

I squeezed his little palm in reassurance. Children may be small but their fears can still be big, and their imaginations; bigger.

“Good thing we know what to do,” I stated.

He looked at me hopefully.

I pursed my lips in contemplation. “Have you tried Monster Spray?”

“Monster Spray?” This sounded intriguing.

“Yeah. They hate the stuff. Makes their noses itch.”

His eyes grew again, this time with wonder. He looked at his mom, clearly expecting her to know everything there is to know about sprays and all manner of remedies.

She raised her palms up in bewilderment and gave me an ‘I hope you know what you are doing’ glare.

“It works every time,” I reassured both of them.

“What’s Monster Spray?” Zane asked. “Mommy, you have to listen, too,” he ordered. “Because you didn’t learn it yet.”

I swallowed a chuckle. I was waiting to see how he would get back at her for not believing him that monsters waited under his bed waiting to eat children (maybe … if they really hungry…).

“It’s a spray and it makes monsters go away. It smells the same as an air freshener or perfume. The monsters don’t know the difference,” I said meaningfully. Mom’s eyebrows lifted and the corner of her month twitched a bit. Good. One aboard.

“Like in the bathroom?” Zane’s eyes narrowed suspiciously.

“Sort of. Doesn’t have to be the same one, though. You can pick any scent you like. They hate all of them. Makes their noses itch. Here is what you have to do. You listening?

He was.

“First, you find a spray that smells good to you. Mommy can help you choose. Next you make a sign that says “Monster Spray” and you tape it on the bottle …”

He nodded in approval. It was important to label things. Especially when it came to monsters.

“…and before you go to sleep you spray a bit under your bed, and if you want you can spray a little in the air, and that’s it. If the monsters are there they will say: ‘Oh, no, Monster Spray, we better come another day!’ and they’ll go away.”

Zane’s jaw hung open in delight. “For really?”

“Yep,” I nodded. “Works every time. If there are monsters there, they’ll run away from the monster spray.”

“What if they come tomorrow?”

“If they come another day, they’ll have to deal with more monster spray … and they’ll say: ‘Oh, no, Monster spray …”

“… better come another day!” he completed, his eyes shining.

“So we’ll have to do this forever?” Zane’s mom. I could sense her wariness about committing to nightly spray-bottle battles till Zane was in college.

“Oh, no,” I clarified. “You see, once you do it a few times, if the monsters come again they will say: ‘Oh no, more Monster Spray; we better go another way.’ They hate this stuff so much, they will tell all their monster friends to go another way!”

“Better go another way!” Zane clapped his hands, intoning, “Oh, no, Monster Spray; better go another way! Hey!” he paused, “Spray-way!” he lisped. “It rhyme!”

“It does indeed!”

“Spray, spray, go away,” Zane sang to himself and doodled as I explained the ‘anti-monster process’ to his mother.

Any scented spray would work. Body mist or freshener or even bottled water with some essential oils, vanilla extract, or lavender for scent. The scent will help Zane remember that the ‘Monster Spray’ is working, and can make associations to feeling safe and in control. I recommended keeping the spray bottle within reach, in case he woke at night and needed a ‘booster squeeze.’

As we returned to speech-sound practice, we spent part of the session making a label with the words “Monster Spray” on it, complete with a drawing of a dark-green/red/black blob (“that’s the monster, but you can’t see it because it is under”) and a figure in a cape holding a spray bottle like a sword (“that’s me, because I am super-Zane”).

The progress report the following week was that the monsters had such itchy noses the first time Zane used the newly minted spray on them, that they declared right away: “Oh, no, Monster Spray; Better go another way.” When a few monsters did not get the memo and tried their luck a few nights later, Zane spritzed them and they reportedly scuttled away to warn all others that: “Zane has Monster Spray, better go another way!”

monster Spray1

Connections

connection muir

The boy, five years old, had his hands deep in soft dough. “What do butterflies eat?” There was a butterfly cutter among the shapes on the table, likely the inspiration.

“Nectar.”

“From the flowers?”

“Yep!”

Silence, a bit more kneading, pulling, twisting and squeezing. This kid has such high sensitivity to textures that it took three months of work with an excellent occupational therapist before he was willing to touch the dough, let alone let it squirt between his fingers. My work with him was reinforcing the OT work in the speech-and-language contexts. Children learn much better when their body is engaged.

“What do frogs eat?” He fingered the frog cutter, put it next to the butterfly one, compared their sizes, lightly pressed the edge of the frog shape into his ball of dough.

“Frogs eat mosquitos as well as other kinds of insects: flies and gnats and such.”

“Good.”

“How come?” I smiled.

“Because mosquitos eat people alive.” His big eyes hang on me, suddenly a little scared by his own repetition of words he’d heard, “but do they really eat people?”

“Not exactly, no. The female mosquito drinks blood for her food, but only a very little bit. It is very small and it doesn’t actually eat you.”

“Oh. Yucky.”

“Yeah, I would not want to be a mosquito.”

“Me neither!” Pause. “Frogs don’t mind, right?”

“Yep.” I can see another question coming.

“Who eats frogs?”

“Snakes do. Some other animals eat frogs, too, even some people eat frogs.”

“People!?” The munchkin was simultaneously impressed and repelled. “People don’t eat frogs, do they?” he turned to his mommy. Usually, I’m an acceptable source for information, but some things require a higher authority.

The mother nodded, amused. “In France they do. Maybe in some other countries.”

“Yuck.” he relished the word. “Yucky, yucky.” He twisted his lips in contemplation, and you could see the wheels turning in the little brain behind the hazel eyes and summer freckles. “But … frogs eat the mosquitos and the mosquito eat blood from people …” he let the question dangle.

I raised my eyebrows, waited.

“It’s like a circle.” He breathed. “It is everything connected!”

From the mouths of babes.

Ice Cream Empathy

The little family was heading to the crossway and in my direction as I was sitting on the bench in the sun, thirty yards from the crossway, waiting for a friend to emerge from a store. They made the prettiest picture: the father pushing a stroller, the mother to his left, holding the hand of a preschooler. The little one skipping, pigtails bouncing, dressed in pink t-shirt and purple tutu, light up sandals, little handbag full of turquoise rhinestones and the latest animated princess character; giddy with the unsuppressed delight that kids that age can have. I had me a feeling they were on their way to the ice-cream store across from the bench I was on. The excited anticipation was written all over the little face.

Steps from the crosswalk and probably noticing the commotion on the corner right behind a row of parked cars and flashing lights, the mother tried to circle to the father’s other side. Maybe she intended to put herself and the other adult as barriers to the scene on the asphalt.

There was a person on the ground ten feet away from the sidewalk, right behind the row of parked cars. Paramedics with a backboard. An ambulance. Two police cars flashing lights and directing traffic from the three lanes to just one, keeping a perimeter so the nosier onlookers not get too close to the accident. Another police man stood by a car parked sideways across one lane, talking to the driver who hit the man. There was concern in the air. I’d been sending some good thoughts when I noticed the family nearing.

The child was too short to see over the parked cars, but either the energy of the congregated people or the movement of her mother caught her attention. She stopped skipping. Stood. Tried to see. The mother stopped, as well, then tugged gently on her daughter’s hand. The child did not move. The woman stood a moment–maybe considering the benefit of picking up the child to get them moving away from the area but give the child a vantage point that could be startling. The father bent toward the little one, said something. The girl nodded and resumed walking, but her head kept swiveling toward the street and as they crossed and the cars no longer obscured everything, she slowed. The mother picked her up and rushed to make it to the other side before the light changed. To put some distance, too.

The child kept talking, the mother shook her head and spoke back, tried to turn the child in her arms to face the other way and still the child kept turning her head over the mother’s shoulder–looking at the scene on the street: the paramedics were lifting the man on the board onto the stretcher. The family walked faster now that the little one was in arms. I could sense the parents urgency in wanting to get her away.

I could hear them as they walked closer.

“So you are ready to get some ice-cream?” The father, his voice kind but a bit too loud and  strained in the slightly false cheer of worried grown ups that children always pick up on.

The girl nodded, her attention still divided. She looked back. “Why he has a big Band-Aid?”

The neck-brace. It did look like a big Band-Aid from the distance.

“They are just helping him be more comfortable,” the dad responded. The mom looked upset, walked faster.

“He has a big boo-boo?” the little girl looked again.

“Maybe. Don’t worry. They’ll take him to the doctor and make sure he’s okay.”

“He fall down?”

“Maybe.”

“I don’t want him to have a big boo-boo,” the little girl said, frowning. Then her eyes brightened. “Maybe he want ice-cream too so he feel all better.”

“He doesn’t want ice-cream,” the mother blurted as  they reached the ice-cream store and walked in.

Maybe not the kind that comes in a cone, I thought, but the energy of sweetness from this child I bet already made him feel better, even if he did not know the pigtailed gold-heart who offered it.

child ice cream2

Evening Standard / Getty Images 1956