Anxiety & OCD

[egoldber]

Our therapist does not do CBT with kids that young. They do need to be have the maturity to be able to reflect on their actions and be able to consciously implement the taught strategies. A 4 year old doesn't really have that maturity.

But like pinkmom said, the therapist could work mainly with you on more effective strategies for anxiety management (older DD's therapist still does this with me) and see him occasionally on a check in basis.

[lmh2402]

thanks, guys

yes, our psychologist is working with us - parents - on a weekly basis. bc he says that's the only way to do it - he gives us general guidance and we talk through things that came up the week before and how to maybe better handle. basically parenting strategies given DS' unique needs

it's helping some. but not enough in the mornings.

[JTsMom]

I spoke with 2 different specialists about CBT for Jason, and they both felt he was too disregulated for it to help, so there's that too.

If you are struggling mostly in the mornings, maybe it would be worth brainstorming with either the therapist, or even other moms, to try to figure out a plan for just that one issue. I've found I have to put out those smaller fires since I can't fix the bigger one.

[sste]

lmh, my ds does not have special needs or OCD but he is one heck of a PITA, esp. in the AM.

Does your DS have a favorite TV show that he is really, really into? I mean, "currency"? Or something else that you can hold off and give him once all morning tasks are done?

What worked well for us at your son's age was to use a visual calendar and then ONLY allow him to watch 20 minutes of his beloved scooby doo once he had finished his morning routine and was dressed, shoes on, fed, teeth brushed, and sitting on the sofa. Then he got the reward of the scooby doo cartoon. That was the only time of day and only way he could watch scooby. We didn't frame it as punishment (per our behaviorist) - - it was I really hope you can finish your oatmeal so you can get your special morning scooby. I don't know that this would work with OCD but the throwing food stuff etc it may help with. If your DS doesn't have a currency it is much, much harder.

[lmh2402]

ok, so i would so welcome brainstorming

we've been talking with the therapist about this since we started working with him

sste, yes, he's got lots of currency

problem is, for whatever reason...beyond anything rational...he is unable to keep perspective AT ALL in the mornings.

so, here's what goes down pretty much every morning.

anywhere from 5:30am-6:30am, we'll start hearing him over the monitor. chatting, singing, talking to his stuffed guys in his crib, etc.

at 7:00am, his time-to-wake clock turns green. he immediately calls out, "dada, the green clock turned green."

99% of the time, all of what has transpired so far (as heard and seen via video monitor) as seemingly pleasant and good-natured.

so then DH goes and opens the door.

and 99.9% of the time, this is where it goes off the rails.

almost instantly, DS will start screaming. sometimes it's words - "no!!! i want to sleep more!! get out!! i want mama! i don't like you!, etc, etc, etc

sometimes it will just be guttural sounds - no words.

almost always it involves physical thrashing. throwing things from his crib. throwing himself around

it can unfortunately evolve quickly into him reaching out of his crib to grab and heave whatever he can get his hands on -the clock, the noise machine, trying to rip the wall-hung lamps off the walls, pulling and breaking the lamp shades, trying to remove the pictures hanging above crib to throw them, etc, etc.

when we see things heading in this direction, we will quickly role up the rug to make room to pull the crib way forward out into the middle of the room to reduce his reach

how long the hysteria will last is unpredictable

there are days when i end up dragging him out of the crib in time to get in the car and go right to school - no food. physically forced through the process of changing his clothes.

he'll be soaked with sweat and snot

other days he can pull it together but the reasons why are not consistent

things we've tried (both before starting to work with current therapist, and since)
- DH altering his entrance. meaning, he tried being upbeat "good morning, DS!", he tried being quiet and calming, he tried being firm, he tried being silent

- doing lots of talking the night before about the positive incentives for not flipping out. "remember, no yelling tomorrow and if you do no yelling, then daddy will have time to play with you before work (huge currency), or you can watch XYZ (also huge), etc"

- also tried adding night-before talk about negative repercussions - "if you yell, you won't have time to play with daddy." or "if you yell and yell, than i will take away xyz toy for the morning."

- tried leaving the room the second he starts screaming and telling him we wouldn't come back until he stopped.

- tried refusing to leave and trying (ha) to ignore the screaming

- tried talking during the day about how yelling makes everyone feel - sad, upset, mad, scared, etc, etc

- hired a behaviorst back in May '12 b/c things were so bad. she came up with a "game" - told DS it was the "(DS' name) game!!" she wrote out each little step for the morning - 25 steps. each step was on a separate index card with a number. DS LOVED the orderliness of this. loved turning the cards and memorizing which task was which number. this worked for almost two months - longest reprieve we've ever had. but then it lost its luster

- the psychologist right nwo has told us that we have to face the fight head on. he said DH should not ever walk out. DS wants him to leave, so he shouldn't. also, we need to totally keep our composure. ha. we have to move the morning along as though nothing at all is amiss. curtains opened, blinds opened and up. theoretically fight getting him undressed and then dressed. of course, this will immediately create opportunity for DS to physically attack/hit/kick. the psychologist said we are to deal with that by just trying to work through - not acknowledging the hitting

- current psychologist is also focusing on DS' currency - wanting me. he is wanting us to talk up, the fact that if DS gets through a very specific list of tasks without screaming, than i will come right into his room. we tried this and it worked so well! for two days. then this seemed to stop being enough.

ugh. this is long enough already. i'm sure there's more things we've tried. but my brain hurts to keep thinking about this

[wellyes]

Trying to brainstorm here, sorry if all this sounds obvious...... I would get rid of the clock. I would wait for him to be up for a couple minutes, then have your DH go in (annoucing he's coming in first) with a cheerful "let's go make muffins" or "do you want to come help me sort my socks?" or "let's go look outside, it's raining". Or something else that is not the he plays ~ he calls your husband ~ he lashes out at your husband dynamic that has become such a deeply embedded pattern. Because with OCD, anything you spend so much time and effort on can become an embedded ritual. Don't try to change the ritual, putting more attention on it makes it MORE important to him. Change the parameters. Again, probably extremely obvious, that's just what jumped out at me reading your post.



It's just, when I have an obsessive pattern or thought, no matter how much I hate it, I really want to spend ALL my energy focused on it. It's like I can't help myself. And it seems to me like this battle is something your son has become so invested in. Don't feed the beast, it only empowers it.

ETA. I know that contradicts what your psychologist said, and he/she probably is the one to listen to. Lord knows I am not an expert.

[egoldber]

Is he hungry? Potentially he could be up from 5:30 to 7 without haven eaten since the night before? Some people (me ) need to eat ASAP upon wakening.

I appreciate you not wanting to wake before 7, but younger DD went through a longgggg phase of waking at 5:15/5:30 because she was starving. I would consider leaving out a non-perishable breakfast for him to eat when he wakes. Something like dry Life or Cheerios in a cup, a Nutrigrain bar, etc. and a juice box.

It has been my experience that many of these non-neurotypical kids also have low blood sugar struggles.

[pinkmomagain]

Read your post and am brainstorming here. A couple of things come to mind:

1) I wonder what would happen if he were sleeping in a bed rather than a crib and had the freedom to leave the bed when he wants to? I wonder if that transition of getting out of bed would be better for him if someone didn't have to come in and take him out of a crib?

2) Have you conisdered putting him to bed in his clothes for the next day? That eliminates fully dressing in the morning (just shoes). I did this for probably 2 years (prek and kindy) with my little one who was (and still is) difficult with transitions and getting dressed for school.

eta: I like wellyes' idea of getting rid of the clock. A clock was terrible for my OCD middle one. I actually had to turn the face to the wall because she was obsessing about the #s/time.

[sste]

Ok, don't lose hope here! It sounds like there is alot of trial and error involved.

Is he better at night. I would personally perm. relocate his crib to the center of the room so that you don't start your morning with things being pulled off and flung -- you need to conserve your patience for later morning challenges. I would also try dressing him at night in his school clothes. Would he tolerate that? My DS has alot of those boden jogging pants and flannel "tartan baggies" that look and feel just like pajamas and there are also carters fleece pants. No need to even tell him he is wearing his school clothes imo. Just dress him for the next day and the next morning remove dipe if applicable and then tell him he can wear what he is wearing now to school.

Then that just leaves breakfast, shoes, and teeth.

Does he not do well with waiting for breakfast? With certain foods? With throwing? Again, to avoid stressing out you and your DH can you at least use foods that are easy to pick up if he chucks them -- I am thinking TJ's frozen waffles and pancakes, not cut up.

Or if breakfast is too much how does he do with a breakfast or protein bar in the car seat? Does he behave decently in his car seat? If that works, I might consider getting rid of the breakfast table debacle too and going with "trucker's breakfast" or whatever cute name you want to make up.

I am sure others here know much more than me . . . I am just thinking of things I might try. From an outsider's perspective I wonder if there is just more than he can do separating him from his "currency." If you haul him out of bed dressed you can plop him at the table and say as soon as you eat some waffle we are going to spend some special time. Or just teeth and shoes and then special time and some food in this car. This makes the reward more immediate and ups his chances of success. Over time if it works maybe you can start reintroducing one at a time getting dressed and breakfast at table.

[lmh2402]

thanks guys!

so clock - yes, we've thought to get rid of it and actually tried. he viewed it as punishment and after several days we caved and gave it back b/c no amount of reassurance that it wasn't punishing could relieve him. also, i think he legitimately missed it b/c he took likes to obsessively check the time

also tried putting him to be in his clothes. this freaked him like you would not believe. we have tried talking about it like it's fun to get to sleep in your clothes. but no. he is SO, SO, SO routine oriented. it was like we were torturing him to suggest he not sleep in his PJs

would love to get him out of crib. BUT - he gets very upset when we suggest switching to big boy bed. also, at this point...this sounds horrible, i know...but right now, given how things often go...i'm grateful for the opportunity to contain the violence and destruction

and lastly food - yes, i've thought that too. i could try leaving food out. what we had been doing was having DH bring something to eat / drink in with him. he usually rejects. but maybe leaving something he can get to on his own would be a good idea

he doesn't always wake at 5:30. the vast majority of the time it's closer to 6:30

we used to have the clock turn green much earlier than 7. but the hysterical screaming that he was still tired. coupled with the fact that he yawns all day long, made us think he really was tired. so we have gradually pushed the time back to the latest it could turn green, and still give enough time to get to school