using our nice words

We have an elaborate routine for school days, to insure that we can get out of the house on time and with everything we need for the day. The boys both wake up between 6:30 and 7:00; they eat breakfast, get dressed, make beds and brush teeth and clean glasses. Henry has his medication with his breakfast, in a tiny bowl of applesauce; the meds take an hour or so to kick in, so it is important that he have them fairly early. After everyone is fed and dressed and cleaned up, the boys get ready to leave the house, which involves finding their shoes and socks and gathering whatever toys they need for the car (why do my kids need an entire Toys R Us aisle to drive ten minutes to school? WHY?). Then, and ONLY then, can they turn on Sesame Street (mommy has chores, you know), which they can watch until Elmo's World comes on--then they turn it off, get on socks and shoes, and off we go.

The whole thing takes over an hour, but we are never late for school (although today, despite the careful planning and staging, we left the house without Charlie's school bag--you know, with his LUNCH in it--and I had to come back for it. NOT a good start to my morning). Earlier this year, Leslie's son said to her, very seriously, "Mommy, just ONCE I want to get to school before Henry."

And Leslie said, "Buddy, it's not going to happen."

Yesterday, while we were in the socks-and-shoes portion of our morning, the phone rang; it was my friend Molly, calling to tell me about an article in the Washington Post about treating ADHD with behavior therapy. She said, "The summary is, 'Drug Safety Fears Are Fueling New Interest in Behavioral Therapy for Kids With ADHD. The Rewards Are Real -- So Are the Demands on Parents' Time and Energy.'" While she was talking, Henry announced, "I HAVE TO GO POTTY. I THINK I NEED TO POOP."

"Yes," I said. "I am familiar with those demands."

I have written before about our decision to go the meds route with Henry; we are now, for those of you not keeping score at home, on our SECOND medication. We are not unhappy with the meds; we understood, going in to this, that the medication would not be a cure-all. The Post article likens ADHD to diabetes, which is a shorthand we have used as well--for a diabetic, insulin is only one part of a complete and successful treatment program. Other lifestyle changes--diet, exercise--are necessary to really control the illness. Henry's meds are just one part of the solution, although right now they are an important part. At this particular time in his life, Henry cannot function without the medication--and yes, this may be a function as much of environment as of neurology. He is in a school that is not equipped to deal with kids with ADHD and ASDs and, unmedicated, was struggling just to keep up, in every way possible. On the meds, though, he is able to function--he is reading and playing soccer and NOT getting into trouble. This is good.

But the meds, as the Post article points out, only help with some of Henry's issues. They make him less impulsive and less distractable; they keep his hyper tendencies in check. He still struggles with social skills, and he still does things that he KNOWS not to do. He is still easily overwhelmed and overstimulated. So we are also continuing the behavior therapy, which in our house, consists primarily of positive reinforcement. Henry has a hard time understanding consequences; he has appropriated the rhetoric of "choices" and will say, "I made a poor choice. NEXT time I will make a GOOD choice." But then he wants to go on his merry way, and he is often angry when we enforce consequences. It is exhausting, and sometimes I wish there really WERE a drug that would take care of all of this. But there isn't, and so we persist with the other therapies.

The Post article points out that one thing that makes behavior therapy difficult for parents is a tendency to go overboard, to have too many rules. This approach is both incredibly logical (here is a kid who NEEDS RULES, if ever a kid needed them!) and incredibly problematic (the boy forgets to get dressed; how many rules can he REALLY be expected to remember?). We have one basic rule in our house: we don't do things that are dangerous. A subcategory of "dangerous" is "mean," because often something mean--grabbing a toy from someone, for example, or menacing someone with a plastic sword--also has the potential to be dangerous. Or to be interpreted as dangerous, either by the other child or by an adult. So--nothing dangerous.

You would think, with only one rule, there would be little to worry about, wouldn't you? You would be wrong.

I spend my day encouraging good choices ("THANK YOU for SHARING with Charlie!" "You're really using your KIND WORDS today!" "I understand that you are frustrated, and I appreciate that you are TELLING me. That's a good choice") and discouraging bad ones ("No wrestling. Wrestling is dangerous." "Please don't wave the sword in the house. Someone will get hit." "Yelling at him probably won't make him want to share with you. Can you use some peaceful words?"). Most of the time, I sound like a freshman psych textbook. Some days, I can't stand the sound of my own idiotic voice. Often, I end the day yelling, "Stop it. Just STOP IT. NOW." Not helpful, really, and not an approved portion of the behavior therapy program.

But all the emphasis on nice words and playing safely works. I can see Henry, very slowly, beginning to internalize appropriate social interactions. He says please and thank you, most often without prompting, and more and more he accompanies it with eye contact, however fleeting. Twice recently, he has come from where he and Charlie were playing (in the yard while I was in the kitchen; at the zoo playground) to announce "Charlie fell and hit his head and is crying. I'll show you where he is." For Henry, this is a learned response; he doesn't feel for Charlie because he is hurt, but he knows that when someone is hurt they will cry, and when someone cries, you get a grown up. And while I wish that he was feeling a pang of fraternal empathy in those moments, I am proud of him for learning the routine and following the conventions. Frankly, I will take what I can get.

The medications are scary, and we are still leery of possible side effects. But specifically because we're not imagining the meds as The Solution to All Our Problems, it seems okay to be leery of them, to see them as part of a larger program of teaching Henry to manage his symptoms. It is a lot of work, for him and for us, because we are having to hyperarticulate something that comes naturally to other kids and other families. And we couldn't do it--the behavior therapy--without the meds. So there we are, for better or worse. We hope--we believe--it's for the better.