Monday, April 8, 2013

Tele-Psychiatry Appointment

This morning we had a virtual appointment with a children's psychiatrist. I thought that originally my DH had said the paediatrician had told him that this was through Sick Kids, but I'm not so sure. That wasn't mentioned at all during the set up of the appointment, or when we signed the papers. Something was mentioned about Ross Memorial though, but I don't know where that is.
It doesn't matter though, because in the end, this guy we conferenced with was great. It was via Skype, basically. And it didn't even matter to me that he wasn't actually there in person, since we could still see him face to face.
The appointment started off with him asking L if he knew why he was there, which led to us telling him what we were there for. There was a preliminary bit where we basically told him what prompted us to get help, but he already had a lot of info there with him, from forms that I had filled out previously.
Then he asked us to step out of the room while he talked with L. That lasted for about 20 mins or so, and then L was asked to step out while we talked to the doctor.
I should also mention that they gave us a couple of handouts to read while we were waiting, that explained pretty basically about kids with anxiety issues. It explains how their mind thinks. Let me see if I can break it down simply and not bore the crap out of you.
  • The brain has two drives - a pleasure seeking drive and a harm avoidance drive. When you are afraid of something, your harm avoidance drive is in charge, telling you to be afraid (whether it's for a legitimate reason or not). You have a list in your brain, essentially, telling you that such and such are dangerous, and are to be avoided. It could mean you're afraid of spiders, or heights, or get really anxious about speaking in public, or many other things. Kids that have anxiety disorders have a very loud harm avoidance drive. Their brains are basically lying to them, telling them that school is harmful, bedtime is harmful, going outside is harmful, or whatever. The only time they can relax is when the pleasure seeking drive is in command, when they're doing something they like, such as eating chocolate, or playing a video game, or again, whatever.
So there you have it, in a nutshell. L's brain is telling him that school is harmful, that the kids at school are harmful, etc. The doctor said that we have to reward him for shutting off that drive, or at least attempting to silence it.
For example, L loves to invent. So it was suggested to us that he have all his inventing stuff taken into a different room. His access to that room is limited by us. He has to earn access to the room (or more likely, box of stuff). Perhaps we will make up tickets or something that give him 10 minute increments or something. He will be rewarded a ticket when he brushes his teeth for bed in a timely fashion, or goes to bed without fuss. It's to give his pleasure seeking drive a chance to take over, by giving him something to look forward to in the morning, rather than letting the harm avoidance drive take over and letting him lie in bed worrying about all that he does.
The doctor said that by punishing L for not say, getting ready for bed, is using the harm avoidance drive. So while it seems the right thing to do to take away his iPod for not getting ready when told, it's just feeding into the whole situation. Instead, we take possession of the iPod, and he is rewarded its use by doing as he's told.
I'm not sure if I'm coming across clearly here, as the doctor was so much better at explaining all of this and made it seem so simple. I'm sure many parents balk at the thought of taking away their child's possessions, as I am doing right now. But he put it very simply: legally, children do not own anything until they are 16 (I think is what he said). It is something I have never thought of, but makes perfect sense. We own everything, and whether he thinks a certain toy is his or not, it legally isn't.
Now, I've never had much issue with taking away my boys' toys as punishments as long as it was reasonable, but this I'm struggling with. We are looking at potentially emptying L's room. It goes against my motherly instinct to take away his "pleasure" when he so clearly seems to need it. But in order to achieve a result, we may have to do that. His room is full of distractions; stuffed animals, toys, kits, clay and plastercine, art supplies, and of course, his inventing stuff.
The thing with bedtime is that he won't get ready for bed. It takes nearly an hour from the time I say "bedtime" to the point that he's actually in bed and I'm walking out the door. No matter how many reminders, no matter how positive he's feeling at the moment, he still walks up those stairs and does god knows what instead of putting on his pjs. And even if I stand over him, I'm still repeating his name over and over again and telling him to "come on", and "get undressed!" like some sort of weird mantra. And I hate being a nag!
So that is our next step, to try this reward system. The doctor said it could be forever (yay) or at least until he moves out (ha ha). He did say that medication was not even something to be considered until he is at least grade seven or eight. When I asked it if was considerable to be still taking him to the psychologist, he said no. I'm quite relieved about that. That will save a lot of money! He said that because of the way they work, talking out the negative stuff, it wouldn't be a good thing for anxiety-riddled children. You want to make them forget their needless worrying, not rehash it.
We have an appt with the psychologist on Friday, to get the results of this test they did on L. Some of me is tempted to cancel it because it's unnecessary at this point, but the other part of me desperately wants to see what these tests say. I'm so curious. But then, why should I have to pay to find out the results of a test that I had to pay for already? It doesn't seem right. And what if they have something outlandish or outrageous they've "found"? That would just make me worry about L more, and cause me to continue on this cycle of doubt of each professional we talk to. Perhaps I can convince DH to call and ask for the results verbally over the phone. Really, after $300 I think they owe us that much. Then he can share whatever parts he thinks are necessary, be a filter of sorts.
So that is the story so far. I've got to suck it up and stick with the plan. No one said parenting was easy, right?

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