The other night I wrote a, dare I say eloquent, post about Noah and why I blogged and where we are with him now, and then I saved it in draft mode (I thought) so I could read it again the next day before I posted it. Somehow it disappeared on me.
That post was flavored by a week or so of seeing some positive behaviors in him, although I've learned to be cautiously optimistic, as this journey is most definitely a roller coaster with more excitement than you'd find in any amusement park. Now that's an idea, perhaps I could sell Six Flags or Cedar Point on "The Wild Ride of Noah" for their next "the best roller coaster ever!" ride.
Anyway...this post is less colored by optimism today than it is by finding Noah had covered his toilet in poop this morning while I was making Rich breakfast for Father's Day. I have a "zero shit tolerance" policy. He's seven. The fact that he still needs help with the "paper work" is one thing, purposely spreading the poop around the toilet is an entirely different thing. And I swear, if one well-meaning person tells me that that it is "normal" for a seven year old to smear poop around, well, I'm just going to loose my own shit.
So yeah, shit and stuff. Noah still struggles with encopresis. And we still aren't quite sure how much of the poop in his underwear is a physiologic problem and how much is a behavioral problem. He says he doesn't know when he "leaks," but considering after it has happened he doesn't seem to care that he has shit in his underwear and he stinks, it's pretty hard to believe he doesn't know.
I started instituting butt checks in the morning before school, since he had two incidents at school where he said he pooped himself before getting on the bus in the morning. So, ten minutes before the bus comes I supervise tooth brushing, wash his face, and do the butt check. It's a great way to start the morning! Doin' the butt check, oh yeah, I'm doin' the butt check. I think I'm going to incorporate that into my next rap album.
So...more on the positive side, we have seen some improvements over the last couple weeks. While the melt downs are still occurring daily, and usually multiple times daily, they aren't always lasting as long. Sometimes he even pulls himself out of them and apologizes and we are able to talk about what happened. We have even had a few days that were actually entirely enjoyable except for one or two short incidents.
The good days tend to be followed by especially bad days, almost as if he can't let himself have too much good at one time.
We are still struggling to figure out what his primary diagnosis is. Right now he's kind of an alphabet soup of ADHD, PDD-NOS, ODD, and mood disorder (he's too young for any of us to feel comfortable formally applying a bipolar disorder to him). We are also considering that attachment issues may still be a problem, although he is clearly not a RAD child. And, he's been showing more OCD behaviors over the last several months, like obsessive toilet flushing, nose picking, and hand clapping, to name a few.
His teacher sees the autism spectrum issues as being the most problematic, and although she hasn't said it outright to us, I know she thinks medication is making him worse. The psychiatrist thinks the mood disorder is primary, (actually that almost simplifies it to much, but I'll save that for a different post). Rich and I see pieces of all of it at different times, and while we see pieces improve, over all it feels like he is getting worse.
When Noah was around two and we first started working with "professionals" we were told that with year or two of therapy he'd probably be fine; that his chances of starting kindergarten as a "typical" kid were good. We believed them. Or perhaps we heard the parts that we wanted to hear and told ourselves that on our own. It's hard to remember.
Hell, even as recently as last summer I let myself believe that a woman in Texas and her behavior program could change our world. I wrote about it at the beginning of the post here. It was pretty much a big fat fail, and in a nut shell not a program I would recommend.
We are going to be doing some work with our attachment therapist next week. Hopefully it will help all three of us (Rich, Noah and me) with coping skills and give us an answer if attachment is indeed still an issue with Noah, or those attachment issue type behaviors are more a result of his other disorders. Either way hopefully we'll be able to dig a little deeper into his brain.