His Empty Room

I have looked forward to Noah's first night away from home for several years. It is a right of passage after all.

I always thought it would be his first sleepover with a friend, or a night with grandma and papa. Maybe his first time at summer camp.

I always thought his first night away would have happened by now.

I have mourned the absence of invites from friends and grandparents.

I never imagined his first night away would be at a psychiatric hospital. Or that one night would turn into fourteen. Or that fourteen would turn into sixteen and then more.

At night as I get ready for bed I look down the hall at his empty room. He sleeps with his door closed, but for now I keep it open. I keep his night light on. I won't pretend he is here, even if I cry myself to sleep most nights because he isn't.

I know he's not sleeping well at night. Yesterday he asked us to bring him one of his blankets from home. (The blanket you made for him when he was a baby Aunt Robyn.)

This morning we were told he is having auditory hallucinations. The door is telling him if he sleeps he will die. When I talked to him about it he said it was a dream. That isn't what he told the psychiatrist though. 

Tonight he asked if I remembered his blanket. I didn't. Now I'm awake at 1:30 am worrying and hoping nothing is talking to him, even in his dreams.

 

This was last week. It's not over.

Since the incident at soccer Noah has become increasingly fast. Not fast like "wow, watch that kid run" fast, but "wow, this kid is manic" fast. Or in other words, Noah's been riding the wackadoodle express, and frankly, it doesn't look like he's headed for a station any time soon.

Typically, Noah holds himself together at school fairly well. He's able to do that because of his awesome teacher and all of the supports he has in place. He has rough days here and there, but for the most part his behavior is acceptable.

This week he hasn't been able settle at school at all. He's all over the place, talking fast, racing through his work, not able to sit still, and very argumentative.

When Noah's teacher says he had a rough day I believe him. When he says Noah is wild or a mess. I get concerned. Especially when what I'm seeing at home is the same thing.

Monday we had an intake visit with a new therapist. In the past Noah has barely interacted with doctors and therapists. Monday he wouldn't stop talking. He also wouldn't stop moving. In this 8 x 8 office he was all over the place. The couch, me, under the therapists desk, hanging upside down over the couch, jumping on the couch. You name it, if he could do it in that little room he did. He was so happy though, and kind of silly in a fun way. It was exhausting, but I couldn't really get mad at him because it was so different from his typical melt downs.

Tuesday he was like that as well, but he was more irritable and argumentative. He refused to come inside after playing and kept running from the front door to the back door. It was a little like chasing a puppy, except that I don't chase. And pork chops don't work as bait.

Wednesday his teacher emailed me saying he was concerned and that Noah again hadn't settled all day. I knew we had to do something, but I wasn't sure what. I emailed his neurologist and was told to take him to the ER. If I had any concerns that they weren't going to be able to handle Noah's psych needs before, I know it now.

Unfortunately, we are in between psychiatrists right now. We were asked to leave the last one (that's a blog post just waiting to be written) and can't get in with the new one until November. In the meantime we have been seeing a neurologist. I thought we would be OK in this "in between" time, but obviously I was wrong.

I paced my office Wednesday trying to figure out what to do. Do we take him to the ER? Am I ready for him to be hospitalized? NO. I'm not. He's bad right now, but I don't think we are there yet.

So I called our counties child mental health hotline and spoke with a crisis worker. We discussed options. An hour later she was at our house. We sat on our back deck and she talked with Noah. He paced back and forth but he did have a conversation with her. In the end we decided to take him for an emergency psych evaluation the next morning.

That was yesterday. I wasn't sure what to expect. We were seeing a psychiatrist I knew nothing about. I never even Googled the guy.

The doc was great. He really picked up on all of what was going on with Noah. Of course Noah made it pretty easy for him. Again he was all over the office. He was more like a two year old than a ten year old.

We have adjusted his medications and are hopeful. He wasn't manic last night, which is the first time in five days I've seen him settled.

I wrote this last Friday. I didn't get a chance to finish writing it until tonight. A lot has happened since then.


 

O.M.G. Guess what I forgot to mention yesterday.

So yesterday I wrote this long and probably rambling post about Noah and taking the PSSA and wanting to make a statement but not using him to do it and then how The New Psychiatrist (TNP) doesn't get me at all. But I forgot to tell you this!

In our conversation, TNP not only told me to not waste my energy on fighting for Noah, but she also told me to take that energy and put it on my other child, who isn't getting enough attention.

Yes. She. Did.

And the only way I can take that after pondering and twisting it around in my noggin, is that she was implying we are neglecting Kiel.

Or maybe just that we don't give him as much attention as we do Noah.

Almost the same thing right? At least to a super sensitive mom it is.

I did not react to it when she said it. I calmly filed it away and then bitched about it to Rich when I got home.

I think that saying anything to her about it is just going to make me sound defensive. There really is no point.

She isn't here. She doesn't see what really goes on in our home. She has only met Kiel once.

Do I wish I was able to spend more time just with him? Yes, I do. Do I wish there were more chances to take him places without Noah? Yes, I do.

Do I think he is neglected? Hell no! Do I think he doesn't get enough attention? No, not really. Do I think the fact that he gets less alone time with us than Noah did is much different than any second child. No, probably not.


Ughhh.

I do think her intentions are good, but damn, her delivery sucks.

Activism, PSSA, and what is best for my child.

I never gave standardized testing much thought until Noah started school, and then it wasn't until this time last year when I read an article about a father opting his child out of the PSSA's (Pennsylvania's assessment) that I realized I should be thinking about it.

I never had any reason to consider it I guess. I was one of the kids in school that rocked standardized tests. They didn't freak me out. I didn't get nervous about them. And I knew I would do well.

(Maybe I should clarify that I mean academic standardized tests. Those physical fitness tests we had in gym did stress me out. I was not athletic, I was not coordinated, and there have been very few times in my life that I would say I was even close to fit. And I hated that there was something that I was not good at.)

Of course I had heard about No Child Left Behind, and was familiar with the arguments for and against it. It never sounded like a very good solution to me, but you know, it didn't really impact me, so why worry about it.

And then Noah started school, and he started struggling, and three years and change later we are in third grade and the PSSA's are just weeks away.

(Now here is where I let you in on a little secret. If you've read me for any length of time or follow me on Facebook, maybe you know this, but if not, you should know I'm a flaming somewhat liberal, and I've taken a stand a few times in the past when I thought the sheeple were not thinking for themselves.)

I don't expect Noah to do well on the PSSA's. He struggles academically, especially with reading and writing. Some days he gets it, some days he doesn't. That's typical with kids with FASD. I can't imagine him sitting still for the number of hours involved in taking such a test, and I can't imagine him having the organizational skills to complete such a test. He can't even fill out a worksheet that has too many problems on it because visual tracking is so difficult for him.

What I don't know is if taking a test like this is going to upset him. He knows he doesn't read or write as well as his peers. In fact, he just mentioned that to me this afternoon as we were doing homework. (It kills me when he has these moments of insight.) At a minimum I think it is going to be a frustrating and boring week for him, and he will probably act out more than usual. Worst case? He starts to hate school? Starts to think he is stupid? Gets in trouble because his behavior is so poor?

Not to mention that none of this is going to accurately represent what he really can do.

So add all of this to my already activist nature that yearns to make a statement when a statement can and should be made, and you have a confudled mommy. Because I don't want to use my child as my vehicle. But, it might be the best thing for Noah not having him take the test.

But, maybe having him take the test and fail would also make a statement? It certainly won't look good for the school if it lowers their "grade." And maybe that is just as important of a statement to make.

Ugh.  See my dilemma?

So, trying to make sure I'm making the right decision for Noah based on his needs, and not mine (or what I think will irritate my biggest fan his principal the most), I emailed Noah's psychiatrist to ask her what she thought was best for Noah. I was very honest with her about why I was struggling with this decision. She didn't email me back, but we saw her for an appointment yesterday and I asked her.

I told her why I was concerned. She said it might be useful information to see how he does do in that environment. She seemed surprised when I said (carefully, so Noah would not hear or understand) that I did not expect him to do well.

Her response was to not waste my energy. I said no, that is not a factor in this. It would not take any energy to opt him out, it would only take a letter because Pennsylvania lets you opt out for religious regions.

She looked at me sceptically and asked what my religious reasons would be. I said cruelty, but it really doesn't matter what reason I use or what religion (including Humanism or Aetheism) because the school can't refuse.

I'm not sure if she gets her back up because it bothers her I don't believe in god, or that I just irritate her because I question so much, but she continued to say that it wasn't worth expending my energy on. She even said I would have plenty to fight for when Noah was in high school.

Really? Don't do anything now because I'm going to have to fight for things five or six years from now? Just sit back and save up all that advocating? Because helping him now won't pay off in the future?

I so don't get her sometimes.

I took a breath and I looked at her, and I said "you really don't understand me at all, do you."

She told me that parents are usually relieved to be told they don't have to do more.

Well, I can't speak for other parents, but I am not going to NOT do something for my child because it takes some effort? I just don't understand that.

Not to mention that it energizes me when I know I'm doing the right thing, especially if I have to work for it.

I'm not asking for permission to let something slide, I'm asking her opinion of what is best for Noah.

We had a few tense minutes, but we brought it back.

I tried to clarify that my desire was to do what was right for Noah, and if it took effort on my part that was fine with me. But, she brought up an interesting point when she said it would be good information to know how he handles it. I hadn't thought of that, and I think she is correct.

So, Noah will take the PSSA in March, and we'll see how it goes. I think that makes sense and is what is best for him this year. Next year, we'll reevaluate.

However, if you want to know more about how to opt your child out you can go here. For another father's take on it you can read this.

And if hearing that schools might be cheating to get higher scores surprises you (or doesn't), read here and here.

Or if you just want to get really riled up read this article about how the tests are scored.

And then consider how much money is spent by each state to conduct these tests. And how much money the testing companies are making!


And don't worry about me losing a chance to stick up for something I believe in. I found out today that the Pennsylvania House of Representatives passed a Resolution declaring 2012 as the "Year of the Bible."

It's freaking insanity. I can't even tell you how many shades of wrong I think it is. Now, go here, read more, and then sign.

I don't think I'll have any problems finding something to stand up for.

On comments and toilet installations

Lies and Beemommy, thank you for putting a big smile on my face with your comments! (Lies, thanks for telling me how to pronounce your name, too!) And GB's Mom, you know how much I love you!

Comments are the chocolate butter-cream frosting on the cake of blogging. I love cake, like really, love me some cake, but it is always better with some frosting on top! I blog because I love to write, but knowing someone is reading me and cares enough to take the time to comment feels very connecting. So thank you for everyone who reads MNT, and especially to those who take the time to leave me their thoughts.

I don't get much time to read other blogs, and I feel bad about that, especially when I know someone is taking the time to read what I have to say. So it is especially meaningful to me that other bloggers are reading me.

All ya'all are just making me feel all gooey inside tonight. :)

So, as a thank you, here is a picture of Noah watching the plumber put in the new toilet. He even brought snacks for the viewing (Noah, not the plumber).

Noah told me he wants a furry toilet seat for it. I tried to explain that while he is having blow farts a furry toilet seat might not be a wise idea. He thought about that and suggested it just be fur on the lid. I suggested he learn how to aim down before we consider that type of purchase.

In other news, the appointment with TNP was non eventful. She was on her best behavior and I didn't say any of her trigger words, like "trauma" or "doing more."

The elephant in the room.

Literally. There is an elephant in the room.

And apparently it is ME.

According to Noah's psychiatrist (TNP) anyway.

OMG I say. I had no idea! I had no idea I am fat and need to lose weight!

Thank god we are paying her the big bucks, right?

Ummmphhh....I'm so frustrated after our appointment with her today. It's only the second time Rich and I have had an appointment with just the two of us. I scheduled it a couple weeks ago because I wanted to talk about how Noah is doing at school, and what else we should be trying to get for him as far as services. I also wanted to get her feelings on Noah now that she has been seeing him for several months.

At our appointment last week I told her what I hoped we could discuss, since our time was limited.

So guess what we discussed today?

OK, I know. I gave it away in the beginning. 

Yes, we discussed that I am fat. Huge. And I need to lose weight.

My weight, exercise, and her "suggestion" that Rich and I take an hour lunch break one day a week to have a "walking date" was what we spent 3/4 of the session on.

She wants Rich and I to meet once a week at lunch for a walking date. Great idea. Really, it would be, if I had the time to take an hour for lunch, and Rich had time to take two hours, considering he'd have to add in travel time to get to me. Hell, I don't even take a lunch. I take on close to a full time load of projects and do it in 24 hours a week. When I am only in the office six hours a day, four days a week, there is no time to take lunch.

TNP wasn't taking excuses.

Finally I let my frustration show. I asked her why we were focusing so much on me and my weight. That obviously I know I have a weight problem. That I have always had a weight problem. That I have issues that I am not going to spend time discussing with her. 

I asked why we were spending so much time on this when we had bigger problems, like the level of aggression and anger in our house, or that Noah can barely read. That I had hoped we would get some ideas of where we are headed now.

TNP told me that I was not directing the session, she was. 

I guess I am the "bigger" problem.

We did discuss a few other less "weighty" issues. Like Noah's need for daily exercise (duh). That swimming would be ideal for him and we should find a non-competitive swim team for him (already discussed at least twice with her). That he may need a "special school" (again, mentioned several times before, but never with any suggestions for what school).

I told her we were looking for her to give us ideas. To help us find a path to travel with Noah. 

She told us that wasn't going to happen. She isn't going to hand me a paper with a road map on it.

She said she considers it progress because he has not been hospitalized or been put in residential treatment.

I call bullshit on that. BULLSHIT! I refuse to accept that as a measure of success. She does not know me at all if she thinks I won't do everything in my power to make sure neither of those things happen to Noah unless we have absolutely no choice. And that would only be because we can't keep him or Kiel safe.

I'm frustrated. 

I don't know where to go from here. TNP came so highly recommended, by a number of professionals that work with or have worked with Noah. She is extremely intelligent. She is highly qualified to do what she does and her practice specializes in complex children.

 

She should be perfect for Noah. 

I just don't think that I should be leaving appointments with her feeling like I need to go to my own therapist to decompress. Seriously, I leave there in tears at least half the time. 

*Just to be clear, what she said is true. I do have a weight problem that I need to deal with. However, I take issue with how she presented it, and that it monopolized the time we had set aside to discuss Noah. You know, her patient.

Yesterday I wrote about Noah slipping into mania and that we restarted his mood stabilizers. 

What I haven't written about is why he wasn't on them.

You may recall we are working with a new psychiatrist (TNP) who came very well recommended. 

She spent the summer getting to know Noah. She has also been trying to get Noah off some of his medications. It didn't go very well, and at the point when the tic surfaced we were concerned it was a withdrawal reaction. That and the slide back into some of his more negative behaviors had us agreeing that we needed to stop and let him stabilize again.

Then TNP suggested we look into a research trial at the National Institutes of Health, which would allow Noah to be in an inpatient facility and be taken off all of his medications so she could see what Noah was like unmedicated, since it had been several years since he wasn't on anything.

There was a trial that seemed like it would fit Noah, and would result in his being taken off all meds, intensive imaging and computer studies being done, and then restabilized on meds that are part of the study.

We started to seriously consider it as TNP was very persuasive with her opinion that Noah needed inpatient treatment before he was going to be able to get stabilized. Since it is almost impossible to get a child like Noah into a truly good facility for the time he would need at a place we could afford, the NIH seemed perfect. 

One on one nursing to child ratio. Only 5 kids on the unit. Personal tutor so he wouldn't miss school. Music therapy, art therapy, sports every day.

The big sticking point though was that it is in Bethesda, and they would only pay for us to visit every other weekend. There was no way I was going to send Noah off like that and not be there to see him every day. The plan was that I would find a way to stay there while he was inpatient. I could work remotely during the day, and spend the afternoon/evening with Noah. 

That was the only way I could imagine doing it. TNP didn't think that was a good idea. She felt I should be home with Kiel and visiting Noah every other weekend would be fine. She felt RIch and I needed the respite and time to just parent Kiel and give him some normalcy. 

I didn't necessarily disagree with TNP, but I still couldn't imagine just leaving my 8 yo child in a hospital by himself.

So, after several phone calls with various people in the department, and then contact with TNP, the head psychiatrist there called to speak with us.

After reviewing all the information he told me that Noah would not be a good match for the study; not that he didn't fit the study based on his symptoms, but because it is a cohort study so the healthy cohort would need to fit his non-mood disorder disorders. And that, would be near to impossible. So essentially, Noah is too fucked up for the NIH. 

Honestly, it was a relief when they told me. I was upset too of course, but I was almost convinced this was what he needed. I was relieved because now I didn't have to make what was feeling like the most difficult decision I had ever faced. 

In talking with the psychiatrist at NIH I asked him what he might do with Noah's case, knowing that we want to get him off meds, or at least minimize as much as possible. He recommended that we stop the lithium. He was part of a study that compared lithium to placebo and kids like Noah, and it showed absolutely no difference between the two.

So, based on that TNP and I decided to try and take Noah off his lithium. He took a half dose for two weeks and did fine. Then we stopped it completely. Within days I could see him escalating. His behavior at school was worse. His behavior at home was worse. He was moving and talking faster. He was having more melt downs, and being more aggresive towards Kiel.

At one week post stopping it completely TNP wasn't convinced that was the reason his behaviors were changing. She said it could be coincidental. At week two when she saw him in his office and saw the mania, she agreed that he needed to restart the lithium and that this confirms in her mind that Noah does indeed have a mood disorder.

He restarted the lithium the night before he had the manic episode at school last week.

The Boy of summer

Despite the tone of the last two posts, we really have had a good summer. Actually, I should say Noah has had a good summer, so we all have had a good summer.

Noah is at a different summer day camp than he was at the last two years. This one has two parts - a special needs part and a "typical" kids part. His group is a bit of a hybrid between the two sides. The staff is well trained, and mostly special ed teachers or in school for special ed. Many of the counselors have siblings with special needs.

Noah loves it! He comes home every day and can't stop talking about how much fun he had. We had a goal for him that he would learn to swim, and he met that goal in week five. Yeah Noah! They have sheep, goats, chickens, dogs, therapy horses, a donkey, gardens, plus all the typical summer camp activities.

They facilitate inclusion and he has had a couple "buddies" from the "typical" side that ask to play with Noah frequently.

I will admit I was nervous about sending him to this camp. I knew the special needs side was highly special needs - mostly low-functioning autism and mental retardation. I wasn't sure how Noah was going to handle that. Well, he has handled it wonderfully. We have had some conversations throughout the summer about how everyone is different, and that some people have brains that work differently and that they need extra help. It's been a good way to work on acceptance and kindness.

The week before he started camp I found out the group he was in was going to range from 8yo to 13yo. Noah was the baby and whether that was a good thing or a bad thing remained to be seen.

Noah has had a perfect summer there. No issues with aggression. A few reminders to keep his feet on the ground and that he is not a mountain goat climbing all over the picnic tables, but basically that is it.

What a difference from the last two summers when I worried every time the phone rang that it was going to be camp calling with a problem and had a constant fear that he would be asked not to return.

For the first time in three years I don't want summer to end! I wasn't sure I would ever say that again.

But in true MNT fashion, I am now worried about school starting and how he is going to handle the transition to a new teacher and the increased demands of third grade work. I had hoped to have more information to give the school about how Noah's brain worked and what he would need to learn, but instead we took a step back from that and are giving TNP time to get to know Noah so she can help guide us.

I'm still concerned about the tic, but I'm no longer crying when I see him do it. He commented today that he couldn't make it stop and it was annoying him. I asked him if it happened all the time and he said no. He was fairly matter of fact about it.

We talk with TNP tomorrow so I hope to have a better idea of our plan for the next few weeks as we head back to school.

Thanks to everyone for all of your support! Your kind and encouraging words mean so much to me! I am very lucky to have such wonderful readers.

I need to write. I need it to soothe my soul.

I need to write. I need it to soothe my soul.

Yet what I need to write about is so difficult, so emotional, so painful for me, that I find myself doing everything but writing.

We have been seeing a new psychiatrist since mid-June. She is horrified by the amount of medication Noah is on. She wants to try and pull him off everything so she can see what his baseline is. She says it will be a long process; six months or more. He may end up hospitalized at some point. And she acknowledges that we may not be able to get him off everything.

Rich and I agree with her. We have been questioning the medications for a long time. Yet we trusted the previous psychiatrist. We needed to trust him. We had no reason not to trust him.

Now we need to trust the new psychiatrist (TNP).

TNP makes me uncomfortable sometimes. It was a rocky start between us. I was convinced after the first appointment that she doesn't like me and that she thinks I am the reason Noah is so messed up. I don't think she believes that now.

Now I think she has had a chance to see just how bad things are with Noah. How disconnected he can be. How disorganized his thinking is. How worried we are about him. How much we love him.

She indicated the disorganized thinking could be an indication of future psychosis.Or not.

Today she was concerned about how disconnected he seemed. That sometimes he just isn't "there."

I wanted to be a smart ass and say "uh, yeah, why do you think we are here?" But I didn't. I just nodded my head and said "yes, I know."

She told me last week that Noah is the extreme of the extreme of the outliers. He isn't a single diagnosis, or even two. He's multiple. And we don't even know all of them yet. Or what may spring up as he grows older.

My child is complex. My child is difficult. My child's future is unknown.

I haven't told you everything though. I can't tonight. I've cried enough for one day. Maybe tomorrow.

New doctor, new hope!

Last week we took Noah to see a new doctor.

The developmental pediatrician wanted him to see a pediatric psychiatrist to help manage his medications.

The problem with seeing a psychiatrist, at least in our area, is that the good ones rarely take insurance. We've found the same thing to be true with psychologists and therapists.We've had Noah evaluated by a psychologist twice, when he was 2 1/2 and when he was 4. Each time was $1000. We've seen therapists at $120 an hour (which is really 50 minutes), where we sit there and tell them the same things we tell all the doctors and Noah refuses to interact or cooperate, and I literally sit there counting down the minutes in dollars. Our first developmental pediatrician wanted us to see a colleague of hers that had recently gone in to private practice. Her initial assessment? $2,500. Yeah, I know. We never did make that appointment.

When we looked in to finding a psychiatrist this time though I knew it was time. Noah's medications have become increasingly complex over the last year and a half and I'd been having doubts for a while that the doses weren't quite right. I hate that he has to take medication. Hate, hate, hate it. But, if he's going to take medication I want to make sure he is getting the right medication at the right dose, and that it is actually helping him!

We knew one of Noah's classmates saw a psychiatrist and that his parents were very pleased with him, so I asked for the information. I was lucky and there had been a recent cancellation and we were able to get in for a new patient appointment with just a few weeks wait.

Our first appointment lasted about 2 1/2 hours. The first 30 minutes the doctor spent reviewing copies of Noah's records that I provided. He spent the next hour talking with Rich and me, and then a half hour talking with Noah by himself. After that he sat with us and we came up with a plan.

This is the first doctor we have seen that I felt was looking at everything that is going on with Noah, including his early history of deprivation in the orphanage.

We talked a lot about how the brain works in kids like Noah and how too much or too little of the neurochemical's serotonin, dopamine and norepinephrine effect behavior. I'm somewhat familiar with all of this but he had a great way of simplifying it and applying it to Noah.

We talked about the difficulty in diagnosing kids this young. He asked what we thought was going on and where we thought we were headed with a diagnosis.

We discussed the different medication options. We discussed how difficult it is for doctors that don't specialize in treating kids like Noah and don't use these medications every day to properly dose the medications.

I asked about brain scans and we discussed the work that Dr. Daniel Amen is doing. He showed us pictures of brain scans of normal brains and brains of adults with ADHD, both without treatment and after taking medication. We discussed that if children like Noah don't get treatment to hep normalize their brain chemistry, their brain suffers permanent damage by the time they are adults.

He told us that treating a child like Noah now and through his adolescence often resulted in the child not needing medication, or needing less medication, as an adult.

We are adjusting Noah's medication. Two of the three prescription medications he takes are not at therapeutic doses, as I had suspected. We started increasing one of the medications and will see how he does. Depending on his response we will talk about increasing the other one.

Noah did great during the majority of the appointment. He started to act up a bit and get silly at the end.  I told the doctor at the end of the appointment as we were getting ready to leave that the most frustrating thing for me is not having a good understanding if Noah's behavior is under his control. He said that it is really 50/50 and that until we get handle on what is going on with his brain chemically it is going to be very difficult to work on the behavior.* He also said that we are going to need to continue to make changes in how we parent, but as we get a better handle on the medication these parenting changes will be more effective!

FINALLY! Finally I feel like we are working with someone who gets it! Finally someone who isn't only focusing on parenting, or only focusing on medication.

Now for the best part! We saw the doctor just over a week ago and increased his stimulant dose the next day. And we saw an improvement! Noah had a great week at school last week, not perfect, but overall he showed improvement. He exhibited more self-control according to his teacher. Monday she told me they had a fire drill and instead of  kicking mulch all over he stood and waited quietly and patiently.

Today in karate class he was amazing. Usually in his Wednesday afternoon class he is all over the place. He listens well, but he does everything twice as fast as everyone else. I can't tell you how many parents have commented on his energy level. Today? Today he was just right. It.was.awesome!

It's not perfect by any means. I think he's more irritable in the late afternoon/evening. Yesterday wasn't as good of a day at school, but he was also up very early in the morning and we already know that lack of sleep makes it more difficult for him to control himself.

I'm seeing more "flash" tantrums. Very quick, very unpredictable. He can go from being quite pleasant and seemingly happy with what is going on to angry and nasty in just a few seconds. With seemingly no antecedent. I don't really think they are happening more often though, I just think that he's better able to control some of his other behaviors so these incidents are more obvious.

I feel good about things right now. I feel like we are on the right track and there is hope. I also feel somewhat vindicated. And yes, I know this isn't about me, but it does feel good that my mommy instincts haven't been that far off.

* I owe all of you an update on the behavior program we started with Noah in late August. I am working on it and hope to have it up in the next week. It hasn't been an easy post to write because of the personal feelings I have towards the woman we were working with, so I want to make sure that what I say is fair and truly represents the program and our experience. I do have a separate blog ready to go, but she didn't follow through with her part of our agreement so I never went live with it.