Therapy Topical Issues

Double-edged sword

N has always possessed astute insight and a sharp power to anticipate errors – both became apparent to me around the time he was 2 years old.  I believe these skills to be double edged swords.  I have always said in my own work that I believe that a high level of insight can cause a significant amount of emotional distress, because one is acutely aware of a problem or set of challenging circumstances that one cannot necessarily change.  Anyhow, my dear little one was gifted with these qualities in abundance.

How did I know that my largely non-verbal toddler possessed these skills, you many wonder.  He refused to say something after being corrected; he would stop and start countless times before saying something and would look at me for approval when pronouncing something correctly.  His first speech therapist often said she felt that he could say a lot more than he did, but didn’t because he anticipated that he would make a mistake.

As it goes, these skills came back ten-fold this year to bite us.  The first term was rocky at best, with N’s behaviour taking a nosedive as a reaction against drastically increased scholastic demands.  I spent about 3 months digging in my heels to convince the relevant parties that what they were seeing was not defiance, but anxiety.  To his credit and detriment, N has the intelligence to know full well when he is being pushed and tested.  You cannot fleece him with games and prizes. 

Welcome to October and “assessment season” – speech therapy assessment, occupational therapy assessment; remedial and teaching assessments.  My happy, confident and settled little boy dissolved into a fraught, insecure puddle in my lap sobbing about the very hard day he had had.  All he spoke about was the assessments – where, when, for how long, with who etc.  Norman, a plush elephant and loyal school companion in term 1, was back with a bang and enduring a multitude of assessments of his own.  Now add these assessments to a change in routine at school and a lot of talk about the move to Grade 1 and you can imagine how the anxiety grew exponentially.

Those of you have followed and read the blog for some time may remember my article about the decision to start N on Ritalin early in 2021.  While I knew for certain it was what he needed, I had my worries and conflicting reservations about how it would affect his personality (among other things).  Nevertheless, we started on that road and are still plodding along it – adjusting doses up and down, fighting about swallowing capsules and having regular reviews with his school team and managing doctor.  Regardless, I do not doubt its place and its efficacy for him.  Ergo, when the discussion around N’s performance-based anxiety resurfaced and it was suggested we see the doctor for review before the end of the year, I found myself grappling with all those same mixed feelings about anxiolytics. 

As I have always done, I booked the appointment and had internal conversations about the issue almost daily.  I grappled with whether I was comfortable adding another medication to the regime of a 6-year-old versus how different my own life experience may have been had someone recognized my anxiety at that age and equipped (empowered) me to deal with it.

Sitting in the appointment, it seemed that the doctor was doing some grappling of her own.  She felt what she was seeing in the report was still a lot of impulsivity and issues relating directly to N’s ADHD.  However, she saw the anxiety coming through and recognised that his team obviously felt strongly enough about it to send us back to her well ahead of our usual scheduled appointment.  So here we are, on day 11 of a very low dose of Lexamil.  It apparently takes around 10 days to take effect and then his dedicated and loving team can assess for any change/impact.  The upshot was that everyone felt it was better to do this now, with a team who knows him, and ahead of the move to grade 1 when the demands will escalate yet again and there will be many changes to contend with.

Coming off the back of this week of medication review and change, we headed to feedback from N’s therapy team.  Their depth of knowledge and intricate understanding of N and his difficulties never ceases to astound me.  The picture they paint of his strength and weakness profile is so detailed, so accurate and so couched in love, care and investment – it is unparalleled to anything we experienced in the past.  Nevertheless, once again I was looking at him through this magnifying glass and suddenly seeing the extent of certain difficulties that I truly had not recognised beforehand.  This new insight just reinforced for me that we did the absolute right thing in starting this new medication now before he too starts to see the divide between what he knows in his brain and what he able to execute on a physical and practical level.  His difficulties are complex and layered, each affecting the other and each relying on each other for progress and development.  We have to do whatever we can to give him the help and support that he is going to continue to need.

I have said many times that this is a marathon and not a sprint.  I have said many times that new waves knock us off our feet at the very times when we feel that we are in calm waters.  I am heading into year 5 of my “neurodiverse” journey and still, when my people were asking me how I felt about this new medication, all I could say was that I felt (yet again) that I really have no idea what I am doing when it comes to parenting N.  Maybe my own introspection is my double-edged sword.

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