Friday, May 19, 2017

Psychiatrist Appointments & FASD

Many psychiatric medications require a patient to see his doctor prior to receiving a refill on his meds. While I understand the reason behind this, when your child has FASD, visits to the psychiatrist can be daunting for both him and his mother!

First there is the problem of finding a psychiatrist who understand's FASD/trauma and who doesn't simply prescribe one medication after the next. It is also very helpful to have a psychiatrist who truly has your child's best interest at heart. Most psychiatrists have a wait list, anywhere from a few weeks to many months. Then you often have an intake appointment after which you schedule an appointment with the psychiatrist. At that appointment he will prescribe a very low does of the medication he feels is necessary. This dose is intentionally low, because they need to see how you react to it. This is especially true for someone with FASD, as their bodies metabolize medications differently. A few weeks or months later you see the psychiatrist again and he will tweak the dosage or add or subtract medications. By this time it is easily a year since you first began seeking a psychiatrist and if this one doesn't meet your child's needs, you are faced with a decision, continue with a doctor who isn't a good fit, or go back to searching for a doctor as the months pass by.

That is the history behind our hunt for a psychiatrist for Joseph. At first  I was thrilled with this doctor, as the months pass, not so much. The other week it was once again time for the dreaded med check.

I try to keep these appointments a secret as Joseph's anxiety spikes when he knows he has an appointment, however he always figures it out. This is due in part to the fact that his psych doesn't speak very good English, he asks lots of questions that Joseph doesn't understand and naturally he wants Joseph to answer said questions, something he has a hard time doing.

So, we walk into the office and sit down. Joseph sits rigidly on the couch and begins chattering a mile a minute. Due to his anxiety, his words are jumbled and he doesn't complete his sentences making it difficult for me to follow his train of thought and well nigh impossible for his doctor. 

"Joseph, how are you feeling?" I know why they ask this question but honestly, Joseph would say, "Good," even if he was miserable.

"Do you like school?" A quick glance at mom because he doesn't really like it but he knows he should say yes. I smile at him and he says, "Yes."

"Do you have friends?"  Joseph nods and goes on to tell a wild tale concerning one of his classmates, becoming more dysregulated by the moment. 

"Are your friends nice to you?" Another nod, "All except______, he kicks me." 

"Do you tell your parents or teacher when someone hurts you at school?" Joseph of course nods and I sigh....guessing what we will be subject to for the next weeks. Stories of, "Mom, so and so bumped me or this,that and the other person wasn't kind to me so I told my teacher."

"Do you ever hurt people at school?" Another glance at mom because he is remembering the trouble he just got into, "No, I am always nice to people."

"How do you feel about your medicine?" Joseph shrugs, "Good, it makes me tired." So the doctor begins asking questions until I jump in and explain that since he takes his meds at bedtime he associates it with being tired. Joseph pipes up, "I don't see and hear things anymore since I started taking these pills!" I sigh deep inside hoping against hope the doctor didn't understand him. See, Joseph has been asked by many doctors if he see's or hears things that aren't real, a question that confused him mightily at first. In his mind, by telling the doctor he doesn't have that problem, he is offering a vital piece of information, except that he never experienced those symptoms although his comment would lead one to believe otherwise. Thankfully the doctor was busy and didn't comment.

By the time we were finished, Joseph couldn't even follow me to the explorer. He was overwhelmed and his brain was no longer processing information, however just because he couldn't follow directions doesn't mean he was quiet. He sat there telling me every thought that entered his head. I finally told him if he sits quietly, I will turn on a story CD. So thankful for audio books! When we got home I put him down for a nap but the poor boy couldn't function for the remainder of the day.

As I drove, I pondered what the psychiatrist thought about Joseph and I, since Joseph looked to me before answering any questions. This type of behavior is partly what got us in trouble with CPS. When Lia's caseworker came to visit another child of ours would look to Dean or I with before speaking, making it appear like he wasn't allowed to talk without our permission. 

Oh well, we have a few more weeks before we have another appointment! By the way, this is the same doctor that at our first appointment when asked what he wants to be when he grows up, Joseph cheerfully replied, "A butcher!!!" You can read about it here: Psychiatrist Appointments And Kittens, Never A Dull Moment
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