Attaching to your child

You may not know this, but I actually do enjoy getting emails from people - especially people who have children with issues similar to mine. It's not that I'm glad others have to deal with the problem, but it does provide a sense of solidarity and let's us know we aren't alone (and we don't have to navigate this by ourselves). However, I'm not a doctor, or a therapist, or anything more than a father just trying to make sense of all this as I go. That said, there are certain things I have found that work better than others. While I'm not perfect at these, I find the more I utilize these approaches, the stronger my daughter seems to be attaching - which is the ultimate goal, is it not?

For starters, I've learned that children with complex trauma backgrounds tend to be hypervigilant and easily triggered by any irritation, sarcasm, anger, impatience, or hostility that my creep into your tone of voice. Think back to the last few times you were frustrated or upset with your child - if you can honestly say you were able to avoid all of the above, you are a saint. Seriously. It's definitely something I am working on, but it isn't easy (go ahead, try it). However, any time your child senses any of the above, they can quickly become defensive and dysregulated. So rule #1 is to remain mindful of your tone. If possible, step away if you feel you are getting triggered yourself.

Since our children are wired to control and resist (yay us!), any direct commands tend to elicit a reaction to an authoritarian stance. If you think that is going to get you anywhere, well... So rule #2 is to try some skillful redirection by prefacing your request with:

1) A caring expression that the child matters to you.
i.e. "I care too much about you to let you run away. I hope you stay here with us where it is safe"

2) Staying emotionally attuned to the child's inner experiences.
i.e. "Your feelings are important to me and I can see you were really hurt by what Susie said. I can't let you go punch her and I don't want you hurt either. I want to understand and help you through this"

3) Focusing on the child's strengths or commenting about your child having been successful previously and you are asking them to do again what they did before.
i.e. "Last week you really worked hard at being respectful and considerate, and it really paid off for you. That seems difficult for you right now and I wonder if you could try as hard as you did last week"


Above all, avoid power struggles at all costs. Any time you are in a position where your child feels you are controlling them or telling them what to do, you risk triggering reactivity and power games. Remember, the child must always feel they are "in charge". Try giving your child permission to do the action while describing the consequences. This is called a "No Problem Attitude". An example of this is something like "We care too much about you to let you get hurt, because you are important to us. If you decide to cut school, you could do that and we would have to call the police to make sure you don't get hurt. But you can do that if you choose". At this point, walk away to give your child space and time to think over her choice. Oftentimes, this will lead to a good choice (assuming they have decent cause and effect skills).

In short, if you find your child is dysregulated, tantruming, or in a PTSD triggered state...
Talk calmly and slowly, using a few short words
Avoid long discussions or lectures
Avoid becoming triggered into your own anger - this just adds fuel to the fire
Side-step power struggles
Calmly describe the choice
Calmly walk away to give compliance time
Do NOT administer any consequences while your child is dysregulated. This will only increase a sense of deprivation and fuel dysregulation
BUT, DO give consequences later on once your child is regulated. Be sure to remind them that you want them to try again next time because you want them to get the rewards and privileges they want.

If you can catch your child when they are just beginning to move into a dysregulated state, you can try to head it off using the PACE method. These are simple attempts at establishing a connection:
P - Playfulness
A - Acceptance (i.e. "I'm sorry it is so hard. Sometimes I don't like rules either")
C - Curiosity ("I wonder what is going on today? Yesterday it was easy for you to help out, yet today seems harder?")
E - Empathy

Lastly, whenever possible apply the 4:1 Rule of Positive Comments to Consequences (pretty self explanatory)

Anyway, these guidelines have helped me establish better attachment with my daughter and I hope they can help you. I would be curious to hear how they work for you!

Diabetes Management and RAD....

There's one thing I don't think I'll ever understand. I mean, I do understand on a deep level, but at the same time I don't understand. Make sense? Neither does my RADs actions when it comes to diabetes management. And yet they make perfect sense.

In addition to RAD, she also has type 1 diabetes which means she has to take insulin to control her blood sugars. Anybody who has a RAD knows that they have a deep rooted need to be "in control". Which makes sense since they had to be that way in order to survive when they were younger. But when that need for control becomes potentially life threatening it's a whole new story.

Let's take a typical daily schedule - test blood sugars when you wake up, get a shot to correct sugars and cover breakfast carbohydrates. At 10am test again and correct sugars if needed so that when lunchtime comes around, your sugars aren't too high for you to eat (when she eats with sugars in excess of 175 the insulin is FAR less effective and she just remains high the rest of the day). At lunch, since the sugars should be normal, simply cover the carbohydrates you're going to eat and then retest/correct in the mid afternoon to prepare for dinner.

Sounds simple, no? One would think. But for some reason, RAD insists on correcting in the morning and covering breakfast (a good start to the day!) but then neglects to do a mid-morning test and tends to have sugars in the upper 200s or higher at lunch. Of course, being a teenager she's hungry so rather than waiting for her sugars to come down, she eats anyway and shoots her sugars super high. That requires an extra large shot in mid afternoon, which then drops her low by the time she gets home. Granted, this isn't all her fault. The school nurse *should* be coming in the morning but she doesn't (that will be addressed in the IEP next month), and the doctors orders she is working off of *need* to be changed so she's getting less insulin in the afternoons (that appointment is next week). But in the meantime, she continues to avoid mid morning testing and her sugars are so high at lunch that we suspect she's eating soon after she leaves the house in the mornings (that is the only plausible explanation we can think of for why she consistently "forgets" to do her mid morning test).

When we approach her about it, she gets really dysregulated and keeps saying "I get it", but she certainly doesn't seem to. We don't want to nag her about it, but high blood sugars now == organ failure later and no parent wants that for their child! Then there is the issue with the low blood sugars. Low numbers are more dangerous than high numbers - they can cause more immediate problems such as confusion, seizures and even death. We even had one instance where her sugars were low, she got confused, and ended up getting on the bus home in the wrong direction. We always tell her to carry raisins with her since they are a fast acting sugar source, but again - her need for control sometimes makes her "forget" those.

Thankfully her Day Treatment Center is way more on top of these things than her last school was, but we still have a long way to go. It's not easy trying to coordinate different agencies (i.e. diabetes clinic, school, etc) especially when you've already been triangulated against (as was the case with her last school when they called an ambulance for high blood sugars and refused to cancel it even after we were onsite because they believed we were abusive towards her - we're still fighting that $1,100 bill). The diabetes clinic doesn't listen to us because they, too, believe we are horrible parents. So they write up orders that we know won't work yet they think they know better, and the school nurses have no choice but to follow those orders (although we have asked them to call us because our word overrides the doctors, but in general they tend to follow what's written).

So we get to deal with this double whammy on a daily basis, with everybody pointing fingers at everybody else while RAD bounces up and down (both with her sugars and with the attention this brings her). It honestly wouldn't be so bad if she would just work WITH us instead of against us, but the RAD in her won't allow that.

Thanks RAD - I hate you (not the daughter, the disease).