It’s Just a Tongue Depressor

It was Just a Tongue Depressor

You might have thought he had a broken arm. If you were outside in the hallway of the doctor’s office today, you probably would have suspected a possible dislocated shoulder that they were trying to reset.  One thing is certain, you never would have guessed that it was a simple tongue depressor.

My adopted son, James, hates to hurt. Now, I think that’s true for everyone, but he really hates to hurt, and I know that, but he was sick and a doctor’s visit was a must.  I did everything right…

I prepped him…I told him before we left exactly what to expect. “The doctor will look in your ears, your nose, your mouth.  You might get a flu test, but probably not…etc, etc”.

But there’s one fundamental problem with that-he still doesn’t completely trust me. And he certainly doesn’t trust a doctor.  Honestly, I knew that there would be some hiccups in this trip.  James was really, really sick, but I never expected the hang up to be right out the shoot…on the “Open your mouth and say ahhhhh….” part.

But we’re talking about full blown panic mode. I mean, screaming, kicking, crying, over a tongue depressor.  Yeah, you would have thought we were torturing him.  I had to physically restrain him so the doctor could just get a quick peek down the windpipes.  It was at that point that I knew that taking James to the doctor rivaled taking my four-year-old Lydia to the doctor (one of the Winter Olympic Sports).

So when the doctor said that he was going to do an injection, my heart sunk like an anchor off the side of a cruise liner. Oh boy….

I did everything right….

I prepped him. I told him exactly what to expect.  We related this shot to the flu shot, which he said wasn’t bad at all.  Personally, I think a flu shot stings like crazy, so for a moment, a fleeting second, I figured that this might just be okay.  But then, I looked into his face, tears still streaming down his cheeks, a look of complete panic in his eyes, and I remembered, no, this child needs more healing than a family doctor can offer.  So I hunkered down, and made the decision that we’re going to get through this together.  We’re just going to survive.

The nurse came in, and we got him ready. I’ve seen him jittery, but this was a new level of panic for him.  He asked to hold my thumb, and I offered him that, and took his other hand in mine.  Even though I told him every single step, the alcohol swab alone was enough to send him into a fresh batch of tears.  The shot came and went, and for a split second, I thought it was over…maybe not as bad as I thought.  And then the wailing began.

I have no doubt that the shot hurt like blue blazes, but what followed was not the typical reaction of an eight-year-old. In fact, my toddlers handled antibiotic shots better, I thought.  But then, they knew that I would immediately grab them and give them the comfort they so desperately needed at that moment.  The crying then lasted for mere seconds.  James just doesn’t have that history.  He isn’t sure that I’ll be able to provide him comfort.  So when he hurts, no matter how big or how small, in his mind, he’s handling it alone, completely and utterly alone.  That’s why the smallest hurts hurt so bad.

The odd thing is that since he missed that toddler experience of being swooped up and comforted, he has to be dealt with completely differently. I can’t just swoop him up and it’s over.  No, because he’s expecting everyone in his life to hurt him, he goes straight to the fight or flight response.  So in these situations, he has to be talked down from the ledge.  I’m sure that I looked like an insensitive parent when I looked at him and firmly said, “James, stop.”  But the thing is that if I allow him to keep going, we will be completely out of control in a few seconds.  Once I interrupted the immediate shock, I start in gentle and firm, “James, it’s over.  It’s done, and you’re going to feel so much better. James, you’re okay!  Look, you made it through just fine.”  It’s a long process of talking him off the ledge.  Over the course of the afternoon, we ordered a milkshake, talked about the doctor and how he wants to help us, how our doctor can be trusted to do the right thing to make us well.  We even talked about the best way to take a shot.  It’s been a long day.  In fact, he was still talking about his shot tonight when I put him to bed.  Because the truth is, it was traumatic for him.  Not just the normal traumatic doctor visit that every kid (and adult) makes from time to time, but worse.  Exponentially multiplied by the past.

Teaching Your Adopted Child to Trust Again

We have to teach them that fear is not a wall that stops us…it’s a wall that we climb. We have to equip our kids with the footholds they need to climb those walls.

And here’s where I have a choice….I could simply say, “Well, I tried. I guess this is just what it is to go to the doctor with him.”  But I won’t.  Because that does him a disservice. I want him to know that fear is not a wall to stop you, it’s just a wall to climb, and I want to give him the footholds he needs to help him climb those walls.  That’s one of the things we do as parents.  We make life a little less scary for our kids, right?

 

So this week, we will be playing a lot of doctor. We will be practicing our “Ahhhhh” tongue depressing skills, and we’ll do pretend shots.  I never knew that I’d have to use every ounce of patience and creativity I can muster for something as simple as a doctor’s visit.  Sometimes, it seems like my patience has run too thin…but right about that moment, we have a breakthrough.  Suddenly, he can tie his shoes.  Suddenly, he doesn’t cry endlessly about a minor bump.  So while this was a tough experience for us both, I’m keeping in mind the victory we will share when we finally earn his trust.

ADHD vs. Hypervigilance

ADHD vs. Hypervigilance

It was a family movie night. James had been cuddled up on the couch opposite me for about an hour, intently watching the show.  Slowly, he rose from his place, gathered his blanket, and trudged over to me to climb up in my rarely empty lap.  He got himself settled, and we sat there for a few minutes together.  Then, I gave him a little squeeze.  When I did, I noticed something….his heart was racing.  Not just beating fast, but literally racing, and he had been sitting completely still for a few minutes.   The strange feeling that I had about his ADHD diagnosis started creeping into my mind once again.  But, I filed it away in my mental notebook so I could research this later.

It was several months before I realized why I had such a strange feeling about his ADHD diagnosis and medication. After researching and reading, I found out that while James certainly has some hyperactive tendencies, he isn’t truly ADHD, he’s hypervigilant.  And hypervigilance is completely different.

In her (outstanding) book, The Connected Child, Karyn Purvis outlines hypervigilance:

“We have encountered many harmed children who are not truly hyperactive; instead they are hypervigilant. This occurs when children were so traumatized by abusive and unpredictable caretakers or situations during their earlier lives that their primitive brain remains locked in a state of high alert, keeping them perpetually on guard.  The ‘fight or flight’ stress hormones continue to rage through their bodies and set these youngsters in motion, making them fidget endlessly, unable to sit still and focus on any single activity because they’re constantly scanning their surroundings for danger.”  P.51

Reading that made everything click for me. Dr. Purvis described my son perfectly.  When I researched it further, there was no mistaking…I didn’t have a child with ADHD, I had a hypervigilant child.  And the treatment for that is very different.  Once we realized what we were working with, we changed our approach.  Thankfully, we have the privilege of homeschooling James.  And that has made a huge difference.  Because of homeschooling, we were able to work with his medications without disrupting his school routine, and we have been able to address the root of the problem…security.

If you want to evaluate your children (or students) for hypervigilance, here are some of the symptoms:

  • Fidgeting, lack of focus on any task
  • Pupils are often either enlarged or unnaturally tiny, even during calm circumstances
  • Rapid heart rate even during quiet, still moments
  • A sense of aloofness, a defense mechanism so as not to get too close to anyone
  • Extreme sleepiness

 

Hypervigilance stems from Post-Traumatic Stress Disorder (or PTSD). And due to unsafe living situations, many of our children have it, yet it goes widely undiagnosed.  The problem is that medications that target ADHD don’t always work best for hypervigilance.  So it’s really important to distinguish the difference.  Here are some of the things we’ve done to help James:

  • Sleep: The first thing we noticed was that James lies awake in bed all through the night. He will lay there are stare until 2 or 3 AM, leaving him exhausted every day. I can always tell when he hasn’t gotten enough sleep because he gets big purple bags under his eyes. So, we spoke with his doctor and we started a blood pressure tablet that helped him to feel sleepy and relax at nighttime. Once we started that, I noticed that he was better able to focus during the day, so we were able to cut his ADHD medication in half.
  • Safety: Safety is tied with sleep in importance. Children with hypervigilance need to feel safe always. We made sure to tell James often that we are here to stay, that no one is going to come to our house and take him away. He is ours. Period. We give lots of hugs and kisses and we try to cuddle often to increase the feeling of safety. We also try to make sure to take care of his needs. If he is hungry, even if it’s right before dinner, I’ll allow him to have an orange or something small so he knows that there is food available.
  • Routine: Like most homes, our family has a natural routine. With homeschool, we also follow a daily routine. If there are any variances to our daily routine, I always begin the day by telling James the revised schedule. This also increases his feelings of safety and security.
  • Work with the need to fidget: Instead of fighting the fidgeting, I try to provide James opportunities to fidget. When we read, he gets to quietly play Legos. During math, he holds a pencil and twirls it. He tends to have some destructive fidgeting patterns (he likes to peel things), so I try to provide him an acceptable fidgeting tool. A rubber band (as long as he doesn’t shoot it), a small squishy ball, or a pencil to twirl are all acceptable for me.

 

Over the past year, we have seen major improvements in James. He now takes no ADHD medication, and he’s doing really well with his schoolwork.  There are most definitely hard days, but overall, he is succeeding!  And we are all so proud of him.  Having James has caused me to think about all the children who are diagnosed with ADHD, but really have hypervigilance.  I wish that there was more awareness about hypervigilance.  The treatment is somewhat different from ADHD, but it could make a world of difference for a child.  In addition to the above suggestions, here are some other ideas for working with hypervigilance:

  • Medication: I am by no means against ADHD medication, but for hypervigilance, it’s not always the best choice. After addressing sleep, talk with a doctor about the options. These may include anti-depressants, anti-anxiety medications, and hypertension medication. Communication with your doctor is key.
  • Weighted Blankets: Feeling secure is not natural to children with hypervigilance, so a weighted blanket can provide that secure feeling that they need and help them to better focus on their tasks.
  • Watch out for sensory overload: Children with hypervigilance can react badly to too much noise or even too much decoration and color in a room. Hypervigilant children benefit from home-like environments with subdued colors and décor.
  • Building Trust: Hugs or pats on the back can help build trust. Also, encouraging words make a big difference. James loves for me to sit beside him while he works. He doesn’t always need my help, but having me near him helps him feel safe and secure.
  • Speaking softly: Children with hypervigilance have very likely been yelled at often, so speaking softly and gently (but firm if needed) can help disarm the fight or flight response.
meerkat cuddles

Safety and security is the key to helping a hypervigilant child.

 

A little bit of further research will give you a few more ideas to implement. But we have seen such improvement in James since we realized the root of the problem.  It’s ongoing, but the success is so encouraging.  It is my prayer that parents and teachers can take this information and apply it accordingly.  Again, I am NOT against ADHD medication or even the diagnosis.  Some children really do have ADHD and need the medicine.  But maybe not all…let’s raise awareness and look at a child’s background and see if hypervigilance is something to be considered.

 

*I am not a doctor, a therapist, or anything with the ability to diagnose.  I am simply a mom who has done her research and wants to help others.  Please talk with a professional about any concerns you may have.