Simple Woman's Daybook 7/13

Outside my window:

It's cloudy and ugly with rain and a morning thundershower expected any minute, hence I'm home from church with my storm-phobia 7-year-old daughter, who is watching a Wild Kratt's library DVD to get her mind off the "dark skies".

Wild Kratt's library DVDs mesmerize my kids. That show came out after we got rid of cable but one of you actually told me about it. I think Teri from PA? A couple years later the DVDs appeared at our library and my kids have been hooked ever since. You would smile if you heard them all sing that theme song together, to which they've learned every word. Once, when we were all in the emergency room for an ailing Paul, the staff put Wild Kratts on the ceiling TV, and my kids proceeded to sing their hearts out without shame, and none too softly either.

It was our plan to force Mary to church, because a forecasted thunderstorm doesn't mean we actually get them. Much emotional energy on the parents' part is required to force the issue, and we've had that energy several times, but not this morning and not usually for church. It would mean drawing attention to ourselves as she cried or possibly screamed going into the building, depending on how menacing the skies looked. And of course, there was that time she did throw up at church because of panic over the rain and thunder/lightning.

And the excitement doesn't end there. Peter has had two instances of heat exhaustion because we recently increased his Prozac for OCD from 10 mg to 20 mg, which decreased his body's ability to sweat to cool off, but improved his OCD. Antihistamines will also decrease the body's ability to sweat, and without Peter's allergy medicine he gets asthma so the two medicines together are a problem (at this higher Prozac dose), at least in the summer humidity.

So last night he threw up after being at the park, but he's fine today. He drinks enough; it's about the sweating to cool off. It just doesn't happen like it should. This week we may go back to the doctor and have it decreased down to 10 mg for the duration of the summer, or rely on water mist bottles to cool him off. Low doses don't usually work for OCD, but for Peter they do, thank goodness. The usual dose for OCD in teens is 10 to 80 mg. It's lower when Prozac is used for depression.

Each time someone throws up Paul's OCD goes crazy because his comes with a vomit phobia; he does rituals to prevent a vomiting incident. He watches his sugar and his fat and does other things to prevent the possibility, drawing from all his knowledge about the various causes of vomiting. There are 3 causes of vomit phobia, one being OCD, another being agoraphobia, and the other being associated with social phobia. Go here if your child excessively fears vomiting.

Yes, I live in an insane asylum. Thus, no energy today to force Mary to church.

I am thinking

...how very grateful I am for having joined an OCD online support group. Through the group I have found the boys a very good psychologist working out of Cleveland, over an hour away, who takes our insurance through a hospital program. He is excellent and specializes in Scrupulosity, which is a subset of OCD dealing with a distortion of religious and/or moral views. He is Jewish, and when a therapist has different spiritual views than the patient, they are trained to bring in the patient's Pastor or other faith "expert" to help the patient experience complete comfort with all aspects of the therapy.

This therapist uses Cognitive Behavior Therapy and Exposure Response Prevention therapy, which are the only therapies proven to beat OCD. There is no cure, but these therapies are the closet thing there is to being free.

Exposure Response Prevention therapy, or ERP, is exposing the patient to his or her worst fears, through graduated exposures, until the patient has habituated the mind to the thoughts or fears, so they become mere background noise to be ignored. Mindfulness training is included, so the patient can allow thoughts to come and go, not reacting to them. It is the reaction to the fearful thoughts that is the problem, not the thoughts themselves.

This is the same therapy (CBT and ERP) that is used for most anxiety disorders, and the same therapy Mary will need for her storm phobia, and for agoraphobia if it turns out she has that.

It is boot camp for sure and things will get worse for the boys (and consequently for us) before they get better, but being free is worth the sacrifice, to be sure. The boys will need every once of spiritual and mental strength they've got to persevere and succeed. They start in August and I have an initial meeting with the therapist at the end of July. It is not unusual for therapy to last up to a year but it depends on the patient. It is usually once a week.

If you or your children or a member of your extended family has OCD, please visit this support group. Many people do not know about ERP because not all therapists are trained in it. Some people suffer for years unnecessarily. There may be a period of denial and/or fear over the treatment because it's a scary concept to be exposed to your fears, especially for those with anxiety disorders, but be patient and have your relative lurk around the support group. I think eventually they will gather the courage to say, "I want to be well."

Another problem is that OCD can be horribly embarrassing because sufferers sometimes spend hours on their rituals. Many people keep it a secret for years. My son Paul has contamination OCD and spends 20 minutes brushing his teeth. That's mild compared to some of the behaviors one encounters, including compulsive checking, compulsive asking for reassurance, compulsive cleaning and arranging and counting, compulsive religious rituals or distorted religious beliefs, irrationals fears of harming others (Peter also has this type), irrational fears of being gay or being a child molester, etc. OCD people are the last individuals to do any of the things they imagine or fear. OCD attacks what is most dear to a person and is a horrible thing to suffer.

If you know someone who needs help and who has severe OCD, here is a list of intensive treatment centers in the United States (and a couple in the UK).

I am grateful for...

~ Peter's corn is finally growing, though not as high as the local farmers' yet. We have quite a few corn farms around us.

~ We had more sun this week and Mary was mostly happy, until the evenings and until this morning. The clouds tended to get organized just as it was time for me to make dinner. But still, these last 5 days there was a big improvement and she went in the van twice voluntarily with only some tears.

~ the tiny toad Peter brought back from the park. He gave it to Mary this morning and that was the only thing that coaxed Mary out of bed at all. I loved Peter so powerfully at that moment.

~ that Sheila, our Compassion child from Uganda, was able to get roofing and housing repair supplies. She is such a dear girl and writes her own letters in English, at age 15.

~ lo and behold, we saw a small fawn in the neighbor's yard two days ago. That's never happened before. It got lost apparently, having come into the neighborhood from the surrounding woods. Paul tried to get a picture for the library photo contest but I'm not sure the focus is good enough. It was sure thrilling though.

~ that God holds us together in the palm of his hands, and that his mercies are new everyday.

~ That at long last, my boys will get the help they need. Our pediatrician was not helpful in knowing what therapy is needed for OCD. It took me finding the right connections and I thank the Lord to have finally found them.

Have a good week, friends!

A Boy and His Frogs (Or My Insanity Post)

The funny thing that happened on the way to insanity. That's what this blog post is about. Cause there's not much funny about this summer and Mary's off-the-charts anxiety that is encompassing new things every week. Suddenly, spiders are not okay. Deep breath, Momma. Deep breath.

Critter photos courtesy of Peter, who is trying to get a winning photo for the annual kids' library photo contest. He won the fishing derby this year, but a photo prize has eluded him for two other years now.

A funny-to-me story about Peter's backyard escapades:

Peter was out in the backyard playing with the neighbor boy who comes to our Bible study--a boy more than slightly frog-obsessed. They conjured up a notion about catching a ton of frogs and selling them to the local pet store. Now, Peter has heard from me that you probably need a license to sell live animals to pet stores...but whatever. Apparently the ten-year-old neighbor boy's story about once selling a tree frog to the pet store for real money held more weight than anything I ever said on the subject.

On my way to the grocery store I stopped by our backyard and encountered their container of twenty-one frogs! 

Um, did I just step into one of Pharaoh's plagues?

Those were proud boys!

Only in Ohio, folks.

Don't ever tell me we made a mistake moving our two tiny boys from the California desert to Ohio back in 2005. This is a great place to raise kids; in this yard my children have cuddled with or marveled at a turtle, several snakes, squirrels, fireflies, yearly robins' nests, a bluebird nest, caterpillars and butterflies and moths and metamorphosis, sparrows' nests, hundreds of frogs and dozens of toads, yearly praying mantises, grasshoppers and katydids, a hawk, bunnies, moles, and the list goes on. It's a veritable jungle out there and not a single toy is ever needed.

I call that a perfect backyard and an ideal childhood...being one with nature and learning about the glory of God early.

So then, Peter, explaining the twenty-one frogs, takes me aside and whispers the tale about Landon's tree frog going to the pet store for real cash money, see, to which I could only shake my head, not wanting to burst his bubble with Landon right there. I did say they should let their brood go soon, though, so as not to terrorize the frogs.

At dinner that night, Peter waxed remorseful about where he let them go. Instead of going around the yard and letting the frogs go in their various and assorted hiding places, he let them all go next to one fence, shared with a neighbor. So the frogs, many of them, went to the neighbor's yard, though that isn't what Peter intended. He rather likes having a large amphibian population in his own yard, thank you very much.

An hour or so later he could hear the neighbors, over the privacy fence, talking to their guests about the bazillion frogs that suddenly appeared in their yard (like it was a huge animal-control crisis). Oops.

Their guests apparently tried to tell the ladies that it wasn't a big deal and the frogs would disappear soon--a sentiment Peter, silently listening, shared. He very much feared the ladies peering over the fence and possibly questioning him or his siblings, or worse yet, telling his parents about it.

So at dinner Peter told us guiltily what happened, thinking any minute the ladies would knock on our door, asking his parents "what the heck is up with these frogs all the sudden?"

I will not say the obvious here. ("What will the librarians think?") I didn't say it to Peter, who asked me, "Isn't this so cute, Mommy?"

I'm sitting here typing this in stitches of laughter. It just really tickled my funny bone, though no one else at dinner thought it particularly funny that night. I was the only one worried about shooting my milk across the table from uncontrolled laughter.

Peter is not used to me laughing at his mishaps. He didn't quite know what to think of his Momma, nor did his siblings, who only stared at me before finally giggling at my lack of control. Secretly, I think Peter suspected Mary's anxiety disorder had done me in.

I told him there was no problem because he didn't mean to do it and frogs are no respecter of fences and property lines anyway.

And I told my husband if the ladies next store do come over and ask about the bazillion frogs, he'd have to talk to them because I personally would not be able to stop laughing, and what if, in my hysterical state, I joked about Pharaoh and the ten plagues or something weird like that?

Because that's just like what a mother would say, who earlier that day helped get her kicking and screaming, ultra-terrified daughter into the van to go to the library on a cloudy day. I hate to think it or say it, but my grandfather had severe agoraphobia and my little girl no longer wants to leave the house. Ever. I won't know until the fall, when thunder storms go away, if it's related closely to the weather or if it really is agoraphobia, but life has gotten very complicated.

The good news is that therapy for phobias is successful 90% of the time. Fear of storms is one type of phobia.

The secret to enduring very intense times of life is...find something to laugh about. (Like Peter's sorta-like mating photos and I don't think I should be standing there when the librarians download them.)

And count your blessings.

I will write soon on part 2 of cognitive behavior therapy for anxiety, and how to integrate it with your Christian faith.

When Parents Enable Children's Mental Disorders & Weaknesses

Parenting: Yikes, no instruction manual!

Any blog writer has to guess as to who might be out there reading, and what their interests and concerns might be. When limited time is an issue, as it is for me, often the blog writer has to stick to writing what they know, and what their life reveals day by day. Increasingly, I'm having to learn about mental disorders, so you are seeing more of that content. Some of you are skipping it, while others are grateful because maybe you're just beginning to suspect issues with your own children.

One thing I'm learning is that diagnosing mental disorders early gives children and families the opportunity to conquer them before they become ugly monsters. These issues don't have to devastating. Keep in mind that parents can make things worse by unknowingly aiding the disorders and reinforcing dysfunctional patterns that will be hard to break later.

You may recall me providing the testimony of an OCD sufferer who was an actor/producer who'd become so impaired he couldn't go anywhere without his parents, even past age 30. His parents participated in his OCD rituals. I don't even have to read more background to know that. His parents made their son completely dependent on them.

Parents make OCD worse, and any anxiety disorder worse, by feeding it--giving reassurances to lessen a child's immediate anxiety. Providing these constant reassurances and lessening a child's anxiety makes the whole family breath easier, but to conquer these disorders we can't give in to the tyranny of the present. That's the easy way out, just as giving the alcoholic another drink is taking the easy way out.

Ultimately, once proper therapy is explained to children and they are trained in it, they have to make the decision to get better. The other choice is to remain a victim of the disorder. We can't force our children to do their therapies; it's an act of their will, requiring their courage.

We can offer them our prayers, the best information and training, and we can be an escort to the Throne of Grace. But we can't make them do any of it on their own, and that's what it takes to get well. If they choose to be a victim of the disorder, we can't cover for them or pick up the slack. That only makes it easier for them to continue on the same cowardly road. We can't pity them or feel responsible for them. We can't say "this isn't their fault". Actually, if they won't do what it takes to get well, it is their fault.

There are times my seven-year-old daughter refuses to do anything but stay in bed because of cloudy weather and fear of thunder, and ultimately, fear of lightning striking the house. I have to walk away during these times, knowing that I've done everything I can for her.

She still has to finish her school work. She still has to do her share of the chores. I can't force food down her throat, and I won't carry her away from her bed, but I can enforce consequences for when she chooses to let her fears stop her from fulfilling her responsibilities.

I'm sensitive to her when it's actually thundering or lightning, but when that happens it's just five minutes at a time; more often the sky might look menacing but nothing happens. This seems harsh, I know, but there are only so many things I can do before she becomes a manipulator and uses her anxiety for her advantage. Kids are like that; they were born sinners and we can expect them to sin pretty often.

Even the child with a simple case of ADHD without any comorbid conditions, can be enabled by a parent if he is not required to wake up on his own with an alarm clock. Don't continually go in there and try to get a child out of bed. The alarm clock is all that's required. Let the child take the natural consequences of failing to get out of bed on time. Each time you cover for a child's negligence, you keep him a child, dependent on you.

Similarly, ADHD children need schedules. Once you train them in the use of schedules, they should be writing their own (depending on age) and sticking to them. Give consequences when they don't, but don't nag throughout the day about where they are on the schedule. Have one accountability time before lunch and one after, not several throughout the day.

It takes courage for us to avoid enabling them, and it takes courage for them to take charge of their disorder.

So in these issues, as in everything else, parenting is a prayer. 

Mental disorders can be devastating, but they don't have to be.

Prayer Time:

Dear Lord, we thank you for your love, for your faithfulness, for your wisdom. We ask for courage. We ask that Your glory will shine through the courage you provide to us. We ask that our children will give this over to you, and give up any anger, resentment, self-pity, and any special status they're harboring, and choose to fight for good health, giving you all the glory for their victory. 

In Jesus's Name I pray, Amen.

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Part 2 Children and Anxiety: Cognitive Behavior Therapy

In my last post, Escorting Children Through Anxiety, I mentioned the importance of educating ourselves about anxiety disorders in children. Today I'd like to discuss Cognitive Behavior Therapy, which is the go-to therapy for anxiety disorders. Traditional talk therapy will only worsen anxiety, so we want to make sure we are choosing therapists who are experienced with CBT, or Cognitive Behavior Therapy.

I need to explain three principles to you: containment, externalization, and competing demands

Today we will have time for the first two only.

Containment
We want to contain anxiety, much like we contain anything--ketchup in the ketchup container, for example. We cannot let children talk or think about their worries all day long. Neither can we constantly assure them when they bring up their worries. This only makes things worse, giving the worries too much power.

The book What To Do When You Worry Too Much by Dawn Huebner uses the analogy that if you keep tending your garden and pulling the weeds and watering it faithfully, you'll yield a huge crop of tomatoes. Anxiety is the same. If you keep tending and feeding it, it just grows bigger, until you've got more yield than you know what to do with.

Containment, so things won't overgrow. We set aside a time each day, say for 15 minutes, and call it worry time. Children pretend all day to put their anxieties in a worry box, only to be taken out at worry time. Mom and Dad, when approached for the usual assurance during the day, can only say..."Sounds like that should go in the worry box." No matter how much your child wants your assurance right now, try hard to only remind her about the "worry time".

Worry Time: Choose a 15-minute time segment during the day when she is not exhibiting bodily signs of anxiety, and when there are no other distractions (not from siblings, TV, computers, etc.). After she unloads everything she's worried about, help her learn to use logic. She must stop the worst-case scenario self-talk. Discuss the improbability of the worst thing happening, and leave it at that. Logic is also knowing that even if something bad does happen, she can get through it. Don't argue these thoughts with her, just present them, and tell her she must learn to use logic on her own with time.

Externalization
The anxious child needs to learn that he is not his anxiety. The anxiety is an outside entity that your child is hosting, and in order to exert control over it, he needs to externalize it.

Teach the following ideas when your child is calm.

~ The worry is a BULLY. Have your child use his imagination to picture what the worry bully looks like, perched on your child's shoulder all day. Have him draw a picture of what his worry bully looks like.

~ Right now, the worry bully is stronger than the child, but that will change and the child will learn to boss the worry bully and gain the upper hand. Teach these truths about the worry bully: Worries lie. They trick you. They exaggerate.

~ Teach your child to talk back to the worry bully whenever it bothers her during the day, especially when it refuses to go in the worry box for later.

"I don't believe you!"
"That's a bunch of GARBAGE!"
"Leave me alone!"
"Scram"
"Get lost."

Next time we will talk about competing demands, which are forms of distraction, some targeted toward reversing the bodily signs of stress, once they've already started.

Escorting Children Through Anxiety (And Surviving Yourself)

Whether it's anxiety brought on by circumstances--a medical diagnosis or procedure, or a significant life change like the death of a loved one or a divorce--or the brain's unreasonable, disordered response to normal life, most children will experience anxiety at some point in childhood. They need a parent to be right there, escorting them through it because anxiety is not just fear. Rather, it's a bodily response to fear that blocks out common sense. Thunder can't hurt you--that's common sense, but it's lost on your anxious child and repeating it over and over only makes your child feel abandoned, rather than comforted.

If it's merely a childhood fear (sometimes the case before age 7), then maybe explaining the science of thunder is in order, but if your child is inconsolable, then you know you're dealing with anxiety, not fear.

This whole process can make us feel helpless as parents, so it helps to clarify our role. We're not there to convince her she's being ridiculous. We're there to hold her hand and love her unconditionally.

My job is to accompany my child along this path that God has chosen, while pointing her toward Him. I am not the crutch, but the escort to the throne of Grace.

What every suffering parent needs to know:

1.  This is not your fault. This disorder is a result of the sin curse, and something that right now, God is choosing to allow in your lives.

2. You and your child will grow closer than ever as you walk through this together. You will both feel intense stress and doubt and pain, but you will experience them together and the shared experience will bond you uniquely. Your relationship will be both deeper and sweeter, and for that you will be thankful.

3. You will recite the 23rd Psalm over and over, and every Psalm about fear will speak volumes to you. Anxiety is a spiritual battle as well as a physical one so fight it with the Word.

4. You cannot fear and pray at the same time. So pray and then pray some more. Together. Keep your role of escort always in mind. You must teach your child to take all her burdens to the Throne of Grace, and never has she been more desperate to do so than now. Take advantage of this training opportunity and escort her to the Throne daily. Both of you close your eyes, and slowly talk her through that walk to the Cross, where you take off all the burdens you've been carrying, and drop them at the foot of the Cross, where all the healing begins.

5. Anxiety is part of your (and your child's ) story and you are not writing it. God is. So trust Him for a glorious outcome because he only writes glorious outcomes. Repeat that over and over, with your child. Use a more child-friendly sentence, if necessary.

I trust you, Lord, because all your outcomes are glorious. 
I trust you, Lord, because all your outcomes are glorious. 
I trust you, Lord, because all your outcomes are glorious.

6. Whatever your child is anxious about right now, don't project it into the future and expect disaster. Take the circumstances one day at a time. This too shall pass is definitely true for the specific fears, if not for the anxiety disorder itself.

I have escorted a child through elevator anxiety and separation anxiety, both of which are gone now, but were intense at one time. The disorder hasn't gone away, but the different manifestations have. So don't assume if there is driving anxiety right now, that your child will never learn to drive, or if it is thunder anxiety, that your child will never leave the house on a cloudy day.

7. If your child's quality of life has slipped considerably, consider medication for anxiety, even if only for a season. Realize that in the lowest doses available, your child probably won't deal with side effects. Most doctors will start with the lowest dose available, rather than go by the weight of child, but if not, demand the lowest dose to start.

Studies show that when difficulties such as anxiety, depression, ADHD, OCD, and bipolar disorder are not diagnosed and treated, children and teens are more likely to self-medicate with alcohol or drugs and get into unhealthy behavior patterns, which persist into adulthood. Find out what is going on with your child by taking him or her to the doctor as soon as a problem arises, and especially if it is still present 6 months after onset. Most conditions have to be present for 6 months to meet diagnostic criteria.

Disregard the unhelpful, judgmental opinions you might receive regarding medications for children (from extended family or friends). No one can truly know what your child and family are dealing with, or what you have already tried as remedies. Sometimes medication allows a child the courage needed to start over and halt all the negative thinking and self-talk. Medication gives them a fighting chance to beat the disorder. They still have to come up with coping skills, but they need a calmer brain to start that process.

8. If anxiety runs in the family, realize that this may be one time you need medication yourself, especially if exercise and proper sleep have not worked to improve your own anxiety. Don't feel guilty or ashamed, because watching a child go downhill emotionally and physically is extremely painful and terrifying. It affects both their sleep and your sleep, exhausting both of you physically as well as emotionally. You must also keep up with caring for the rest of the family, along with the house and meals. Your children will take cues from you, and if you are completely angst-ridden, you will only increase their anxiety, and that, in turn, will make things worse for you. So put your own oxygen mask on, so to speak. If you have definite bodily signs of excessive stress and anxiety, see your doctor.

9. You and the affected child should share a gratitude journal. Write in it at the same time every day, perhaps right at tuck-in time, to make the bedtime transition easier. Your minds need to dwell on God's power and faithfulness...on what is right and beautiful in your lives. And don't forget to give thanks for your relationship!

10. Educate yourself about anxiety disorders, especially those in children, including age of onset. Find books appropriate for your child to help him understand what is happening to his body and mind. He needs to know he is not going crazy, and that this is not his fault. Balance the reading of Scripture with the reading of technical books, so that your child understands that God has ultimate power over everything, including the brain. Siblings can benefit from hearing the information, too.

11. Let your church know that your child and family need prayer. Don't keep this hidden. Nothing good can come from shame or a false smile. Again, watching a formerly happy, healthy child go downhill is extremely painful. You really do need prayer, my friend, as does your child. So put out the word.

12. If anxiety is causing weight loss, arrange to always have your child's favorite foods on hand, so that on good days you can sneak in some extra calories (being careful not to let your child use food as a form of manipulation).

What has worked for your family in dealing with anxiety? How has God weaved anxiety into your story?