Friday, April 07, 2006

Coping with triggers...

As I mentioned in my last post, B has been having more & more trouble with OCD triggers this week. The thoughts that are triggered cause him a range of difficulties, from mild discomfort to near-complete shut-down. The main triggers occur on the way to & from school, which is fortunate from one point of view, since once we get him calmed-down at school he's been doing very well. His focus has been wonderful & he's enjoying not only the work but interacting with the other kids while he does it. Home must not be nearly as diverting, though, because for the past couple of afternoons the triggers on the way home from school have been causing major melt-downs. Part of the problem is that one of his important after-school routines, homework, has gotten a bit of a shake-up. For most of the year B's homework has come from a book of reading-comprehension exercises because he does not tolerate anything that requires much more energy than reading a passage & answering a few multiple-choice questions. The importance of doing homework at all has come into question repeatedly & school has said that it's not really necessary for him to be doing it, but his psychologist seems to think it's important so we're following-through. When the rest of B's class has anything more complicated than math problems for homework, B gets the reading comprehension exercises instead. Or did until a few days ago, when he finished every exercise in the book. Cherie found another book, a bit more advanced, & B is not happy with it... sigh. They'll sort it out, I'm sure, & anyway It's really more of a symptom, with his distress from the OCD being the biggest irritant for him.

When he's exposed to a trigger, B usually starts to tic (physical jerks & vocal "exploding" & hissing sounds) , which is sometimes all that happens. I can tell if he's going into crisis because all of a sudden he'll start rejecting options (say, being offered an orange for snack...) & saying "uh" & "um" in a very distressed voice when I ask him what he wants to eat/do... He starts to clench his fists & gets a grimace on his face, which is my signal to get him somewhere safe, like a bed or the sofa, because he often goes into a fetal-like position next & I don't want him to fall off the chair. I try to hug him if he wants, & give him some compression (which he will often reject- it's as if he doesn't want any comfort at this point). Then I will ask him if he can imagine the thought that's bothering him as separate from himself... if he can imagine squashing it or sending it into a black hole to be crushed... although he does not actively do this (yet), B's psychologist has suggested this strategy as part of the cognitive/behavioural therapy for the OCD, so I at least put the idea out there for consideration. It's hard, at this point in B's distress, to know what he's seeing/hearing/feeling. What I have been doing for the past couple of days when this happens is to broach these ideas, then sit quietly beside him, sometimes holding his hand or hugging him, if he'll let me. Eventually (5-10 minutes?) B's face relaxes... which is my signal to grab Rufus & pounce. Rufus does the rest- foofing B, tickling him, saying funny things. When B's face relaxes it means that he's "back" & ready for some distraction. Anything we try to do before then is rejected. When Rufus & I get B giggling, he's really ready for major distraction- usually a video. If snack was missed then I bring something up to him while he's watching. Then I collapse in a heap- this is so emotionally exhausting.

Yesterday this whole process happened twice after school, once right after we got home & once after dinner. It was good to have C home & observing this new way of getting B back to earth after an OCD meltdown. He had been trying to get B ready for his bath when B started melting-down again, pretty suddenly, so I did what we'd done earlier in the day- got him to our bed, sat with him, etc. Once B was out the other side & ready for distraction, he still wasn't convinced about a bath, but we were (nice, warm soothing water- usually he loves it) so Rufus decided to facilitate (with dad's help) by "pantsing" B (leaving him in his boxers, of course :), to much hilarity. I left them to their tubby & went downstairs to wilt for a while...

After B was successfully in bed & asleep (yay!) C & I talked about it all. He thought this new way of helping B cope worked well (for now... I have no illusions). I am trying so hard to be respectful in my approach & also be aware that I may not really understand what he's experiencing- although he's clearly in emotional pain (asking us to kill him to put him out of his misery is not the sigh of a happy person...). It seems that the combination of being actively present for him & "riding it out" does the trick, for now. Up until now I have been frightened that his melt-downs would progress to the point where he hurts himself (since that's what's happened in the past) but this doesn't seem to be the case right now, so I feel much more comfortable with "riding it out" rather than trying to intervene/distract earlier in the whole process (which clearly doesn't work anyway).

This morning I thought about the triggers to & from school & decided to alter the route I take. B noticed that we were going a different way, but that was all he said... C had mentioned keeping B chatting about Pokemons as a distraction, so I did that too. We arrived at school with no tics or triggers & he was in fine spirits when I left him... so, I guess we have a new route to & from school, which can be altered yet again if necessary (we're lucky there's so many ways to get there!).


At 12:50 PM, Blogger AnneC said...

This comment has been removed by a blog administrator.

At 12:51 PM, Anonymous zilari said...

Several things come to mind here...

It definitely sounds like transitions are a source of stress for B (but I'm sure you knew that!).

Also, given that you said he was thinking a lot about mortality lately, could he possibly be worried about being "one year older"? I had a "thing" about this myself for a while which probably reached near OCD levels. Not sure if I'd actually bring this up to him since it might be scary if he hasn't thought of it himself, but it's a possibility (in addition to the other things you mentioned like the new homework book, etc.)

It's definitely best to "ride out" meltdowns if possible...if I am in that state, one of the worst things I can possibly encounter is to be asked questions or given attention (usually...sometimes I also want compression / hugs). Questions are probably the worst of all since they put pressure to interact. But I can see how it can be really difficult because B seems like someone who needs to know that people care about him and that they won't let anything "get" him.

At 12:53 PM, Anonymous zilari said...

Also, the deleted comment was also me...I was accidentally signed in to a different username for another blog I keep on a different topic.


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