Psych Eval

[pumpkingirl71]

After trying to work with our agencies counselors and specialists, we bit the bullet and called our pediatrician. Nothing the agency offered was helping and one counselor was actually making things worse. The pediatrician suggested a full psychiatric evaluation. I agree that this is the best next step, but it is killing me

I know that we are trying everything to help our dd, but agreeing to this just feels like I am admitting she is damaged goods. It makes me so sad. But unless we can stop her aggressive and destructive behaviors, we can’t be a family.

Has anyone been through a psych eval? Any ideas about what I can expect? I will take any words that make me feel better Also, I am not sure what to tell the agency, as we think they are a bunch of big losers. They have really disagreed with everything our pediatrician has said, and so far, the pediatrician has always been correct.

[lauren]

Do you know what the pediatrician's hypothesis is about the cause of her behavior?

Psychiatric evaluations (IMO) are not as scary as they sound. A psychiatrist is an MD with additional training in psychiatric disorders. A child psychiatrist goes on for further training in the child disorders. Your child should see a board certified child psychiatrist to get the best eval, and hopefully someone that has A LOT of experience in differentiating between certain disorders, because there are huge similarities between many of them. For example, a child with an attachment disorder could easily be diagnosed bipolar because of the rage, or ADHD because of the hypervigilant nature that often comes from trauma and lack of attachment (no self-regulation), by someone that doesn't know how to discriminate between these things. A psychiatrist with a strong developmental background and lots of awareness of problems with attachment would be able to sort these things out. Psychiatrists have a tendency to identify things they can treat with medication--because that is what they are trained to do. So if a psychiatrist can treat bipolar in children, they will often 'see' more bipolar. I hope this is making sense.

In practicality, it will be a lengthy interview with parents, child, and parents/child together. I hope this is helpful.

[pumpkingirl71]

Originally Posted by lauren

Do you know what the pediatrician's hypothesis is about the cause of her behavior?

No, but she wants the eval because dd has so many risk factors (born addicted to methadone and exposed to alcohol, removed from birth home due to neglect, extensive medical needs due to the neglect, and adopted as a toddler). When I write all of those risk factors down, is seems like dd is doing great, but we are not coping well as a family. Dd has spells of hypervigilance, spells of what I call mania (kind of the opposite of hypervigilance) and seeks negative attention in extreme ways. Figuring out where to start is the confusing part here

Thanks for the help!

[lauren]

I wonder if some of Bruce Perry's writing might be helpful to you. He is an expert on child neglect, abuse and trauma and writes about brain development in ways that might be helpful to you. Here is one place to start:

http://childtraumaacademy.org/Caregiver.aspx

[Sierra]

Originally Posted by pumpkingirl71

I know that we are trying everything to help our dd, but agreeing to this just feels like I am admitting she is damaged goods.

No, just a child who has faced some challenges and who needs help in healing.

It makes me so sad.

Oh mama, I wish I could hug you. I know that pain well.

Has anyone been through a psych eval?

I have had some kids who have had them. I agree with Lauren that it will likely be interviews, or for your dd, more "playviews." I concur that it is not scary.

This is just a part of getting to know your dd better.

Also, I am not sure what to tell the agency, as we think they are a bunch of big losers. They have really disagreed with everything our pediatrician has said, and so far, the pediatrician has always been correct.

Recently I decided to get a developmental eval for dfd even though the SW kept going on about how great she was doing, etc. etc. I wrote her an email just saying it had been recommended by the therapist who visits our home to work with ds (as she did say it wouldn't be a bad idea), and told her I went ahead and scheduled it. I treated it nonchalantly, and was sticky sweet, and she responded in kind.

[pumpkingirl71]

Originally Posted by lauren

I wonder if some of Bruce Perry's writing might be helpful to you.

Thank you!

[pumpkingirl71]

Originally Posted by Sierra

Recently I decided to get a developmental eval for dfd even though the SW kept going on about how great she was doing, etc. etc. I wrote her an email just saying it had been recommended by the therapist who visits our home to work with ds (as she did say it wouldn't be a bad idea), and told her I went ahead and scheduled it. I treated it nonchalantly, and was sticky sweet, and she responded in kind.

So weird how similar this is. The SWs just keep telling me she is doing great and making us feel like we aren't patient enough. We also had a developmental eval done and the visiting nurse was amost insulted.

[OnTheFence]

Originally Posted by pumpkingirl71

After trying to work with our agencies counselors and specialists, we bit the bullet and called our pediatrician. Nothing the agency offered was helping and one counselor was actually making things worse. The pediatrician suggested a full psychiatric evaluation. I agree that this is the best next step, but it is killing me

I know that we are trying everything to help our dd, but agreeing to this just feels like I am admitting she is damaged goods. It makes me so sad. But unless we can stop her aggressive and destructive behaviors, we can’t be a family.

Has anyone been through a psych eval? Any ideas about what I can expect? I will take any words that make me feel better Also, I am not sure what to tell the agency, as we think they are a bunch of big losers. They have really disagreed with everything our pediatrician has said, and so far, the pediatrician has always been correct.

My son has. PM me and we can talk.

[vermonttaylors]

I have nothing usefull to add (sorry) but I give a great . So consider yourself squeezed. I know you guys can get through this to become a family.

[lauren]

I think that sometimes the social worker that placed the child has a different agenda than the foster family. The social worker's interest is in maintaining the placement and not having a disruption. I have noticed that at times this causes them to not listen to families and to just try to 'prop them up' to think that everything is o.k. (kind of like 'if we all pretend it is o.k. rather than naming the problems, then perhaps it WILL be o.k.).

Also they may be concerned that foster families will ask the agency (CPS) to pay more, either for evaluations, daily rate, or the post-adoption subsidy, if more bona fide problems are identified. So the result can sometimes feel to families like they are speaking a different language (or are on a different planet!) than the social worker and the agency.

I think this also applies to the lack of information some families are given about their foster child's history or degree of abuse or trauma. I think this is unfortunate because if families had more information and could go forward with eyes wide open, they might have more empathy for the child and be more open to doing whatever it takes to help the child. It also might turn away some prospective foster parents that know their own limitations, but IMO this would be good because it wouldn't be setting people up to potentially fail. When families feel that 'love will be enough' and then a child is placed with them that does have significant abuse, neglect or trauma, the family and the child begin to feel like failures: which seems to be how you are feeling now, due possibly to lack of information and lack of thorough evaluation.

So I do think that the evaluation can be very helpful if it sheds more light on the situation, and shouldn't reflect an admission of failure or that your child is 'damaged' necessarily. When families feel that there is something missing from the picture, they should feel empowered to get more information until they feel that things are making sense.

[editmom]

I wanted to add that I know the feelings of being a damaged good all too well. The difference for you is your child has you to love her and help her on her journey. It is not easy but it is never easy being a parent. I also wanted to add that it's a really good idea to research all modalities of treatment. Humans are complex creatures and many different therapies and living environments can benefit. I am glad you have a pediatrician you can trust. That is way important.

You can love your child and help learn what makes her tick so she can have the greatest potential. In the meantime remember that she is in a safe, loving home and that you ARE ALREADY doing something.

[Sierra]

Okay, I feel the need to say some more.

Originally Posted by pumpkingirl71

exposed to alcohol

I have been thinking about this, and I think that for many kids, this can be among one of the most significant difficulties leading to behavioral issues. Because the brain starts out with wiring that makes it difficult to make connections between things like cause and effect, and when that connection is made one moment, to maintain it in the next and actually apply it. Neglect would be second to that, because it too can change the brain's structure so that it interferes with logical processing of external and internal inputs into the neurological system.

What I am trying to say is that this can make healing very, very, very slow (years) because you actually need to help the brain rebuild and rewire. This can only be done to the extent possible of course...there is no cure, and many struggles will be lifelong. But recent developments in the field of neuroscience have uncovered some really positive news about the pasticity of the brain, which can rebuild to an extent never thought possible before.

In the meantime, the pysch eval will help you sort out what is what and actually identify the exact nature of the issues...but on top of that, if there is a medical option that can help your child become livable for herself and others so that you can all focus on truly helping her heal, then this will be another area of assistance for you. I want to say that now because I know it is a long journey ahead and that is probably scary to you. But this is one step that will help with figuring out how to help her heal over the longterm, as well as how to survive the shortterm. So I want to again reaffirm your decision to do this.

Oh, and I will add affirmation to the momtomany's suggestion that you research all modalities of treatment. There are things like neurodevelopmental therapy (we do this with ds through the HANDLE institute) that help the child work on rebuilding the brain from the lowest/earliest developing to the highest/later developing parts...starting, as I recall, with the vestibular system. It isn't a miracle cure. But I am just pointing this out because on the surface, neurodevelopmental therapy might seem somewhat disconnected from something like Oppositional Defiant Disorder or Reactive Attachment Disorder or Attention Deficit Hyperactivity Disorder, etc. Complimenting whatever other treatment options you end up doing, both medical and therapeutic, with stuff to support brain development will be one piece of the puzzle for your little girl I think. Even stuff like fish oil would be worth doing. Again, not for a miracle cure. But for longer term support that will help over the years as the brain corrects as much of its faulty wiring as it is able.

[Sierra]

Originally Posted by lauren

The social worker's interest is in maintaining the placement and not having a disruption. I have noticed that at times this causes them to not listen to families and to just try to 'prop them up' to think that everything is o.k. (kind of like 'if we all pretend it is o.k. rather than naming the problems, then perhaps it WILL be o.k.).

I think this may definitely be at play in our case.

I think this also applies to the lack of information some families are given about their foster child's history or degree of abuse or trauma. I think this is unfortunate because if families had more information and could go forward with eyes wide open, they might have more empathy for the child and be more open to doing whatever it takes to help the child.

And I think they'd have a better idea about *what* they need to do for their child and what responses are helpful. With ds, the SW was so helpful in disclosing all we needed to know, but with dfd, we definitely feel like we are missing enough pieces that proper care of her issues is also jeopordized.

It also might turn away some prospective foster parents that know their own limitations, but IMO this would be good because it wouldn't be setting people up to potentially fail.

...or worse yet, to put the family in a situation that leads to further hurt for the child beyond disruption.

Amen.

When families feel that there is something missing from the picture, they should feel empowered to get more information until they feel that things are making sense.

Yes. Absolutely.

[Sierra]

Originally Posted by pumpkingirl71

So weird how similar this is. The SWs just keep telling me she is doing great and making us feel like we aren't patient enough. We also had a developmental eval done and the visiting nurse was amost insulted.

Ugh. I hate that. It is very, very frustrating. I am so "there" right now with dfd's SW. Yeah, very similar. Hugs from one mama to another experiencing the same barriers to caring for our children's needs. May we continue to overcome these so that we can be our children's advocates when the world can't.