Interviewed Two Parents at My

¶ … interviewed two parents at my church who have a son who has had a challenging childhood so far. "Bobby" is ten and in fifth grade. His parents, Judy and Dave, have been struggling for years to get an accurate diagnosis so they could find the kind of help that would benefit most.

I asked them to describe Bobby to me. They told me that they finally got a solid diagnosis on Bobby, and that they feel the diagnosis explains a great deal. In the past they said Bobby had been diagnosed as having AD/HD, and put on medications for that. While the medication helped some, they felt that more was going on. Bobby had social problems. Many children with AD/HD have social problems, they pointed out, but Bobby's seemed different. As they learned about AD/HD, they found that many of the problems from AD/HD came from impulsiveness. Other parents they talked to said that their children understood, for instance, that they should not trip another child, but they impulsively did it but afterwards understood why the other child was mad.

They felt Bobby was very different than that. He did not seem to understand why other children did the things they did, and it seemed very inconsistent. For instance, Bobby loves to play soccer and understands the basic rules of the game. He understands that everyone's feet are very close together, and that the players wear shin guards because of that. Even though, sometimes if another child accidentally kicked him, he was fine about it, but other times he stormed off, angry and complaining that the other child was mean. At these times, reminding Bobby that people get kicked accidentally in soccer, or that the boy didn't mean to do it, or even that the other boy had said he was sorry, would just make Bobby angrier, and he would often spiral out of control.

Last year they finally got the first diagnosis that they thought really explained what was going on with Bobby: Asperger's disorder. About four months after that, bipolar disorder was added to that. The diagnosticians think Bobby probably also has AD/HD, but that it's not the main thing making so difficult for him. With careful analysis and by using functional behavior analyses, they have come to understand that sometimes when Bobby doesn't understand what's going on around him socially, the frustration can trigger a manic state. Once that has happened it isn't possible to talk to Bobby about what happened or is currently happening. Bobby's parents feel that finally getting the diagnosis right for Bobby has finally put them all on the right track.

Bobby's parents are educated people. Dave is a fireman/paramedic and has a lot of medical knowledge. Judy has a master's in biology and some work toward a Ph.D., and teaches science part time at a local junior college. Completely by accident, their schedule has worked well with Bobby's difficulties. Dave's work schedule is 24 hours eating and sleeping at the fire station, on call for any emergencies, and 24 hours off-duty at home. Judy's part-time job provides good income without taking up a lot of time. In addition, their extended family has welcomed Bobby, even with his difficulties. Grandparents as well as aunts and uncles are ready and willing to spend time with Bobby. When Bobby is calm, he is a pleasant child to be around. Nevertheless, Bobby's rages have created serious problems. At one time, Bobby got extremely angry while in the car and tried to loosen his little brother's car seat and push it out of the car. Fortunately Judy and Dave had the foresight to buy a car where all windows and doors can be locked from the front seat. He was able to loosen the car seat, but not open the door. There have been other times when Bobby's rages have put his brother or sister at risk, so those children have had to learn to go to their rooms immediately if that happens, even at a very young age, and Bobby is never left unsupervised. The parents note that the right medications for the bipolar helped tremendously with this, and that since they added EFA's to his regimen (essential fatty acids) as recommended in a book on bipolar in children they read, rages are now rare. They feel that with the combination of good support for the Asperger's and the bipolar, Bobby is finally making real behavioral progress.

His parents acknowledge significant family stress, but that they did not spend too much time grieving over Bobby's difficulties (Diamond, 1999). They knew before they adopted him that he might inherit some difficulties, as the birth mother was a troubled individual. Their other children are not adopted, and so far show no signs of having any significant kind of problem. Their biggest challenge, they say, has been making sure that all three children get the attention they need and deserve when Bobby's needs are so high, and say that the unswerving support of their extended family has made a huge difference. An aunt and uncle, or older (college age) cousin, or grandparents, will take Bobby for several hours so the parents can do something special with one or both of their other two children.

The parents report that Bobby has simple chores he is to perform, but that the four-year-old also has a simple chore to do. They have adopted Ross Greene's system of "baskets" for deciding how to deal with things. In the first basket, they said, go things that must be dealt with -- actions that might harm another child, for instance. In the second basket are things important to them, but that might wait, for instance, having Bobby take full responsibility for chores. In the third basket are things not important enough to worry about. In that basket they used the example that some families have a rule that a child must "clean his plate," but they know that both Bobby's medications and his moods can affect his appetite, and they just don't worry about whether he's eaten everything on his plate or not. For the future, they want to see Bobby able to hold a job and live an independent life as an adult, and they are ready to do whatever they can to see him achieve that goal, including working with him at home (DiPipi-Hoy & Jitendra, 2004), (Graham, 2003).

They reported that school has been the biggest challenge. They have found that any time Bobby gets upset, there's a logical reason if they can only tease it out, but that the school at first did not know how to do functional behavior analyses, which look for what need the child's behavior meets for him, so they can find a more acceptable way to meet the need. For Bobby, one of his biggest needs was the ability to leave the classroom if it became overwhelming. He now has a full time paraprofessional who has been trained in autism and Asperger's, and he can leave with her. If he runs, he has several "safe spots" he is allowed to go to in the school. If he goes to one of those spots, he is praised for doing the right thing rather than punished for "leaving the room without permission." They feel this has taken a lot of pressure off him.