Pragmatic Compendium

When I wrote the post entitled The Underwear Principle and now, underwear. step by step., I mentioned that I had applied this principle in other situations in my life. One of those situations involved my son.

FavoriteSon attended a Montessori pre-school from age three to five. The Montessori philosophy encourages independent work and allows the students to physically move around the classroom during the day. The “lessons” are clearly defined as separate activities with very specific, step by step instructions which follow the “left to right” and “top to bottom” concept employed by reading. The classroom was lined with low shelves on which sat rows of restaurant trays. On each tray were most, if not all the components of each lesson. It was the perfect learning environment for FavoriteSon at the time. (There’s a lot more to the Montessori philosophy, but I’ve covered what relates to the background of my situation.)

When it came time for 1st grade, we moved FavoriteSon to a traditional classroom environment at a non-denominational Christian school and it quickly became apparent that he was having a difficult time making the adjustment.

Someone, I don’t remember who, used the term “ADD.”

So I applied the The Underwear Principle:

Step 1: I didn’t approach the situation from any pre-conceived notion of how things “should” be. I opened my mind to the possibility that I DIDN’T KNOW what the problem was. I didn’t assume that my current knowledge and past experiences were enough to lead me to a conclusion, a diagnosis, a punishment strategy, or a resolution. I admitted that the “answer” might be different than anything I could think up on my own. Even worse, I had to consider the possibility that my parenting style was influencing the situation as well. (yeah. not liking that idea.)

Step 2: I tried to stay focused on the fact that my little boy wanted to learn. He wanted to behave appropriately. I understood that he was faced with an obstacle he couldn’t overcome without our help. We didn’t punish him or lecture him. We didn’t want him to feel defeated by school in the first grade.

Step 3: I analyzed what was happening. I took into account as much information as I could - the actual behaviors, the time of day, any possible cause and effect or trigger, his seating assignment - if there was ANY information available, I wanted to include it in my analysis.

The classroom layout was structured and decorated very differently from what he had experienced before, with the “lines” for each learning activity now blurred. There were no more distinct, individual tasks or lessons. Rather, unrelated information surrounded him on every wall. Not only was FavoriteSon no longer encouraged to move around the classroom during the day, but now he was actually discouraged from doing so. No more independent study or activities. Now, everyone worked on the same lesson together. When the teacher spoke to the children, she most often spoke to them as a group, rarely speaking directly to each individual child and making eye contact. The teacher reported that FavoriteSon frequently spoke out during class - but often, when he did so, it appeared as if he was talking to himself. He sometimes didn’t seem to hear her when she spoke to him. He often continued with lessons and activities after the teacher had concluded and moved on to the next lesson. Almost every morning he disrupted the class by talking to his classmates.

Step 4: I began researching the possibilities. I read books and articles, searched the internet, talked to other parents, teachers, counselors and even kids. The first thing I did was read some books on ADD.

FavoriteSon was displaying a few signs of ADD. One I noticed immediately was “hyperfocus.” If he was fully engaged in a task, he didn’t seem to notice anything around him. That’s what he was doing when he continued the lessons after the rest of the class had moved on to the next activity. I used to do that as a child when I was reading, and I never thought much of it. But FavoriteSon took it to the extreme. If he was interested and engaged in what he was doing, it was VERY difficult to get his attention. And not so much fun to get him to stop the activity. So what did this mean? Was there anything I could do about it? Back to the books.

I zeroed in on Chapter 10, Addressing the Imbalance: Non-Drug Treatments for ADD, in the book, “Running on Ritalin,” by Lawrence H. Diller, M.D. In the section entitled Behavioral Training: An Indispensable Tool, he suggested an interesting concept: (emphasis added)

Structure tasks into smaller components. For example, instead of telling a child, “Clean your room,” break the job down into stages: “First pick up your clothes off the floor and then put them in the hamper.”

I had an “Ah HA!” moment. I realized that, for my son, the instructions “Clean your room.” or “Do your homework.” were:

1. Too abstract. With so many things to do in order to accomplish that task, he was paralyzed and didn’t know where to start.

2. Too overwhelming. The job seemed bigger than it really was.

3. Too confusing. We didn’t have the same ideas with regard to what “clean” was when it came to his room. To him, it was clean. There were just toys and clothes on the floor.

(I read a LOT more and talked to a LOT more people, but it’s just too much to relay here. I’ll note some book resources at the end of this post.)

Armed with a plethora of information, it was time to turn all this knowledge and theory into action.

Step 5:
First, I wanted to rule out any physical problems, so I took FavoriteSon to the doctor for a checkup and had his hearing checked. His pediatrician didn’t discover anything unusual and his hearing was fine.

Secondly, I tried Dr. Miller’s suggestion to break things up into smaller components. I started at home. I gave short, step by step instructions for chores, homework - even bathing:

Instead of “clean up your room,” I said, “Pick up all your Rescue Heroes and stand them up on the shelves, please.” The first time, I said “put them on the shelf” and he PILED them on the shelf - but he had done what I asked. After a few times, he started to put all the water guys on one shelf, all the firefighters on another . . . my freakishly organized tendencies manifesting themselves in my son. I was so proud.

Instead of “Do your homework.” I said, “Hmm, how old are you? 6? If you do 6 math problems you can play for 12 minutes.” The first time he did his 6 problems in less than 5 minutes. After a few times of this “little bit of homework, little bit of play” he did his 6 math problems, I set the timer for 12 minutes and when the time was up, I said, “Hey bud, it’s time for 6 more problems.” He grinned and, without even looking up from the video game he was playing, he said, “Nuh uh. I finished all my math.” Little stinker had done ALL his math problems in one sitting. Because when he sat down to do them, he was only faced with the small, manageable task of completing 6 of them. (microactions, gotta love ‘em) I wondered why it took him a little longer that day. I just thought the problems were harder.

Instead of “Take a shower.” I said, “Pop in the shower and get your hair wet, please.” followed by “Get some shampoo in your hands and make bubbles before you put it on your head.” He used to spend way too much time in the shower and come out dry and dirty. Now, he had a clear understanding of what to do. I just walked by the bathroom door every few minutes to remind him what he was supposed to do next. If I didn’t, he would get distracted and we would hear him singing - and not washing.

It was amazing. Everything I asked FavoriteSon to do, he did. Fast. With fairly good attitude. So, I spoke to the teacher and explained what I had learned and what we had tried at home. She began modifying the way she gave instructions and reported that she noticed immediate, significant improvement. Lessons were completed, there were less instances of hyper focus and generally, he was doing better in school.

But he was still talking in class - to himself and to the other kids. I recalled something I read in Dr. Miller’s book, Running on Ritalin:

“The family of drugs to which Ritalin belongs - the stimulants - has been both a blessing and a blight on humankind. The stimulants, which include such drugs as caffeine, cocaine and amphetamine, are so named because of their generalized effects on the body’s organ systems, particularly on the heart, blood vessels, and brain. Stimulants increase blood pressure; they make the individual less sleepy. Stimulants such as coca leaves and tobacco have been used for centuries by indigenous peoples for there energizing, pain killing or medicinal properties. Many of us can’t start the day without our hit of caffeine.”

I drink coffee every morning. At least two cups. And we’re not talking 8 ounce cups. Who’s to say FavoriteSon couldn’t have a little Coke instead of a little Ritalin? And weren’t those tiny little half size cans just perfect for this little experiment? Bingo. He had his little can of Coke during snack every morning and the talking lessened. Significantly. (He was in 1st grade, did you really think he would completely stop talking in class?)

A few years later, we had his vision checked and found out that FavoriteSon was nearsighted and needed glasses to correct his vision. Was that another problem for him that we didn’t discover at that time?

So, looking back, I’m not sure. Did FavoriteSon have mild ADD? Or did he, like his sister, have problems with his blood sugar? Or both? Did his experience in Montessori school lead to some of the problems he had adjusting to the traditional environment? Was I a bad mom all those years for not realizing that one of the reasons he seemed so disinterested looking at alligators in the lake we drive over was because he couldn’t see them?

I’m not going to spend time on the diagnosis (or blaming myself) now and I didn’t focus on it then. What I DID do was take action. I applied The Underwear Principle, step by step.

For us, it worked. And make no mistake, as nice and neat as this wrote up, we didn’t live it out so smoothly. See, it’s easy to do all the stuff we did. But to do it consistently, over and over and over, every day, without giving in?

Now, THAT. Was hard.

Running on Ritalin by Lawrence H. Diller, M.D.

Should I Medicate My Child? by Lawrence H. Diller, M.D.

The Myth of the A.D.D. Child, 50 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels or Coercion by Thomas Armstrong

Beyond Ritalin, Facts About Medication and Other Strategies for Helping Children, Adolescents, and Adults with Attention Deficit Disorders by Stephen W. Garber, Ph.D., Marianne Daniels Garber, Ph.D. and Robyn Freedman Spizman.

Sometimes you find something so wonderful, you HAVE to share it. So here it is:

www.lotsahelpinghands.com

Are you in a crisis situation? Do you know someone who is? Someone who is fighting cancer? Suffering from a chronic condition? Recovering from an accident or injury? Someone who’s just had a baby?

Do you want to help, but don’t know what the needs are? Do you want to deliver meals, but don’t know what foods they like (or don’t), what day to cook or when to deliver the meal? Do you want to offer to pick up kids, but don’t know when or where to show up? Do you want to help with cleaning or laundry, but don’t know when your presence in their house would be convenient for the person who needs help? Do you want to shop for groceries, but don’t know what to buy or when to deliver them? Do you want to offer to pick up prescriptions, babysit or take someone to the doctor - but you just don’t know what the exact needs are?

Do you just wish there was an easy way to organize all the volunteers?

That’s where lotsahelpinghands comes in.

Let’s say you have a friend who’s on bed rest due to an injury. We’ll call her Grace. You go to www.lotsahelpinghands.com and create an online community for your friend, Grace. You decide to designate yourself as a Coordinator and you recruit others to be Coordinators as well, because many hands make light work. So there’s a Coordinator from Grace’s son’s 3rd grade class and another for her daughter’s 1st grade class. There’s a Coordinator for her Bible study group, and two people have volunteered to be Coordinators from her church. There’s even someone from her husband’s office who wants to serve as a Coordinator. Grace wants to be a Coordinator as well!

After Grace’s online community is created, the names and email addresses of friends and family are entered into LHH and a notification email is sent to each one of them. These “invitees” simply click on a link in the notification email and confirm their email address to become active members in Grace’s community.

Now they can log into Grace’s online community any time they want. They can check out the master calendar and see that meals are needed on Mondays, Wednesdays and Fridays. They can see that Grace’s kids need to be picked up from school on Wednesday and taken to play rehearsal. They can see that Grace would love to have someone come over and do her laundry on Monday morning. They can see that she needs someone to go to the grocery store on Thursday and they can even see her grocery list! Members sign up for any activity they want!

The really cool part is that all members can see when needs are filled or “taken” and when they are still “open” so there’s no confusion. All members can see who’s signed up for an activity and activities can even be “assigned” by any coordinator. LHH even sends out reminder emails when someone signs up for a task. What if a community member signs up for something and then gets sick? They simply contact any Coordinator and that Coordinator can remove their name from an activity, freeing it up for another volunteer.

If friends and family haven’t been “invited” to join, they can go to www.lotsahelpinghands.com and request membership in Grace’s community. Any coordinator can approve membership and send the notification email. Any coordinator can enter the needs, called “activities” onto the calendar.

LHH communities have pages for announcements, well wishes and even a secure blog so Grace can let everyone know how she’s doing! There’s also a “people” page which lists all the members while allowing members to determine their level of privacy.

But the really best part? It’s FREE.

Is this cool or what!?!

UPDATE: I’ve written an ehow article on www.lotsahelpinghands.com Check it out!

PinkGirl caught my germ. And she was NOT happy about it. She caught it on Wednesday. Wednesday is play rehearsal day. Wednesday is the day she and two of her friends (sisters) play and sing in the car all the way to rehearsal - and back. Wednesday is usually a REALLY fun day.

Except this week PinkGirl had a fever of 101.2 and a really bad headache. She went to the school office at 2:00 p.m. and they called me on my cell to tell me. I was in the car pool line to pick up one of the play rehearsal friends who goes to another school. I had to call the friend’s dad and tell him, which threw a major monkey wrench in his afternoon because he then had to drop everything and come to school to pick up his girls and take them to play rehearsal because I couldn’t. I had to take care of PinkGirl (and try to keep the friends from catching the germ).

When I got to PinkGirl’s school, she immediately began crying when she saw me. She knew.

“Can you just give me medicine and let me go anyway?”
“I don’t get to ride and play with FRIEND1 and FRIEND2!”
“But my head is only hurting, I can still sing and dance!”
“I’m going to miss EVERYTHING!”
“Please! Mom!”

and many more tearful pleas as I continued to wipe her tears and say, “I’m sorry honey.” over and over again.

We got her brother out of school a little early and headed home. I had already made an appointment with her doctor for first thing Thursday morning (just a few hours before mine). We spent the rest of the evening curled up in a chair together, with breaks to take FavoriteSon to youth group and back.

Thursday morning, I scooped her up at the last minute, wrapped in a blanket and tucked her into the pre-warmed van to take her brother to school and then her to see the doctor. Everything went like clockwork until we got into the waiting room. We were the second patient to be seen and were sitting comfortably - until I looked at PinkGirl. I had just enough time to push her jacket in front of her before she ralphed. Only the jacket got it. She hadn’t eaten anything, but she did drink some water in the car. I walked her in the bathroom, and after a few minutes, she seemed stable, I washed out the jacket, and asked for a bucket on the way back to the waiting room. I ran out to the car and switched out the wet jacket with another one (it’s a minivan, there’s an entire wardrobe in there). I didn’t even have time to sit down before she lost it again. I tried to convince her:

“Honey, let’s get a room by ourselves for some privacy.”

“NO!”

“Come on, sweetie. I”ll carry you.”

“NO! I’m not going!”

She was not going to move in case she ralphed again. I ran back to the bathroom for wet paper towels and to ask for a room on the way. They were smart and called us in. She laid down on the examining table, shivering, so I spent the few minutes waiting on the doctor by wrapping her in my jacket and putting my arms around her to keep her warm. She had a pretty good fever going on.

The doctor came in and examined her while I told him what I’m just getting over. He says it’s a virus, but he wants to give her an antibiotic to prevent any secondary infection. And she should have a shot for nausea to prevent more vomiting.

Shot.

Tears. Pleading. More Tears.

This is the same girl who, twice before, when she was 4 and 5 years old - actually CHOSE the shot because she didn’t want to vomit. I try to talk to her, but she’s starting to freak out. I tell the doctor I’m going to hold off and if she vomits again, we’ll be back. PinkGirl immediately calms down.

So we left. She buckled up in the middle of the backseat and laid down with a pillow and a blanket (it’s a mini-van, there’s an entire linen closet in there). We drop off her prescription, I pick up some breakfast at McDonalds, and with a few minutes to kill before the prescription is ready, I stop at Target to buy movies. I left her in the van alone for the first time EVER. I locked her in and I actually ran into Target, grabbed 4 movies, paid for them and got back to the van in less than 8 minutes. She had fallen asleep. I picked up her prescription and drove to my doctor’s appointment.

In the parking lot at my doctor’s office, I wake her up and she immediately ralphs again. Perfectly calm, she says, “I want the shot.” I take a risk and give her the anti-biotic and a dose of ibuprofen with pseudoephedrine (it’s a mini-van, there’s an entire pharmacy in there). I dump a plastic container and hand it to her, just in case (it’s a mini-van, I had my choice of plastic containers - it’s like a dishwasher on wheels). I call my doctor from the parking lot to cancel my doctor’s appointment, drive back to HER doctor, get the shot, drive home.

I get her tucked in on the couch and put Ella Enchanted (movie #1) in the DVD player. We get to Ella’s rendition of “Somebody to Love” and I peek. Sound asleep. I pause Ella, mid performance and PinkGirl and I crash for two hours.

I have to wake her again to pick up her brother from track practice. We drive through Sonny’s BBQ for take out and, although she still has a fever, she EATS! We go home and finish watching Ella Enchanted, follow-up with a movie-long snuggle while watching Aquamarine (movie #2) and then more medicine and off to bed.

Today is Friday and PinkGirl woke up with a fever of only 99 degrees! Just in time to be better for daddy, who’s been on a business trip since Monday morning. He’ll be home tonight. I’m keeping her home today even though the medicine makes her seem completely fine. We are honoring the school rule of not brining a child to school within 24 hours of a fever.

Right now, two red blankets are on the floor (red carpet), the costumes are prepped and the fashion show is about to begin.

Gotta go.

That would be my temperature for the previous three days. It hit on Friday night along with chills that didn’t stop. I slept in a tshirt, sweatshirt, long pants and with 4 blankets. Chills all night and the fever never broke. FirstHusband was my knight in shining armor (if knights do laundry, work on the taxes, finish multiple outstanding home repairs and take complete charge of the kids all weekend).

I didn’t get out of bed Saturday until I dragged myself to a Doc in the Box at 4:30 p.m. After waiting 2 hours while the ibuprofen wore off and my temperature rose again, the doc came into the examining room and greeted me with “so we have a sick little girl here.

No verbal response (Do not mess with me).

Then the questions:

“When did this start?”

“Friday a week ago I came down with what I thought was just a head cold, hardly any fever, stuffy nose, sinus pressure. By Thursday I was feeling much better. I even worked out with my personal trainer Friday morning and I felt fine. Last night, I got much worse, fever of 103, chills, pretty bad chest congestion, horrible sinus pressure . . . and then the helicopter landed on the roof and the aliens ran away with all my tissues . . . (What?  Ok, I didn’t say the last part, but I could have.  He wasn’t listening.)”

(there were more questions with lack of eye contact or acknowledgment of answers, but I would just get irritated reliving them, so let’s just skip it.)

First, the doc looks in my ears.  (Did I say ANYTHING about my ears?  No.  No I did not.)

Then he looked at my throat.   (Did I say my throat hurt?  No.  No I did not.)

Then he holds the stethoscope on my back, on top of my double layer of tshirt and fleece pullover while I breathe once, twi . . . (choking coughs) and doc says, “sounds clear.” (what? one breath? how could you even hear over all the coughing?)

He doesn’t look in my nose.  Doesn’t touch my neck to see if anything is swollen.  Nothing.

His diagnosis? “A little cold.”

So it’s viral? (a little cold? a little cold? Buddy, I’ve had a little cold before and I can stand up with a “little” cold.  I can sit up with a “little” cold.  I don’t have to sleep with my upper body elevated when I have a “little” cold . . . arrg!  let’s just skip it.)

“Probably viral, but just in case, I’ll write you a prescription for a Z-pak. (and do I take it just in case it is bacterial? or just in case I get worse?) You do have a low-grade fever, so just take ibuprofen for that. (low grade fever? 103?  what is a high grade fever?) Get plenty of rest and drink lots of fluids (Carole Brady could have told me that.)

Since I have no confidence the Doc in the Box and since I’ve had pneumonia 4 times in my adult life, I filled the prescription to fight off any secondary infections that this “possible” viral infection is making me vulnerable to. I already have an appointment with my doctor on the last day of the Z-pak to follow up.

I came home from the Doc in the Box at 7:00 p.m. Saturday and went in the dry sauna for 20 minutes. (I have one in my garage - tell you about it later.) After completely clearing my sinuses, sweating out lots of toxins and hopefully boiling some nasty little germs, I went back to bed and did not get out until Sunday night. A few hours later, I forced myself to go back to bed with an Ambien so I could expedite more internal germ fighting.

Unfortunately, I really had to work Monday (today) and need to tomorrow as well. I loaded up on Sudafed (the real stuff) and ibuprofen and I actually felt pretty good. Tired, but not bad. No fever while the ibuprofen lasted and more than 24 hours since my first antibiotic.  Although, I was a total germaphobe today. I used an entire bottle of hand sanitizer on my self and the keyboard I touched, I wouldn’t shake anyone’s hand, I wouldn’t touch anything or sit near anyone and told everyone I encountered to wash their hands.  (To which nearly EVERYONE I encountered replied, “It’s okay, I’ve already had it.“)

Tonight, I let the ibuprofen wear off and my fever is only 100.2. Now that seems low grade.

So is this the flu everyone is talking about? I thought the flu included nausea and body aches with a little ralphing. I don’t have nausea or body aches and although I didn’t eat anything all weekend, I still don’t think I would have parted with it later. I’ve just got cold/bronchitis/sinus infection symptoms - but some kick (my) butt symptoms. And when I do get better, will I be immune to this nasty little flu - until it morphs itself again?

What a pain. How irritating. I’m going to bed. After I pray my kids don’t get this. I’ve been giving them “air” hugs since Friday.

Anemia? What? Are you sure? Iron supplement for two months? TWO months?

I don’t wanna. (in a big baby whining voice.)

I’m just going to sit down for a minute.

I’m wiped out. I’m going to bed. (at 9:00 p.m. on Friday night)

Wait, what’s that on my leg? And another one on my arm? How did I get BRUISES?

ohhhh.

I took my first iron pill yesterday. Why don’t I feel better yet?

How long is this going to take? I need to finish painting the bedroom and the lawn needs mowed.

DO NOT TAKE (wow, all caps even) within one hour before or two hours after antacids, eggs, whole grain breads or cereal, milk, milk products, coffee or tea.

COFFEE? Seriously. COFFEE?

AND I can’t take the iron within two hours of taking Nexium!

When am I supposed to take this stupid thing then? (again with the big baby whining voice.)

Stupid Nexium probably caused this.

Stupid fibroids probably caused this.

Stupid weight training probably caused this.

Well, this is . . . a pain, annoying, inconvenient, ridiculous . . . stupid.

I don’t WANT to play anemia. This game is stupid.

I’m going over to read Elle’s post again.

And I’m going to paint the bedroom. It’s just going to take a little longer to finish, that’s all. Hey, FavoriteSon! Mow the grass please!

Thank you God, that blogging doesn’t require physical exertion.

. . . just need a snack? How many kids are disciplined for poor behavior when they really just need a complex carb? We spent a few years giving time outs and taking away privileges before we figured it out.

Recently, our 1st grader’s teacher was diagnosed with “really bad germs in her chest.” She’ll be taking “really strong medicine” to kill the “bad germs” and some of the medicine will kill the good germs too, which will make her very tired and she won’t feel well. (PLEASE add her to your prayers.)

Among other things, this means PinkGirl has a different teacher for the rest of the year. I had to write this letter to the new teacher tonight and it got me thinking. Before you get frustrated at your child’s behavior or issue the time out, check the clock. You know your kid. When is the last time they ate? Could it really be this simple? Here’s the letter I wrote:

Mrs. L,

PinkGirl mentioned that she cried yesterday after recess, which we understand is just before lunch. I’ve sent a box of unsweetened fruit juice with her today for snack and would like her to have it at that time. It should prevent another problem such as the one she had yesterday. She was very embarrassed that she cried in front of her friends. We know the other children are drinking water, so anything you can do to minimize the fact that PinkGirl has juice would be very much appreciated.

PinkGirl has hypoglycemia and we have been successfully managing it for nearly 3 years. She can usually make it from snack to lunch, but when she is excited, has physically overextended herself or is under stress, that window of time diminishes. Her symptoms vary, but the big thing to watch for is emotional instability. She may cry and not be able to tell you why, she may find tragedy in an inconvenience or she may just simply display irritability. These are the mild symptoms.

When she exhibits any of these or similar behaviors, our first response is to check the clock. Nine times out of ten she needs some “energy.” It is very important to us that PinkGirl not internalize this as “I feel bad, I need to eat something.” We call it energy and are teaching her to recognize when she needs some. We are also teaching her which foods will help her (and which foods will not).

It’s important to understand that she cannot, by sheer will alone, modify her behavior. If not addressed, her symptoms can escalate. An extreme episode is very rare, but is characterized by uncontrollable crying, difficulty catching her breath, excessive yawning and extremely negative self-talk. Again, this is very rare, and she would be crushed if this happened to her in front of her friends.

In an emergency, sweetened juice or soda can provide an immediate relief, but she needs a complex carbohydrate very soon after to maintain a steady blood sugar level or she crashes again.

I’ll send the juice for snack for a while. We believe this will help PinkGirl during this time of adjustment. After we switch back to water, I’ll still send the juice in her lunch box, just in case you need it.

I’m sorry to inconvenience you. PinkGirl seemed to be doing so well with this, we weren’t expecting a problem.

Thanks for your help.

Recognize anything? If so, give a hug and a snack instead of a reprimand and a time out. I’m going to go kiss my daughter now.