Hyper-Active Intervention

A foster parent came to me with a question, "My child is hyper active to the point the dog is nervous to be around her.  Any suggestions?".  The dog used to go to sleep in the car; after being around this 11 year old girl the dog urinates in the car, won't sit down, and begs to get out.  The child talks endlessly, jumps out to scare the parent when he gets home from work, startles when approached from behind, can't settle down once she gets wound up.  All this activity without any reprieve and the parent is going to get burnt out.  With holiday activities in full gear and additional family members in the home, some members whom the child has never met before, anxiety and hyperactivity are only increasing.

 I have more questions than suggestions.  Does the child have the ability to control herself?  Often times medications physically effect a child, beyond her control.  What has happened recently that might have influenced her behavior?  Changes can include medication, people she comes in contact with, family visits, change in legal status, situations at school, change in season, or simply the end of a honeymoon period.  Does the child realize that her behavior is hyperactive?  The child may or may not recognize her behavior as out of the ordinary or problematic.  And even if she does recognize that she is "hyper", she may not be able to identify in concrete terms what "hyper" means.

Three cheers for this foster parent!  First, this dad preserved the safety of his home for everyone, including the animals.  He put limits on time with family pets.  Therapeutic Foster Homes need to put safety first.  Ensuring a safe environment allows for children to trust.  If dad had not protected the animals, then how does the child know who in the home falls within dad's protective bounds.  Second, both dad and mom provided opportunities for the child to play, go outside, draw, do pottery, talk and sing to herself (what child doesn't love an opportunity to be their own rock star!).  The family bakes, does crafts, and puts on puppet shows together.  What a rich opportunity for this child to be active and creative after sitting still and being quiet at school all day.

However, all the activities do not negate the need for learning the appropriate times for such heightened activity and the appropriate times for calm. Often times children do not make the connection between their feelings and their behaviors.  As emotional teachers, parents need to facilitate children making those connections for themselves.  I'm all the time helping my own children make the connection between their grumpy, whiny tantrums and their recent sugar consumption.  My hope is that as they grow older they will be able to take care of themselves and make healthy decisions.  I also hope that they will be aware enough of their own body to put precautions into place when needed.  I suppose this is the 3 year old's equivalent of appointing a designated driver when attending a party where alcohol is being served.

We have to teach children emotional intelligence; teach them how to pay attention to their bodies and feelings, understand how those feelings impact their behavior, recognize how that behavior impacts themselves and others, and then know how to alter their behavior and make safe decisions.

The first step is to engage that child in a conversation.  The child is the clue to the interventions that will work for her.   Always use the sandwich model for these conversations: remember positive-what needs to change-positive.  ("Honey, I'm really proud of you for staying calm and focused at school."- "Let's talk about how you might be able to do that at home a little more."- "You are an amazing kid to help me figure all this out.  Thank you so much.")

 1)  Explore the problem and desired behaviors.  Lead the child in a brainstorming session about what hyper looks like: what does she feel when she's hyper, what does she do when she's hyper, how do those behaviors impact her and other people?  What does calm look like: what does she feel when she's calm, what helps her feel calm, what can others do to help her be calm?
2)  Define Expectations.  Children need to know they can trust someone else to be in charge.  They also need to concretely know what we expect. ("Listen to me" is not a clear instruction.  Define "Listen", what does "listen" look like.  Listen means to close your mouth, look at my eyes, hear what I am saying, then be able to repeat it back to me.)  Discuss important times to be calm: school, meal times, bed time, church.  Discuss times when it's okay to be hyper and what levels of hyper are okay: recess, after school, running outside, screaming outside, etc.
3)  Make a game.  Come up with a way that together you and the child can help her achieve success.  Help her start connecting her feelings and behaviors.  Is there a secret signal you can give when her hyperactivity is starting to increase?  Think baseball.  Can you pull your ear or scratch your nose to signal her to use some of her calming skills?
4) Reward.  What does the child like?  What does she think she deserves if she's able to accomplish the task at hand?  How is she going to earn that reward?  Maybe she gets a sticker every time she is able to calm down 5 minutes after you flash the secret signal.  If she gets 4 stickers in a week, maybe she earns a magazine or a trip to roller rink or a special outing with dad.  Figure out what works and use it to REINFORCE positive behaviors.

Remember a lot of adults do not have the emotional intelligence to make safe decisions.  Don't expect your child to be perfect.  Catch her using her skills and reward her.  Do this again, and again, and again, and again.

Home for the Holidays

I think by adulthood most people understand that holidays and anniversaries are not always as easy or as happy as we are led to believe.  Even a close-knit, healthy family has its share of dysfunction riding above the underlying joy.  As we grow and mature, we hopefully become better able to work out our differences, establish our own personal boundaries, and love each other through our humanity.  We learn the gift is giving, more so than receiving.  We learn that our families are our heritage, where we come from, but not necessarily where we are going.

Children in foster care have not necessarily learned these lessons yet.  Often the hurt of fear and rejection is still too raw to establish healthy boundaries, too raw to effectively balance the pain and the joy.  Holidays, anniversaries, and family visits throw a child into a whirlwind of expectations, excitement, hopes, confrontations, and dichotomies.  Often, children are reminded of what they don't have or confronted by the reality of home not being what they remember it to be.  Children are unconsciously being asked to weigh the life with their foster family against their life with their birth family.

This is an unfair expectation to place on a child.  As loyal advocates of the child, it is a family's and a worker's job to not make the child choose between parents.  We know asking a child to choose between parents in a divorce situation is wrong; it is just as wrong to ask a child to choose between sets of parents in a foster care situation.  Our job, as champions of the child, is to help in the restoration of the family.  Restoration does not always mean reunification, though that is certainly optimal.  Restoration means bringing the family relationships back to an earlier and better condition.

Here are some practical ways foster parents can enable this restoration to occur and make being home for the holidays easier on both the family and the child:

1)  Talk with the child before visits, being candid and respectful of what the child can expect from their family.
2)  Discuss with the child and with the family what would make this a good visit.
3)  Brainstorm with the child good ways to handle situations that might come up.
4)  Discuss and validate the child's emotions surrounding the event.
5)  Help the child to establish rules for himself (what is okay for my family to do with me and what is not).
6)  Always speak positively about the visits and the family members (this includes to other people and includes facial expressions).
7)  Provide the child with a way to connect with family (photos, work that the child has done, gifts for the family).
8)  Set the family up for success (one foster parent shared how she never let the child receive more presents at the foster family's house than at home, sometimes this meant giving the family presents to give to the child).
9)  Communicate with the family about what they can expect from the child and parenting techniques that have worked for you.

Pieces

I heard tell of a man, a used bookseller, who collected items used as bookmarks that he found in used books.  He found concert ticket stubs, love letters, receipts, postcards, letters from a daughter to her dying father in a nursing home.  The thought of collecting these items fascinates me and tugs at my heart.  Think of the lives these items represent, the hands who so often touched these items.  So often, I mindlessly grab things to stick into a book, but often the items are significant in some way and represent some memory that I want to hold on to or revisit often.  Bookmarks are only glanced at, but for a moment they recreate that special memory every time you open the pages of a book.  To other people, the items stuck in a book look like random worthless items, but to the keeper the item is a link to pieces of their life.

Imagine that you hear a knock on your door.  A person of authority enters your home and explains that she is taking you to a new home to live with new people.  If you say you won't go, the person explains very calmly and firmly that you have to and you will.  If you say you will run away, the person explains that you will be found and brought back.  If you ask why, the person explains that there is no other choice.  You are told to pack your things, but there is not room for any living things.

You are then taken from your home, your family, and brought to a new home, with new people you have never met.  This new family has been told all about you and they are very excited to have you come live with them.  You are shown to a room and told to make yourself comfortable.  You do not know when you will see your family again.  All that you have of your family, of where you come from, are those few things you packed in the 30 minutes before you were taken from your home.

What did you pack?  Some clothing essentials, a toothbrush, a favorite t-shirt, a book or some pictures.  Did you pack a blanket or a pillow?  An item belonging to someone you love?  How would you feel if your new family tried to replace those items, buy you "nicer" clothes and give away the clothes that you came with?  What if they washed that blanket or pillow and that familiar smell of home disappeared?  What if, as you sat on your new bed in your new home, your new family tried to "help" you and unpack all of your belongings, touch everything that you brought of your old life?

Children removed from their families and placed in foster care often show up on doorsteps with a garbage bag of belongings.  Often the children have little time to prepare for a move, little time to pack, little control over what happens in his life.  He has no control over the home he is placed in or when he can talk to or see his family.  Everything is new, the people he is living with, the school and church he attends.  Be careful how you treat a lice infested stuffed animal or a crumpled carton of cigarettes or a holey t-shirt. What a child brings may look like random worthless items, but for the child the item is a link to pieces of their life.

Deceit, the Downfall of Loyalty

Very seldom does sports news intersect with social work.   Listening to NPR last week, I heard a sports editorial on the child sexual abuse scandal at Penn State.  The commentator spoke of the loyalty Joe Paterno exhibited to the accused party, Jerry Sandusky.  The idea was stated that loyalty is valued and is often commendable, but loyalty would not be so valued if it did not come at such a high cost.  Loyalty comes with the risk of deceit, the risk of being let down and disappointed, the risk of finding yourself loyal to someone or something that cannot hold up their end of the bargain.

Foster parents experience this disappointment with children all the time.  Often a child will surprise the adults in their life and do incredible, amazing, out of character things.  A child will be vulnerable and share his heart, he might go out of his way to perform chores around the house, he might make a good decision to not use the drugs in his possession.  Foster parents hold a child to a different standard of expectations then the child might have previously known, and the child responds, blossoms.  In care taking, teaching, disciplining, and loving this child, in short, parenting this child, the foster parents begin to believe in the child.  The foster parents become fiercely dedicated to the idea that the child is doing well under their care.  The foster parents become committed to this child's future, fiercely loyal to the child and his ability to overcome all obstacles.  This is the way it should be.

But loyalty comes with a risk, the risk of deceit.  The risk that this child will not live up to all those standards and expectations.  The risk that the child will make decisions that hurt you, the foster parent.  The child might run away in the middle of the night, the child might steal from you, the child might accuse you or a family member of doing something you didn't do, the child might reject your offer of adoption, the child might go on with their life and never call you again.  This is the risk you take as a foster parent.  You take the risk of putting your life, your family, your word on the line, committing everything you have to the success of the child, only to find that the child might leave those aspects of you in disrepair.  We take the same risk with our own birth children.

This deceit, however, is what makes loyalty so valued.  If a child has one loyal person in his life, he can count on that person to love him unconditionally.  He can count on that one person to see the best in him, even when he can't see the best in himself.  He can count on that one person as seeing him as valuable,worth the risk.  Everyone needs someone in their life to be loyal to them and loyal to their best interest. Children need a loyal champion, someone who will not stop believing in them, someone who will not stop dreaming for them, someone who will not stop fighting for them.  Even when they are gone.  Deceit is a tenet of loyalty.  Loyalty, just like love, is a choice that we make.

Loyalty is not a choice to always believe someone, or to always defend someone.  Loyalty is the choice to stand by what is good for that person, whether it be to experience the consequences of his actions or to support him in reunifying with his birth family.  Loyalty gives a child a chance to believe in himself because someone believes in him and is willing to risk everything.

Song of Solomon

In Song of Solomon, Toni Morrison's character Pilate recalls an unsual incident from her past.  Pilate, employed as a housekeeper, is washing dishes when her employer enters the house.  The man is shaking and frightened, convinced he is standing on the edge of a cliff.  Standing in the middle of the kitchen, the man is terrified that he is about to fall off the edge of the cliff and plummet to his death.  Pilate, in an act of creative wisdom, walks behind her employer and grabs him around his waist to prevent his falling.  Pilate holds the man there in the center of the kitchen, soothing his fear of falling off the cliff.  While they are standing in this position, the wife enters the house and is immediately suspicious of Pilate's activities with her husband.  Pilate explains that she is keeping him from falling off a cliff.  The wife demands Pilate release her husband.  Obedient to her employer, Pilate let's go and the man immediately falls face down on the floor dead.

The symbolism of Pilate's intervention parallels to the way foster parents use their creative wisdom to help children.  Children come into foster care in crisis, experiencing trauma from varying types of abuse and neglect.  The trauma is often so severe that a smell, a fabric pattern, a room, a tone of voice, can trigger  a child back to the circumstances of their abuse.  To the outside observer, the child is not experiencing anything abnormal, but in the mind of the child the trauma is happening all over again.  The experience is just as real to the child as it was the first time and we have to respond accordingly.

As professional parents, it is critical for foster parents to make their home safe.  Just like Pilate, foster parents need to provide safety to a person who is experiencing an unobserved trauma.  Safety can be established with appropriate boundaries surrounding routine times, times that to many families are not threatening: bath time,  bedtime, travel time in the car.  Often, this need for safety must result in parental creativity.  What do you do when a child will not sleep in his bed at night?  What do you do when a child refuses to take a bath?  What do you do when a child hoards food and sneaks food into their room?  How do you show a child affection when they refuse to be touched?

Foster parents working together with each other and supervisors generate some of the most creative and sensitive ideas to respond to a child in crisis.  One foster parent told a story of a child who refused to sleep in the bed provided for her.  No matter what the parent did, the child slept in the closet.  The child shared that, when she was at home,  her mother kept her safe at night by hiding her in the closet.  Instead of forcing the child to sleep in bed, the foster parent made a comfortable pallet in the closet and decorated the walls.  The foster parent abandoned her own need to be seen as the perfect parent, with a home where children sleep in beds, for the higher priority of meeting the child's needs to feel safe.  The same foster parent was caring for several abused children.  Because so much of their abuse had occurred at bath time, the children would not get in the bath tub and would not allow themselves to be touched.  Weighing the costs of cleanliness and safety, this foster mother came up with an idea.  The solution?  Set up a kiddie pool in the kitchen and let the children put on their bathing suits and play in soapy water.

We must engage children in creative responses to their fears and traumas.  We must maintain both physical and emotional safety in the home.  When we move beyond our natural responses, when we overcome our own pride, when we acknowledge a child's experience as real, when we help them overcome their fear and meet their need for safety, this is creative parenting.