Tuesday, July 19, 2011


The therapist recommended that we arrange to have Neuro-psych testing done on our son. 

We had no idea that Neuro-psych testing even existed.  Neuro-psych testing is a special series of psychological tests, including an IQ test. 

We were going to be able to find out how his brain worked!  The therapist also thought that it could help us understand more about why he has trouble in school.  She thought that we would be able to find out what other problems he might have that would have an impact on his abilities and on how he learns.

This is the recommendation that she wrote for the pre-registering paperwork:

“He struggles with school including following directions and following through even when h seems motivated and is cooperative (not defiant or oppositional).  During some interactions, he seems to have the abilities that one would expect of someone his age.  At other times, he does not seem to have the reasoning skills that we would expect of a well-parented child of his age, and we have questions about intellectual functioning and executive functioning.  I suspect that he covers for himself when he doesn’t know things or understand what it is that’s expected.  He uses his sense of humor and avoidance as well as other strategies.  Also, he has significant visual impairment, and we’re wondering if he does not receive visual information due to perhaps filtering out since so much is blurry to him.  What recommendations can be made or referrals for occupational therapy or other interventions to help him find a successful career path?”

Wow.  That is a lot to think about.

She had come to really know a lot of things about our son during the previous 4 months or so.

I would say that a kid who got himself started on drugs at the age of 12, definitely has a problem with reasoning skills!  It was nice of her to say that he was a well-parented child, though.  She does seem to think that we are good parents and that our son should be glad that he has such good parents.  It makes me feel better about how things have been when I hear her say that.

We had to wait five weeks for the appointment.  Then, the testing lasted for seven hours.  After it was over, my son said that he didn’t know that a brain could hurt, but his did.  He said it was more like a pulled muscle than a headache. 

We were interviewed together and individually before the testing started.  During the interviews we learned that drug use to the brain is just like having a traumatic brain injury—much like the concussion that he had from crashing into a tree while snow-boarding without a helmet.  She said that the concussion was not a good thing for his brain, either.  Even a few weeks of drug use can lower a person’s intelligence.  Especially drugs like Ecstasy.  She was genuinely sad to learn that he had used Ecstasy. 

And, a baby born with drugs in his system starts out with possible damage to the executive functioning area of the brain.  If that child uses drugs at some point, he just does more damage to his executive functioning abilities.

I wanted to learn more about executive functioning and found out so much that explains why my son has struggled in many areas.  Problems with executive functioning can affect:
Decision Making
Deciding what to do with information or knowing what information is relevant
Error correction or trouble shooting
Needing to override automatic responses
Technically difficult situations
Dangerous situations
Situations that require the overcoming of a strong habitual response
Resisting temptation
Being able to select the appropriate responses or behaviors
The ability to recognize and learn patterns
Having the cognitive flexibility to respond to set changes and make a shift in set
Relatively simple processes like attention and processing speed.

Two weeks later we met with the Neuropsychologist for a verbal report on the findings from all of the tests.

I took notes as fast as I could and they came out like this:

       Verbal comprehension:  average range
       Vocabulary:  excellent
       Comprehension:  average
       Social conventions:  harder
       Perceptual reasoning:  average
       Working memory:  average
       Processing speed:  Below average 

       How quickly you can access your intelligence shows a significant difference. Your brain goes slower than your intelligence.
       People who have this, often give up because the big discrepancy between the intelligence and the processing speed causes frustration to the system.  It likes things to be even.

       Processing speed is affected by drugs and alcohol.  It will just get worse if he keeps using.  He can’t afford to do that anymore.

       School will actually help protect his brain.

       Reading:  average
       Math:  high average
       Verbal fluency:  Very superior
       Vocabulary:  average
       Fluency:  Very superior

       She said with his verbal fluency being so superior that he would make a really great salesman and that he should make sure he uses his powers for good, not evil.  She laughed.

       Now when they tested verbal fluency in a situation of switching back and forth from one subject to another, he went back down to average.  So, his ability to switch back and forth brings him down.

       His visual function is average to low average but is based on his poor vision.

       He should pick a verbal field of work over a visual field of work.

       Memory Function:
       Visual:  low average, more difficult
       Verbal:  Fantastic
       Word selective memory:  high average
       Object recall:  high average
       Paired recall:  no difficulties
       Verbal memory:  looks really good

       Executive functioning: 
       The switching ability that she mentioned earlier is a discrepancy that creates a problem.  Most of the world can shift from point to point with no problem. 

       He expects his brain to “click fast” and his “clicks slower”.
       When he gets frustrated she told him to take a break, relax, take a walk and then go back to the task and start again. 

       When things are structured and provide immediate feedback, he does really well.
       Unstructured, timed things that don’t give feedback he does not do well on.

       Recommends 504 plan to give more time for assignments and to break assignments up into pieces.

       His pre-morbid history affected the executive function of his brain, but he is still doing better than average.

       Said again that he should pick a more verbal job than a visual job.

       She said that nothing is stopping him.

       He should make sure that he doesn’t use drugs or alcohol because he has enough risk factors.  Everything will change for the worse if he continues.

       He should set a goal for healthy living and exercise.  She said he should become a health food fanatic.  She said that it has been shown that exercise improves brain function.

       Mood functioning problems:
       Shifting of tasks
       Working memory
       Keeping on task
       Staying on task
       Giving up before you start

       She asked him how he could approach tasks more slowly and deliberately.
       He said that he would have to make a conscious decision to slow down.
       His processing speed is so significantly different that it takes longer to access it and he stops trying.

       She said for on-going support:
       Mood functioning
       Possibility for cognitive therapy to learn to create structure when there isn’t structure, but right now school is the best thing.
       Substance abuse disrupts structure.

       Executive functioning has more difficulties in problem solving and switching.

       Keep ongoing evaluation of visual function.  Occupational therapy for visual function is in its infancy and will be a possibility in the future.

It took several months to get the actual written report.  This is the paragraph that she wrote about her impressions:

“The patient is a 14 year old male who was referred to a neuropsychological evaluation in order to assess his current cognitive functioning.  While intellectual functioning is noted to be in the average range for verbal and performance domains, his processing speed is in the borderline range.  This represents a significant discrepancy in his functional abilities and likely is exacerbating affective and behavioral functioning.  Further concerns in this evaluation indicate marked differences between high-average to superior verbal abilities in multiple situations as compared to low average visual spatial processing.  This is likely linked to lifelong Nystagmus and resulting is problems in scanning as well as incorporation of information.  The patient is demonstrating difficulties in executive function, again complicated by the above noted problems.  Finally, these problems are most likely associated with difficulties in mathematics (given its heavy visual processing component) as well as visual memory issues.  This patient also demonstrates mild disruptions in delayed verbal memory functioning despite intact immediate performance.  This is again likely linked to executive function disruptions and processing speed difficulties.  It is a further complication for academic achievement.”

Some of the most interesting things that we learned were that his intelligence is above average, but his processing speed is below average.  This means that he has difficulty accessing his intelligence as quickly as his brain wants him to.  When learning anything in school, or when trying to complete a problem because of this discrepancy, his brain just tells him to give up.  The reason that the ADHD medicine helps is that it helps him speed up his processing a little bit AND helps him with his motivation.

The second thing is that every use of drugs and alcohol will adversely affect the processing speed and make things worse.  She repeatedly told him that he can’t afford to do that anymore because he has enough risk factors as it is.

In school from now on, he will need to be given more time for assignments and break assignments into pieces.  Getting one piece of an assignment done and then receiving immediate feedback on it will help him.  He will need to approach tasks more slowly and deliberately, making a conscious decision to slow down.


I have been saying this for years!  I have repeatedly told the teachers that he has a hard time getting the information from his brain to a piece of paper, that it took 2 or 3 times as long as normal to complete assignments, and that he has a problem sticking to an assignment until it is done!

It feels so good to have PROOF.  Now, the school will HAVE to accommodate him and help him succeed instead of just setting him up to fail!  I think it is going to be a very time-consuming process to set up and manage, though.  But, I am excited to see how this information can help him have 3 more years of school that are actually successful for him.

This is what I mean about getting more and more information that I wish I had known and had validated years ago.  He could have had more help in school.  He could have had more understanding.  He could have had more success.  We could have had less school-related arguments.

He could have not turned to drugs.

Could have..

They say you should not “should” on yourself.

I guess we can’t “could” on ourselves either.

But, I probably will.

Sunday, July 17, 2011



We get used to being treated certain ways in certain situations and maybe we come to expect it every time.

Or, maybe it was just happening again.  A problem with a teacher at school.  A problem with a teacher understanding my son.

I have already talked about how he was doing a lot better with school since starting on ADHD medication.  He was able to pay more attention, get more work done, and was so proud of all of the A’s that he was getting. 

After the first month or so in treatment when he was refusing to cooperate in school or in any other way, he actually started trying to do his school work.  But, he could not get along with the teacher.  They clashed all of the time. 

When he was released to Day Treatment he said that if she didn’t change how she acted toward him, he WASN’T going to go back to school.  He even wished he could be switched to the class with the older boys, just to have a chance at a better student/teacher relationship, but that wasn’t able to be done. 

He said that during the first few months in the program when his cooperation level was so low, he understood why she was exasperated with him.  He thought that now that his attitude had changed and he was trying so much harder, she didn’t really have a reason to be impatient with him anymore.  But, she was short with him, wouldn’t listen to him, would cut him off in the middle of a sentence, was unwilling to listen to his questions, and acted like she couldn’t stand him.

And so during his first few weeks at home, he had quite a few days where he was too “sick” to go to school.  For the most part, though, he did not give us the hard time that we thought he would, even when the teacher/student relationship did not improve with “Mrs. Smith”.

I may have suspected that he was just trying NOT to get along with her, but this problem seemed almost exactly like all of the other teacher problems that we have had with him at school for years.

On the day that we admitted him, during our interview with her, we explained how our son struggled with school, had a hard time completing work as quickly as expected, and that teachers would become impatient with him—acting like they thought he was just lazy and unmotivated.  The more they thought he was being lazy, the more he would just quit trying.  She promised us that it would not be like that in the school program there.

And yet, most of the time, it seemed exactly that way.

The sad thing was that if my son hadn’t gotten anything else out of rehab up to this point, he did seem to have gotten a desire to improve in school.  He was still so happy with all of the A’s that he was getting and credits that he was earning.

I knew that his success at school depended a lot on how things were going at home, but when our home situation improved after his re-instatement, the school situation continued to be a struggle.

After his re-instatement, “Mrs. Smith” began to point out more and more wrong things that he was doing as if she were out to get him.  Was she upset that he had not been expelled?

I was worried that if this feeling of being disliked continued and that if she always seemed to be angry with him for not understanding the material and needing help and more time on assignments, then the old cycle of “why bother trying?” was going to start with him again.

Many, many times his daily target sheets stated that he “didn’t complete homework”.  It seemed like an all or nothing kind of expectation with her.  Not one question or math problem could be left undone, even if he didn’t understand it and wanted to get help with it the next day.  This constituted the statement “didn’t complete homework,” which didn’t make any sense to me.  When he did complete every problem—if there were any wrong, then she still would comment that he didn’t complete his homework or that he did sloppy work. 

I wished that she would realize that she could get more cooperation and motivation out of him if she would be patient, understanding, and helpful.

Seriously.  In a rehab school class that consists of 8-10 boys with emotional and behavior problems, why isn’t the teacher patient, understanding, and helpful?  That is what the boys need and that is what the parents probably expect.  I really think that kids who have to be in rehab, kids who hate every minute of it, and kids who feel like they are never going to forgive their parents for putting them in rehab, deserve a teacher who will make school the best it can be while they have to be there.

I am proud of my son for persevering though.  He would say that he was “done trying with her”, but then his sponsor would encourage him and he would do his homework as best as he could.  Thank goodness for his sponsor.  I am glad he has someone else in his life who can give him advice about school and life in general, especially when it is someone that he has a lot of admiration for. 

I had to walk a fine line of offering help and encouragement, while not lecturing and trying to force him to do his homework as I have done in the past.  I had to stay detached and make sure that feelings and emotions didn’t get involved.  That was hard for me.  I was used to getting into homework wars with him.  I also was used to getting very upset when I felt he was being treated unfairly by teachers. 

His therapist helped us see that trying to make him do his homework, fighting with him about school, and even insisting on helping him when he doesn’t want our help—are all things that we cannot do anymore.  We can let him know what the expectations are.  We can offer to listen to him.  We can help if he asks us to.  But, we can’t force him to learn.  And, we can’t make teachers understand him.  The only thing we can do is give them as much information as possible about him that could help--and hope for the best.

I wish we had known years ago that we should not make school such an issue in our relationship.

We keep learning things that we wish we had known years ago. 

It makes me wonder what kind of difference it might have made in the direction his life went.

Hindsight doesn’t help that much now.

I just hope that what we are learning helps him in school in the future.

Not that I am looking forward to school in the future.

I think school is most likely one of the most dangerous places on earth for a recovering teenage addict.

The new school year is going to be here before I know it.

I can honestly say that it terrifies me.

Saturday, July 16, 2011


Sometimes when I watch my son and his behaviors, I wonder if he is OPENLY CONFORMING, WHILE SILENTLY REBELLING.

What is he REALLY thinking while complying with the rules most of the time?  What is he REALLY thinking when he chooses not to argue as much anymore?

Is he going along with one of the recovering addicts philosophies of “Fake It Till You Make It?” 

or is he faking “Fake It Till You Make It?”

“Fake It Till You Make It” means that he begins making changes by faking the behaviors that he is supposed to have and practicing the skills that he is learning long enough for them to really stick.

I think that once the kids get over being angry at their circumstances, and stop blaming others for their problems, that the next step probably is pretending that they are what they are supposed to be or what they want to be.  Then, maybe it will  feel like they naturally CAN BE that way.

But, I think that some of them get away with the faking and pretending part and never achieve the actual BEING part.  They don't ever get to the point that they know they are doing it for the right reasons.  I think those are the ones who relapse again and again.

So, I don’t like the phrase “Fake It Till You Make It.”

The same philosophy could be said in other ways that don't sound as catchy, but do sound more honest.

I like:  “Act the way that you want to be and soon you become the way that you act.”

“Act as if..”

“Old habits die hard, but if we keep practicing the new behaviors, they will feel comfortable and righteventually.”

“See yourself as the person you would like to be and act the part until you are that person.”

I want to believe that my son is really trying to be the person that he would like to be.

But, does he even know at this point what kind of person he wants to be?

I wonder if he is he just going through the motions until he can be released from the program and get back the freedom that he lost?

What will he do with that freedom?  And how easy will it be for me to let him have it, not knowing if he is actually ready for it?

In some ways, I think he is just the kid who doesn’t want to be in rehab anymore.

But, I also desperately want to think that I see the kid who doesn’t want to be an addict anymore; the kid that knows that going back to using drugs would be a big mistake; the kid that wants to change his life; and the kid that gives me hugs because he wants to have a good relationship.

I want it to be real, not fake.

I have hope that it is.

Wednesday, July 6, 2011


It was very nice to have him back at school for the rest of the day, but when he came home he was very grouchy.  We had been trying to have dinner together every night, but he refused again, just like he had been refusing for the last week.

He thought that since he had been re-instated to rehab, he should have the X-box back, immediately.

He quietly listened as we explained that we needed to establish some new rules since everything had gone haywire in the last week.

Then, he went to his room. 

The rules were:
1.  Do one chore each day, before playing the X-box.
2.  X-box time is determined by parents.
3.  X-box usage is on a daily basis depending on all rules being followed.
*4.  Treat parents with respect and in a positive, kind manner.  No swearing and talking negatively to us.
*5.  Follow rehab facility rules and behavior expectations.   Keep committed to working through the program positively.
*6.  Do homework
7.  Give controller back each night.
*8.  Be willing to do family things with us that we normally do.  (Go out to dinner, go to movies, go camping, etc.).
*’d numbers are general rules, not just X-box rules.

Lose the X-box for a day for:
1.  Disrespect (breaking rule #4)
2.  Swearing (breaking rule #4)
3.  Not doing rehab facility requirements. (breaking rule #5)
4.  Telling us what you think you are going to do without regard to the rules or expectations.

Apparently, he wasn’t planning on doing anything with the new rules that night. 

He had taken up “tagging drawing” in the last week and spent the rest of the night lying on his bed drawing.  He acted as if he could care less about playing the X-box anymore. 

He definitely had a hidden talent for tagging and had actually done some pretty good work on his sketch pad.  We wondered why, all of a sudden, he had decided to start this kind of drawing, but at least he was doing something.  Maybe this could lead to an interest in graphic art and would be something he could make a career of.  Anything was possible, I guess. 

It made me slightly nervous that he was practicing tagging since he had a period of time in rehab where he had been gang-talking and would only wear his red and black clothes.  He declared that it had nothing to do with gangs and that he wouldn’t go around spray painting buildings and fences.  

It was another one of those things that we just didn’t know what to think about, but couldn’t help but worry about.

It was fine that he didn’t want to play the X-box, but not fine that he was still isolating himself and acting as if the rules were inconsequential to him.

So, I decided to give a small lecture.

Because lectures are so effective.

I told him that one chore a day isn’t that much to ask and that it definitely helps me out if others who are living in our house, actually contribute a little bit when it comes to keeping it clean. 

I also reminded him that there were things on the list (the ones with stars by them) that pertained to everyday life, not just the X-box and that those rules needed to be followed whether he played the X-box or not.

He seemed to understand that.

I asked, “Is it really worth it to you to just not play the X-box so that you won’t have to do one little chore a day?”

I did not get an answer.

Surprisingly, after my little lecture, he stopped acting as grouchy toward me.  (Not necessarily toward my husband, though).

But, he still did not do a chore that night.

Over the next few days there gradually began to be more cooperation in our house and less arguing.

Something seemed to have changed for the better, as if some kind of awakening had happened in my son.

It was nice to see him waking up.

It was a good thing.