It's All About

MORGAN!

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LIFE IS AN EMOTIONAL ROLLERCOASTER 

Having a brain and nervous system bombarded with bipolar disorder, anxiety, and autism, it is no surprise Morgan's emotional state can turn on a dime. One minute she's puttering along contentedly, then suddenly she is sobbing her eyes out saying, "Morgan be happy now! Morgan stop crying!" Add to that the physical symptoms of mental illness (like headaches, malaise, stomach pain) and autism's typically screwy gut and even screwier sleep patterns, and it is no wonder she struggles.

Meds aren't perfect (but WOW have they helped!). Even when the meds are at their best and she has no specific reason to be anxious, angry or sad, she has bad times within the day or bad days, when she is miserable or angry seemingly out of the blue. Sometimes she just needs a good cry to vent it out.

behavior

SPECIFIC KEYS TO BEHAVIORAL SUCCESS

Monarch's methods have been very effective with moderating Morgan's behavior over time. She thrives on schedules, visuals, the talking timer, social stories, video modeling and the like developed at Monarch and MTEP. Since Lifeworks continues on the same model, the "keys to success" below are those that are not part of the Monarch Model, but are specific to Morgan's personality. 

CONTROLLING HER RESPONSE TO VIOLENT IMPULSES - THE NUMBER ONE BEHAVIOR GOAL

When Morgan was a toddler, she was a Tasmanian devil of violent destruction. Every frustration or emotion came out as scratching, biting, kicking or hitting those around her. As she got older and gained some control, the violence turned towards herself. She always had open wounds from biting herself, and bruises from hitting herself. She would still lash out at others, but mostly she beat up on herself. 

The older she got, the more she understood that violence was a "bad" thing, and the better the mix of meds got at helping her control her impulses. Now she completely understands conceptually that it is not OK to physically hurt others or herself, and if she does get overwhelmed to the point of violence, the self-recrimination and self-loathing after the fact is heartbreaking to watch.

She has come a really (really really) long way! But bipolar emotions, anxiety-fueled adrenaline spikes, and the frustrations of not being able to communicate are a volatile mix, and controlling her violent impulses is always going to be a behavioral challenge for her.

If she doesn't strike you as being violent (literally or figuratively lol), and some of the "keys" below seem like coddling, then YAY! We're achieving our goal!!! Trust me on this - the following keys really are key to everyone's safety and happiness.

Determining the difference between a meltdown and a hissy fit
Telling the difference between the two is absolutely vital because they need to be handled very differently. It can be something of an art form until you get to know her well (especially since either one can be precipitated by being told "no" about something she feels passionately or OCDishly about...) If her pupils are dilated, that is a sure sign of a meltdown. If she agitatedly bolts out a door, that is very likely a meltdown. If she is hitting or biting herself with intent to harm, it can be either. Raising her arm threateningly as if to hit you is usually part of a hissy fit.

Handling a meltdown
Once she is in meltdown, there is no reasoning with her. Disciplining her during a meltdown only serves to escalate the situation and does no lasting good, as she doesn't remember it. Meltdowns are a chemical fugue state, and until the adrenaline and other villains have settled down, all you can/should do is give her a safe, quiet place to get back under control. 

Handling a hissy fit
A hissy fit, on the other hand, needs to be handled firmly - hold the line!!! If you bend the rule "just once" and give her what she wants, that becomes the new "rule" and is MUCH harder to correct. Give into a hissy fit, and you'll have many more hissy fits in your future. She WILL test you. But usually, once you have "won" a battle of wills on a specific rule or subject, she complies thereafter. If she raises her arm as if to hit you, acknowledge that you know she is mad, and praise her for not hitting. But don't give in.

Handling self-injurious behavior
Do not attempt to stop her from biting or hitting herself. It will only prolong or escalate the situation or turn the violence to lashing out at you. 

Whenever possible, reword to avoid using the word "no"
Saying the word "no" can be like waving a red cape in front of a bull if Morgan is in a mood. Instead of saying "No fast food today," say, "Fast food is on the schedule for tomorrow. Want some popcorn?" Deflecting works better than confronting.

Don't lie to her
It often seems like it would be sooo much easier not to tell her about something upcoming that you "know" is going to to be a point of contention (I put "know" in quotes, because I have found you never really do know lol. Just when you think you've got her figured out, she surprises you...). Yes, it might work once to spring something painful on her without warning. But you will never get her with that tactic a second time, and she won't trust you from then on. Every schedule or request you make will be treated with suspicion and her general anxiety levels will skyrocket.

Caveat to the lying thing...
She loves to script and has a vivid fantasy life about what "her" people are doing when they are not with her. If she asks "Where's Mom [or Jordyn, or Bella, or the kiddos etc.]?" it is best to say "Mom is at Mom's house"  (or "Mom is sleeping" if it is night). If she insists that when you leave her, you are going to the PB&J restaurant and the movie theater, you will find that it is ridiculously difficult (and ultimately pointless) to dissuade her of that. In that case, just go with the flow.

Morgan is an emotional sponge 
As much as possible, keep your demeanor happy and calm. She will absorb your mood - if you are grumpy, she will be grumpy (and that will make you even grumpier - believe me! lol). "Good morning beautiful!" gets you "Why, hello wonderful!" and [mostly] cooperation in response. Whereas an impatient "Get up now!" gets you an agitated, "Stop fastering me! Be happy!" and the behavioral version of "bite me."

Use the power of your anger sparingly
Morgan sincerely dislikes making others unhappy. She gets extremely (disproportionately) upset if she thinks you are mad at her (deserved or not). Acting angry or giving her the "silent treatment" to underscore the importance of a reprimand will backfire - if she asks you, "Please be happy now," (which means she "gets it") but you persist in acting mad at her (even if warranted) her anxiety spikes, adrenaline dumps into her system, and she's off into meltdown fugue state. Any lesson that might have been learned is wiped out.

Morgan thrives on positive reinforcement
Positive consequences for desired behavior works. If you want her to change a behavior, tell her the specific behavior you want in a social story, and set up a system of bribes for cooperation. Getting angry or shaming her for undesired behaviors agitates her in the extreme and leads to meltdowns. Punishments for undesirable behaviors escalates the behaviors and has never been successful (she doesn't connect the punishment to the behavior, and just thinks you are mad at her).

Treat the time after bedtime meds as if she were in meltdown mode
To get her to sleep at all, she is on enough meds at bedtime to tranquilize an elephant. Now is not the time to "draw a line in the sand" or expect any discipline lesson to stick. Handle her much as you would handle a touchy drunk: deflect, cajole, de-escalate and get her horizontal so she'll pass out. There is a "sweet spot" between 45 minutes and 2 hours after taking the meds when they are most effective.

Handling a crying jag
Sometimes she will just start crying, seemingly out of the blue. (A classic warning sign of an approaching tear storm is if you hear her playing the Barney "I Love You" theme song over and over.) Let her cry it out in a safe private place. Offer her a white ice pack and/or Motrin (in case it is pain driven), but defer to her if she declines them. Give her a washcloth to dry her eyes and wipe her nose with. But generally, don't talk to her or try to physically or verbally comfort her. Just leave her be until she cries it out, checking on her occasionally. If she wants comfort, she will ask for a hug or hold her hand out to you. If you try to comfort her physically or talk at her, she will try to remember to use her words and tell you to "get a move" ("go away"). But if you persist, she may escalate into violence. Don't go there!

Handling defiance
She is usually good about sticking to her schedule, even if it is a "nonpreferred activity". If she balks, there is something going on (either physically or emotionally), and she is generally unable to tell you what (or how serious) it is. (For instance, she may not want to leave the house because she is having bouts of diarrhea... She may not want to wash her hair because her ears are feeling painfully sensitive). To gauge the seriousness of the request, I usually write out two (carefully chosen) scenarios with a big "OR" between them. For instance, if it is a fast food day, "Stays home today and no fast food OR go to Lifeworks then fast food" and have her choose. (If she chooses the "no fast food," you know it is serious lol). I make her point to the choice and say "Deal."

Handling lollygagging
Some days transitioning is harder than others, and she will "10 more seconds!" you to insanity lol. Making a deal with her about a certain number of minutes on the talking timer ("ten minutes on the talking timer, and then we go. Deal?" and make her verbally answer "deal") usually works. If you've tried that, and reminded her she made a deal, then casually pick up and walk away with her DVD player. That will get her moving.