I’m sure most have heard about the 15 year old girl from South Hadley, Mass who committed suicide after enduring the bullying of a group of classmates for a prolonged time.  As Amy was a victim of bullying, I can only imagine the heartbreak of her family.  It is this parent’s worst nightmare.  We struggled so long to keep Amy going so she didn’t choose this option to end her torment.

Below is a link to an interesting article by Dr. Keith Ablow which sheds some light about how bullies choose their victims.  I found it very interesting and probably true in Amy’s case.  His theory is that they can somehow intuit sensitive kids who can be more vulnerable than others.  I know this is the case with Amy.

http://www.foxnews.com/story/0,2933,590111,00.html

It’s funny, she has friends now who are trying to help her become stronger in sticking up for herself.  They’re trying to help her learn that she should confront those who disparage her at school.  One has even become her self-appointed body guard!

Hank and I are now on day three without Amy.  She is on spring break and enjoying it with her grandparents.  We are decompressing.

Amy is not an easy child to parent.  Don’t get me wrong, she is delightful and one of the greatest people it has been my pleasure to know.  I love her with all of my being.  However, it is exhausting to be her parent.

Until today, I never really could put my finger on why this is.  Today, however, out of the blue, it hit me.  I have to be constantly leading her.  Although it has been nearly two years since she was last hospitalized, I am still leading her daily.  Those three years of finding the right meds, therapist and hospitalizations, she lost three years of development.  She just doesn’t understand how life works.

We have to explain so much to her – why people do what they do, how to make friends, what she needs to do to complete a project, how to keep track of her stuff, etc.  It’s like puberty on an accelerated course.  We have to teach her what she should have learned along the way from ages 12 to 15 as quickly as possible and it’s exhausting.

So Hank and I are taking this week as a breather.

It’s been four and half years since Amy was diagnosed and we’ve just experienced the best year since.  She’s been doing great at school, has many friends, is involved in extra curricular activities and we haven’t had any lengthy depressive episodes in a year.  Life, as we knew it before, is returning.  The only problem is, I really don’t remember what it was like before.

I’m noticing spring as if it was my first.  When she was ill, I don’t think I ever noticed the change of seasons.  Now, I am seeing the grass going from brown to green and anticipating leaves on the trees.  I notice changes in the clouds again.  I feel the cold crisp air of the morning gradually warm to a more comfortable temperature by noon.  It’s hard to believe it’s been so long since I last noticed these things.

I’ve lived in the Midwest all of my life and the most destructive source I know is a tornado.  Living with a depressed child is a lot like dodging an errant tornado.  You’re never quite sure which way it will jump.  You just see the swirling chaos and try to stay a step away from the vortex.  As it moves, it destroys everything you know and just spews it randomly around you.

It feels now as if the tornado has passed and I’m going back trying to pick up the pieces that remain.  I was triumphant, though, because we all survived and at least we are all here to pick up the pieces together.

I’ve talked with many parents of teens with depression and a few are afraid of putting their children on medication.  They fear unknown long term side effects.  It is a difficult choice but Hank and I put it in black or white terms – either she gets the meds or she is successful in a suicide attempt.  That made the choice pretty easy in our case.

It’s not to say that we didn’t have problems with Amy’s meds.   During a six month period where we were trying to find the right combination and dosages, there were some nasty side effects.  And, even with the right meds for her mood, there are also some less desirable, but manageable, side effects.

She was on one anti-psychotic that made her like a zombie.  I swear she did everything but drool in the corner.  Another gave her what we came to find out was called dystonia.  The symptoms looked like a stroke.  She had weakness on her left side and her face was drooping.  I remember rushing her to the emergency room with her sister, all the way thinking my 13 year old was having a stroke.  We were very lucky as some benadryl took care of the problem (an allergic reaction to the med).

I wouldn’t want to change our decision.  I am hopeful as her psychiatrist is going to try to wean her off the anti-psychotic in May.  This is the worst med for her physically as it has caused a great weight gain and a higher than normal cholesterol and triglyceride level.  Maybe when she’s off of it, she’ll get back to a healthier weight.  Even if we’re unable to take her off of it, she’s still here every day for me to love.

Treatment facilities have different approaches in their treatment of child and adolescent psych patients.  Of course, upon Amy’s first admission, we had no clue about this.  This was one of the many first mistakes we made during her first year of treatment

The treatment facility we first sent Amy for treatment had the reputation for being the best so that’s where we went.  We were frantic – we just wanted to get her the best help.  She had attempted suicide and was deeply depressed.   We were also brand new to psychiatric treatment.

This treatment facility was very rigid in their approach.  Parents were only allowed to visit every other day for just one hour.   They told us we had to sign a blanket consent/treatment order allowing them to treat her any way they deemed fit – including electroshock.  Hank and I both got the feeling that we were suspected as being the source of Amy’s problems.

We did question their methods.  Their responses were condescending, as if we were questioning their experience and training. At the time, we had grave reservations about their style of treatment but we assumed that this was just the way psychiatric patients were treated and we should comply in order get her help.

Amy said that they were very strict in their discipline, too.  She later told us that she just did whatever they instructed and gave the appearance of getting better just to get released quickly.  She was released after a week and then went into the day program, which she participated in for another couple of months.

In retrospect, that treatment facility was probably very effective for adolescents who had a history of acting out.  During family group therapy, we learned that was the case with the other kids there.  It was, however, completely inappropriate for a scared, depressed 12 year old.

A year later, when Amy needed to be hospitalized again, we were more savvy.  We decided to shop around for her treatment facility treatment.  There were two other treatment facilities in our area that provided treatment and we decided to check them out.  We found a completely different program from the first.

We interviewed the program manager about their facility and treatment methodology.  We found that it was a better fit for Amy.  They were more nurturing in their approach.  They recognized that any treatment facility setting was stressful and the kids were already stressed before they were admitted.  They didn’t require a blanket consent form – we would have to consent to any treatment that was a deviation from what she was currently receiving, including any change in medication or dosage.  He stated that parents can be a contributing force in the child’s problems but it wasn’t just assumed that they were.  Visiting hours for parents were for two hours every day with the hours being accommodating to working parents. The staff was caring and treated the children as individuals.  The kids in the ward seemed calm.  I observed a nurse give a kid a hug and heard staff encouraging the kids.

Parents need to understand that each treatment facility is different and you need to do some comparative shopping to find the right fit.  Although you’re confused, trust your gut.  If we had, we never would have admitted Amy to that first treatment facility.

A Yale School of Medicine researcher is studying to see the causal effect of bullying and suicide attempts in children.  As this is what lead to Amy’s depression, I find this fascinating.

I’ve long suspected that this occurs more frequently than not.  The Columbine shooters singled out victims who were considered popular by high school standards.   Many other students who have carried out violent attacks also expressed similar feelings.

Here’s a link to the press release on the studies: http://opa.yale.edu/news/article.aspx?id=5913

Remember when your child was a toddler and you put the covers on the outlets to keep them safe? Although it might not seem like it, suicide proofing your home is much the same. You’re keeping them safe. I know this seems very surreal but you need to suspend reality during this. The world as most know it is no longer the one you’re concerned with. You are now focused on keeping your child alive and that is much more important.

You have to look through the house and remove anything that could be used as a suicide attempt. We first started with the bathroom. All medications, both prescription and over the counter, need to be removed. Check the bathroom for any other sharp items, like scissors.
We had no guns in our home but obviously, those should be removed immediately.

In the kitchen, there are many possibilities. Knives are obvious but we also removed the shish kebob skewers, kitchen shears, scissors, steak knives, and meat thermometer. You need to be thorough and look in each utensil drawer.
Other rooms generally don’t have sharp items but you need to look for anything that could be used for strangulation. For us, this was scarves, belts, curtain tie backs, purses with straps, neckties and jewelry.  Don’t forget to check for belts on robes and other clothing, too, and remove them.

We found it helpful to put all of these things in tackle boxes with padlocks. I kept my scarves, belts and purses in the trunk of my car where I could get them as I needed.

You become pretty adept at this while you go through your house and develop methods of storage that work for your family.

Obviously, you need to make sure your suicidal child is never left alone.  We extended this to include the bathroom.  We had Amy keep all doors open when she was in a room.  At night, Hank and I took turns sleeping next to Amy’s bed at night. That way, she couldn’t get out of bed without us knowing it.

After Amy’s first prolonged stay at the hospital, she was released to return to school part time.  I had no idea how to make this happen but I found that the school is required by law to provide reasonable accommodation.

I found with my daughter that the school system was ill equipped initially to do this for her. It honestly appeared to us that they had never dealt with this type of situation. They all said to us “but she’s so bright and taking honor classes, she doesn’t need any accomodation”. They seemed to believe that accomodation was only necessary for children with learning problems.   Although it’s hard to believe, I think we were the first parents of a child with emotional problems seeking accommodation.

You will need to be persistent in your attempts to get help from the schools. Talk with staff members at the school until you find someone who “gets it”. Try to find an ally at the school – we talked with teachers and guidance counselors but I was prepared to take it to the administrative level (principal, superintendent) if necessary.

I found that a firm but friendly approach with them worked best. I started each conversation with the assumption that they were an ally.  You never know how much influence the person you’re talking with has so it’s best not to alienate them in your early discussions.

I would start my conversations with “Amy is having a problem making it to class early in the morning and her doctor doesn’t feel that she should be in classes full time. Can you tell me what we can do to try to help accomodate her with this?” Key words to drop here were “doctor”, “accomodate”, and “help”.

We finally found a teacher who had studied psychology. He helped convince the other staff members that Amy’s needs were just as real as those with learning difficulties. He championed Amy’s cause so well that when we had the meeting, everyone was very helpful.

The end result of that meeting was that Amy went to school in the mornings from 9:30-12:30 and took a class online in the afternoon. She only needed this for one semester but it really made a difference in her recovery.

Over the years, the school has been willing to provide additional accommodations for her.  Things that, back in my day, never seemed acceptable.  Since Amy had no behavior problems, they were willing to let her leave class any time she felt overwhelmed.  This did not even require getting permission to leave class!  They would allow her to simply get up and leave to go to her resource teacher for a pep talk and a little break.  I’m proud to say that she has now come to a point where all she needs is to leave class to go into the hall for a few minutes to calm down.  She’s such a marvel!

Moral of the story is just ask for help and keep asking until you find the answers.  The schools can be very creative in providing help once you get them on your side.

Often times, the local mental health association or state department of education has resources to help you in this, as well.  Try contacting them with your problems to see what guidance they can provide.

A new study published  bythe Australian and New Zealand Journal  of Psychiatry has found a link between depression and being victimized by bullies.

http://www.msnbc.msn.com/id/35020704/ns/health-kids_and_parenting//

As a parent of a bullied victim and subsequent depressed teen, I am not surprised.  Amy’s problems began in 5th grade, when she was targeted by a group of boys and verbally degraded and harassed.  She spent the whole year putting up with it, never letting on at home, but it ate away at her.  She lost her self confidence and succumbed to their torments until she began to believe them.

We didn’t know about any of this.  Her withdrawal from family and social activities was put down to her approaching teen-hood.   We just figured that she was just being a usual teen and spending all of her time in her room.  It wasn’t until a few weeks before she was to start 6th grade that we started to suspect it was something else.  She would cry at the drop of the hat and moped around complaining that school was going to start.   A few weeks after the start of school, she made her suicide attempt.  We then found out about the bullying.

We did report it to the school.  The guidance counselor told us that this couldn’t be true, those were good Christian kids and they were part of his prayer group.  And no, it wasn’t a faith based school, it was a public school.  They were given a slap on the wrist.  We were left with a shattered child.

No, it’s not fair and schools need to keep up with new developments.  Her school guidance counselor was ill equipped for his job and probably shouldn’t be in his position. I didn’t have time to complain about his handling of the situation.  We were fighting for Amy’s life, literally, and we couldn’t fight two battles at once.

Not all therapists are the same and each has a different approach to things.  One of the many mistakes we made for Amy during the first year was finding the wrong therapist.  In fact, Amy has shared with me recently that she always felt more guilty and worthless after her therapy sessions with her.

Amy’s suicide attempt came as a result of bullying.  She was really low in self esteem and felt victimized.  She needed a therapist who could be her ally and help her sort everything out.  Of course, this was easy to see one year into therapy but at the time we found her first therapist, we were just desperate for help.

I remember thinking that when we sent Amy to her first therapy appointment.  I felt like I was taking a kid with a broken arm to the doctor and saying “just fix it”.  We had chosen this therapist because she was referred to us by our family physician.  We didn’t do any pre-qualifying or asking any questions about her style.

Amy’s first therapist would have been great for a kid who had parents with weak parenting skills, for her approach was to become a “super-parent”.  She treated Amy’s symptoms of depression rather than getting to the root cause.  She gave Amy a laundry list of things to do – pick up her bedroom, turn in her homework, do her chores, etc.  Then, each week, she would grill Amy on her results and discuss any shortcomings.  Again, this would have been fine for a kid without discipline in the house but not what Amy needed.

My first clue that it wasn’t working out was after a year with this therapist.  We were disciplining Amy for something and she actually said,  in a begging tone of voice, “don’t tell Sally” (her therapist).

By that time we were much more savvy about what she needed and how to direct her care.  We started shopping for therapists, no small task!  We asked her psychiatrist and all of the caregivers in the hospital ward where she was being treated for recommendations.  Another place you can find them is on the website for your state department of mental health.

Working with a little more confidence and a lot less desperation, we started talking with potential therapists.  I had a list of questions which I asked them over the phone to try to do some pre-screening.  I asked them about their style and philosophy for treatment.  The questions were very open ended so I would get honest answers.

Some of the questions were:

1.  How do you establish your relationship with your clients?

2.  What are your thoughts on handling children with depression?

3.  Can you tell me about a client of yours who you successfully helped through their depression?

4.  What are your goals for treating children with depression?

5.  Where were you trained?

I recognize that each child is different and has different needs in a therapist.   However, you, as a parent, know what is best for your child.  You know how that child learns and grows, you’ve been helping them all of their life!  My focus was getting Amy to be happy and able to handle life by the time she becomes an adult.   I wanted someone to guide her along that path.

We found a new therapist, Jean, and the improvement was nearly immediate.  Jean was much more nurturing.  She made Amy feel safe and started to draw out Amy’s fears and worries and help her find ways to address them.  Amy has been with Jean for nearly two years now and it’s made all of the difference.

There is a downside to Jean, though.  Our insurance didn’t cover her appointments.  It’s been very much worth it though.  My advice to every parent is to remember that failure is not an option here.  You have to find the right fit for your child with every choice.  This means thinking outside of the box and considering other options, including a therapist who isn’t covered by the insurance.