Hangry

This little infographic shows the typical process we experience when we’re hungry:

And this little infographic shows how hunger turns to hanger and how easily the state of hungriness can lead to escalation in our house (and I suspect we’re not alone):

I love hangryness, its a real joy.

I’ve previously written about Interoception  and Adopted Children & Eating Issues and Demand Avoidance if you’d like more info than the little bits here that you will no doubt need to squint at (it does look pretty though).

I’m assuming that time and working on interoception are going to help with this. I also need to remember to leave Little Bear a tray of healthy snacks outside of his bedroom door for when he wakes up at the crack of sparrows and none of us are ready to leap out of bed and make him some breakfast. On the occasions when I’ve remembered, it seems to have worked well in terms of pre-empting some of the issues above. Anticipating hunger and regular snacking and routine mealtimes do seem to keep things as calm and even as possible (though don’t actually take away the underlying issues). If anybody else has any clever tricks, I’d love to hear them.

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Holi-yay or Holi-nay?

I have spent much of the past week wondering whether we were brave or foolhardy when we booked a holiday to the Finnish wilderness. Many adopters have quickly learned that familiar places and familiar routines equate to smoother breaks with their children, so either return to the same tried and tested venue or go away in their caravan (home on wheels). It is quite possible that those people are wiser than us.

However, as with most aspects of life, we are somewhat prone to doing something different to everybody else and wandering off on our own merry path. On this occasion, that wander led us to deepest, snowiest, most remote Finland. We were so deep into Finland, we could have walked to Russia. There is no real relevance to that fact, apart from to illustrate how remote our location was.

It seemed like a good idea when we booked it.

We’d been to Finnish Lapland before and had an amazing time (see A Magical Adventure? ). Of course it had not gone without hitch, but the life-enhancing experience of seeing The Northern Lights whilst husky-sledding in temperatures of minus twenty-something had obliterated any more minor concerns. The boys crave adventure and I am repelled by any water-based activities, so winter adventures suit us well. We saw this trip, advertised through a reputable company, with amazing reviews, and billed as a ‘family adventure’ and thought it seemed perfect.

However, warning bells rang on arrival, when we discovered there had been a stomach bug in our accommodation the previous week and our arrival would now be delayed due to a ‘deep clean’. Hmm.

Trying not to be paranoid, we got on with it.

The first thing we noted about being on holiday with a new group of twenty or so people, was that Little Bear’s behaviour stood out as different. I suspect it always does, but usually we are with familiar people who know and understand him. Usually the difference doesn’t affect us. But there, with strangers, we were more aware of the transparency of people’s thoughts. ‘What is he doing?’ they thought. ‘Why is he rolling around in the snow when everyone else is standing at the coach stop?’ ‘Why has he wandered off when the guide is explaining the intricacies of husky-husbandry in heavily accented English?’

Again I found myself caught between wanting to enlighten them and wanting to protect Little Bear’s privacy. I said nothing. I attempted to parent as usual.

A big problem, with a holiday such as this, is the impossibility of sticking to familiar routines. It wasn’t self-catering as our UK holidays always are: we were trapped by hotel feeding times. As dinner was at 6pm, the time Little Bear usually begins his bedtime routine, things were bound to be harder than usual. Clearly, it is far from ideal to ask a child who struggles with flexibility, to be flexible about his meal and bedtimes when they are usually very strict with good reason. I suspect the reason we have generally faired quite well on UK breaks is that no matter where we are our familiar routines have anchored us. In Finland, however, we had a tired, hungry and understandably dysregulated bear at points during the first days.

We tried to be resourceful – making sandwiches at breakfast time so that we had more flexibility later on and Little Bear could skip the dining hall altogether if needed. It sounds a bit ridiculous but because Little Bear’s behaviour is so inconsistent, it is difficult to predict and I don’t think we were as good at spotting that this was likely to be a problem in advance as we should have been because there are times when Little Bear would be able to cope with more flexibility.

It is ironic really, that I am becoming a person who is better at solving problems after they’ve occurred than predicting them beforehand, given my propensity towards morbid-thinking. I suspect that in an attempt to be easy-going enough to attempt wilderness holidays, I have had to relax the side of me which anticipates myriad problems. There is certainly a freedom in just dealing with things as and when they occur but the downside is I get to berate myself for not being more prepared.

Anyway, after several nights of lengthy and emotionally challenging bedtimes (a child continually moving and wriggling and verbally scribbling to keep themselves stimulated into wakefulness is nothing if not a little insanity-inducing), we changed our approach. I realised that freedom on the outdoor journey from the dining hall to our room was too difficult for Little Bear at that time of night: he couldn’t cope with the demands to bring himself back inside when we asked, triggering escalation. This was akin to our issues on the school run which have been solved with holding hands and keeping Little Bear close – not putting him in a position where there are any demands – and this worked on holiday too. He was also helped by having his pjs and toothbrush etc. all laid out in the right places for him so he could complete his whole routine without any adult prompts (we agreed to do it that way in advance of dinner). These tweaks led to vastly improved bedtimes.

Although the change in routine wasn’t ideal, there were still solutions available to us. It was good to know that. Even when stranded in the Finnish nowhere, difficulties didn’t have to become crises.

The other mistake we made was forgetting (I know, honestly!) about the need to establish clear new rules in any new place. Little Bear’s bed was up on a mezzanine above ours. We could hear him up there but couldn’t easily see him. Evidently, being away from grown-up eyes meant that Little Bear set his own rules of what was permitted on the mezzanine, none of which were conducive to sleeping. Once I’d figured this out, I realised he would need one of us to provide supervision up there, much like we’d had to do when he was small and made no association between bedtime and sleeping. Like then, he did not appreciate my presence (it curbed his fun no end) and I was insulted, threatened and hit. However, I knew it was important to persevere and not be bullied back downstairs by a six year old. It wasn’t any fun and it took ages but the next night, he lay down and got straight to the business of sleeping.

It was reassuring, in a strange kind of way, that we had enough tools in our portable therapeutic toolbox that we could have a good go at resolving these issues wherever we were (even if they could have been avoided by better forward-planning).

As many people will already know, there were further problems with the holiday, though they couldn’t have been reasonably predicted.

On day three, Grizzly and I both woke up with The Bug. Yes, the one they had supposedly deep-cleaned away. It knocked us both off our feet for the whole day. Clearly this was undesirable.

I have always been very anti-cruises because every time I imagine a huge ship with all those people on board, my first thought, like a weirdo, is of Norovirus. I could envisage a nightmare scenario where everybody gets confined to a tiny cabin, shitting and vomiting, for the duration, and that, my friends, does not sound like fun. Yet here I was, in basically the same scenario, in a snowy forest in Finland.

And yet… I didn’t feel the depths of despair I thought I might. I was grateful Gary was with us to look after the boys and she hadn’t been struck down – yet. It was strangely nice to spend some time with my husband, even though we felt rubbish, and, outside, it was snowing. There could certainly have been worse bedside views.

The next day, we were okay and managed to go on our planned excursion. I was grateful we had bounced back quickly.

By now, Gary was ill and couldn’t join us. With the majority of the wider group dropping around us, this seemed inevitable. While I was sad she was missing out, I was grateful she wasn’t actually sick – things could certainly have been worse.

That night, Little Bear settled well for bed. He’d been asleep half an hour when he awoke vomiting all over his bed. Evidently things were going from bad to worse. He was now in my bed and I was relegated to the mezzanine with its broken light to read my book by torchlight. And yet…

Despite having vomited so much the mattress was beyond salvation, Little Bear’s brown eyes peeped from under my duvet, glinting with mischief, and he launched into an hilarious rendition of Baby Shark. Of course I didn’t want any of us to be ill on holiday but when Little Bear is ill, I’m always reminded of his resilience, Marine-like toughness and general gorgeousness.

On this occasion, being poorly had also made him feel emotional and loose-lipped. He instigated an in depth adoption conversation about how scared he felt when he first met us (“because you’re both so tall”), how he really hadn’t wanted a brother (“I wanted to punch him in a private place”) and how angry he was with us for having ‘taken him’ from his foster carers. He has never managed to verbalise any of these things before and they certainly would go some way to explaining some of his behaviour. Although these are difficult things, I would far rather they were expressed than not.

I found myself wondering whether if we had not found ourselves trapped inside a wooden cabin in Finland by a vomiting bug, we would have had this (potentially progressive) conversation at all.

We talked for a long time. It felt like the kind of chat that would open things up and move things on.

All of us did a really good job of maintaining our humour for the first days of The Bug. Considering the circumstances, things really weren’t as bad as they sound because we were together and writing and reading kept me sane. I can’t lie though, by the end of the third day of being stuck inside the cabin, I was done. Beam me up. Take me home.

When we eventually got back, I felt I may have been released from prison which is obviously not the vibe you’d hope for after an amazing holiday. The getting back, with a partially well, partially unwell, highly dysregulated Little Bear in tow was not particularly easy. A big kick off several thousands of feet in the air, in a confined space is not any fun and is one way of calling into sharp focus the level of challenge we seem to be taking for granted.

The Bug was really unfortunate. Bad luck. But aside from that, was it worth it? Did the pros outweigh the cons? Were we brave or were we foolish for attempting such a holiday in the first place?

There were some clear pros: husky-sledding, meeting the reindeer, snow, sledging, snow, beautiful scenery, the Northern Lights, Big Bear discovering a love of cross country skiing and more snow. We couldn’t have got any of that here and the boys certainly gained from those experiences. I think there are even some perverse pros in having survived such an unwelcome scenario and coming home in mostly good humour: there is nothing like overcoming a challenge to make you realise what you can do.

I shall certainly not be booking another holiday abroad any time soon and long-haul is absolutely out of the question for some years yet (unless we wish to cause some sort of emergency diversion situation) but would I do it again? Yeah, probably. Not in the same place, obviously, but I would take Little Bear somewhere new again. I don’t know if that’s sheer bloody-mindedness, a refusal on our part to accept the full extent of Little Bear’s needs or a desire to plough on despite those needs. I don’t know. I think we might stick to self-catering for the foreseeable future though and maybe remember to anticipate some of the possible issues in advance.

But, you know, life is short and the world is wide. And some of us are more foolhardy than others.

Sensory trial and error

One of the biggest priorities at our house these days is helping Little Bear with his regulation. It has always been an issue but I think because other things have settled down, it has come more to the fore. I have been experimenting with various sensory hacks to see what works and which ones we can use routinely to improve things in our daily lives. Here are some things we have recently tried and how we have got on:

Regulation at the table

Little Bear has always struggled with sitting still. He’s fine on a sofa and can sit for quite a while but finds sitting at the kitchen table for mealtimes particularly tricky. He is better on our wooden bench than on any of the chairs but still tends to kneel up and change position a lot and get down a lot. I have been trying to engage Little Bear in his own regulation more so I recently asked him why he moves about so much. I had no idea if he’d have enough insight to be able to tell me but it seemed worth a try. He said he didn’t like being too low down. We then experimented with putting various items on the bench to make him higher and a bit more comfortable. Several were no good or too unstable but in the end we settled on a beanbag. We can tuck it through the gap in the back of the bench so it stays in place and Little Bear has given it his seal of approval.

I have to say it has been pretty miraculous in its efficacy. Little Bear is certainly able to sit still for much longer with it and doesn’t change his position half as much. Crucially Little Bear prefers it and goes looking for it if I have taken it off the bench for any reason. My feeling is that children will show us when we are getting the sensory input right for them and this hack is ticking all the boxes. I have been considering a wiggle and sit cushion for a while but I don’t think we need one, the beanbag is perfect.

Regulation when out and about

This is the biggest challenge for us and one I would really like to come up with a solution for. We generally notice Little Bear’s difficulties with regulation when we go on a day trip somewhere or go somewhere new. I guess there might be an element of anxiety underlying the behaviour and we certainly feel Interoception has an impact. We are continuing to work on that but it is not a quick fix and I don’t think we are ready to feedback about how it’s all going just yet (but I will when we’ve made more headway). In the meantime, we have been experimenting with things that help in the instant of dysregulation, while we are waiting for longer term solutions to work.

If we are having a dysregulated day out, Little Bear continually seeks movement, which can be unsafe depending where we are. Often we let him run where we can or swing or climb to his heart’s content. I realised on a recent day out though that all the movement doesn’t actually seem to help, if anything, it gets Little Bear more and more dysregulated. Therefore I hypothesised; we needed to add in more calming elements, rather than encouraging the seeking elements.

I remembered that we used to use a rucksack for that purpose so we have re-introduced it. On the first attempt it didn’t go particularly well as the straps were a bit loose and kept coming down Little Bear’s shoulders which annoyed him. The next time we tried a different bag which has a little chest clip to keep it in place. It was a mixed outcome. We could certainly tell the difference in Little Bear’s behaviour – the weighted bag did calm him and stopped the running and swinging almost completely. I would say this was a fabulous outcome apart from one crucial factor: Little Bear doesn’t like wearing it. I don’t want him to think it’s a punishment of some sort and the fact he doesn’t like it makes me think we haven’t quite got it right sensory-wise. I suppose we need to experiment with the weight of the bag; how long he wears it for etc. I know that when I was taught about weighted blankets, the rule of thumb was always to remove them after 20 minutes as otherwise the body modulates to the weight being there and the effects cease. However I have played around a bit with just letting Little Bear wear the bag for a bit then taking it off but I feel as though the effect goes with the bag and as soon as it goes, he’s back to seeking movement again.

I also wonder if there is another way to give him ongoing proprioceptive input that doesn’t involve wearing a bag? I know you can get pressure jackets but I feel as though he would be too hot. Please make suggestions if you have any as we are certainly in the market for trying something else.

Regulation at bedtime

Little Bear has one of those heavy cuddly toys that is filled with sand, I think it’s a large newt and I have been experimenting with that lying on him to help him calm at bedtime. Again I would say it works a little but then he chucks it on the floor!

In the winter if Little Bear can’t get to sleep, we have a heavy knitted blanket that he sometimes likes me to put over the duvet on top of him which works well. It is generally the sensory approaches that Little Bear is collaborative in that work the best. He will tell me when he does or doesn’t want the blanket and I assume that relates to when he does or doesn’t need it.

I have noticed recently that he has a big fluffy blanket on his bed at the moment and he likes to get all cosy inside that, especially if he hasn’t got his top on. I feel as though it would be quite an unpleasant sensation but it obviously works for him. Looking at how children self-soothe can be a key way of discovering sensory hacks that work. Little Bear still has comfort blankets in bed. They are muslin squares and it is the label that he likes – he strokes his lips with it which seems to soothe and calm him. I can’t think of anything worse and he often tests it out on me knowing full-well that it will make me squeal in discomfort. I suppose it’s a good way into talking about how everyone’s sensory needs are different!

I am now wondering whether proprioception is the best avenue for calming for Little Bear or whether the right kind of tactile stimulation would work better for him. How would we go about providing that whilst walking around a zoo or museum I wonder?

This has definitely been a post with more questions than answers (apart from beanbags, they are an answer) so I apologise for that but if anyone has any clever solutions I’d love to hear them.

Dinner Winner

I have decided while I Am Writing to post some shorter blog posts for a few weeks about some products we have bought recently.

This week’s product is the Dinner Winner plate made by Fred.

 

 Meal times have always been a bit tricky here, ever since we first met Little Bear. I suspect his development was disrupted around the weaning stage and when he first arrived I probably should have gone back to basics with introducing solids and different textures. He was over three at that point though and I was pretty distracted by many a pressing behaviour challenge. I did do purees for him and I have fed him on and off since.

Little Bear is six now and at mealtimes, especially tea time when he’s tired, he tends to mess with anything and everything but doesn’t focus his energy on eating. He will clamber over the bench, fiddle with his cutlery etc. but not touch his food. It has always driven us a bit mad but we have tried to be patient and to feed him if that’s what he needs.

I wasn’t looking for another solution but a few weeks ago I was flicking through a therapy magazine and came across these Dinner Winner plates. I immediately felt it would be worth a try because it is essentially a visual support for eating your meal. It evidently struck a chord with the speech therapist in me: it’s such a clever and practical idea and I couldn’t believe I hadn’t seen one before. We found you could buy them on Amazon and one was with us the next day.

There are lots of designs but I chose the superhero one as I felt Little Bear would like that one and it was a bit more grown up.

On the first day, the plate worked like a miracle. Little Bear LOVED it, especially the fact that there is a compartment with a lid for you to open at the end of your meal and hopefully find a treat. I explained to him that you start at the beginning and eat one compartment at a time. There was a risk Little Bear wouldn’t care about the order but he took that aspect very seriously and finished his dinner in record time. I don’t want him to rush but tea it is usually a very lengthy affair so this was a clear improvement.

The second day was similarly wonderful. After that, the novelty wore off a bit. However, I can honestly say that though the plate hasn’t delivered a miracle it has certainly improved things significantly. I think Little Bear is much less prompt-dependent now. Previously I had to prompt every mouthful or load his fork for him but now he does often feed himself the whole meal, without prompts, just with a bit of dithering between compartments. I now wonder whether seeing a whole plate of food was overwhelming for Little Bear and he was having difficulty breaking the task of eating into parts. The plate has done that for him and one compartment at a time is not overwhelming. Also, when one has gone, counting the remaining compartments gives a natural countdown to being finished which seems to help Little Bear with seeing an end to the task. Sometimes we are winning at dinner.

I don’t think the treat at the end would be appropriate for all children, depending on their issues with eating but it does work for Little Bear. One chocolate button seems to be motivation enough.

On a practical level the plate requires a bit more preparation from me. I tend to serve his food onto a normal plate to check I’m giving him the right quantity and then I need to chop it up and divide it between the compartments. It is a bit more faffy but I feel as though it is worth it. The first meal he had on it was baked potato which obviously had to be modified a bit more than usual!

Overall I think it’s a fabulous piece of design and a really clever use of visual support. I would definitely recommend it and this is not one of those blog posts someone has paid me to write!

As an added bonus, Little Bear practises his reading on the words written in the compartments. It’s a big thumbs up from me and my little dude.