ERP Help Needed!

[lynn]

DS got out of the intensive with high hopes, and in fact certain extremely troubling symptoms are gone entirely (like hitting me, thank God.) But I need to figure out a smaller step for starting homework. The therapist had given him the idea of making a schedule and letting the schedule drive homework instead of me or DH. But he doesn't seem to be able to make the schedule and/or stick to it until about 9 at night, which leads to going to bed at 2 am--too too late. So I need a smaller step that carries less anxiety to get him on the homework track earlier. Have any of the experts (you know who you are )had a similar problem or can think of a good intervention? We really need sleep! Thanks for everyone's help--without this board I would just be nuts!

[LNN]

DS got out of the intensive with high hopes, and in fact certain extremely troubling symptoms are gone entirely (like hitting me, thank God.) But I need to figure out a smaller step for starting homework. The therapist had given him the idea of making a schedule and letting the schedule drive homework instead of me or DH. But he doesn't seem to be able to make the schedule and/or stick to it until about 9 at night, which leads to going to bed at 2 am--too too late. So I need a smaller step that carries less anxiety to get him on the homework track earlier. Have any of the experts (you know who you are )had a similar problem or can think of a good intervention? We really need sleep! Thanks for everyone's help--without this board I would just be nuts!

Not responding b/c I think I'm an expert - especially on teen issues - a total foreigner in this world for another 5 yrs. But I'm assuming that OCD that's bad enough for an intense program means you may have a 504 or IEP? If so, have you, or can you, put something in place that limits the time that needs to be devoted to each subject matter? That would allow him to pre-build a standard schedule - say 45 min per subject - that would start at the same time every night, instead of creating a schedule from scratch each night. Also, make it a requirement that any schedule have a pre-established end time - it cannot end past 11pm.

 

Can you contact the therapist who worked with him during the program? He/she will know the situation best. You may also ask if you can arrange for periodic check-ins with this therapist via skype. The Univ of Fla (Dr Storch) also has a skype program for long distance OCD treatment (I'll get the info if you want it). I think for someone so new to "recovery", it's essential to maintain that support system that comes with an intensive program. Sounds like it's too soon to be tightrope walking without a net.

[smartyjones]

have you checked out anxietybc.com? you may find some suggestions there.

 

 

[lynn]

I agree with you about the check ins--they offered me that but to keep the research honest they wanted me to wait at least a week prior to starting. That ends next Tuesday, so I will request as many boosters as they will give me! I'm also asking for a referral.

 

As far as the ERP step, genius about switching the focus to the endpoint and making a master schedule. I think if he could just get into a routine it would make things much calmer! I will tell him that I asked my friend the expert on the board and she suggested this (anyone other than parents has automatic credentials .) Don't know if I can get the HW load decreased though--this is a very competitive school and although they've been great with the 504 you really have to do a certain amount of geometry problems before you get it. And although there are certain teachers who give a lot of what I consider um pointless homework, I probably can't go up to them and say DS didn't do your homework because he has enough to do and yours was stupid. (Entertaining though the picture is...) But really, his workload isn't bad and he could easily get it all done in 45 minutes per day per subject. If, of course, he could only get started.

 

I always appreciate your clarity of thought. Thank you for giving me a new way of looking at the problem. We'll work with it!

[MomWithOCDSon]

Hey Lynn --

 

LLM has some great ideas, and we might try those, as well. Our DS14 has some homework issues, too, so I thought maybe we could compare notes a bit.

 

Is your DS having trouble getting it done because he avoids it? Or is he sitting in front of it, but just not doing it? Does he claim to be "afraid" of it? Or confused by it? Or is it that he's spending his time doing other stuff and not even sitting down to do it until 9 p.m. or so?

 

We've been in an OCD ramp-up recently, and our DS's thing is that he's confused by it or scared of it. The deal we have is that he gets home from school, he can have a snack and a 30-minute or so break, and then he needs to get started; if he's not finished in time for dinner, he breaks for dinner and then gets back to it right after. The only way he gets "free time" to play video games or watch TV is if/when he gets all the homework done, so sometimes that alone serves as incentive enough to drive him forward.

 

Another thing I've discovered is that the "confusion" he claims is generally the OCD pestering and distracting him; it seems to literally disturb his ability to process what he's doing. So, when he's having a really tough day, I'll ask him to do his homework "out loud" . . . literally speak out his math problem as he's writing it down, solving it and working it. Most of the time, this engagement of more of his senses and processing, including speech and auditory, helps "push out" the OCD chatter in his head, and he's able to not just work through it, but actually feel good about it. It seems like success breeds more success.

 

Finally, you might want to consider having an additional accommodation written into your DS's 504. I completely agree with you that sometimes some homework seems like little more than busy work, and it seems to do more harm than good to insist that DS muddle through it, at least in our house. You know, here we are trying to support the education system and help our kids make sense of having to undertake all this stuff in the name of "getting a good education so you can be who you want to be when you're an adult," and one lame teacher is having a 9th grader color a freakin' map!!

 

So, anyway, we have two accommodations in our DS's IEP that helps reduce, if not entirely eliminate, that sort of homework excess. 1) During periods of exacerbation or "high anxiety," we get to eliminate all "non-essential" work; in other words, if DS can articulate his mastery of the geography behind the Cold War, he doesn't have to spend an evening coloring in the stupid map. 2) Another accommodation requires that teachers "Modify assignments for length, not content" because it can take our DS 3 times as long to do some assignments as it does a "normal" kid due to the OCD ("Obsessive Slowness" Obsessive Slowness by Fred Penzel). So, with math, for example, his teacher generally cuts his homework assignments down by half but makes sure that a problem of each "type" is represented. As DS can demonstrate in quizzes and tests that he's getting all the concepts without the multi-problem drilling some other kids may need, this accommodation has been a life-saver without causing DS any additional academic stress.

 

Then, of course, there are those days where even those strategies don't work for us and it becomes a long, drawn-out drama. I'll look forward to hearing what you find works for you!

[Worried_Dad]

I'm interested in the homework angle, too. Our ds is doing so much better than during the "dark days" 18 months ago, when OCD held him prisoner in 2 rooms of our house and made him wear latex gloves constantly and go thru 4-5 cans of Lysol a day. But - over the past month - he's struggled tremendously with school and homework. He missed 3 full years of school prior to this year. Right now, he's sometimes only making it thru an hour or so of school before calling to have us pick him up. He can't get thru the homework for his classes - says it drains him and that he "can't do it, just can't."

 

Please pardon the bragging Dad mode here... but - at the end of 5th grade - we got a letter notifying us that he'd been identified by the Northwestern University Midwest Academic Talent Search (NUMATS) as a candidate to take some college-level courses at our local university. Now, he struggles to manage 15-30 minutes of 9th grade homework at a time. This is the lingering symptom that still plagues him.

 

A wonderful woman on a Sydenham's Chorea forum once told us that it's like somebody has taken the card catalog in the afflicted person's "brain library" and tossed it up in the air. All of the books are still on the shelves, but you can't find them. Has anyone's PANDAS child described a phenomenon like this?

 

 

Hey Lynn --

 

LLM has some great ideas, and we might try those, as well. Our DS14 has some homework issues, too, so I thought maybe we could compare notes a bit.

 

Is your DS having trouble getting it done because he avoids it? Or is he sitting in front of it, but just not doing it? Does he claim to be "afraid" of it? Or confused by it? Or is it that he's spending his time doing other stuff and not even sitting down to do it until 9 p.m. or so?

 

We've been in an OCD ramp-up recently, and our DS's thing is that he's confused by it or scared of it. The deal we have is that he gets home from school, he can have a snack and a 30-minute or so break, and then he needs to get started; if he's not finished in time for dinner, he breaks for dinner and then gets back to it right after. The only way he gets "free time" to play video games or watch TV is if/when he gets all the homework done, so sometimes that alone serves as incentive enough to drive him forward.

 

Another thing I've discovered is that the "confusion" he claims is generally the OCD pestering and distracting him; it seems to literally disturb his ability to process what he's doing. So, when he's having a really tough day, I'll ask him to do his homework "out loud" . . . literally speak out his math problem as he's writing it down, solving it and working it. Most of the time, this engagement of more of his senses and processing, including speech and auditory, helps "push out" the OCD chatter in his head, and he's able to not just work through it, but actually feel good about it. It seems like success breeds more success.

 

Finally, you might want to consider having an additional accommodation written into your DS's 504. I completely agree with you that sometimes some homework seems like little more than busy work, and it seems to do more harm than good to insist that DS muddle through it, at least in our house. You know, here we are trying to support the education system and help our kids make sense of having to undertake all this stuff in the name of "getting a good education so you can be who you want to be when you're an adult," and one lame teacher is having a 9th grader color a freakin' map!!

 

So, anyway, we have two accommodations in our DS's IEP that helps reduce, if not entirely eliminate, that sort of homework excess. 1) During periods of exacerbation or "high anxiety," we get to eliminate all "non-essential" work; in other words, if DS can articulate his mastery of the geography behind the Cold War, he doesn't have to spend an evening coloring in the stupid map. 2) Another accommodation requires that teachers "Modify assignments for length, not content" because it can take our DS 3 times as long to do some assignments as it does a "normal" kid due to the OCD ("Obsessive Slowness" Obsessive Slowness by Fred Penzel). So, with math, for example, his teacher generally cuts his homework assignments down by half but makes sure that a problem of each "type" is represented. As DS can demonstrate in quizzes and tests that he's getting all the concepts without the multi-problem drilling some other kids may need, this accommodation has been a life-saver without causing DS any additional academic stress.

 

Then, of course, there are those days where even those strategies don't work for us and it becomes a long, drawn-out drama. I'll look forward to hearing what you find works for you!

Edited March 5, 2011 by Worried Dad

[MomWithOCDSon]

I'm interested in the homework angle, too. Our ds is doing so much better than during the "dark days" 18 months ago, when OCD held him prisoner in 2 rooms of our house and made him wear latex gloves constantly and go thru 4-5 cans of Lysol a day. But - over the past month - he's struggled tremendously with school and homework. He missed 3 full years of school prior to this year. Right now, he's sometimes only making it thru an hour or so of school before calling to have us pick him up. He can't get thru the homework for his classes - says it drains him and that he "can't do it, just can't."

 

Please pardon the bragging Dad mode here... but - at the end of 5th grade - we got a letter notifying us that he'd been identified by the Northwestern University Midwest Academic Talent Search (NUMATS) as a candidate to take some college-level courses at our local university. Now, he struggles to manage 15-30 minutes of 9th grade homework at a time. This is the lingering symptom that still plagues him.

 

A wonderful woman on a Sydenham's Chorea forum once told us that it's like somebody has taken the card catalog in the afflicted person's "brain library" and tossed it up in the air. All of the books are still on the shelves, but you can't find them. Has anyone's PANDAS child described a phenomenon like this?

 

 

Hey WD -- You've EARNED your bragging rights! Go for it! Full disclosure: we're in your camp, as usual, so I'm not being entirely altruistic there. Our DS, too, has been identified as intellectually gifted, but when he's ramped up, you'd have a hard time knowing it. And yes, our DS has actually used a similar analogy to the card catalog although, being the 21st century kid that he is, his description is about a Microsoft Explorer list of files that have gotten moved around and jumbled up without his knowledge and now he can't find anything where he thought he left it. In this recent ramp-up, "confused" is his general state of mind when he's trying to tackle homework.

 

Knock on wood, thus far, he's doing okay during the school day, but he does have an extensive list of accommodations and will sometimes ask for permission to leave the classroom so that he can go talk to his case worker or the social worker about something that's bothering him. But, in general, I think his classes are well-enough designed and run that they keep him tuned in and therefore push the OCD and its "best friend" confusion out of the way.

 

But when he gets home, and it's just him, the book, and the assignment, that's another story. So far, the multi-processing approach -- speak it, write it, hear it, read it -- has been helping, but it requires either DH or me to be by his side to coach him and make sure he follows through. Another technique his ERP therapist came up with which works (though DS despises it) is that, if he's feeling confused and as though he can't focus, he needs to do something physical for a few minutes and then come back to the mental task at hand and try again. Living in the frozen Midwest like you, we've had to resort to having DS run the stairs to the second floor and back in the house, sometimes repeatedly, before he can settle back down for another try. Sometimes we have to send him for another run, and sometimes even a third run, before his "file cabinet" is sufficiently reordered to do that one piece of homework, but it has worked more often than it's failed.

 

Sorry to hear your DS is struggling again, too; there must be something in the air/water/ozone layer that's making this period especially difficult for our kids!

[wornoutmom]

School - homework - uggh! We too have this struggle, though greatly improved this year since receiving some treatment. My son is typically EXHAUSTED when he gets home from school, like his brain has run a marathon. Sometimes he sleeps for several hours. Even when he doesn't, he needs serious veg time. Usually that's in front of the TV, sometimes playing outside. In general this first year of highschool, we have settled into homework being done after dinner, and agreed that it's a reasonable expectation that he have 1 hour of homework a night. He does have an IEP that gives him an "Academic Lab" class each day. Basically a study hall with a special ed teacher. This allows him to do 1.5 hours of "homework" while at school, while getting a credit for the class. His schedule basically only has 2 core classes at a time. We also have reduced homework accomodation. His Algebra teacher set it up so that if he assigns more than 20 problems on any given day, he only then has to do "evens". In World History when they pass out homework, he gets a special edition with only the truly necessary questions highlighted, and those are the ones he's responsible for. We also have a time extension accommodation, so he can take his time on longer assignments like essays,etc. Basically we're trying to take as much pressure off as possible while he grows into feeling more confident and less overwhelmed. He's starting to email his teachers for clarification on things when he's confused and they have been very responsive. For him, he is overwhelmed by workload. Though he only missed 3 months of school in 6th grade, I think he "missed" alot over the last few years when the PANDAS was at the forefront, even though he was physically present in school. It takes a lot of cognitive restructuring for him to look at an assignment and not feel overwhelmed. If it is smaller, he is able to be successful and reinforce over and over that he CAN do it - it isn't impossible and WONT take forever. Not that the OCD won't tell him otherwise - but he has lots of evidence to the contrary now to help him boss it back. He has chosen to eliminate all extracurricular activities except once a week on Fridays. Though sometimes bored and socially withdrawn, he needs this time to unwind, do nothing, sleep, etc and it helps him to realize he has seven free hours once he gets home from school, and only one of these is for homework. We still usually need to sit with him side by side to help with the homework unless he is feeling particularly confident. But he's growing in the right direction (and so am I)to try and find balance between his health and his desire to do well. This plan isn't going to get him into Harvard, but it might just allow him to graduate from highschool with his sanity in tact...

[lynn]

After reading everyones's extremely interesting and helpful ideas, I realized that we have actually ended up doing the exact opposite from you WOM. DS's rage appears to connected to our attempting to get him to confront and do homework and study for tests, so our previous attempts to sit with him and get him to read out loud, etc, just result in meltdowns, screaming, and long periods of paralysis. Our options were to either become draconian and require homework to start by a certain time, regulate breaks sit with him at all times and demand production, or to back off entirely and let DS know that we expect him to be able to work out how to do this stuff by himself. So of course we tried draconian first and it (as we should have forseen) was spectacularly unsuccessful. Our new model (now two days old) is to carefully not suggest starting HW, not criticize any distraction or time wasting behavior we observe, withdraw immediately if he picks a fight in order to divert to that instead of doing homework, and allow DS to bear the consequences of not getting started, not finishing, or not studying. At our bedtime, we go to bed, whether DS is done or not (although I can't say I sleep while he is sitting there struggling). So far, this has resulted in 2 1:30 am bedtimes, both with homework still to do at lunchtime, but no blowups, no hitting me, and no fights. The real sticking point will be the rest of this week, since it is the end of the marking period and every single subject has a test (including the scary English essay test.) At midterms last month our draconian approach resulted in uniformly poor grades, lats of screaming and hitting, and pervasive depression from DS, me and DH. This time, I have offered him assistance in applying his ERP rules, in studying, and in answering questions and he has allowed some assistance (e.g., drilling on Spanish vocabulary) but not much. We'll see if it works.

 

I also wanted to say that one of the major scary parts of this condition is the fact that our lovely gifted children lose a pretty big portion of their self esteem and self image when these ramp-ups occur and they suddenly have the card catalogue upset syndrome (very interesting discussion). I think that's what has driven DS's OCD to this level this time. I'm just hoping that the combination of treatment and ERP can get him back.