Oxygen masks are hard to put on

 We've all probably been reminded of airplane rules, how they tell adults to put on their own oxygen mask before their child's one.  It's part of a series we get told as autism parents, and I don't think I'm the only one that can get annoyed by them.  The reminders feel like they are saying "You are responsible for your own burnout, your own tiredness.  You need to take time to put yourself first.  That's on you"  And I don't even need to explain to those of you who are living this life the flaw there---how impossible it can be to get even a minute to take care of yourself, how none of us can just say "Okay, today is for ME!  I'll call the handy available affordable babysitter, who will be right over, and I'll go out to the spa and to lunch and to the museum and a hotel overnight and then I'll come home and be a better autism parent, because I did the right thing and took care of myself!"  Ha.  HaHaHa.

I say this because I think you'll all get why over the past 9 or 10 years, I ignored a lot of signs my health was worsening.  I had a few diagnoses already---NASH liver (non-alcoholic liver disease), Sjogren's syndrome (an autoimmune disease that causes dry eyes and mouth and extreme tiredness) and hypothyroidism, along with smoldering diverticulitis.  I figured all of those were more than enough to explain why I was so extremely tired all the time. I assumed they were also why it was becoming increasingly hard to concentrate or multi-task, and even why I had pain in my muscles and in my bones al the time, every minute, always.  When a year or so ago my vitamin D was extremely low, low enough that several doctors said they'd never seen a lower read, I just took more D.  When, over the course of the past 9 years, I had blood test after blood test that showed I had high calcium levels, I didn't investigate and neither did any doctor.  Those tests were never the focus of my blood tests.  Instead, my primary care doctor constantly tried to get me to take cholesterol drugs, which I weren't convinced were safe for my liver.  Finally, I decided to switch doctors.  I was feeling increasingly unheard.

I saw my new doctor, he ordered blood tests, he saw my calcium was once again high, and miracle of miracles---he ordered one more test, a test of what is called Parathyroid Hormone.  My PTH level was sky high.  That was all it took.  He diagnosed me with Primary Hyperparathyroidism.  

For those of you who don't know what that is---in a nutshell, it's when a parathyroid gland (or two or three or four---you have four, located on the back of your thyroid) goes haywire.  It tells your body you don't have enough calcium, when in reality, you have too much calcium.  Your body goes crazy trying to get more calcium, and takes it out of your bones.  The result is the symptoms I'd been having, and more---extreme tiredness, muscle and bone pain, low Vitamin D, confusion---and there are many more. Do a quick Wikipedia search about it and you'll learn a lot.  And PLEASE---the next time you have blood tests, check if your calcium is high, even a little high.  If it is, ask for a PTH test.  Right away.

There is only one cure for hyperparathyroidism---surgery to remove the haywire gland.  I had all kinds of imaging tests to try to locate exactly which gland had gone bad.  They weren't definitive, so I went in for exploratory surgery.  Luckily, the gland was found quickly.  The surgery took about 4 hours, took out the bad gland, I was in the hospital only one night, the main pain afterward was just from having had a breathing tube, and as parathyroid hormone has a half life of only about 4 minutes, by the time I came out of anesthesia, I was cured.

And, incredibly, within days, the pain I had felt non-stop for years and years and years was GONE.  Not just better, but gone.  My confusion was greatly improved.  I felt just...better.  Better like I had thought was no longer something I could feel.

My point here?  Well, it's partly just to educate people about hyperparathyroidism, which is sadly underdiagnosed.  But it's more to say---we as autism parents, sick or not, undiagnosed with some surprise disorder or not, just can't put on the oxygen mask easily.  We are used to being tired.  We put our kids first, not because we are saintly self-sacrificing parents, but because we don't have a choice.  Our kids need us.  They need us 24 hours a day, 7 days a week, 365 days a year.  And if our kids have severe autism, by any name you choose to call it, as Janey does, this will not change, not for our whole lives.  I could have easily gone the rest of my life without the surgery, without the diagnosis, because my life simply didn't leave me the energy, the time or the help we needed to get the diagnosis.

Even to have the surgery, Tony and I had to ask our sons to take time off of work.  They did, willingly, and they took excellent care of Janey.  But that is not something we can do except in emergencies.  If they had not been able to do that, or if I had been a single parent---I don't even know how I could have had the surgery.  

We need a structure in this country to provide REAL help for people caring for those with severe autism.  We need it NOW.  It exists in most countries.  I know that from my hobby of exchanging postcards with those around the world, and from hearing from other parents through this blog.  We need it not just so we parents can get a break, but so we can live.  Literally, live.

Janey did not do very well with my surgery.  The day before the surgery was her last day of school.  Usually, we would have talked to her a lot about this, and had a busy day set up to make up for the lack of school the next day.  But we were pretty distracted.  So, the day of my surgery, she had no school, and Tony and I both were gone from the house---something she is supremely unused to.  She had fun with her brothers, but then the next day, again, Tony was gone getting me home.  When I got home, I had to stay away from her for a few days.  She likes to jump on me with enthusiasm, and my incision made that unsafe.  The incision was also big and scary looking, like someone had tried to cut my throat (it's already a lot better looking now) The surgery was on a Thursday.  By Sunday, Janey was in the worst shape mentally we'd seen in years.  She was screaming non-stop, all day.  She frantically took shower after shower, asked for ride after ride, bit her arm and wailed and was so unhappy we worried she'd broken a tooth or something.  It took me getting up the strength to go for a ride with Tony and her and me finally doing what I should have done from the start---explaining over and over what had happened, telling her my hurty place would get better soon, giving her treats and spending calm time with her--to get her calmed down.  She still is avoiding me when she can, quite bothered by the scar, but much better than that awful Sunday.  We were given a vivid reminder we can't ever take the years of vastly improved behavior and happiness she has for granted.  We were also given a vivid reminder of the challenges of self-care.  Caring for ourselves as parents isn't a zero sum game.  Caring for ourselves often results in less time to care as well for Janey as she needs.

And so---we are into another summer.  I hope it's starting out well for all of you.   Good health to you all, and check your calcium!

The tasks of adulthood and a big surprise possibility

The last few months have felt both uneventful and hectic. The uneventful part is good. Janey has had a very good stretch of happy and easy behavior. She's loving school, enjoying home for the most part and generally being quite a delight. The hectic part---us trying to do what needs to be done for an adult with severe disabilities. We are working on getting legal guardianship for Janey and getting her Social Security income---both things that need to be done when or soon after an adult like Janey in the US turns 18.

Applying for Social Security was surprisingly easy, but that's all that's happened so far---applying. We applied I think last November, and haven't heard a single word since then. We were told it could take until May or so to hear, so we are waiting until then to inquire further, but I certainly hope eventually she is approved. She seems like a pretty straightforward case, but you just never know. We did an application mostly by phone, and did a long questionnaire about her abilities, and she has no income or savings, so we hope we did everything we needed to do and it's just a matter of time.

Guardianship---that's another kettle of fish, to be sure. What an incredibly long and hassle-filled process, which isn't over yet. In Massachusetts, getting guardianship involves getting statements from 3 different professionals---a doctor, a social worker and a psychiatrist. Supposedly the second two get done by the schools, and the first through our health plan. We started with the doctor, in November, and got the paperwork for the schools to do. We had thought there had already been a psych eval. done at the schools, as we were told there would be, but somehow it got lost in the shuffle due to a maternity leave. We eventually got it done, and got the social worker's report, but then realized a couple crucial things were missing. Because Janey takes a psychiatric medication, we needed to have her prescribing psychiatrist sign a form about that, and then there was a question involving whether she was capable of understanding the medication and its potential side effects. That was marked yes, which is certainly not the case.

So, with the pressure of time, as the guardianship papers need to be turned into the court within 6 months of the first signature, we had to get the form done and the question corrected. That involved lots of unanswered calls and waits. We had by that point gotten the help of a free legal service for low income people, but with all the delays, they closed our case. Once we finally got the information we needed, we did get them to reopen it and help us complete the endless forms, and we finally turned in the paper, just in time.

The next step was serving Janey with papers stating we were requesting guardianship of her. This seemed a bit useless to us. Janey doesn't understand anything about the process, and it seemed like someone spending two minutes with her could have told them anything they needed to know. However, we certainly do understand that in getting guardianship of a person, the person is giving up a lot of rights, and the process needs to be complete and thorough. So---we took the papers to serve to the house of my dear friend Maryellen, who has known Janey since birth (she was there when Janey was born!), we did our best to explain things to Janey (we basically told her that we were going to make sure we could always take care of her) and Maryellen handed the papers to Janey, officially serving her (it had to be a non-relative doing this) We videoed the big moment.

Now that the papers have been returned, we actually have a court date, next month. I am crossing my fingers that all goes smoothly and we get guardianship (or actually, Tony gets guardianship---it's recommended that just one parent becomes the guardian) Then there are just reports to be filed at regular intervals after that, etc... It's quite a complex deal.

During the very first phase of all this, when we talked to the developmental pediatrician who did the first form, she suggested we might want to take Janey to a geneticist, since there have been so many advances in genetic testing lately. That sounded like a good idea to us, and I set up the appointment, for which there was quite a wait.

We saw the genetic counselor and the geneticist on Friday. I was not expecting too much information from this visit. I figured by this point, we had covered most bases with Janey, and I had pretty much resigned myself to never getting much in terms of the "whys"---why did Janey regress so suddenly and badly? Why did she have such slow physical development early in life, which isn't usually an autism thing? Why does she have the few other odd things---the lack of periods, the mild scoliosis, the strange eyes rolled up high at times, the occasional severe hand wringing?

To my vast surprise, after a very thorough and well conducted history and physical exam, the two person medical team said they had a strong suspicion that Janey might actually have a genetic disorder---Rett Syndrome.

I had heard of Rett Syndrome. It's always listed as a variant of autism, one that only girls get. But all my reading about it made it sound far more severe than what Janey has. My understanding was that girls with Retts didn't ever walk or talk at all after they regressed, that they had no useful hand function due to hand wringing or other hand movements that never stopped. But the genetic counsellor told me that with the increased availability of genetic testing, it's been realized that there are many forms of Retts, including ones that sound a very lot like Janey. One of those is called the Zappella variant, or the Preserved Speech variant, and girls with that retain some speech and have much more use of their hands.

We agreed to have Janey tested---in fact, to try to get our health plans to cover testing of almost all genes that have been mapped, but that failing, to start with the Retts gene. It will take months to get the results (we haven't even yet gotten the testing kits that come in the mail)

I admit this all has flustered me a good bit. I am not sure why. It wouldn't change anything about Janey. It would perhaps relieve some of the guilt that I imagine you other mothers are familiar with, the feeling that I did something somehow to cause Janey's issues. Rett Syndrome is something that happens at conception. It isn't even passed down by parents. If she has it, her fate, her regression, so much of what she is, was determined the moment she was conceived. I am working, as several friends have advised me, on not trying to analyze why this is feeling like such a shock, a somewhat unwanted shock. But it is.

Of course, we don't know for sure Janey does have Rett Syndrome. If she does, I will go into full research mode, and I will share what I learn with all of you. It sounds like, with the recently discovered variants, that others reading this might also have a girl with Rett Syndrome, without knowing it. And I know I might be getting the facts or terms about it wrong---please forgive me if I am. This is extremely new to me.

The other hugely bizarre thing is that literally DAYS before we learned about the Rett Syndrome possibility, the first ever drug for the syndrome was approved. It's called Daybue. I have no idea if Janey would be a candidate for taking it with a variant, and I've avoided reading too much about it. It would be almost too much to believe that there could be an oral medication that would help Janey's functioning. I can't start thinking about that right now, but as I have so very many times over the years, I wanted to share this journey with all of you---partly, as always, for myself---because it helps to not take these journeys alone.

So---adulthood. Wow. It's been something so far. But at the core of it all is our Janey. She seems to be enjoying life. This past week was vacation week, and several times she brought us her backpack and said "Go on the school bus?" We love her love of school. She has fun with most of the same things she's had fun with for a while---car rides, eating everything and anything Daddy makes, watching Vampirina and Little Einsteins and Fancy Nancy and all the Toy Stories, listening to music, jumping and dancing---just being our (most of the time) joy. Janey, you are turning out to be one fine adult!

Independence when possible

If Janey were able to tell me what she most wants in life, my guess would be it would be increased independence, and that can be heartbreaking to me.  With her intellectual disabilities and severe autism, she will never live independently, she will never be able to leave the house on her own, she will never indeed even be able to be at home alone for even a minute.  The few times she's been able to express thoughts in this area, she has asked me to go inside while she plays outside.  Even that isn't really possible---we live in a busy street in the city.  We sometimes stand just inside the door, to give her a little feeling on being on her own, but that's the most we can do.

So lately, we've been working on ways Janey can be independent in the areas where it IS possible.  We've found a bonus in this---it makes life a lot easier for Tony and me, and gives us a bit more time to ourselves.  It's a true win-win.

We had a breakthrough a few months ago with the shower.  As you might recall, Janey adores showers.  She will happily take four or five a day.  Once she hopefully starts getting social security, I think most of the money will go to our water bill!  But we have gotten weary of the shower routine, which we somehow assumed we always had to do most of the work for.  Then she surprised us.  One of the those nights when we simply couldn't keep our eyes open any longer, after she had been awake night after night, she got tired of waiting for us.  We awoke to find her soaking wet, having given herself a shower.  We rushed back to turn off the water, but otherwise, all was mostly fine.  

We had no idea Janey knew how to turn on the shower.  It's a little complicated, like everything else in our old house.  And the next day, when she asked for a shower, we told her to start one herself, to try to see how she did it.  Well, she just stood there.  We decided to wait it out, and finally, after 38 minutes (we kept track), she got into the shower and reached up and turned on the water.

So---the jig was up.  Now, when she asks for a shower, we tell her "Go ahead!  Take a shower!"  And she does.  It sometimes takes a very long time for her to do all the steps, but she's happy, going at her own pace and working toward what she wants.  I still wash her hair when it needs washing (maybe someday we can figure that one out, but not yet!) and we block access to the shower now at night, to avoid water being left on for hours and overflowing (turning OFF the shower isn't in her toolkit yet), but during the day, if she wants five showers, she gets them, and we get a little break.  We check on her a lot, we make sure all is well, but mostly, she does it on her own.

Another breakthrough, one that took Tony and me stupidly long to figure out, was TV access.  We have an Amazon Fire system to access the streaming services we have, and even for us, it's not the easiest thing to figure out.  For Janey, despite us trying very hard for years to teach her, it seemed impossible for her to learn.  So when she wanted to watch a show, she'd come to us with the remote and say "I need help!"  Which we were happy to do---for the first 5 or 10 times an hour.  The problem is that she doesn't generally just watch a show or movie all the way through.  She like the intros or certain scenes, something she can do easily on her phone and tablet, but something beyond her on the "big TV" using the remote.  

Finally, we realized that all the streaming services can be accessed by computer.  Janey uses a mouse with ease.  I'm not sure why she can use a mouse but not a remote, but I think it has to do with the visual cue of the caret on the screen.  Our TV is set up so it can also be a computer monitor, with the push of a button.  So---we "lost" the Fire remote.  It stays lost at any time Janey is home.  If she wants a show, we tell her "You know how to do it!" and she does.  She switches easily between services and YouTube and rewinds and repeats to her heart's content.  It was a rough few days at first, with many hours of "I need help!", but when she realized the remote was "lost" for good, she adjusted.

This is an example of something that we should have figured out years ago, and you might wonder why we didn't.  I think part of it is we just get tired.  It can feel easier in the moment to once again put on a show for her, to say "Okay, one last time!" when we know it's not one last time, than to take the time to figure out how to change things up.  I have a feeling most of you caring for someone like Janey get that.  Constant tiredness, constant vigilance---those are not friends of innovation.

The third area we've made some progress with is Janey being awake at night.  No progress in keeping her from BEING awake at night---we've realized that's probably not going to happen.  Janey goes in cycles.  For a few weeks, she sleeps more than most people---sometimes going to sleep soon after coming home from school and sleeping all night.  Then there might be a few days of near typical sleep.  Then....the few weeks of very, very little sleep, where she can be up nights in a row with NO sleep, or sleep only a few hours a night.  

These times are currently the hardest part of being Janey's parents.  It's no coincidence that being prevented from sleeping, being woken all night, is sometimes used for torture.  When we are up all night with Janey, we simply don't function at all close to normally during the day.  We are in a constant haze.  So, figuring out the nights is a priority.

We are lucky in a few things.  Janey is not an eloper.  She doesn't try to leave the house.  Over the years, we've childproofed, or Janey-proofed, so that she can't get at things that aren't safe for her.  But still, when she didn't sleep, we didn't sleep.  Part of that was just habit---even though she now was pretty safe at night awake on her own, we couldn't relax.  And partly, it was because if she ran into something she wanted we couldn't help with, she'd wake us up.

This problem isn't solved, but it's better.  We have started setting things up for Janey to access in the night.  Her phones and tablets are always accessible and charged, and we finally figured out (thanks to Freddy, our in house IT guy) how to take the passwords off them safely, so she doesn't need to wake up to constantly reinput the passwords.  We started leaving food Janey likes front and center in the fridge, leftovers for her to find.  She can get herself a midnight snack if she wants.  And now, we can better doze as she's awake.  Not totally---she can be loud, and she still wakes us fairly regularly, but our sleep (and by our sleep I'm doing a disserve not to say Tony's sleep, as he has always done the lion's share of the night shift) is more than it used to be.

It's striking me that it's fairly little things like this that make life easier---finding small ways to let Janey be the adult she is, and let us be the tired late middle aged people we are, letting us co-exist in a way that works a bit better for all of us.  There's areas that can't be changed---Janey is not going to learn how to drive so she can take herself for the car rides she so craves---but at times, it feels like we are making progress in figuring out, after 18 years, this unique lifestyle.

The Scariest Hour

 Well, once again, it's been a while!  I think often about writing a post here, but it seems often thinking is as far as it gets.  But an experience a few months ago has been on my mind constantly, and I guess I'm ready to write about it.

In early October, COVID finally hit our family.  I was starting to wonder if we were one of the rare families with some kind of immunity, as Janey had been going to school unmasked and Freddy to work unmasked for a long time at that point, and both of them had been exposed without getting it several times.  But, it turns out, we aren't immune!  I'll say in advance we were lucky---aside from what I'm going to write about, we got off a lot easier than a lot of people, and we know how fortunate that is.  

Freddy, the younger of Janey's two older brothers, came home from work on a Friday very sick and finally we saw the two lines of a positive test.  Tony felt sick on Sunday, and again, two lines.  I woke up Monday morning with quite a sore throat and got my own positive result.

As Monday wore on (Columbus Day Monday, so Janey was home), I felt sicker and sicker and sicker.  My fever went up to over 103 and wouldn't come down, and I was shaking.  My oxygen started dipping.  I have several fairly serious pre-existing conditions, so I knew my risk level was high.  Around 3 in the afternoon, I decided I better call my doctor's office, and they told me I should go to the ER.  As I processed that, trying although my thinking was foggy to decide whether to call an ambulance or have Tony drive me, Tony started suddenly getting worse.  His fever spiked, he started to shake and the oxygen monitor was showing some truly alarming numbers.  He's an insulin dependent diabetic, so again, high risk.  

And there we were, at the moment we've always known could arrive.  Both of us were potentially very dangerously sick.  But there was Janey.  We could not, simply could not, both go to the ER.  If one of us went, how could the other, just as sick, take care of Janey?  Freddy was too sick to help, and William wasn't home.  Although I am blessed with wonderful friends, they are not able to care for someone with Janey's level of needs, and even if they could, the local friends who I can count on for almost everything else are all over 60,not in need of being exposed to COVID.  

We sat there, or lay down there, shaking and fearful.  We tried to discuss options, with minds that were not at their best.  We had no idea what to do.

Freddy had gotten some Tylenol earlier in the day for himself.  I don't like to take Tylenol at all due to my liver problems, but in my feverish state, knowing Motrin hadn't lowered my fever at all, I decided to take a dose.  Then we just waited.  Tony's oxygen slowly came back to less scary numbers.  I slowly started to feel less like I was going to die that moment.  My fever went down to 102.  We both stopped shaking.  And, without really consciously making a decision, we both decided to stay home, to risk waiting it out.

It worked out.  We had a rough night, but Tuesday was better.  We were both still weak, had sore throats, were coughing that COVID signature dry cough, but we were okay.  We tested Janey, who tested positive also (with a very faint second line) and we of course kept her home that week.  She never really got more than mild cold symptoms, and Freddy also got better quickly.  William never got sick (he's better than any of us with masking)  Now it's mostly just a scary memory.  I am still having a lot of tiredness and some brain fog, but I know we got very lucky.

But that hour...wow.  It's what it all comes down to, isn't it?  It's what all of us with children like Janey fear---that there will come a day we can't care for her.  Mostly when I think of that time, I assume it will be when we are old (hopefully) and we die.  But the horrible hour that Monday made me see that it could be before then.  

I don't know what the solution is here.  Even if we did have respite care, this wasn't something we could have planned ahead for.  We have two adult sons in our house---but in this particular case, they couldn't help.  I honestly, truly don't know what we would have done if we both got worse.  All I can really picture is taking Janey in the ambulance with us.  We would have figured out something---that's what we as parents do.  But it's where this particular parenting life is so scary.  There are so few people that are able physically and mentally to care for an adult with a toddler's level of function, and so few people that we as wary parents of a very vulnerable person can trust with our beloved child.  I know you fellow travelers on this path get that.  I guess we all have to just hope for health and long life, and try to push down the fears that have been keeping me up nights lately.

A system that only rewards those able to be demanding

 I recently read a report a consulting firm wrote about an investigation they had done into a now closed school that had been part of the Boston Public School system.  None of my kids went to the school, but I read the report with interest as it was addressing larger problems within the district.  In the report, I came across this passage...  "Finally, we found that BPS’s current practice of more urgently addressing SPED issues or “crises” when they are raised by vocal parents results in an inequitable system within BPS where certain families are at a disadvantage because they may not be aware of this option and/or able to advocate for their children in the same manner."

Wow.  That hit me hard.  It brought back, vividly,  different times when I know that Janey missed out on help and services she should have gotten, because I was not one of those "vocal parents", because I didn't know how to forcefully push the district to address her needs urgently, because, as I've always seen it in my own mind, because I failed Janey with my own lack of knowledge or wimpy nature.  But reading that sentence, I was hugely struck by how unfair it is to expect parents of special needs children to both know what to advocate for and also to know how to advocate in general.  And I had a lot of advantages that many parents wouldn't have had---I speak English, I have a college degree, I'm fairly well-spoken.  Imagine if I were none of those things.

When Janey was first diagnosed, she was in a half day Boston Public Schools preschool.  She was there because she had a sibling preference, as her brother Freddy was a student at the same school, and she started, at age just turned 3, as a regular ed student.  When she was diagnosed, a few months after starting school, we called for an IEP meeting, which was held pretty promptly.  At that meeting, we were told verbally that the next year, when she was 4, for what Boston calls K1, 4 year old kindergarten, her needs were such that she would go to school all day, not half a day.  We didn't push for the whole day to start right away---I was okay with waiting until she was 4.

However, at the end of her 3 year old year, I was told that she wasn't going to get one of  the two full day slots in her class, that the slot had been given to someone else.  

I was very upset, of course, but I didn't insist or scream or call everyone I could think of or demand.  i should have.  But it's not my nature, and I also didn't want her moved to another school that DID have a full day slot.  I loved the school she was at.  I did ask hesitantly why they couldn't create a 3rd slot, and was told that "just wasn't possible".  

The slot went to another child.  I won't get into any details about that, but it was pretty obvious the other family did the things I didn't do---demand, threaten to sue, make their needs very strongly known.  That is what I should have done.  Or that is what I've always told myself.  But why?  Why wouldn't the schools just do the right thing?  Why did Janey getting what she needed depend on me being a parent who was informed as to what I had a right to, knowledgeable about the right people to call, and also willing to not worry about hurting feelings or alienating people?  

At that first IEP meeting, we were told that Janey would be assessed for ABA services.  That happened---about a year after we were first told it would.  The IEP services finally started a full year and a half after the IEP meeting.  I was told, over and over, that the district was swamped, that they just didn't have the resources necessary to do an evaluation, to say nothing of offer ABA.  Again---I let it go.  I mentioned it off and on, but I easily accepted the answers that it just wasn't possible.  I don't know if earlier ABA would have made a difference or not.  Over the years, the ABA services Janey has gotten have been (mostly) delivered by well meaning and kind people, but the providers seem to constantly change and to use widely different approaches.  I've been very pleased with the last few years, finally, in high school, with Janey's ABA services, but did she miss some kind of crucial time for help because I didn't demand she gets services for that year and a half when she was so young?

I should have demanded more.  I tell myself that all the time.  But WHY?  Why isn't the system set up to HELP THE CHILD WITH SPECIAL NEEDS, not to reward those with loud voices and special abilities to navigate the system?  Special needs kids occur in all kinds of families.  Why should Janey has missed out because we weren't good at demanding?

I've gotten more knowledgeable over the years, and I've gotten better at being persistent in getting what Janey needs.  I'm still not a pro at being demanding, and I probably never will be.  But in those early years, I was about as weak an advocate as I could have been.

Reading the sentence I read tonight in that report---I can't tell you how much it resonated with me.  It was like someone had finally seen what I had seen all these years---a special ed. bureaucracy that seems to exist to deny help, not provide it, unless they are faced with a very specific kind of parent---one with the resources, knowledge, means and personality to get what their child needs.  Boston schools have come close recently to being taken over by the state, and part of the reason is the problems in the special education central office.

The poignant part of this is that despite the lack of support from the higher level people, the rank and file of the Boston special ed. educators are truly some of the finest people you could possible imagine.  I can't even start to tell you how wonderful most all of Janey's teachers have been, as well as her aides, her therapists, the school staffs from top to bottom including the clerical staff, the cafeteria workers, the principals, the IEP team leaders---I am happy to count many of those people as friends, and Janey and our family are so lucky to have them.  And they are as unsupported by the bureaucracy as we are.

I know this isn't just a problem in Boston.  It's a problem that exists all over, and until we decide that we will put children first, and give them what they need to succeed, it will keep existing.  Let's have a system that, instead of waiting for the demanding voices to demand, listens instead to the unspoken needs of those who, for so many different reasons, don't demand but so much need the help.

The Cycling Life

 Janey turned 18 last month.  I would have pictured myself writing a post about that, talking about her becoming an adult, reflecting on her childhood.  I found myself unable to do that.

It hit me today what made it so hard for me to write about the milestone in Janey's life.  It's the lack of forward motion in her life, and ours.  Janey changes, all the time, but the changes are cycles, for the most part.  There are many Janey modes---very happy Janey, talkative Janey, sleepy Janey, crying Janey, quiet content Janey, no-sleep Janey, manic Janey---and there have been, right along, since the regression and start of her autism, when she turned three.  Days today, with the exception of her being older and bigger, could be days when she was 3, or 7, or 12, or 15.

I'm sure some who know Janey will say, and probably rightfully so to some extent, that that isn't true, that she's made progress. And who is to say what progress is?  But at a very basic level, she hasn't.  I think we've learned about her more, we understand her more, we know so very well what makes her tick, how to best respond to her varying states, how to keep her happy more of the time than not.  But progress?  I'm really not sure there has been much of that.

Does it matter?  In some ways, no.  We aren't holding Janey up to some standard that just doesn't work for her.  We aren't working toward a goal that will never happen.  She won't hold a meaningful job, she won't live on her own, she won't get married or have children, she won't drive a car or read books or go to college.  Much of progress is working toward goals.  The kids she started school with are going to college now, preparing for careers, maybe meeting their future spouses.  The progress they have made over the years has led them to this point.  I don't think it was ever in the cards that progress Janey made would do the same---so does progress matter?

The last few days have been in the mode of one of Janey's toughest personas.  She is not sleeping, she is crying half the time, she is pacing and volatile and demanding.  But we know it won't last.  She will pass into another mode---maybe the sleeping all the time mode, or the cheerful but quiet mode, or the rare very talkative and happy mode.  That's the flip side of cycling rather than progress.  Progress, if you think of it as permanent change, could mean that tough behaviors will never go away, and we have learned that with Janey, if you wait it out, they do, at least for a while.

I think why it's hard for me to admit to myself, why a 18th birthday sum-up was something I couldn't write, is because in some ways, we as autism parents are sold a false bill of goods.  I don't think anyone is doing this on purpose.  It's more how we are as a society, and so maybe it's automatically the standard we apply to kids with autism.  We believe that with the right education, the right attitude, the right therapies, the right parenting, the right foods, the right medical care, the right everything, our kids will progress.  We tell that to new parents with autism. And for some kids, it happens, and they attach a causation.  They assume the progress is because they did the right things.  But I'm here to say---that might not be the case.  You can do everything right, and your child might still not be toilet trained at age 18.  They might not read.  They might not talk any more than they did as a toddler.  They might not be able to do basic tasks of adulthood like walk to a store by themselves and buy something.  On the other hand, you might do nothing that is supposedly the right thing to do.  You might be the most hands off autism parent in the world, and your child might undergo a total "cure".  I honestly, truthfully have come to believe that's the nature of the autism beast.  There's a natural history of each person with autism, one we have very little control over.

So---what's the deal here?  Today, because of lack of sleep and days of trying to keep Janey from crying, I feel pretty down.  But overall, I don't think the message is totally a negative one.  I think it's one of acceptance, acceptance that goes beyond the lip service sometimes given acceptance.  Janey is amazing.  She's one of the coolest people in the world, one of the most interesting people, one of the most fun people.  She makes me proud every day.  And that isn't because of progress.  It's because of who she is and always has been.  That doesn't mean life with her is easy, or that we don't need a lot, lot more help that we usually can get.  It means we value her for being her, not for meeting goals or checking off milestone boxes.  

Happy birthday, Janey.  Welcome to adulthood.  It might not look like most people's adulthood, but it's just as valid, and valuable, and we celebrate the memory of your childhood and look forward to knowing you as an adult.

Hot and bothered

 The last three weeks have been the hottest ever recorded in Boston, and it's been miserable.  Hot weather is miserable everywhere (or it is to me) but Boston's hot weather feels like a special kind of awful---humid air but no rain and a feeling of there not being a full breath to take outside.  I hate it.  And so, take that into consideration when I rant here.

Janey had a tough day of school today.  We got a call from her summer school teacher.  He seems great, and I really liked the way he told me about her day---emphasizing the good, outlining all she was saying and why she was getting upset.  She wanted to go home, and failing that, she wanted to go to the dance studio, and if she couldn't do that, she wanted to go swimming.  It was too early to go home, the dance studio was closed for the summer and the pool for some reason is not available for special needs summer school students.  And so she was angry.  When her summer ABA therapist tried to get her to do work, she pulled her hair and then bit her (not badly, but a bite is never good).  She later also tried to bite her teacher.

It's not unheard of for Janey to pull hair or bite, but it's quite unusual in the last few years.  I think she was feeling what we've all been feeling---just fed up.  She's tired of the heat keeping us from doing anything much fun.  She is tired of schoolwork.  She wants to do the things she wants to do---dance and swim and go for car rides.  And she expressed what she wanted, with words, as we always ask her to, and it didn't make any difference.  She lashed out.  It is not acceptable for her to pull hair or bite, or to hit as she did this evening with me while I was trying to talk to her about the biting and hair pulling, but I can somewhat understand why she did.

I was feeling in a mood today before we got the call from the teacher.  I read an article in the Boston Globe about a new law that allows young adults with disabilities access to colleges in Massachusetts.  That is great---I am truly happy for the people that will be able to take advantage of that program.  But reading about it, it soon became apparent that Janey won't be one of those people.  The article acknowledged that---it said the state's total population of college aged students with serious intellectual disabilities and autism is around 3500 to 4000, but that "a smaller number are likely to seek college access under the new law". Then it said that those who do will "improve their chance of employment" and that "Individual campuses will determine their own criteria for acceptance"  There were quotes from students who accessed college under past pilot versions of this program, and while I was very, very happy for those students, the language level in those quotes made it clear that Janey was not going to be one of those students.

And none of this is new.  As I'm seeing expressed more and more, thanks to groups like the National Council on Severe Autism, people like Janey are left out not only from the mainstream but for a huge percentage of programs expressly for people with disabilities and more specifically, people with autism.  We all know the key words and phrases "Must be able to follow directions"  "Must be able to function with a teacher/child ratio of 4/1" "Must be able to read music" "Must not have any self-injurious behaviors" "Must be completely independent with toileting".  They might as well be saying "Must not be THAT kind of autism.  Must be the "good, quirky, interesting" kind of autism, not the "bad" kind.  They don't say that.   I am sure most people don't even think that.  The truth is, I think a lot of people, even in the disability world, are not totally aware people like Janey exist.

I am weary.  I don't know what the future will hold.  Janey turns 18 a week from tomorrow.  Tomorrow, we will be keeping her home from school---the teacher did not ask us to, but I know how her angry and lashing out moods can go, and we need to break the cycle.  Because there is no plan B.  We will never again take her to an emergency room.  There is no respite.  There is no residential home waiting for her as an adult.  Hopefully, at age 22, we will find her a decent day program, once she ages out of the public schools.  She won't be going to college, special new law notwithstanding.  

I think parents of children like Janey are starting to speak out, and that is so important.  Parents like us love our kids so much that we can be inclined to not talk about how hard it is.  But if we don't, if we let Janey and all the people like Janey be without a voice, they will be left out.  Nothing will change.  And on a night like this one, where I am tired and hot and weary and discouraged, I can say that just can't happen.