Generic Abilify

Mood Chart and Records

April-June 2015

	See the pretty blue line in April? That's the day Abilify went generic. See the differences in the before and after? It's clear that his moods, irritability (Blue triangles and rectangles) and anxiety (Yellow triangles and rectangles) all changed. His psychiatric nurse practitioner sent these mood charts and mood journals to the insurance company along with some additional paperwork and wrote a script "Dispense as Written: Name Brand Medically Necessary". Now it's a waiting game to see if the insurance improves it. This is our life the past couple months:
	Mood Journal 06-23-2015:   Good day. A little irritable and a bit sad (About losing his $$) but no major issues. 06-22-2015:   Good day. Anxiety at school graduation, but participated and stayed in the auditorium through the whole thing without any issues. (Was shaking a lot afterwards.) 06-21-2015:   Good day. 06-20-2015:   Good day. 06-19-2015:   Good day. A bit depressed in the evening regarding going to middle school in August and missing a certain class aide he's gotten close to. 06-18-2015:   Good day. A bit grouchy. 06-17-2015:   School: "Acting like a monkey noises during morning meeting". Had refused to participate in field day or even go outside until Mom came. "Too many kids" he told me. He did sit with me, back away from the festivities a bit. He chose to participate in 1 activity in the morning (Out of 8) and one in the afternoon (Out of 5). Lots of sensory seeking, kicking sand/woodchips, rocking, moving feet back and forth on ground, tons of different animal noises, silliness. Did go into time out space in afternoon (Upset he could not find his chair). While in time out, opened and closed door which disrupted the class and was unsafe. Stopped on his own after a few minutes. Home: Good morning but silly. Afternoon went well, although silliness persisted through the early evening. 06-16-2015:   Lots of anxiety this morning on way to school. Chewing fingers. Good day at school. Picked up early for an appointment. Sensory seeking today (Touching everything). Hyper, but well behaved. Tons of energy. Silliness. Animal noises. Singing commercial songs. **SCHOOL DIDN'T GIVE HIS NOONTIME TENEX. 06-15-2015:   School: Refusals (Morning recess, afternoon recess); reported he was "Cranky" as he "Didn't sleep enough"; Became upset when he didn't earn stars (Began writing on table with a sharpie and scratch the desk); Became upset he couldn't do what he wanted at sensory time, so began to escalate again. Principal had to come down to clarify expectations. Home: Irritable in afternoon. Good evening. Woke up night before to use bathroom and change self. Went back to sleep rather quickly though. 06-14-2015:   Good day. 06-13-2015:   Awesome day. 06-12-2015:   Daily sheet says "...didn't do so well today. He never went out for recess and did not do much work at all. He only drank about 9 oz of water because he poured one out on the floor and so I took the other one. He ripped up papers, banged things and was very disruptive at times." 06-11-2015:   Orientation at middle school today. Anxious. Overstimulated. Biting nails. Zoned out. Couldn't handle overstimulation in cafeteria so I took him in the hallway. 06-10-2015:   Awesome day. Only issue at school was refusals. 06-09-2015:   School: Good day. Home: Good afternoon and evening. Good job at counseling. Seemed restless today and full of energy. Fell asleep at kitchen table. Tried 3x in an hour to get him to go to bed. He refused. He kept talking stuff that made no sense. He was sleep talking I think. Rage came out of nowhere on our last attempt. He kept saying "Off me" and to leave him alone. Natasia tried bribing him with going for a walk tomorrow. That did not even work. Daddy finally escorted him to his room where he was trying to rip his sheets, hit Daddy with a pillow pet, hit himself with it a few times in the face pretty hard and called Daddy a "Bitch". 06-08-2015:   A couple small struggles and refusals at school this morning. Fine all afternoon and evening at home, but full of energy. 06-07-2015:   Irritable today. Very hyper. Kicking socks across room. Stepping on Princess feet on purpose. In everyone's personal space. 06-06-2015:   School: A bit upset another child said he'd bring a ball but didn't, ripped up star charts, lots of tapping on desk. Home: Screaming silliness, lots of noises, "Jack" was with us (He escaped from jail). Issues listening. Hyper. Used some not-so-nice (But not "Bad") words. 06-05-2015:   Slept 9pm-3am. Went back to sleep from 4am-6am. Very hyper this afternoon. Screaming and making all sorts of noises on the way home from school. "Jack" (Either an imaginary friend or person who shares his body) was with us for the ride. He hadn't been around for a while. He told me he was in jail, but escaped. Day sheet says how he had a great morning, but got upset at recess "As he thought + another student said he'd bring in a kickball and didn't. That set his afternoon on a different path. He ate, but after lunch was over for our class he ripped up his star chart for the 3rd day in a row. He was just writing and tapping for a while." 06-04-2015:   School: Great day until 1:15. At that point he ripped up papers and made threats to turn over desks and tables (But didn't do it). He seemed to be worried about technology. He was able to regroup, discuss and made a plan B for when upset. He then got right back on track. He chose to refuse PT today" Home: VERY irritable most of the afternoon and evening. Seemed a bit down too. 06-03-2015:   School:Did not want to eat lunch in the cafeteria, so he just sat at his desk. At 11:50, it became clear he would not budget so I got his lunch for him. He ate it and then brought his tray back + got his medication. He never got out for recess. After lunch, he got back on track but then changed his mind about what he wanted to do + an issue with line order arose. He protested and eventually ripped up his star chart. However, he went to music OK and did Word Of The Day. He was our line leader..." Home: Afternoon was irritable, but no major issues. 06-02-2015:   School: Refusals, tipped over desks and chairs, time out from 12:20-1:15. Home: Irritable in afternoon, but no major issues. 06-01-2015:   Day sheet explains how he is back on yellow. He had a good morning, but had difficulty choosing an activity at incentive time, struggled during indoor recess, demanded being able to put together a volcano and explode it (Which is not possible at indoor recess... didn't want to play games, draw or read which were other choices), poured his water on the floor, tipped over a desk and chairs (Picked up the items after he calmed down yet refused to acknowledge the consequence for his actions), had a difficult afternoon with lots of refusals and again tipped over desk and chairs. Evening pretty good. Impulsively hit the dog once. No other issues. May 2015 05-31-2015:   Honeybunches had another good day! He was a bit hyper today, was playing "Rocket" kicking the dust pan, pretending a bag of cat treats was a bomb dropping it on Princess' head and other little stuff. At one time he did lose a star for throwing a lollipop at the dog on purpose. 05-30-2015:   Awesome day. 05-29-2015:   This morning, Honeybunches got upset with the dog. He was trying to pet Brownie, but Brownie growled at him so he slapped her. He lost a star for not using nice hands. Hyper and silly in afternoon. 05-28-2015:   Good day. 05-27-2015:   Silly day at school and ripped up star chart but no major issues. Good afternoon. Seemed a bit anxious. Lots of rocking side to side when visiting the middle school. This evening him and his sister were playing. When she was done he had trouble regulating again. Began pushing the table back and forth across the kitchen. Natasia was sitting at the table eating salad. He began pushing the table into her chest. Continued pushing table into her. Escorted to his room. Kicked the dog on his way by. Rhymically banged his door against his side table repeatedly. Threatened to choke to death in the night. I forgot his exact words but he mentioned not being able to control what was going on. 05-26-2015:   Day sheet from school says: He became upset and refused to go to Art. He was tipping his desk back +forth and then stopped after a few reminders but eventually he started again so I took it away." Went into the time out space when upset, took off his belt and was informed by the teacher if he hit anything the teacher would take the belt. He said he'd take off his pants. He hit the window with the belt, teacher took the belt, Honeybunches took off his shorts. Thankfully he had boxers on. Hard time at counseling all because he could not have a pen. Throwing objects, trashing the office, tried to bite me. 05-25-2015:   Good day. 05-24-2015:   Good day. 05-23-2015:   Good day. 05-22-2015:   Extra cuddly. Singing in bath. 05-21-2015:   Mom and Dad not getting along so well today. I think he felt the tension. (Related to Daddy's Bipolar.) 05-20-2015:   Hyper and silly today. 05-19-2015:   Some refusals at school. No major issues. 05-18-2015:   His daily sheet explains how he refused to go with specialist this morning; refused to have snack; refused to do his math assignment; continued noncompliance resulted in a significant amount of stars not being earned; "Upon realizing that he would not be able to move off of yellow level, he proceeded to destroy the level system board (All papers were ripped up and shoved into the heater). His star chart was also put into the heater... This means it can not be replaced. At 12 he was able to get back on task. Unfortunetely at 2:!5 he refused to do cursive assignment. 2:30 refused incentive work "I'm not doing nothing" (He said)..." Irritable at home in afternoon, but no major issues. 05-17-2015:   Awesome day. 05-16-2015:   Good day. 05-15-2015:   Rough day at school. Teacher out. Refused lunch. Got called to pick him up at 2 pm. Broke computer monitor in pieces with a pad from the time out space. Went in time out space. Broke pencil. Drew on floor pad. Bit own hand leaving mark. Began when aide told him to carry ball inside and not kick it. 05-14-2015:   Good day. 05-13-2015:   Good day. Please Note: Abilify generic began on May 13th. 05-12-2015:   Few struggles at school today. Had to change classes at school because of PARCC testing. Got upset about that. Ripped Music teacher's poster. Had to serve time out. Afternoon and evening good. Anxiety school related. Irritability related to changes at school. 05-11-2015:   Good day. 05-10-2015:   Family party. Overstimulated. A bit irritable in evening. 05-09-2015:   Awesome day. 05-08-2015:   Good day. 05-07-2015:   Okay day at school but had a couple issues with walking feet, then getting upset that another child in his class who was the only one with walking feet got a sticker on his car for doing so. Didn't participate much for an hour or so. He was being "Unsafe" tipping his desk over and had to serve a time out at his desk. Fine at home. 05-02-2015:   Good day. April 2015: Unless otherwise specified, was a good day 04-30-2015:   Good day. A bit silly. 04-28-2015:   A bit silly. 04-24-2015:   A bit irritable, but it was an overstimulating day at the Boston Museum of Science, where he said "People keep getting in my personal space". Very overstimulating, noisy, crowded, etc. Did a good job controlling his body though. 04-01-2015:   His day sheet explains how he had a good morning, but the afternoon was difficult for him to stay on schedule. He refused lunch and did not follow his music contract, so did not earn his incentive time. Very hyper. Hopefully this will help him get the name brand again, although I am doubtful based on past experiences with Risperdal when that went generic.
	Honeybunches will have Summer tutoring 2 hours per day, 4 days a week for 4 weeks with a one week break in the middle. A teacher from the middle school who will be doing his Reading and Math will be doing it this year. I'm still waiting to hear what dates that will happen.

Middle School Orientation

Honeybunches orientation at the middle school went okay, although he was very overstimulated and anxious. First, they all went into the larger auditorium for a presentation where they met some teachers and learned a bit about the school. He was overstimulated and anxious. He would not stop biting his fingers. He sat back away from the other children, which is where he wanted to be. After that, we went to a regular 7th grade class which I didn't even understand him going to, but that's how they did it. "When is lunch time" is a question he asked several times. He spent most of the time staring at posters on the wall. He's used to having morning snack, which they don't even really do there (Although certain teachers accommodate). His belly is used to having one. Lunch is early though, at 10:40. At lunch, he went up with me, got his tray and food. Then he chose to sit at a table all alone with just us. When he was done eating, he was a bit confused about the process to clear the trays so I asked staff to clarify things again for him. Then we went to sit back down for a minute or two before he decided it was "Too many kids... Too many kids... Too Too many kids". I took him out in the hallway. I can see lunch becoming an issue. It's more than just his current elementary school that feed into the middle school. Two other towns schools do as well which makes it more overstimulating. From there, we went to the class where he'll have reading and math. He did okay in there. Besides finding the sign out sheet interesting and fiddling with the door, he conversed with one of the teachers which was awesome. He refused to sit and stood up the whole time looking around the class. Then we went to Mrs. C's room, who will be his teacher next year. We learned that a boy J who used to try to be his friend that was in his 3-4th grade class will be in Mrs. C's too. (Although I remember them feeding off eachother's behaviors a bit too and J riling Honeybunches up.) She'll have 4-5 7th graders she said. He enjoyed playing with some play money he found on a desk. He organized it all with J. From there, I took him to meet the nurse since he'll be seeing her every day to take his noontime med. Then his current teacher said I could bring him home, since they were going to another assembly in an even smaller auditorium. We both figured that would be too much for him, especially since he just barely handled the one this morning in a larger one. The school was hot, with no air conditioning. Ugh. I told Honeybunches we'd come up with a plan for lunch. I might have him try it for the 1st week-and-a-half since we have his yearly review in the 2nd week of school. I told him, if he can't handle it he can go tell the Dean or the pastor at the church next to our house who is also a neighbor a few houses down and who works at the school doing various jobs including recess duty that "It's too many kids" and they'd help him come up with ideas. Although overstimulated and anxious, he did a good job controlling his body and using his words. Oh yeah, we'll have to find him another coping skill to use when he's anxious. He bites his nails and fingers bloody sometimes, so at his current school the teacher gives him chewing gum. There's no gum allowed at the middle school.

I emailed the SpEd Director and IEP Chairperson.  This is some of what I wrote:

"... Orientation went okay today. He seemed very anxious and overstimulated, but did a good job using his words. In the auditorium this morning, he chose to sit behind all the other children and not with them. I want to make sure this is an option for the 1st day of school assembly (And future mandatory assemblies) if that's what he chooses to do. Honestly, I don't think he gets much out of those type of assemblies. He spent much of the time biting his fingers (Anxiety), looking at the floor and closing his eyes a bit (Not tired, trying to zone out from the world, which sometimes happens when he is overstimulated). For important pieces of information, it would be best if he could have things presented to him in a much smaller group instead. Speaking of anxiety, when he begins chewing his fingers, Mr. M has let him have chewing gum. I learned today that chewing gum is not allowed at (Middle School). We'll have to find something else for him to do when anxious so he does not chew his fingers bloody. 

A bigger concern I have is lunch time. He went up through the line, got his tray and picked a table alone to sit at. He tolerated it for a few minutes, but then when he was done eating he said it was "Too many kids... Too too many kids..." I took him out into the hall.  Lunch accommodations is something we might want to consider as we see how things go in the first couple weeks of school.  I told him until we come up with another plan, he could go tell (Dean) or (Lunch worker, who is also a neighbor and a pastor at the church next to our house) that it's too noisy or too many kids and they could help him come up with ideas. Even if he seems to tolerate lunch okay, if his afternoons get rough it may be from overstimulation at lunch time. I guess we will just wait and see, but I wanted you aware that's an area he may need additional accommodations thought about. I know the difference, where today's lunch was 40 minutes and on regular days it will only be 20-something minutes. With it being a shorter time, maybe he'd be able to tolerate it better. It took him a long time to be able to tolerate lunches at (Elementary School). At (Middle School) it's even more children from the other elementary schools. Even with there being a lot of room in the cafeteria, it seemed to be too overstimulating for him. 

Changing for gym is another concern. He can change and dress himself, but sometimes needs help getting his shoes back on or at minimum tying them. Are shoes that tie mandatory? I am wondering if sneakers with those elastic stretch lasces that do not tie like these:

http://www.walmart.com/ip/Kiwi-No-Tie-Curly-Shoelaces-White/25289317
or something like these would be acceptable:
http://www.locklaces.com/lock-laces/

I am glad that we have his annual review in the beginning of September. That'll be a good time to discuss these and any other concerns that may come up.

As for the last scheduled visit to (Middle School), if we did plan another one (Which he's interested in doing), I think he might be more focused in the morning.  With the previous tours, he voiced to me that he liked them because he could come home early.  I think that he rushed through things and was more focused on getting to come home early than he was on things happening at (Middle School). I think if we planned a trip earlier in the day if possible and had him go to (Elementary School) when it was done then he may be more focused. I don't know if that would mess up his day at (Elementary School) though.

I hope that in planning his UAs and Gym/Health classes, you'll place him in the smallest groups possible.  Also for UAs please keep his getting overstimulated and sensory needs in mind.  (For example, noisy classes such as band and music would not be good options for him.)

I thought I'd update with these concerns that presented today.

Thanks,
------
PS: Next year I'm going on a mission to find a way to get more middle and high school parent's involved with the SEPAC. I am thinking maybe we could have a poster and table with pamphlets I could make set up at Parent's Night.  There has to be other ways to get the word out to those parents too, which I hope we can work as a team to find."

Sensational Stars

I began using a new Behavioral System which we're calling Sensational Stars today. I have it in a cheap portfolio thing I found at Dollar Tree.  Each sheet is in page protectors, so that way we can use white board markers and wipe the pages off instead of using ten billion pieces of paper.

Here are some pics with explanations:

 He had me add in to the one above: animals, objects and people to be more specific.

 An example of nice words:

 Each day, he can earn stars every 1/2 hour that he uses nice hands, mouth and feet plus using nice words.

 The weekly talley:

 Daily rewards: I might change this up a bit as we go along if his interests change. He had me add in going to TD bank under the 100%.

 We actually just changed this to Saturday reward, because the library is closed on Sunday.  The weekly talley above we changed to reflect this as well, making it go from Saturday-Friday so he can have his reward special on Saturday.

 I am going to add in some other sheets about what he can do when he feels certain ways. I am emailing his counselor to see what feelings we should work on and any suggestions he might have for coping skills when he feels certain ways.