They say life isn’t like the movies, as if every day’s agenda will be definitively pulled from a drop menu of easily parsed platitudes. Some days can not be bound by such lists and assumptions. Entire years even can be unrestrainedly defiant of them. In this house we have been given a different script to live through, and so we’ve learned…every day is Groundhog Day.
Prior to the past six years, I never really thought a great deal about all of the things that could be entailed in impulse control issues. On the milder end you might have slightly riskier behaviors and thrill seeking. On the other end, you could have a kiddo who is not only incapable of keeping themselves safe from common dangers, but who also does things like dumping all the clothes from his dresser before he goes to sleep at night, or goes through phases of emptying out all of the balls from his ball pit. If it’s a particularly bad month, Tony might be doing both concurrently. And then there are those evenings and mornings where the clothes get dumped out more than once. This past Wednesday/Thursday, he emptied out his dresser four times in a ten hour period.
Or, you could have a kiddo who dumps out all of his books, and throws his plate or upturns his cup every time one is set before him. Or who will smash every jar in the pantry because his neurology isn’t capable of holding onto what happened to the last jar he smashed. These are all things we’ve seen or are currently seeing in our house, and as with so many things, I could go on because there’s definitely more. And you should probably just assume that about every post I write…there’s always more.
And so it goes. Every day- over and over again for years- a relentless tide of impulse control wreckage has been beating against the walls of our home, waiting to be cleaned up and recede so that it can crash against us with time eroding force the next morning.
I do not talk a great deal about what the Fetal Alcohol Spectrum Disorder (FASD) part of Tony’s diagnosis list means for his future. Just a brief heads up for those of you finding this blog and post for the first time: our son is adopted, so I did not do the drinking, and I am quite certain his birth mom had no idea what it would do to him, so please be merciful in your thoughts towards her. Truth be told, when an individual has so many conditions that can have overlapping symptoms, it can often be very difficult to figure out which diagnosis contributed most to a particular situation.
Most of our little man’s conditions come with impulse control issues: Sotos, Autism, ADHD, and the FASD. Medication can help an individual with ADHD, therapy can help an individual who is Autistic (although our son has been diagnosed at level 3, which is the category for the most severely affected individuals, so that is a longer road), and for Sotos alone many things may gradually improve over time as overall development is delayed but does progress. But for individuals with an FASD, the alcohol exposure actually creates permanent damage to certain areas of the brain. So symptoms related to his FASD will certainly be limits that aren’t going to be so easily improved upon.
Because he has all of those conditions, it may be years before we understand what Tony’s ultimate overall level of functioning will become with impulse control. With some areas, years of intensive reinforcement has led to a resolution of some of our sweet son’s impulse related struggles. You can now set plates and cups in front of our little man and he’ll use them appropriately, for example.
For things he tends to dump- like toys, books, his clothes, or his ball pit- we work with him daily for each incident in cleaning it up. I long ago stopped trying to keep his clothes folded, my battle is simply with getting him to put things away in his drawers. This can take up to an hour for his bedroom (likewise for anything he upturns downstairs) because he often doesn’t want to do it- even in exchange for items or rewards he loves enthusiastically. I know that it would be much quicker if I did the cleaning myself, but the cleaning is aversive enough to him it’s about the only thing that gradually moves him past the need to empty these containers out.
After over two years of daily cleaning, Tony no longer dumps his downstairs toy bins. That was particularly challenging because it happened several times a day and I have purchased him a therapy clinic worth of toys and supports…maybe two or three clinics worth if I’m being perfectly honest. Books are only a weekly battle these days instead of the two to three times daily they once were.
So we’re moving forward bit by time-consuming bit, taking “baby steps.” Always “baby steps,” ever so slowly shuffling and wobbling forward. But we’re still cleaning up clothes nearly every morning, and sometimes the ball pit too. For now, we still have so many of the same themes playing out like “lather, rinse, repeat”, and in our home for over five years every day has been Groundhog Day. Now Bill Murray- get out of my head.
A Note on Impulsive Behavior
Tim Bilkey, M.D. noted the following in an article for Psychology Today:
“The official DSM label, Attention-Deficit Hyperactivity Disorder, actually doesn’t describe one of the most invisible of the symptoms, impulsivity…Decision making is part of the prefrontal cortex, which is the thinking part of the brain behind your forehead. It is the last part of the brain to mature and this doesn’t occur until our 20s. Decision making is an important part of the brain function in the prefrontal cortex. This explains impulsive decision making in teens, for example. People with ADHD have an even greater delay in the maturity of this part of the brain, which may explain some of the impulsive traits that they have.”
One of the areas of the brain damaged by alcohol exposure during pregnancy is the frontal lobe, which contains the prefrontal cortex. You can find a good breakdown of all the areas of the brain damaged by alcohol exposure if you are interested by visiting the following link: https://www.mofas.org/resource/areas-of-the-brain-affected-by-prenatal-alcohol-exposure/
