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A Summary of the Week's Doctor Visits (February 19, 2009 - 7:06 p.m.)

As promised, here is an update on Stephanie's recent doctor's visits.

First, on Tuesday morning, we had a very nice visit with the new therapist, Dr. Leslie Faris, a psychologist.

This was Steph's second meeting with her, but my first time to meet her, and I was very impressed. I wanted to stay in her waiting room because it was the most serene place I had seen in a long time. Heh. Nice and comfy, with big, cushy couches, and the local classical music station on the radio.

For the meeting, though, I got to giver Dr. Faris a little of my perspective on Stephanie's situation, which is pretty much the same as her mother's. We asked her to write something up, though, to present to the school for today's ARD meeting. She did that and sent it to us in an email yesterday. Here is what she said in the letter.

To Whom It May Concern:

I am the treating psychologist for Stephanie Bickley. I have seen Stephanie and her family since February 12, 2009, when they came to Psychology Services of North Texas requesting treatment for anger, depression, and behavioral issues. It is reported that these problems have magnified since November, 2008, when her Grandfather passed away. Our treatment goals consist of the following: Anger Management, Anxiety and Depression treatment, Grief/Loss Therapy, Coping Skills and Strategies, Social Skills and Boundaries, and Frustration Tolerance. Depression was noted in the first session, and a recommendation was made for the patient to be seen by her treating physician for a medication evaluation.

Having researched Stephanie’s previous file and testing information, it is reported that she was diagnosed with a mild form of Autism and Anxiety Disorder in 2006. At that time, consistent with research into the best accommodations for these conditions, it was recommended that Stephanie have small group instruction, speech/language therapy, resource assistance, and content mastery.

Stephanie is currently integrated in the classroom setting and it is becoming apparent that her intellectual abilities and social development are incongruent with those of her classmates. Stephanie is not an outwardly aggressive-natured person, but finds herself reacting to frustration with acting-out behaviors. Persons with Autism tend to become overwhelmed easily, and the size of the traditional classrooms at Central High School may not be the best environment for her to progress. In addition, consistency, confinement and stability are very important for Autistic patients. My hope would be that Stephanie be placed in an environment with minimal environmental stimulation, and with students with whom she can identify. If there is a smaller classroom setting that might be able to accommodate someone with mild Autism, it is preferred.

I will continue to work with Stephanie to behaviorally integrate into the school setting, and will work with her on developing appropriate coping strategies for handing stress, anger, disappointment, sadness and frustration. My hope is that you will find a place for Stephanie at the school that will help her to feel as though she is learning, achieving and progressing.

If I can be of any assistance at all, please don’t hesitate to contact me. I will continue to work with Stephanie on a weekly basis and will do whatever is recommended by the committee as well to help Stephanie.

Thank you for your time in this matter.
Sincerely,

Dr. Leslie M. Faris
Licensed Psychologist
Clinical and Health Psychology

Very good recommendations, I think.

Then Steph spent about 15 minutes alone with her and we scheduled our next appointment for next Tuesday afternoon.



So, today (Thursday), we had the ARD meeting. It was a mixed bag. I would feel a little more positive if we had gotten a little more acknowledgment of her condition from the Vice Principal, but at least I have gotten him to do some research on autism. I challenged his knowledge in a previous phone call, and he has risen to the challenge. That impressed me. He still thinks that some of Stephanie's actions, however, are more "choice" than "symptoms." We shall see. The most positive thing that came from this meeting is that we all agreed that they would do a complete re-evaluation of her sometime during the next few weeks. This will be pretty comprehensive, with paperwork filled out by us, Steph, her teachers, and a team of diagnosticians. I feel a little more confident in the results of this. We still have three professional opinions, now, though, to fall back on.


After the ARD meeting, we headed back to the psychiatrist's office to see the nurse practitioner to try to get a handle on the drug situation. To update a little on that, Stephanie was previously put on Wellbutrin (150mg) and Abilify (15mg). The new psychiatrist felt that Wellbutrin was not the right thing for her and pulled her off of it back around the time that Steph's Pawpaw died. This resulted in her having much more anxiety, which has increased ever since. Last week, the psych increased the Abilify by 5mg to make it 20. This has not helped. This afternoon, when we picked her up after the ARD meeting, she was already crying. She said she was scared and didn't want to go to the appointment. We told her we had to, because we need to get this straightened out.

She cried almost all the way through the appointment, and hardly said a word the whole time. (We saw the nurse/practitioner on this visit.) We discussed the situation with the nurse and all agreed that Steph needed something else for the anxiety. She still felt that Wellbutrin was not the answer, and that an SSRI (Seratonin Reuptake Inhibitor) would be better. We had tried one of those a few years back (Lexapro), and it caused Steph to "act out" a little more. However, we were not taking Abilify at that point. So, we left there with a prescription for Zoloft (she will start with only 25mg a day, a very low dosage), and a little bit of Xanax, if we need a "quick fix." However, we have the understanding that Xanax is potentially extremely addictive, and we certainly don't need that. She only gave us 14 of those for an "as needed" basis.

We have another appointment for her in two weeks.

Sigh.

It's been a rough day, to say the least. But I/we feel positive/hopeful that these things will help.

I plan to continue to use this diary to keep updates on the therapist's visits and psych visits, and any updates from school. As well as my usual nonsense like book reviews, baseball news, etc.

TTFN, y'all

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