Tag Archives: medication

Freestyle

About a year and a half ago, a fairly new friend of the family came over for a visit on a day that Nigel had forgotten to take his medication. Behaviorally, he was difficult – highly agitated and unfocused.  At one point, when he was prevented from doing something that he wasn’t supposed to do, he went into full meltdown mode, growling and writhing on the floor, grabbing my legs and biting them.

Our friend tried to put a humorous spin on things. “Oh, he’s freestylin’!”

“Yeah,” I said, yanking a leg out of my son’s grip. At the time, it was painfully obvious that Nigel very much needed his two types of medication to manage his behavior, both at home and at school. And it made a huge difference for him, enabling him to be mainstreamed with assistance and – unless a dose was forgotten – eliminating or subduing his meltdowns. I think both of us were relieved by it.

But Risperidone, like most medications, has its drawbacks. In addition to Nigel’s excessively itchy scalp, it also caused noticeable joint stiffness for which he needed to see an orthopedist. And then there was something noticeable only to me – his eyes. I didn’t get to see much of them anyway, but I saw them enough to know them. Now when I looked in his eyes, there was a listlessness – a vacancy – caused by the Risperidone. I wanted his behavior to change, not his countenance. Of course I welcomed the behavioral management, but his eyes were different. He didn’t look like himself, even when he smiled. I looked forward to the day when I could look into his eyes and see him again.

That day came last week.

This past November, we discontinued the Zoloft, and he did fine with that. Every week afterward, Nigel kept asking me when he could stop taking Risperidone, and as much as I also wanted him to stop taking it, I wanted to be sure that he was ready. If not, we could have him go back on it, but that would have been difficult after the six-week weaning process (cessation of Risperidone can cause withdrawal symptoms if not done gradually). In March, I felt that he was ready, and we began the process. There were a few times when I wondered if it was too soon, but we pulled through. In fact, Nigel’s overall adjustment has been phenomenal. During that six-week period, we had two weeks of considerable upheaval while all of the flooring in our home was being replaced. Every room of the house, including Nigel’s, had to be completely emptied and furniture had to be relocated, including pieces of our sectional couch being kept in the kitchen for three days. Nigel was a bit on-edge during that time, and his medication was down to half-dose, but I am thrilled to report that he did not have a single meltdown. Not even close.

He became a little agitated at school during the weaning process, but he worked through it. This is huge progress for him! In the past, his agitation would lead to outbursts because he could not regulate his emotions or behavior. And now he can. The real test came last week when he was completely unmedicated and we attended his Court of Honor to receive a Scout rank advancement that he’d worked toward for two years. He had a new merit badge sash that he spent quite a bit of time applying his merit badges to, and he looked forward to wearing it. That night, we ate dinner and then got ready to go to the Court of Honor. After he dressed in his uniform, Nigel built some Lego while I washed the dishes. When it was time to go, I grabbed my camera and my dessert contribution, and then we left. The meeting room, before the presentation started, was unstructured and loud with parents chatting and kids playing, and I looked to see how Nigel was handling it. I could tell he was getting a little amped up, and then I noticed that he had forgotten to wear his new merit badge sash. I had to tell him before he discovered it during the presentation, which could have been disastrous.

I approached him quietly and broke the news. Angrily, he sucked in his breath and clenched his fists by his side. “It’s okay,” I told him. “Look – several of the other Scouts forgot their sashes too.” I could see him processing, regulating. Within ten seconds he had unclenched his jaw and fists and merely sighed in disappointment. “I was distracted by the Lego,” he muttered.

Sighing and muttering. This is freestyle now, and it’s a far cry from growling and writhing on the floor. In addition to that, he reported last week when he got home from school that for the first time ever he did not feel drowsy during second period, and he feels like he’s able to focus better. His scalp no longer itches. To top it all off, the next night at dinner he looked at me as he described a new movie idea, and he held eye contact for the longest I’ve ever experienced. It was incredible. And this time, the vacant look was completely gone. It was Nigel again. I gazed into his beautiful eyes, absorbing his essence.

I’ve got my son back. And he’s better than ever.

 

Re-Evaluating

I used to love Magic Slates when I was a kid – those black wax drawing boards with gray plastic sheets on top. Not so much because if I messed up, I could start over, but because I could adjust my drawing as I went along. If I started at the top and worked my way down, I could lift up the film a little bit to make changes. Nothing was set in stone.

And so it is with behavioral medication. If a certain type isn’t working, you can try another one. If the dose doesn’t seem right, you can increase or decrease it. And when you think you’ve reached a point where it’s no longer necessary, you can stop taking it. Or, you can ask your mom for six months until she agrees.

Nigel had an appointment with his psychiatrist on Friday afternoon. As we often do in that office, we waited for quite some time before she opened the door to the waiting area. And then she called in someone else whose appointment, we learned, had been scheduled forty-five minutes before ours. I looked at the doctor, and she suggested that we reschedule, which I got up to do. I was shocked to find that she had an opening just a few days later, and we took it.

We got back in the car to leave, and Nigel began his negotiating process. He’s been doing this with me since at least October – telling me that he wants to stop taking the medication, that he doesn’t think he needs it anymore. And I respond the same way, telling him that he feels this way because the medication is working. But this time was different. This time I thought about the fact that he has been on Risperidone for fourteen months, and in the last twelve months, we have not increased his very low dosage. During that time, his height has increased by five inches (!), and his weight accordingly. At this point, the medication is probably having minimal effect. And even though it helped him when he really needed it, I’ve never felt comfortable with him having it in his body, and I’ve looked forward to the time when he could discontinue taking it.

And I think that the time has come. He has enough medication left to gradually wean himself off of it for the next three weeks. Half of that time is Spring Break, so it will be a low-stress time for a transition. And we’ll be checking in with his doctor tomorrow to confirm our plans.  

What’s comforting is knowing that, as with my childhood toy, we can always start over. If it turns out that we were a bit premature and that Nigel still needs the Risperidone to help regulate his behavior, we can always have him start taking it again. But we wouldn’t know unless we tried, so we’re going for it. He thinks he’s ready, and now, so do I.  

Counting My Chickens

So you know how when you blog about how well your child has been doing lately, very soon after that something happens just to keep you in check? Just to tell you don’t-be-counting-your-chickens and such? Yeah, that’s what happens. Apparently I forgot to knock on some wood (does my particle-board desk count?) when I wrote a few days ago about Nigel possibly discontinuing Risperidone sooner than I’d thought. About him learning to regulate his behavior on his own. Yeah, about that.

First, a disclaimer: Nigel has a really full plate right now (sort of like the one who gave birth to him). He’s enrolled in a full day of classes, in a transitional year (adjusting to a new school as well as a new level of school). And although he’s not experiencing the bullying of middle school (a huge relief), he is experiencing some stress in keeping up with assignments. Add to that the time spent in wrestling practice (Monday through Friday, right after school until 6:00 PM), and he doesn’t have much down time, which he sorely needs. He needs to have his time to watch movies, build Lego, and read. But he also loves wrestling and doesn’t want to give it up.

Any given day of the week is full. But Tuesdays are too much even for me. On Tuesday, he has school all day, then wrestling practice. I pick him up around six, we rush home, wolf down our dinner, he throws on his uniform, and we run out the door to his Boy Scout meeting. Boy Scouts is another thing that he loves and has been doing for several years. I sit off on the sidelines with some of the other parents while he participates in the meeting. Afterward, we go home, he showers, brushes his teeth, and has a little time to read before bed. It’s a long day for any kid, and especially for an autistic one.

But this week, this Tuesday, was like nothing I’d seen in a long time. Someone gave him a stick of gum when we arrived at the Scout meeting, and it was all downhill from there. His behavior was through the roof. No screaming (fortunately he seems to be well past that), but he was all over the place. Running around, acting like a little kid at a playground, disrupting others, bouncing off walls. It was like he had ADHD and was in a manic episode at the same time (for four years, I lived with someone who had ADHD and bipolar disorder, so I have some experience with this combo). I tried to discreetly redirect him, calm him down, but he exploded at me in response, making a scene. I kept watching the clock until the meeting was over. (In the past, I’d tried giving him his evening dose of Risperidone before the meeting, but then he literally had his head on the table the entire meeting and was falling asleep.)

As soon as we got home, I went directly to his pill organizer to get out his evening dose for him. It was then that I discovered that he had not even taken his morning dose. And I was relieved. I was so relieved to have an explanation for his behavior, having spent the entire meeting wondering what the hell was going on with him. Any other day of the week, a missed morning dose would have gone unnoticed. I know this because I don’t get any calls from the high school as I did regularly when he was at the middle school. And it was the same with this particular Tuesday – no calls regarding any behavioral disturbances. Amazing. He missed his morning medication and went through a full day of classes, a two-and-a-half-hour wrestling practice, and a rushed dinner without a single issue. That, my friends, is rather impressive.

But that last push with the evening Scout meeting was just too much for him. So, now I have my answer. He does still need the Risperidone, especially on Tuesdays. But he really is learning to regulate his behavior at school, which had previously been a big concern. All things considered, he’s doing pretty well with his full schedule. Even better than the one who gave birth to him.

The Regulator

“Did you refill your pill organizer for next week?” I ask Nigel as he walks into the kitchen.

“Not yet.” He walks over to the cupboard where we keep his bottles of medication, takes a bottle out, and proceeds to shake it vigorously as he walks to the kitchen table. It sounds like he’s got a maraca in his hand. Then he puts the bottle down, opens it, and begins filling his weekly pill container.

Two weeks ago, we saw his psychiatrist and discussed weaning him off of one of his medications – Zoloft. He had been taking it for almost two years, and had been at the same dosage for over a year, in spite of the fact that he’d grown a lot in that time. The OCD behavior he’d exhibited that made me realize he needed the medication (systematically pulling his hair out and eating it) is no longer present at all, and hasn’t been for a while.  The doctor concurred, and told us to halve the remainder of what Zoloft we had, and Nigel would be completely off of it in two weeks. The Risperidone, which he has been on for almost a year, he will continue to take for several more months at least. I figured that it would take him about two years to learn to regulate his behavior himself, which is why he started taking it.

Before leaving, we stopped by the front desk to schedule our next appointment two months out, as instructed by the doctor. The scheduler, a friendly but disheveled-looking woman with erratic movements (tics, possibly?), gave a little “Yay!” and started looking through her agenda. I recalled her reaction six months previously, when the doctor told us to schedule the next appointment in three months, how the scheduler actually whooted and did a little happy dance. I politely smiled in response, not sure what the celebration was about. Yay, we don’t have to come back for three whole months to a place that Nigel despises? Yay, you don’t have to see us again for three whole months? Or Yay, we’ve reached a positive point with the meds and they don’t need to be tinkered with for a while? I’m guessing it was the latter. But still. My day of celebration will come when he no longer needs the medication at all.

And with the successful departure of Zoloft, we are getting there. The fact is that, even at small doses, the Risperidone is something that needs to be watched. Nigel was required to have blood drawn last week for several routine tests and had to see a specialist to make sure the drug is not affecting his joints, among other things. The fact that he developed a trigger finger on one hand and a sore joint in one foot, both in the past year, disturbs me. I don’t like this stuff. I don’t like pumping his growing body with chemicals.

I’m certainly not against medication; it is integral to the functioning of those who need it. I have seen how much it helps, and I know that some children truly need it for their conditions. Nigel needed it to stop pulling out his hair and eating it. Then he needed it to help with his behavior regulation, since his autism prevented him from regulating it on his own. But he’s learning how. And, as he says, he learns by doing. Each time he demonstrates appropriate management of his behavior, he learns from it. Yes, for now it’s facilitated by his medication. But as he learns (and as his dosage is not increased with his growth), his behavior regulation is going to become more and more his own doing, not that of the medication.

“How much longer do I have to keep taking this?” Nigel asks after he swallows his morning dose. He knew that he needed it a year ago and requested it, but he believes that it makes his scalp itch and wants to stop taking it. “Because even on days when I forget to take it, I’m still calm at school.”

“Well, that could be because it’s still in your system. But I also think it’s because you’re learning to regulate your behavior yourself.”

“Yeah. I am. I don’t get angry like I used to.”

I tell him that we’ll talk to his doctor about it at our appointment in January and see what she thinks. And maybe I’ll have my day of celebration sooner than I’d originally thought.

Suspended Reality

I sit in my quiet house watching snow falling on branches of trees that had already started blooming again. But the really unusual part of that sentence is that one word – “quiet.” That’s right – my sons are not home this week.

They visit their father in LA for several weeks every summer, as well as Spring Break and Christmas. I’ve mentioned The 700-Mile Kid Swap before, as well as what happened the last time we did it. But this time was by far the most beautiful (scenery-wise). We took a little detour into north-central California to meet up with their dad at a different spot, since he wanted to take the boys to visit his mother for a few days. And the drive there was simply incredible. At one point we drove through seven miles of orchards. Yes – seven miles of orchards one right after another! And through the trees we could see views of beautiful Mt. Lassen, which Nigel and I climbed last summer. Nigel liked seeing Mt. Lassen, but Aidan was enamored with the orchards. “I would love to live here,” he said in a dreamy voice.

So now they are away this week, and my home is quiet. And I have tons of things to do to fill that time, but I feel like I’m missing an arm and a leg with the boys gone, and it’s hard to get anything done that way. I don’t feel like myself when they’re not here. I’m living in a suspended reality.

I sometimes wonder if that’s what life is like for Nigel – he has his way of viewing the world, and a lot of it is very different from how others view it. And I especially wonder how it is for him being on Risperidone. He is calmer, yes, and can regulate his behavior a bit better, but he is not himself. It is a subdued version of him, a suspended reality.  His eyes – and his demeanor – are different. I know – this was what we wanted. He wanted it, too. We wanted the change in behavior. But I didn’t know there would be a change in him, in his countenance.  

Again I remind myself that he doesn’t need to be on it forever – just a couple of years, I hope, until he learns to regulate his behavior himself. And eventually he will, of that I am sure. He says he can feel the difference in himself, and he is satisfied with the results, which is most important. But I’m looking forward to the day when he no longer needs to take it, and I can have the real Nigel back. For now, though, I know that I’ll still enjoy the company of the modified Nigel. He may not appear to be himself right now, but he’s still unequivocally Nigel.  And I’ll smile as I think of him at the sunny beach this week, while I watch the snow fall.

New Year, New Behavior, Part 4

There are times when we wonder why we waited so long to do something. Why we fretted, why we were hesitant. This is one of those times.

My family’s sensitive genetic makeup is such that we respond almost immediately to anything in our systems, whether it’s ibuprofen, caffeine, cold medicine, or stronger stuff. With prescriptions, doctors warn us that it may take two to three weeks to see any differences. With us, it’s often by the end of the second day. For instance, eleven years ago when I was on Zoloft for OCD and anxiety, I felt noticeably better on the second day after starting it. I felt so much better that I wished I had started sooner, that I hadn’t kept putting it off.

Last weekend, Nigel began his experience with Risperidone. His doctor started him on a very low dosage, and the literature included with the prescription mentioned that we probably wouldn’t see any behavioral changes for about two weeks. At the end of the second day, I could already see a difference. He was not argumentative. He was more complacent, relaxed. He was agreeable. His behavioral therapist also noticed it at his social skills class the next day. This is the kind of improvement we need for him to be able to go back to regular school. Of course, now that his body has adjusted to the very low dosage, he is no longer as agreeable as he was for the first few days, which I expected. We see the doctor in two weeks whereupon the dosage will be increased. But the process has begun. And it’s working.

And so, since I can already see how much this medication will help Nigel with his socialization goals, I can’t help but wonder why I was so reluctant to get him started. Why didn’t we do this before? Why did we constantly bang our heads into the wall (literally) in frustration, when we had options? Why was I so fearful of going this route? I don’t really know, but it’s not worth it to me to obsess about it any longer. Life is about learning. We learn and then we continue on. We make adjustments and we move forward.

Part of moving forward for me is recognizing when I need to take a break and then actually doing it. We tell our kids to let us know when they need a break, but we tend to ignore our own needs. When you have a lot of plates up in the air, it’s hard to justify walking away from them to take a break. But I know I need one, and I know my boys do too. So we’re packing up and heading out. This little clan is going to the coast for the weekend. We’ve rented a small cabin right on the beach, and my sister and brother-in-law are joining us. It’s a place we’ve been to before, one we all love, but we haven’t been there for three years. And that’s just too long. Nigel came to me last night at midnight, red-eyed, asking, “Mom, are you sure you remember how to get there?” He is so excited; he’s beside himself. This morning he actually said, “I am overzealous about going to White Rock.” He and Aidan have been counting down the days. So that’s how I know – we all need this. And I shouldn’t have waited so long to do it. So whether it’s trying new medication or taking a break when we need to, I’ve learned not to put it off. I’ve learned not to be afraid. I’m letting the plates fall where they may, and we’re taking off for a few days. Ciao!

To Med or Not to Med

The term “self-medicate” has a negative connotation.  It makes me think of alcoholics or drug addicts, both prescription and illegal. Yet, taken literally, the two words simply mean to administer medicine to oneself. Or to want to.

Nigel and I saw his doctor – his psychiatrist – today. He goes in every couple of months for his “med-management” appointment. He doesn’t like these appointments because he doesn’t like answering questions about himself (really, he only likes answering questions about Indiana Jones, or Lego, or the JFK assassination, or either of the World Wars). And even though I prepared him ahead of time, reminding him that the doctor is required to ask these questions and that he could write the answers down if he didn’t want to say them (“Why would I want to write anything, which would cause pain to my hand?!!”), he still got impatient with the questions and often sneered his answers. Or instead of actual answers, he would sneer – in reply to “How would you rate your mood today?” – “Same as it was last time!!

This level of verbal hostility probably encouraged the doctor to nod in agreement when I indicated to her Nigel’s desire for some medication that would help him to not blow up at certain peers of his who think that it’s fun to antagonize him. He wants something to control his tendency to respond in anger because he wants to go back to being mainstreamed. And he knows that that is his most difficult hurdle. Not because anyone told him, but because he actually has the self-awareness to see it. Yet, he does not have the ability to control his reactions to people when they upset him. So, he wants medication. He knows that medication helped him to stop habitually pulling out his hair and eating it, so he figures that medication can help with his behavioral issues. He wants to self-medicate.

And I had done my research and knew what the doctor would suggest: antipsychotics. There’s another negative connotation. Is that really what he needs? Are the occasional times that he blows up worth putting him on a daily medication with significant side effects? I asked him, there in the doctor’s office, gently, “I know that some of the kids bothered you every day, but did you respond with anger every day?”

“Yes. Every day.”

I took a deep breath and tried to let what he’d said sink in. It was too difficult to imagine, again, what he went through at school, day after day, and to think that in spite of that, he still wants to go back. He wants to be like everybody else.  It means that much to him. But I still wasn’t ready to say yes to antipsychotics. So I suggested that he try behavioral therapy to learn different responses when his peers anger him.

“I don’t want to see more psychiatrists,” he said, right there in the doctor’s office. “They’ll do the same kind of treatment!”

His psychiatrist smirked as she wrote that down. I asked, “What kind of treatment are you expecting from the psychiatrists?”

“Asking me questions!” And, of course, the psychiatrist politely laughed.

But the issue was still hanging over my head. He wants to change his behavior but he can’t handle therapy sessions. So, the doctor went and got several pages’ worth of printed material for me on the two medications she suggested as possibilities (Risperdal and Abilify). She gave me her cell number if I wanted to discuss anything with her. And I left feeling just as unsure and melancholic as when I’d arrived.

Right now Nigel is sitting on the couch in the living room, watching The Never-Ending Story III, which he was excited to rent tonight. Most of the time, I hear the faint sounds of the TV, which he keeps at a low volume, but once in a while he makes stim-type sounds or repeats one of the lines of the movie. He is happy; he is doing his thing. And he is not on antipsychotics. I wish it could always be that way.

New Year, New Behavior

Often at the start of a new year, we note things that we would like to change about ourselves or our lives. We make resolutions and take steps to lose weight, be healthier, save money, or achieve a goal.  We are determined to improve.

Yesterday, I began preparing Nigel for his doctor appointment at the end of this week. He tends to detest these medication-management appointments, being asked to rate his mood, and answer other questions that he would rather not. So I thought that I’d prepare him a few days ahead of time, asking him some of the questions that I recall the doctor asking previously, so that Nigel can start thinking about his answers. “How would you rate your mood?” I asked.

“Fine,” he answered as usual. Then he added, “But I don’t see any changes.”

Surprised and intrigued at this part about “changes,” I pressed further. “What changes are you hoping to see?”

“My behavior. I want to not get angry so much so that I can go back to regular school.”

And my heart thumped as I understood what I had always wondered. Even though Nigel is much calmer with homeschooling than with mainstreaming, he is an extroverted autist, and he misses being in a more social environment. Even though he is regularly involved in Boy Scouts and attends a weekly social skills class, it’s not enough for him. He craves more. The sad part in all of this is that, because of his autism, he usually can’t handle more. It is very difficult for him to regulate his behavior and emotions. He is learning, but I’m hoping there is some medication that can help him with this. He has been on Zoloft to help with his OCD symptoms and anxiety, and that has been beneficial. I explained to him that the medication that he’s been on is not designed to help with behavior modification, but that there might be medication available that can help with that. One of his problems is that when kids do or say something to purposely agitate or upset him, he blows up, and he’s not able to regulate himself. Then he ends up getting in trouble, and it becomes a vicious cycle, because it’s fun for the bullies to upset him. Suggesting to him that he “ignore” them does not work for him. He is not able to ignore them (in my opinion, they should not be doing it in the first place, but that is another issue).

I don’t know if there is a type of medication that can help him with his behavior. We’ll be discussing it with his doctor, but if any readers have any suggestions, please let me know. I’d love to have Nigel be able to attend the local public school, at least part-time, because it would mean so much to him. His new year’s resolution is to go back, and I want to help him achieve that goal.

Mountains and Milestones

Nigel at Mt. Lassen summitAn adventurous spirit runs through Nigel’s blood from both sides of the family. In spite of his fear of bees and other flying insects, he tackled Mt. Lassen with a fervor usually reserved for Lego-building. I, having climbed Mt. Shasta earlier this summer, was impressed and proud.

He was often ahead of me on the 5-mile round-trip trail, which isn’t long compared to the 14 miles for Mt. Shasta, but for a 13-year-old climbing his first mountain, it was quite an accomplishment. He noted with excitement that this, at 10,457 feet, was the highest he’d ever been on land.

Meanwhile, Aidan had a fun time kayaking with Grandma around the lake. She said that he followed her instructions and they made a great team.

Day 2:

Nigel, sore from yesterday’s climb, has a bee-induced meltdown while on an interpretive trail in a section of the park called the Devastated Area. I’m not joking; it’s really called that. I can laugh about it now. On the way back to camp, I realize that I deserve the Slacker Mom of the Year Award for not reminding Nigel to take his medication. We had packed it, but he had forgotten to take it. I note once more, after the meltdown, that the medication really does help, because of how his behavior is affected when he doesn’t take it.

Meanwhile, Aidan stayed in the car.

Ranger MadelineDay 3:

We got to see my mom in action doing one of her Ranger programs! Here she is holding a bobcat skull. It has been her dream since childhood to be a Ranger at Lassen National Park, and this summer she achieved it! Way to go, Mom! 

After the program, we started on our drive home, stopping at Burney Falls State Park in northern California. I had been here over twenty years ago, and the falls are just as beautiful as I remembered them. I was happy to be able to share the experience with my sons.

Meanwhile, Aidan refused to be in the photo. But he agreed that the falls were pretty!Nigel at Burney Falls

 

Medication Check-in

Yesterday I forgot to give Nigel his Zoloft. All day long I was wondering why he was being so difficult: irritable, non-compliant with any little thing, lashing out, complaining, and then, sometime after dinner, it hit me. I had forgotten to give him his medication that morning.

It was good to note that the Zoloft really does make a difference for him. I had already forgotten (or probably blocked the memories of) how he had been the months prior to medicating him. His anxiety level was so high that he was constantly irritated and often lashed out. I remember one afternoon going into his room and noticing that his desk chair (the kind with the adjustable, pedestal-supported seat on rollers, with a curved metal bar covered in ribbed plastic connecting the seat and the chair back) had been broken. He had ripped off the chair back, wrenching it off of the bolts that connected it to the curved bar. I tried to fix it, but the damage was beyond repair. I ended up removing the curved bar so that the chair is now just a rolling seat with no back.

I asked Nigel what had happened to the chair. He said in a low voice, “It was because of my anger. I feel different from everyone. I have a defective brain because of the a-word.”

He has referred to autism as “the a-word” for a few years now, ever since he asked “What’s wrong with me?” and I told him about autism. That day with the vandalized chair in front of us, I assured him, as I have on so many occasions, that his brain is not defective, it’s just wired differently. I reminded him that he has a very good brain that taught him to read at age three and a half. He seemed to feel a little better.

But since going on Zoloft almost two months ago, he has not destroyed anything because of self-esteem issues. He is more relaxed, more comfortable in his skin. He sleeps better. He no longer eats his hair. He doesn’t talk about his brain being defective. He is happier, I think. It pained me to think of him breaking his belongings because he feels angry about being different, that his self-esteem should suffer because of autism. If Zoloft can alleviate any of that, then I’m sticking with it. Nigel never balks at taking it. It makes me wonder if he notices the difference in how he feels. I think he does. He just isn’t able to put it into words.