The Attachment/Autism/ ADHD/ BrainDamage Combo

I woke Chef at 7:30 this morning so I could check his feet again. Thankfully they seem fine. He has had a bit of frostbite on one of his toes recently, but didn't tell me about it til a few days after he'd realized he had it. We talked again of the importance of wearing socks in the winter. And given the rate at which Chef's clothing disappears and the responses from him about putting on socks in the morning ("Socks first, then boots." "I don't have any socks." "Where are the 7 pairs you just got on the weekend?" "I don't know. I can't find them." "There were at least 4 pairs in your hamper." "After I did my laundry they were gone." Etc., etc), I think a sock basket by the door would be a good idea. A couple of winters ago, Chef had disappeared from school. When he reappeared, we learned that he'd gone off to play on some snowbanks he'd heard about on his schoolbus. He ended up with frostbite on his leg that day because he'd had snow in his boot and didn't remove it.

This is one of the pieces where I still wonder if Chef needs a different type of support around hygiene/dressing than what we've presently discussed as a team. Is it possible that Chef might actually require hands-on supports in areas such as hygiene and dressing? This week, we're sure going to be working once again(still!) on training Chef to use his book of lists/reminders.

Presently, Chef's home program revolves around training/re-training his brain through positive experiences, positive activities, prompts as needed, "is that working for you?" "how well did that work?" "what would have worked better?" conversations, and allowing Chef to live with the natural consequences of his choices over and over and over and over (except in cases where a change needs to be put in place otherwise due to the possibility of choices leading to dangerous results such as frostbite!)

Physically, Chef is definitely capable of washing and dressing himself. But there seems to be such a strong disconnect when it comes to doing "daily routine" things that require effort - or, maybe it's "chores, and whatever falls under the category of taking care of self and belongings." That said, Chef no longer attempts to power struggle over participating in a daily exercise routine (though he is starting to complain about it now as of today because it is needing to be changed) nor over things like being asked to carry or bring in groceries. Chef never argues or "gives attitude" over any request of him whatsoever unless it's something that is regularly required of him (hygiene, daily change of clothes, chores, etc.) or if someone his age is around and he is trying to act cool around them. Back to washing/dressing - it continues to be an ongoing struggle for Chef at 15 years of age.

When Chef was younger, I used pictures/charts/stickers/rewards/incentives/etc., and often I would end up having to dress him when he wouldn't get dressed. Sometimes he would then remove the clothing. We tried all sorts of different fabrics/elastic waistbands/etc. At that time, he was saying that he didn't want to get dressed because he just wanted to stay home - from everywhere (some of you know about the "firehose the clothing" plan as well!). Sometimes he said he just wanted to wear pajamas. Sometimes he said he didn't want to get dressed because he didn't want people to come over to our house. When he was around 8'ish, I stopped dressing him when needed, and started completely letting him live with the consequences of not getting washed/dressed to go somewhere because we (everyone on his team at the time) agreed that he was capable of dressing himself. Flash-forward to today: it is only recently that Chef has expressed any sense of desire/acknowledgement that he does not want to be outside of his home dressed inappropriately (still working on the "inside of his home" part!), but that still isn't strong enough to motivate him. And from the time clothing is taken from the hamper to the laundry room and back to the main floor for a check before going upstairs, it still continues to "disappear" so this week I'm working on another clothing system.

I remember taking Chef to school one day and putting his boots back on his feet numerous times only to have him continually remove them. He said it was because he didn't want to go to school, yet when he removed them again he just walked into the school building not wearing them. His foster mom used to say that he wouldn't keep his shoes on, though he loved tromping about in adults' shoes. He used to fill his boots with stones. He usually goes through numerous pairs of footwear a year. (This year, he's only on his second pair of boots and second winter jacket so far!) He was recently complaining that his shin was bothering him. I reminded him again that he needed to change his exercise program to include different activities. When I asked him what he'd done with his shoes at school, he said he didn't know. When I asked what he's been wearing at school this whole time, he said he's been wearing his boots. I told him my legs would sure hurt too if I wore snow boots all day long. So now I'll be picking up some supportive insoles for his boots/school shoes (though I'm pretty sure those will disappear or be damaged in short order), and his exercise program is being changed this week to include different activities. The "change" part isn't going so well. It took a few years for Chef to embrace the idea of exercise and, after much journeying/adventure, he was presently at a point where he would get up and do exercises on his own in the morning! Now the exercises need to change.

For years, Chef has been taught basic lifeskills using a variety of techniques/reminders/prompts/etc/etc., etc. It often takes Chef a long time to learn/embrace something, but when he does, it usually clicks. He's learned how to read. He now does quite well in math. He will participate in physical activity at times now, and does some form of exercise every day (which I thought was coming from his own "feel good" or something along those lines, but I've been told from others that he only does it at home and only because "his mom makes him do it" - but he does it on his own every morning without prompts, nonetheless). His verbal skills have come a very long way, and his social skills are continuing to come along nicely. All of these are areas where he greatly struggled when he was younger and are areas in which much work and support was required for Chef to see positive results.

So let's see. A hanging clothing storage unit with five shelves in the downstairs closet. Forget the hamper for now. Each shelf will hold a complete outfit. At the end of each day, instead of the clothing going into the hamper, it goes back onto its shelf so I can easily see whether anything is missing. On laundry day, each complete outfit is checked before going to the laundry room, then reorganized back on the shelves afterwards. Sock basket by the door. Daily foot checks. Over-the-top verbal prompting on using his books of lists til Chef tires of hearing it and is willing to pick up his book.