Wednesday, September 16, 2009


Like many children who have been institutionalized, our girls have come with their own set of behaviors and mannerisms that they have developed over the years to help them survive. Some of those behaviors we have already seen diminish (although they do pop up every now and again) like Danielle trying to talk over everyone else and sticking her hands out for things (as in, in your face) to try to get things before someone else or instead of someone else.

But we've had a few behaviors that have hung on, in particular for Danielle. It's not surprising since she was in the orphanage for a long time and she is older than Emily (even though Emily was in the orphanage from birth). One particularly problematic habit is coughing in the night to try to wake Emily up. If Danielle wakes up in the middle of the night, instead of going back to sleep or calling out for one of us (or anyone), she starts coughing. She will cough and cough harder and louder until she gets Emily to wake up (which usually makes Emily cry) and then stops. Initially we thought perhaps it was allergies, but it's become apparent over several months that this is an intentional behavior. One of the problems with it is that it becomes very hard to know if she has a real cough--not to mention that coughing is not good for your airways and that she's waking other people in the house up. This is obviously something she was already doing before she came to live with us--she doesn't cry or cry out (although she does if she wakes up and is scared, like during a thunderstorm)--but using the coughing as a way to wake someone else up for company. I'm guessing maybe she was able to cough at the orphanage loud enough to wake other kids up but not loud enough to get in trouble for it.

We've now taken a more proactive approach to dealing with this since we can't have Danielle waking everyone else up just because she's awake. So now if she starts coughing in the middle of the night we move her to a separate room. It's not intended to be a punishment, and we have told her (and she understands) that she goes in the other room so that she doesn't wake Emily up. But she doesn't like sleeping by herself and we are seeing less and less of the coughing at night. Last night she woke up, coughed once, then stopped and went back to sleep (I give her one or two tries to get the coughing under control before I move her to the other bedroom--sometimes you just need to cough!). I know it will take some time for her to stop this since it has become such an ingrained behavior, but we really want to encourage her to stop for her sake and the rest of the family.

Danielle also has another habit which is pretty typical for kids her age and probably even more so for kids who have been institutionalized--especially ones with special needs who got little to no stimulation or activities.

Danielle likes to pick at things. She specifically likes to pick at scabs, but if she doesn't have a scab she will pick at her cuticles or anything else handy until she strikes blood. Then she comes running asking for medicine. :) I certainly don't have a problem putting medicine on her cuts and scrapes, but we want to discourage her from self-inflicted wounds so I have finally told her that I will not put medicine on things she has picked at (that's not entirely true but she doesn't know that--I'm certainly not going to let something get infected even if it was self-inflicted). It seems to be decreasing the amount of picking. Part of the picking is attention-seeking, but I think part of it too is boredom. While her English is coming along great (way better than the boys at the same amount of time home), I think it's still hard for her to understand everything and she gets bored of trying to pay attention and understand all of the time. It's much more entertaining to pick at scabs. :) :)


Marsha said...

Courtney, when I was a kid, I would chew on my fingernails until they bled. My Mom would clean those and ONLY those self-inflicted cuts with alcohol instead of hydrogen peroxide. It didn't take long for me to stop drawing blood. Just a thought!

BT said...

On the coughing. This is so familiar, except that our older son rustled his covers progressively louder and/or moved around in ways to get the bunk bed unit jiggling. You'd be surprised how loud one determined boy can get covers to rustle! Anyway, I love your approach and wish we'd thought of it way back when. (We're past this phase now.) We did have gradual success with practicing (repeatedly practicing) calling us in the night. We would practice it in the middle of the day -- role play everything -- and again around bedtime. I liked that it was teaching him to attach to us. Sometimes the night wakefulness is related to fears/anxiety churning through their minds/bodies (at a biochemical level), and they need help soothing. So we figured if we could get him to call to us, then we could go sooth him. And one call that we could hear, didn't tend to wake up the younger brother.

On the picking: This too may be anxiety. I am wondering whether you can substitute something appropriate for her to fiddle with or pick at. A squishy, for example. (See Diana's blog at Gold To Refine -- or get back to me.) Or some cotton balls that could be picked apart. I'm trying to think of soft things because that softness might be comforting to Danielle. You could even tell her that the softness is like your love for her. Just a thought.

Diana said...

My Joseph is also a picker. It is DEFINATELY stress/anxiety based in his case. If he's not picking at himself, he's destroying something else. He picks at anything and everything that can be picked at - scaps, eyebrows, nails, paper, anything made of foam, stickers, plastic toys, etc. I've yet figured out something that is an effective long term substitute or that stops the behavior - other than alerting him to the fact that he's picking. Yes, that will stop the picking temporarily, but more often than not, he just moves to some other anxiety based behavior - like wetting his pants. Joy.

Because of Matthew's attatchment issues, we've yet to be successful in getting him to come to us at night, either - or really to get either of them to come to us consistently for help with anything...except when they don't really need it and just want the attention. More often than not, we have to remind them that they need to ask for help.

One thing that has been hugely helpful both in deminishing the nighttime waking and especially nightmares and restlessness is to play a CD of soft, restful music as they are going to sleep. It has made an AMAZING difference for both boys. We now have very few nights where we have nightmares/night terrors. Both of them sleep a LOT better all night long since we started doing that.

Courtney said...

We tried music at night and it keeps Emily awake. It always seems like what helps one, hurts the other. :)

Danielle's picking really doesn't seem to be anxiety related--i.e., I don't see an increase in it when she's in stressful situations (lots of people, school starting, etc.) just an increase when she's sitting around (in timeout or waiting for the other kids get shoes on, for example). She only picks at her skin--not paper, clothing, or toys. I'm hoping once she understands more English and can be more engaged that some of it will go away. I may also try painting her nails as a "reward" to encourage her not to pick at them.

The coughing is so frustrating because she actually will call out to us at other times at night (when she's scared or in pain). The coughing doesn't seem to be a way to get comfort so much as a way to get company. Although her 4 yo sister crying because she's been woken up doesn't seem like much company. :) :)

Anonymous said...

My son did the coughing, too. It took a long time to get him to stop doing it, maybe almost a year. It was to wake us up because he wanted to get up at 6 every morning!! Nothing ever really worked, it just took time for him realize it just made people mad and no one ever got up with him.