Audrey’s daughter Casey began to have troubling behavior problems in preschool.  Audrey talks about Casey’s issues and the family’s experience with Parent-Child Interaction Therapy. 

What was the first thing you noticed about Casey that concerned you?

Audrey: The first thing I noticed, which was a little red flag, but it was kind of a cute red flag, when Casey was an infant, maybe four months old, she would do this thing with her hands. It was like she had excess energy and it was coming out in a frustrated or angry thing. It didn’t alarm me, but I noticed it. It’s like she’s got that in her. Cute, and then really not cute.  And now, manageable.

What was Casey like as a toddler?

Audrey: Spunky kid, great kid, social. I was extremely proud of her, I just thought she was so bright. She was very social. But she was social with kids, not with adults.

So she ran into trouble in preschool?

Audrey: She went to a two’s program, and she wasn’t really interested in the work they have the children do—she was interested in the children. She would go up to them and hug them, but she was hugging them in a way that was too aggressive. And it was kind of not the right thing at the right time. So then the school thought maybe it was a sensory thing. Maybe her fine motor skills weren’t good and she couldn’t do the work, and so she instead turned to the kids. As something to do. So they suggested we go to occupational therapy, which we did in her three’s.

Did the occupational therapy make a difference?

Audrey: I couldn’t see anything that was happening. Maybe it was useful, but it didn’t feel useful. And it felt expensive.

“By the end of the three’s, her hugging had transitioned into pushing, pinching — but it was covert, like she could do it like without anybody seeing. Super sneaky.”

 How did your husband David respond?

Audrey: Casey’s lot like my husband—she’s very aggressive, very kind of hyper sometimes. And he can relate to her, he sort of understands where some of this might be coming from. He grew up in a small town. In first grade, he was so talkative and so hyper, they didn’t know what to do with him, so they put him in a cardboard box and cut out a hole for him to look at the chalkboard. So he was stigmatized and he was put in remedial classes. He’s a smart guy, but they didn’t have any way to deal with him. So he was very sensitive to how Casey might be stigmatized if she went to occupational therapy, and was put on a certain path. Because we’re very clear that she’s very bright.

What happened next?

Audrey: By the end of the three’s, her hugging had transitioned into pushing, pinching—but it was covert, like she could do it like without anybody seeing. Super sneaky. So it wasn’t just like she had some kind of impulse problem, she knew what she was doing. And then at the end of the year there was this incident, she pushed a little girl for touching some thing she was building. And the little girl flew back and hit something.

What were the consequences?

Audrey: All the parents knew about that, and Casey really got a name for herself. The school suggested we have a SEIT—someone who comes into the classroom with your child. It was really towards the end of the threes, and we decided not to do that. There was so much going on—the school psychologist was saying one thing, and the OT people, and the teachers and, you know, other parents. We were all feeling a lot of stress and a lot of pressure and decided to get out of the city for the summer, hoping that a break would mellow things out.

“We learned that you don’t really have to get flustered, you don’t have to get crazy, and you don’t have to get emotional. We learned consistency.”

And outside of school?

Audrey: Everything was just so stressful. I was pregnant at the time, and we had moved. We were in temporary housing. Our family life was stressful, school was stressful, no place was comfortable or safe. We’d go somewhere and just dread: Is she going to say hello to her grandparents? Is she going to, you know, say hello to our doorman? Is she going to hit our doorman?

How did you try to manage Casey?

Audrey: I tried to be very patient and understanding. In day camp that summer, she started out well, then she started hitting kids. So I told the counselors, this is not okay, call me if this happens, and I will come pick her up. So I was picking her up like three, four times a week. I would say, why is it that you would hit this person? We don’t hit people. I told you, if you do that again I’m going to pick you up. That type of thing. And my husband, on the other hand, was like yelling, and we just had totally different styles. And you know neither one of them was completely right. That created a lot of tension because I didn’t like the way he handled it, and he felt like I wasn’t handling it right either.

What happened the next year?

Audrey: So then we came back here and school started again last year in four’s. The first week was great, and then the second week was not so great. She was like stepping on kids’ feet in line, and the teachers tried to give her time-outs, they tried everything they knew, but they couldn’t control her. Then she bit a kid, and that’s when we pulled her out of school, and started doing the PCIT twice a week, I guess, for like two months.

What was PCIT like?

Audrey: We learned the script:  “Please sit down. If you don’t sit down you’re going to have to sit in the chair” ….  And we learned that you don’t really have to get flustered, you don’t have to get crazy, and you don’t have to get emotional. And we all learned consistency. And we all know exactly what to expect, we all know the consequences of any behavior, and it’s just a lot easier.

How did it work for Casey?

Audrey: She went back to school in January, in the second semester. She was great. She’s very likeable, you know, other kids really like her when she’s not doing that stuff. You know, it’s like she’s kind of like “there once was a girl, who had the curl, right in the middle of her forehead.” And so when she’s good she’s great, and when she’s bad she’s a disaster.

Did the teachers use the techniques you learned in training?

Audrey: No. We had a meeting with the school, with the administrator, the therapist, the teachers, Dr. Steven Kurtz, and us. We had a few meetings. But at the school they were offended that we didn’t go through their channels. We tried to explain: Look, we’re trying to save our family here. This is not about your school, this is not about the class or your teachers. We’re like in a mess here, and we’re struggling, and we’re just doing the best we can here. And I don’t feel like they ever quite caught on to that.

So Casey went back to school with a SEIT?

Audrey: Yes, someone who had worked in the PCIT program. And that was really invaluable. I really don’t think she could have done it without that. In the beginning, the SEIT was right next to Casey, hovering. And then if something came up, like a difficult situation — someone took something from her or she took something from someone — you know, she would be there to help them work it through. She became like one of the teachers in the room. So she started the year by sticking very close, and over the course of the year moving further back, further back, further back. At the end of the year she would just be sitting over there, kind of on-hand.

How is Casey doing at home?

Audrey: Before PCIT, we were having to say to Casey 10, 11, 12 times “put your shoes on” or whatever. Dr. Kurtz said something like, “Would you be satisfied if you only had to ask her once, like one more new time, but always you’ll have to ask her one more new time?” And we’re like, uhuh, uhuh. And like that’s what it is. It’s like, she still will never just put on her shoes. Like, you still can’t just say, “Please put on your shoes,” you almost always have to say, “Please put on your shoes. If you don’t put on your shoes…” But she does often comply with the second one, you know. And we were like, we’ll take it!

“I’ve seen her do things that I know she couldn’t have handled in the past. Like when I dropped her off at camp this summer, and she sat in the circle, the girl next to her said, ‘There’s no room here for you.’ Before, Casey would have like knocked her block off or something, you know. And I saw her just sit, and I was so proud of her.”

How does she do with kids outside of school?

She’s a lot, lot better. She is a lot better. Like, I’ve seen her do things that I know she couldn’t have handled in the past. Like when I dropped her off at camp this summer, and she sat in the circle, the girl next to her said, “There’s no room here for you.” Before, Casey would have like knocked her block off or something, you know. And I saw her just sit, and I was so proud of her. You know, that’s hard to do, that would be very hurtful if someone said that. So she’s handling these types of situations really well.

And is the diagnosis conduct disorder?

That’s what they said it was, conduct disorder. Though at the end, at the very end of our time together, I asked Dr. Kurtz, “So is this going to be with her always? Does one have conduct disorder for one’s whole life?” And he said, “I’m not entirely sure that is the diagnosis I would now give.

How does David feel about the way it’s worked out?

I think he feels very good about it. Yeah. And I feel I totally lucked out. I really lucked out.