Hmmm

Zack's regular therapist just called and just wanted to catch up to see what had happened on Friday. She raised the question 'I wonder whether residential treatment might be better for him than outpatient counseling. This doesn't seem to be working well. It is not good for him to be in and out of the hospital like this.' I told her that I had wondered about that too. She is going on vacation, so I won't talk to her till next week. But it is a good issue to bring up and I am glad that she brings it up since that would have more weight than if I mention it.

It's a depressing idea to put him in residential treatment, but I have to admit that the fact that he seems to escalate his violence is not very good and fuzzy either. I am not too convinced home is the best place for him right now, however much it hurts to admit that.

She also assured me that calling 911 would NOT have been an over reaction when things happened on Friday, which is both good to know and makes me sad that I would call 911 on my own kid.

Sigh.

Spoke to Social Worker

Today, I spoke to his social worker at the hospital. She basically wanted information on what happened, and I told her the pertinent details. She will talk to doctor and they'll go from there.

She also told me to expect call from legal department to inform me about when the IEA hearing is. I am so not looking forward to standing in court yet again to tell the judge that my son wants to kill himself and others.

This sucks.

Back in Hospital

Well, yet again I had to commit Zack to the hospital involuntary. This is getting old :p

Today started off with him waking up by himself, so I figured tiredness could not be an excuse. First issue was the bowls. He could not find any bowl that was clean enough for him to eat breakfast. None of them passed the Zack test, and I ended up cleaning one of those bowls for him. No idea whether that was right or not, but that's what I did.

He ate breakfast, and I hoped that would put him in better mood. After breakfast, he wanted to play computer, and I told him sure, after he spent some time outside (one of the rules we have in summer is that people first need to spend outdoors time before playing computer, this is for all the kids). He got really angry , started kicking me, was throwing chairs, laundry baskets.

He threw a toy to his 8yo sister, who got very upset. Then he took scissors, and threatened to stab me and his 11yo sister with them. He was waving them, but far enough away from us, and instead of following through on his threat, he threw them at us. By now I felt things were detoriating too much and I read all your comments in my head and realized things were going too far.

I called counseling center who was going to get emergency counselor call me back. It took them ages, I never actually talked to them before I left. So much for emergency counseling :p

Now he was holding a pencil with a sharp point, and threatening to stab himself in the head. Later, he tried to stab me with it, I actually had to block it. I feel that the physical violence towards me is a new development, yesterday and today, this has not happened before. It's like he entered a new level of aggression. Too bad , after things went so relatively well for a few weeks since he came home from hospital.

I asked him whether he would be willing to talk to a counselor on the phone. He replied 'NO!!! But I would be willing to stab them!' He also threatened me 'I am going to rip off your arm and will kill you with it.'

I decided to just take him into emergency room, because i felt we had run out of options. He agreed to come with me, but hid for a while before we left. I didn't care, i was waiting for counselor to call me back anyway, and he wouldn't hurt anyone while he was hiding. Eventually he did show up and we were off.

We did the standard wait wait wait in the ER. We had diverse people come in, and at some point we even got a committee in our room, three people to explain to Zack that no, hospitalization was not optional, and no, whatever he said would not make a difference, he needed to be safe and we all needed to be safe.

He started screaming and kicking chairs and losing it, and we ended up with our very own security person, who spent the next four hours in front of our door, being very bored. The presence of the security person helped him calm down.

We were in ER from 2pm to 10pm, when he got transported by ambulance to the hospital an hour away. There goes another $750

This was not very fun, and I am not looking forward to yet another appearance in court to get him committed. I have no idea what is good and what isn't, but I feel that hospitalization definitely was warranted at this point. Still feels sucky though.

One high suckiness moment was in triage, when the nurse said 'ok, suicidal and homicidal' and marked the appropriate boxes. Nothing like seeing your baby labeled as homicidal.

Ponderings

Thanks for feedback, L and W, I have been pondering and thinking. W, they do have crisis counselors, but it always takes a while to get a hold of them and I didn't see how I could handle a phone call while the stuff was going on. I tried im-ing a good friend to make call for me, but she was afk and I didn't feel like trying to get their crisis counselors on the phone by myself, which is often long process, or at least, longer than i felt i could use, and I wasn't sure how helpful a phone call to them would be if I couldn't talk easily. (yes, it's a run-on sentence, but too tired to fix) I didn' really want to leave Zack alone.

L, thanks for your very clear feedback, I hadn't verbalized it this clearly to myself. I needed an outsider to point it out to me, you are absolutely right.

Tonight, I spoke to a friend about Zack.

Friend: Have you thought about having him placed in an assisted living place right now until the problems can be worked on? Because behavior like this, could turn outwards towards the other children and harm them.
Me: I dont' think he is bad enough fro that, but i have dreamt about it
Friend: I hate to ask this but how would he be bad enough, when he finally does harm another of your children?
Me: that is a good point :(
Friend: So far he has talked about it, and scared the other children with it and has shown that he is willing to do actions which could be harmful. Isn't it a little naive to believe that these two actions won't occur together if even by accident? I don't know if it is even worth the risk with little children in the household.
Friend: Sorry, I will be quiet
Me: it's ok, it's a very good point. I just like to think it can't happen. But you are right, it could.
Me: maybe i shoudl have taken him into ER today or called 911 on him. I just don't know what's right, and calling 911 seems a bit much
Friend: okay there is a seperation that I dont think you completely grasp. That is, there are two sets of rules. Let's say one of your children gets upset and throws something, calling 911 is a bit much since they will come to their sense while they are enraged. But while dealing with a person that has documented mental problems, that coming to the sense or mental break is possible that it wont occur. So 911 might not be a bad option for not only your safety but the other children's safety. And while you think you are doing the best thing for him, what about the other children. Is it fair to make them see him like this and risk their safety?
Me: You bring up very valid points and I will have to ponder. The thing is that he usually does calm down after this. But you are right, what if he doesn't, one time.

Calmer

He is calmer now, he behaves like nothing has happened. I am watching that vulcano though and wondering and worrying.

I Don't Know What to Do

I am on the verge of calling for help, not sure.

Zack is in his room now and quiet for now. But since we came home from therapy, he has been throwing chairs, laundry baskets, other objects. He has kicked me. He has spat on the floor and on other people. He has threatened to kill me in my sleep or at least cut off my legs. He has threatened to jump out of his window head first. He has threatened to hang himself in our yard.

He has been curled up on the floor screaming that his parasites were eating him. Screaming he was being possessed by demons. He went outside, and came back inside screaming about dogs, they were going to kill him 'Close the doors!!! They will come in!!!'

He spat on his siblings food. He put his face into his 3yo's siblings face and yelled at her 'That's NOT funny! You are ugly!' in a scary and loud voice, although she mostly ignored it and laughed more. He repeated this till I physically steered him away from her. In a way I am sad that she is so used to things like this, that she mostly ignores. It shows well for her spirit, but is makes me supersad that she has to live this way.

I feel he might be calmer after some time in his room, but not sure about it all.

Bad Morning

Sleeping has been being more and more of an issue, the melatonin does not seem to make any noticeable effect. The biggest problem is getting him up in the morning/ afternoon when we have to go somewhere, like today.

I spent at least an hour trying to get him up.
He did not want to get up, he'd rather die than go to therapy. It took me ages to get out of bed and then he threatened to jump out of the window, he even opened it partly. He was going to jump out head first. I was right there and was ready to prevent him from doing so, but he did eventually close the window.

When he finally was up, he was spitting on me, twice, and he kicked me, rather hard. I am not sure how to deal with this all.

This is very frustrating. And makes me realize, yes, the vulcano is still rumbling. I am stressed and sad and frustrated. Oh , overwhelmed too.

Time to get to therapy, wish us luck. We'll see psychiatrist and counselor.

Eye doctor

Visit this morning went well, Zack definitely is very nearsighted and needs glasses. He would prefer contact lenses, so in a few weeks he is going to learn how to put them in. His OD = -1.50, his OS = -2.50 so he definitely can use some vision aides.

Done!

It wasn't half as bad as I expected. We turned out not to have filled in the right form, the front desk person was a bit bitchy about that. So we spent time filling in the correct form. THe person who dealt with our case in the interview was very nice. She took all our information and talked to us like we actually knew what we were doing, unlike the front desk person.

We applied for 90 days retroactively, which means that everything that happened since April 23 is going to be covered if he gets approved for this program. This is going to be very helpful.

A decision can take up to 90 days and the squeaky wheel is more likely to be heard. We'll do a lot of gentle squeaking.

If he does get into the program , it will pick up everything our insurance doesn't cover, including copayments. That would be a nice side benefit, we talk about $15 every time we see a doctor or therapist. This is not much per visit, but does add up if we have like eight visits a months at least.

Please send good vibes for him getting into the program, I have no idea how we will afford therapy otherwise. 26 sessions a year are just not going to cut it for him, and that's all that our insurance covers. Not to mention there is all kinds of services he wouldn't even be eligible for, unless he is part of the program. Respite care and teen groups come to mind.

Nerves

Today, will go to the social security office and get the Katie Beckett process started. I am very very very nervous about the whole thing. What if they take months to evaluate and then deny anyway? What if he isn't severe enough (yes, I realize that is a good thing, but services-wise it would be a bad thing) What if I cannot remember anything I wanted to say. What if, what if, what ifs.

Yes, I do recognize it is just nerves. Both the psychiatrist, and the counselor had no doubts at all that he would qualify for Katie Beckett. But my mind is going over worst case scenarios and worrying about money, services, life.

I Will Cut Off My Foot!

Last night, I told him it was time to go to bed, and e got upset for no clear reason. He screamed 'I will cut off my foot and then we'll see whether you care! I am NOT going to bed! I am NOT going to sleep! I am NOT going to take my meds.'
Over and over, didn't calm down.

Eventually, I just ignored him after telling him very clearly that going to bed wasn't optional. He sat there, pouting for a while and then eventually made his way upstairs. Not that he slept, mind you, but at least he was in his room.

Not an easy, calm way to fall asleep I guess, but sleep was erratic on Saturday to Sunday too. So it wasn't only the night time happenings, it seems part of a bigger pattern. He has been taking melatonin every night, 3mg.

Sleep, or Lack Thereof

Last night, at 3:30am, Zack came downstairs complaining about not being able to sleep. I offered relaxation or meditation, but he claims he tried all that and still couldn't sleep. He couldn't read a book, he couldn't listen to music, it would keep him awake. He had been miserable at night already, so that wasn't helping.

Of course, I find myself worrying that we are at the top of yet another slippery slope, and starting to slide off. I still have felt like living at the summit of a vulcano, looking down into the crater and wondering when it will erupt. My calmness isn't there as much as it should be.

Just Snippets

• On Thursday, before going to doctor, I was trying to get Zack out of bed, and he was back to his 'I want to die' tune. But it wasn't said with much conviction, it felt more like a token 'I dont' feel like getting up' protest.
  
  
• Victoria (8yo) told me 'The Tums really are helping Zack!' He doesn't scream as much anymore. The power of Tums.
  
  
• We started melatonin seriously two nights ago. This morning he got up in time, maybe it is helping already? I can at least be hopeful, right?
  
  
• I hope to go to soc security office next week, and get the Katie Beckett application started. Hopefully on Monday, still have to check my calendar and see whether that works.
  
  
• Even with everything going ok for now, I find that I still have a high level of stress. It feels more like a 'honeymoon period' than a real solution, even if I desperately want to believe this is the real thing. I guess I do realize this is going to be a long process, and I also know that the next few months will be trying to figure out a new balance, and start dealing with the past stress.
  
  
• A good friend told me 'Don't see this as the crisis weeks, or months, be prepared for this being a crisis year.'
  
  
• I still have no idea about public school, the psychologist at the center is really pushing it, saying that OCD kids need more structure, and that it is important to him not be withdrawing from society. I recognize her bias, but there also are good points in what she is saying. I will need to make list of advantages/ disadvantages of school to help me think through it.
  
  
• I am more and more realizing how many of my last fourteen years have been spent trying to prevent people from erupting. Not only Zack, but also hubby. It is not a good realization, or in the long run it will be, but for now it makes me realize more how much I still have to work on, to deal with, to find myself again. I feel I am coping as ok as I can, but I also still have a LOT of processing and thinking to do.
  
  
• I feel overwhelmed. Life goes on, and doesn't stand still to deal with stuff like this, which makes me even more overwhelmed :p
  
  
• I am strong and I can do this, even if it's not easy. But I'll come out stronger, with a stronger family at the other end. There is much love around me, which is what is helping me cope.
  
  
• Thanks all my friends who are here to listen to me. And thank you W, for pointing out to me that I wasn't writing much about my feelings, I think you are right in pushing me a bit there, it will be more therapeutic for me. It will also help me to get feedback from people. Any comments are welcomed.

Blood draw

One thing I forgot to mention yesterday. When it was time to get his blood drawn, he was hesitant to sit in the chair
'Do you clean this chair?'
'Yes, we clean it with bleach.'
'Do you clean it in between every patient?', staring at it suspiciously.
'No, we just clean it at night.'
He looked doubtful 'Would you mind cleaning it now?'
'No, not at all'

She cleaned it with bleach spray and then he was willing to sit down and have his blood drawn.

He also still isn't touching any door knobs, which is not new, but I just am documenting it.

Physical

Today, Zack had a physical with our family doctor. It was hard to get him there are 1:15pm, his sleeping definitely is starting to get messed up again. Will have to get more serious about the melatonin.

It was nice to update her on all the things that had been happening. He is healthy, his thyroid numbers were fine again (after having issues during the first hospital stay) She had some concerns about liver function, which might be a side effect of the meds. She also wants to test for celiac, since he complained about stomach aches and he is convinced he has parasites.

We talked about the hearing test he flunked at the center, and she was going to have it repeated in the office. Of course, at the end of the visit we both totally forgot.

He is 96 pounds now, which put him a bit higher on the growth charts than he used to be, still less than average. His height is a bit above average though, so that is cool.

She drew blood to check for a bunch of his levels. I will get the results by tomorrow, or early next week.

We talked about school and options, she thinks that it could be a good and positive thing for him. She said that OCD people often need a lot of structure, and that school could help at that. I still have no idea what is good.

Katie Beckett Forms

I got the most important form filled in! Just need to look up some drs addresses, but the other questions all are done. It was both depressing and sobering to verbalize the answers to the questions showing why he needs more than a 'typical' child.

Now we'll have to go to the social security office and see whether they agree with me.

New OCD development

When we were out, I noticed that Zack is not using his hands anymore to open doors. When the door can be pushed, he uses his feet or elbow. When it couldn't be pushed, he asked me to open it. I noticed it for the first time on Tuesday (five days ago). A friend who gave him a ride one or two days before that said he wouldn't enter the car till she had opened the door for him. This is new, I had not seen that before.

Insight

I talked to someone about how things are going. I told him I felt overwhelmed, and had a hard time meeting everyone's needs. He said 'This is not about everyone else's needs, this is about YOUR needs. Take care of yourself first. Don't be supermom. They can take care of their own needs. You take care of your needs.'

Good point, the more I thought about it, the more I liked it. I feel I have spent too much of my time the last years trying not to make people erupt. Not good. I have been trying to take better care of myself, not perfectly so yet, but I am trying. I am soooooo used to preventing eruptions, need to get over that.

A few days ago, I spent time with good friends, and got to talk a lot, about Zack issues and other issues. It was very helpful and soothing.

Therapist

After seeing the psychiatrist, we finally saw Zack's therapist for the first time. She is nice, I like her. An older lady, calm, accepted anything he said, and seems like a good fit. He was oppositional , but in a pretty innocent way. He took a tissue again, and used it as a 'smile hider' putting it in his nostrils so that the tissue covered his mouth. He put feet on her chairs, put his legs in his neck, and just was negative about things. The only time she showed visible reaction when he talked about wanting to kill someone.

She says that the aggression and threatening of siblings is the first thing we will work on. She basically stated 'I do not care how bad you are feeling, how stressed you are, it is just NOT acceptable to threaten or hurt people.' This seems like a good first goal.

For the OCD she wants to work on breathing exercises with him, he was totally unimpressed by that. We also talked about ODD, I told her it was part of his discharge diagnosis after the first hospitalization, not this time.

She did agree with the psychiatrist that getting Katie Beckett for him would not be a problem at all, should be very easy. I hope I can believe them. My friend has all the forms, hope to get them filled in today or tomorrow. Then we need to go to socical security office and talk to them. It seems like this will have to be a priority to get everything rolling.

I thought it was a good visit, even if there wasn't much cooperation from Zack. At home, he has been doing very well though, some issues, but no major ones.

Psychiatrist

On Tuesday, we first saw the psychiatrist. We talked about the meds he is on, and she expressed concern about the fact that he still has a very hard time falling asleep. She said she might add some medication that has been known to help with that for ADHD kids. Of course, I have long forgotten the name, even if I did recognize it when she said it. It is a high blood pressure medication, but can be helpful in cases like Zack's. Zack immediately told her he did not want to be on new medications and the Prozac hasn't totally kicked in yet anyway, so for now we are holding off on anything. We decided to try melatonin for helping him sleep first.

She said he looked better physically, which was nice to hear. He was not being very cooperative, but in an innocent way. He took a tissue and put it in his nose to hide his mouth, like a half face mask 'Now you can't see my facial expression'. Any question about the hospital and how he felt was answered with 'boring'.

She talked about public school, saying that he might need more stimulation than he could get at home. But she also recognized that kids often say that they are bored when they are depressed or anxious. Zack told her that he would not go to school, not to a public school, and not to a private school.

She told me it should be no problem at all to get Katie Beckett for him, which was good to hear. It seems like the Katie Beckett status will open lots of opportunities for Zack which aren't there otherwise. There are things like respite care, teen groups, and such.

We will see her again two weeks from now.

Sigh

Today, Zack made spaghetti for lunch 'Can it be just for me??? Because if Ysa gets it, I cannot stand the sound her fork makes against her teeth'. I told her that was not an option, the spaghetti was for everyone.

Later, when he was finished making and started to eat, Ysa came over.
Zack: 'You cannot have any!'
Ysa: 'Mama said it was for everyone'
Zack: 'NO!!! You are going to make too much sound!'
me: 'Zack, if it bothers you, you are more than welcome to take your plate somewhere else'
Zack: 'No! I want to eat at the table'
Ysa: 'I was going to eat outside anyway'

Ysa, grabs spaghetti and puts the spoon down.
Zack: 'NO!!! You are putting it in the wrong place!'
Ysa, moves it to another spot, which she thinks is the right one. Zack says it still isn't right and fixes it. Ysa takes her spaghetti outside.

I don't even want to tell the others that there is spaghetti while he is still eating. This makes me feel bad, am I giving in, am I making it worse? I am glad we'll start therapy tomorrow and we can start dealing with stuff like this, because I am at a total loss. This is taking a lot of my energy. It still feels like vulcano land here.

One More Thing

When Zack had his outburst this morning, Monica was sitting in room, eating some cereal. She asked me, in a small voice 'Would you like me to go eat outside, so that Zack won't be bothered?' This is not a kid who usually has a small voice.

Yes, I think family therapy would be a good idea.

The rest of the day was good, but it helped that most of the siblings were doing other things and not interfering with him.

I HATE You, BlackBeard!

Today, a friend came over and Zack was upset immediately. He yelled at her 'I HATE You, Blackbeard!' He did turn around when she stayed calm and offered to drive him down to visit his brother.

She drove him down and they talked about rollercoasters. Sounds like they had a good time together. I wanted them to have something positive together. The thing is, it also shows, it's not about the persons, it is just the fact that there are visitors at all.

he did pull himself together rather well when this happened, I was impressed.

Home!

Yet again, we have him home. He spent almost three full weeks in the hospital this time.

We went geocaching and out for ice cream before going home. At home , he did very well, especially during card games tonight. He participated nicely and was not aggressive, actually very pleasant to be with.

I have spent quite some time already with the discharge paperwork. Will have to make copies for myself and family doctor.

His discharge multiaxial diagnosis this time:

Axis I: OCD, PDD-NOS
Axis II: deferred
Axis III: none at present time
Axis IV: mild
Axis V: GAF: 35

The five DSM axes are:

* Axis I: major mental disorders, clinical disorders, developmental disorders and learning disabilities
* Axis II: underlying pervasive or personality conditions, as well as mental retardation
* Axis III: medical conditions contributing to the disorder
* Axis IV: psychosocial and environmental factors contributing to the disorder
* Axis V: Global Assessment of Functioning (on a scale from 100 to 0) 31-40 Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.

He has therapy set up on Tuesday, much better than last time. He will see psychiatrist and the therapist who is going to see him regularly. I have heard good things about her. Wish us luck!

Tomorrow!

Tomorrow morning, I can pick him up and take him home! Both looking forward to having him home and dealing with things, finding a new family balance. Wish us luck.

Looks like medicaid and Katie Beckett can be done for permanent residents who have been here for at least five years. SO that's one less worry. The medicaid might have to be the buy in, at $135 a month, but it seems like it would cover a lot that our own insurance doesn't. Katie Beckett, I have to go to social security office at 8am and wait for at least a few hours and apply in person.

I hope we can start therapy next week, we were out most of the day, so I haven't called around yet.

It is Too Loud!!!!

Most of the morning, Zack had been hanging around in his room. When he came down, the other kids were eating breakfast and just being. He wanted to cut his nails, but got overwhelmed almost immediately. He put his hands over his ears and went 'It is TOO LOUD!!!' I told him that he could go and cut his nails in his room, which seems to solve things for now.

A few minutes later, Valorie (8yo) told me 'We will be very quiet so that we don't upset Zack.'

Last night, around 2am, he got up to check for fire hazards.

Off to the thrift store now.

Katie Beckett

Just called the center, and I am going to meet with someone this afternoon to talk about the Katie Beckett program, after I drop off Zack. I will make sure to bring up the citizenship issue, although it sounds like green card will be ok too, just will have to double check. But first we are going to visit the thrift store, where Zack wants to look for new books to read in the hospital.

The visit so far has been good, that's a relief. Just hoping I am not jinxing us by saying so.

Home!

I picked him up earlier today, had to wait till they had eaten some ice cream cake ^^ They made the cake last night at cooking group. They do quite a lot of fun stuff in between the more boring 'group' and 'school' events. It is nice to see Zack participate in them.

He played his gameboy DS the whole way home and is still playing it. He obviously has missed it. His siblings were happy to see him. So far everything is going well. Apart from the rain, that is, fireworks might not work out.

They stopped the risperidone, because it was giving him the low white blood count. At the moment he is only on antidepressants, Fluoxetine, 30 mg in the morning. They are clearly still experimenting to find the right medication combination. He also is taking two tums in the morning, and two tums at night.

Fireworks!

Well, he won't be coming home yet, but, the good news is that they will give him a pass to spend July 4th with us! I will pick him up tomorrow at 2pm, so we can all attend the fireworks, like we do every year. And he will go back to the hospital on Thurday. This also will be a good test to see how he does at home and how sleeping will be at home.

She also told me about family services, offering respite care and such, and gave me a phone number. I haven't contacted them yet. But I am happy for Zack that he can be home for the fireworks, because missing them would have been A Big Thing for him.

Stupid Stress

Still under considerable stress for no apparent reason. I can't get anything done, just sitting here, being mad at myself for not functioning the way I should. I think M hit it right on the head in his comments a few days ago, I still hate it though and I want to be strong and effective already :p

Maybe it's just the uncertainty of how things will go once he is home? How I will get him the services he neeeds? How we all will manage? I don't know.

So much to do, so little done.

Some Links

A friend sent this and I want to save them here

*****This one explains the five categories well.

http://www.brainexplorer.org/factsheets/Psychiatry%20Diagnosis.pdf

has this and more:

http://www.eprom.pitt.edu/UL_media\527601625.doc
http://psychservices.psychiatryonline.org/cgi/reprint/54/6/916
http://expertpages.com/news/psychiatric_diagnosis.htm
http://www.hss.state.ak.us/dbh/sq/clinical_forms/instructions/01c-Intake%20As
sessment%20Instructions.pdf

this page has an excerpt on I thru III

http://search.barnesandnoble.com/booksearch/isbninquiry.asp?ean=9780890420256
&displayonly=EXC&z=y

Update

I wanted to post this on Friday, but life kept getting in the way. I spoke to Zack's social worker, and we are tentatively thinking about a Tuesday homecoming date. They are not totally sure yet.

She has been trying to set up homebased therapy, but according to our mental health center, this is only possible if he is in the Kathy Beckett program, some special kind of social security program. I have a name I can call, and try to get him in. Although thanks to your comments, I realize that citizenship might be an issue. Feh. More phone calls, more forms to fill in. More things to research.

It is amazing the discrepancy between what kids / families need and what can be gotten in the current system.

Now I will sleep :p

GAF score

Figured out what axis V means, it is Zack's score on what they call the GAF (Global Assessment of Functioning) scale, or for kids the C-GAS (Children's Global Assessment Scale ). It is a numeric scale from 1 to 100, used by mental health clinicians and doctors to rate the general functioning of children under the age of 18. 100 is superior functioning, 1 is very bad. Zack scores 42-45, which places him in

50-41 Moderate degree of interference in functioning in most social areas or severe impairment of functioning in one area, such as might result from, for example, suicidal preoccupations and ruminations, school refusal and other forms of anxiety, obsessive rituals, major conversion symptoms, frequent anxiety attacks, poor to inappropriate social skills, frequent episodes of aggressive or other antisocial behaviour with some preservation of meaningful social relationships.

So much new knowledge to absorb. But at least I now have some idea what Axis V means.