This one is where things start to get a little clearer for Becky, and a lot less clear for Billy.
I hope you like this,
Billy had been sleeping for about an hour as Sharon looked through the photo album that Craig had given him. She was curious where he got it, and what made him get it in the first place. She was ecstatic that he did, and enjoyed looking through the photos he had put in there. Every one of them was of Billy and her looking at each other, smiling. She could see that these were all taken at Disney, some on the train, some at the water play area, and various other places. She still had the album open on the bed when he entered the room.
Sharon smiled when she looked up and said “Hello.”
“How is he doing?” Craig asked as he looked at Billy still attached to her breast.
“Much better thanks to you.” Sharon answered.
“I’m glad.” he told her.
“Where did you get this album?” Sharon asked.
With a smile, Craig answered “I called Lisa.”
“What made you think of this?” she inquired with a puzzled look.
“When Peter called me, he explained that Billy was reluctant to ask for his pacifier, and yet showed a strong desire to have it. He also said he was embarrassed when you gave it to him. That told me he had a problem with how others perceived his behavior. I immediately thought a photo album would help.” he explained.
“But did you think he had dreamed that we laughed at him?” Sharon asked.
“No, originally I was just going to try to get him to remember your interactions with him in each of the photos. Once I understood that he was confused, and his concerns were based on a misperception, well, I changed my tactics. Seeing Becky as she was dressed and with her pacifier was the first step. She was the one that caused the most tears when we talked about it, so I wanted to deal with that first. Once he saw that she wasn’t going to be mean to him, it was easier to get him to see the rest.” he told her.
“I’m curious why he reacted the way he did when you pointed out the binky, blankie and diaper. It’s like he was shocked to see them in the photos.”
“He probably didn’t even notice them until I pointed it out. I purposefully kept my questions simple, and moved from photo to photo so that he wouldn’t scrutinize them, but would take in the whole picture at once. Most people do that, did you ever notice? When you look at a picture, you don’t see seventy percent of what’s there. The fact that he’s been taking a pacifier and a blanket and wearing a diaper for some time now, made them “normal” in those photos so he didn’t even notice them.” Craig pointed out.
Sharon glanced down at Billy. He had suddenly started nursing again in his sleep. She smiled as she watched him. “I was wondering if he would still nurse in his sleep.” she commented.
“It’s become habit.” Craig stated with a smile.
Sharon looked up at him and asked “So how do we deal with him like he is now?”
“What do you mean?” Craig asked.
“Well, I’m not sure what to do. He’s talking normal aside from the pacifier, he understands what we say clearly now. Should I stop talking to him like he’s a baby?”
“I would keep doing what you were doing, unless he shows you that it makes him uncomfortable. Until we have an idea what his final status is going to be, stick to what’s worked in the past.” Craig answered. “He needs to know that while his body and abilities are changing, what he can expect from you and Rick will not. It will help with feeling secure.” he added.
“Thank you.” She told him. “I’m really at a loss as to what to do here.”
“No, you know what to do, you’re just scared, and that makes you doubt yourself. Trust me, it’ll get better.” he offered with a warm smile.
She reached out and patted his arm and said “You’ve been a lifesaver in all of this. I really appreciate all you’ve done.”
Craig was about to respond, but Billy chose that moment to open his eyes and start fussing. Sharon felt him pull away from her nipple, and looked down to see what was wrong. She asked “What’s wrong Baby?” in a comforting tone. A moment later when he hadn’t answered and he started fussing louder, she looked to Craig and said “Get Peter.” in an anxious tone.
Craig got up immediately and made his way from the room. Sharon picked Billy up and held him with his head against her shoulder, supporting his head so he didn’t have to use muscles that would tremble if he did it himself. Billy wasn’t upright for more than six seconds, before he burped loudly, and then vomited a moderate amount of milk onto Sharon’s shirt. No sooner did he do so, he stopped fussing.
Sharon started patting his back, ignoring her soaked shirt, and just as Peter entered, Billy burped again. “Goodness, you had lots of piggies in your tummy didn’t you Sweety?” Sharon asked him. She looked up as Peter approached the bedside and said “Something’s different.”
Faith had come in with Peter, saw the drenched shirt, and left.
Peter watched Billy for a moment before he said “Billy, can you hear me?”
Billy didn’t respond to the question.
Repeating the question louder, Peter again got no response. “Lay him down.” he told Sharon.
When She laid Billy on his back, Peter watched his eyes. They were moving from one thing to another, never resting in one place for long. Peter reached out and brushed Billy’s cheek with his finger and wasn’t surprised when Billy turned toward his hand.
“What’s going on?” Sharon asked.
“It looks like he’s back where he started. The question is why?” Peter asked.
Faith came back in with a scrub shirt and several towels. “Go get Dr. Roach please.” Peter told her.
She immediately put the stuff down and left again. Gary entered the room a moment later, and asked “What’s wrong?” when he saw the concern on Sharon’s face.
“He’s behaving like an infant again. I need you to order another MRI of the brain ASAP.” Peter told him. “And I’ll need another dose of Thiamylal. I also want to do another spinal tap. I need to know what his ICP is.” he added.
“What’s ICP?” Sharon asked when Gary left the room.
“Intercranial pressure. The pressure inside his head. The last time we saw changes like this, his ICP was very elevated. If it is this time, I need to find out why.” Peter explained.
Ten minutes later, he was drawing up the sedative into a syringe so he could do the spinal tap, and Billy yawned a big yawn, dropped his binky and turned to Mommy and said “Binky Mommy.”
That got Sharon’s attention, and as she returned his binky to his mouth, she said “Billy, can you hear me?”
Billy said “Mmmm Hmmm.” as he looked directly into her eyes, nursing his binky.
Peter was at his side in an instant. “Hi Little boy. How are you feeling?” he asked.
“OK.” Billy answered.
“Does your head hurt? or does it feel strange?” Peter asked him.
“Does anything hurt?”
“I’m hungwy.” Billy answered, turned his head and said “Nummieth Mommy.”
Sharon was about to say no, when Peter, out of Billy’s line of sight nodded his head.
“Alright Baby, let’s get you snuggled down.” she answered and pulled Billy into her lap and laid him on his side. Once he was nursing at her nipple, she looked to Peter.
“Billy, I need to give you some medicine in your IV. It might make you sleepy, but that’s alright.” Peter said as he slowly injected the sedative into the tubing.
Craig remarked “OK, that was unique.” with a puzzled look on his face when Billy went to sleep.
“Yes, that’s one way of putting it.” Peter replied. “More like one of the strangest things I’ve ever seen.” he told them.
This did nothing for Sharon’s nerves however. “Peter is he going to be alright?” she asked fearfully.
“Well, he seems to be stable, there isn’t any indication he’s in any distress, so physically, I think so, yes. As for what his ultimate function will be? I can’t answer that without seeing what’s going on inside. That’s what the MRI is for.” Peter answered.
Craig looked at Peter and said “It’s possible what we just saw has nothing whatsoever to do with his surgery.”
Both Peter and Sharon looked at Craig and said “What?”
“There’s a good chance that the emotional status and just now, the complete regression is not due to a physical problem. It may be purely a reaction to what happened with social services, or a combination of the cyst and the circumstances, that was brought to the forefront by the incident with social services.” he explained. “Or a combination of all of them. I can’t be sure at this point.”
“What would make you say that?” Peter asked.
“Becky.” Craig answered simply.
“What about Becky?” Sharon pressed.
“I think she’s got a problem that’s a bit more serious than we first thought. I wanted to speak with you about this yesterday, but it just wasn’t possible to get both you and Rick in the same room without her there at that time.” He told her. “She’s BECOME a toddler. In talking with her during the session, there was no indication of her ever having been eleven. Normally you see a child regress in areas, like potty training in younger kids, or a need for certain comfort items, but rarely do they completely regress. That tells me that there’s a problem.” he added.
“What do you think is wrong?” she asked.
Looking to Peter, he asked “Is Billy going to be out for a little while?”
“Yes, at least an hour.” Peter answered.
“Will you need to be with him?”
“No. I can send Gary with him. Why?” Peter asked.
“I want to sit down with you, Sharon, and Rick and I can explain what I think is going on with Becky, and explore Billy’s history some more.” Craig answered.
“Alright. Give me a couple of minutes to get him settled and give instructions to Gary. I need to get a nurse to stay with him though, I don’t want him left unobserved.” he explained.
“Alright, while you take care of that, I’m going to call Rick on his phone and explain what we need him to do.” Craig told him. Turning to Sharon, he said “I’ll be glad to answer your question, but I want to save having to do it more than once.” he told her.
“Alright, I understand.” she told him.
Fifteen minutes later, Billy was down in the MRI suite, Becky was snuggling with April as she nursed her bottle, and Peter, Craig, Rick and Sharon were sitting in the conference room.
Craig had gotten the TV and the DVD player brought back in so he could show some of the video that he’d recorded of Becky. He played a five minute segment before turning it off and saying “I see a typical two year old in that video. A large one, but every behavior I see belongs to a two year old. Can any of you see the slightest indication of an older child there?”
They all thought about what they saw. Rick was the first to say “No.” without reservation. He knew his daughter, and he’d seen her behave this way before, Nine years ago.
Sharon took a little longer before she said “No.” as well. She also remembered Becky from years ago. She was showing some of the same mannerisms she did then, things she had long since grown out of.
"That’s what makes this unique. Most kids regress in one or two areas. Like a six year old losing his potty training and wanting to be closer to Mommy, but he doesn’t lose his vocabulary, or his six year old point of view. Becky isn’t seeing things from an eleven year old point of view at this point. She’s reacting like a two year old.
I need to ask both of you, is there any behavior that Becky is displaying now, that she didn’t when she was two? In other words, did she hate something then that she has no problem with now?" he asked.
“Several things.” Rick told him. “When she was two, she hated, absolutely hated to sit in a messy diaper any longer than she had to. Now, it doesn’t bother her in the least. In fact, if I didn’t change her, she would sit there until she got a rash.” Rick explained.
“What else?” Craig asked.
“When she was two, she made every effort to move ahead. She didn’t like being referred to as a baby. Now, she’s making no effort, and prefers to be called ‘Baby Girl’. I assumed it was because of the fear. The other thing that I don’t understand, is she hasn’t even looked at Charlie Bear since she got the Minnie. She wouldn’t be able to sleep without that bear even a year ago.” Rick told him.
“I noticed myself, that she didn’t try to help at all when we were dressing her or bathing her. It’s as if there’s no desire to move forward. I too figured it was because it made her feel secure.” Sharon added.
Craig sat for a moment considering this. “What you’re telling me makes the case stronger. I believe this isn’t simple regression, but a split.” he told them.
“What does that mean?” Rick asked with concern.
“We see it in kids that have been through trauma. It can happen immediately, or it can happen later, sometimes years later. The trauma can be physical, or it can be emotional. We see this as often in sexual abuse cases as we do in emotional abuse. The child endures a traumatic event, and essentially splits who they are into more than one ‘personality’ if you will. It’s referred to as Dissociative Identity Disorder. It’s a defensive mechanism. The child dissociates themselves from the trauma, by creating another personality or identity. It can be a complete personality with a whole new set of likes and dislikes, or a partial personality with only relevant pieces. The additional personalities are called Alters. Some kids have only two Alters, others have more, sometimes many more.” he explained.
“The Alter can exist to endure the abuse and allow the child’s core personality to escape what’s going on, as in cases where there is repeated abuse, or it can exist to allow the child to escape the abuse which is what I think Becky is doing. She doesn’t want to be the eleven year old, because it’s painful and frightening.” he continued.
“So should we not have allowed her to have a pacifier and all the other things?” Rick asked.
“No, I think if we didn’t give her that avenue, things would have been a lot worse. Don’t misunderstand me, I’m not telling you that Becky will be doomed to diapers and bottles for the rest of her life. What I am telling you is, it will take longer than we thought to help her get back to where she needs to be.” Craig answered.
“How do you treat this?” Sharon asked.
“The goal is to integrate the two parts. There might actually be three, one a little girl. But the goal is to get them all as part of the same personality. But even if that never happens, Becky can learn to get the parts to work together. There have been countless cases where this allowed the individual to lead a productive, rewarding life. I’ve seen cases where the children move on to become doctors, lawyers, just about anything that people aspire to become.” he told them.
“OK, so what do we do now?” Sharon asked. She felt a lot better after hearing that.
“For now, I advise you to keep things as they are. Once she gets back home and into a stable routine, then Cathy should be able to help her. She’s had experience with this type of thing before. I know this scares you both, but whatever you do, don’t try to push her to move forward right now. Like I told you before, there’s absolutely no security in this situation, and you can’t possibly expect to foster change in an environment that’s constantly changing. She needs to get back to a routine that will offer security before you attempt to move forward.” he told them adamantly.
“Alright, we’ll let her be two for now.” Rick said with a sigh. He didn’t like what he heard, but like Sharon, he felt better knowing that people do get through this.
“How does this relate to Billy?” Peter asked. While he was concerned about Becky’s welfare, his first concern had to be Billy because he was primarily responsible for helping him get better. He knew that he didn’t have the skills that Becky needed to help her.
“It’s possible that Billy is in a similar situation, but exactly the opposite. Where Becky’s core personality is an eleven year old, it’s possible that Billy’s is a small child, and the nine year old is an alter.” he told them.
“How is that possible?” Peter asked before Sharon or Rick could get their questions out.
“We know that Billy’s been having a hard time for some time. From what you and Cathy have told me, it’s been years, at least two. I’m inclined to believe it was longer than that. One of the things that makes me consider this possibility, is his change in temperament. You indicated he became distant, but it only happened when you interacted with him” he told Sharon. “Tell me, have you found him with a pacifier or his bear before this whole thing started at Christmas?” he asked.
Sharon thought about this and answered “Christmas eve when I went in to diaper him for the first time, he was sound asleep, nursing his thumb and cuddling with his Pooh Bear. I had thought that he had put the bear away several years ago. I hadn’t seen it in years. Part of the problem is, we try to teach the kids respect for privacy, so it would have been difficult to witness that without breaking our own rules. That was the first time in several years that I entered his bedroom without knocking.”
“No other incidents of regressive behavior?” Craig asked.
“Not that I can see, other than normal stuff like being clingy when he was a bit younger if he got sick.” Sharon explained.
“Well, the only thing I can suggest at this point is to watch his behavior. Make a note of what different stages you see him at and especially keep an eye out for clear changes from one minute to the next. Once the MRI results are back, then we will hopefully have a better idea if there is a physical reason for this. I still think there’s more than that, but without any more evidence, I can’t advise you to do anything but go with the flow. When I think about it, I would give you the same advice no matter which way it went. Once he gets home, then will be the time to start treating him if there’s evidence to support what I think is happening.” Craig told them.
“Alright, fair enough.” Peter replied.
Sharon didn’t like the idea of what he was suggesting. She really hoped it was a physical issue that could heal in time. She didn’t want to think about the fact that it may not heal. When she thought about it a moment though, it didn’t matter right now. Her main concern was to provide him all the love and care she could.
Rick contemplated Becky’s fate. He would do what Craig suggested, and continue to care for her like a two year old. When they got home, they would see Cathy and talk about how to help her get back to where she needed to be. From his perspective, allowing her to be a toddler right now was a small price to pay for eliminating the fear. The fact that he could be sitting here right now was a good example of what she gained by being a two year old right now.
“I’ve got to go see another patient thirty minutes from here. I’ll be back in about two hours to see what the results are, and to check and see how they’re doing. If you have a problem, call me.” Craig told them as he stood up.
Everyone stood then, and the gentlemen shook hands, while Sharon hugged him and thanked him for his help. Once he was gone, Rick looked to Peter and asked “Do you think he’s right about Billy?”
“Honestly Rick, I’ve never seen that behavior before. I couldn’t tell you right now. I need to see the films and the results of the spinal tap. I’ll let you know more once I’ve looked at those.” he answered.
“Alright, I guess I should get back to Becky then.” Rick said.
“I’ll call you when I know more.” Peter promised him.
Sharon followed Rick out and went with him down the hall toward Becky’s room. “I don’t care what you call it, I just hope they’re alright.” she said as she took Rick’s hand in hers and squeezed it gently.
“We’ll get through this no matter how it plays out Honey, like I said, I love you.” Rick told her with a gentle kiss.