Since Sunshine has returned from residential, table manners are a big topic of conversation among parents and siblings.

Sunshine has always struggled with table manners, but not to this extent. She has taken things to a new level, which everyone is struggling with.

It's to the point that siblings do not want to eat at the same time she does, because of how gross her process of eating is to them.

A few days ago, Sunshine and I had a conversation about her table manners. 

I was very honest about family concerns, including that none of us feel comfortable taking her to restaurants or on vacations because of what's going on.

The comparison of Beauty and the Beast came up. Right now Sunshine eats like the Beast. All of us, including her, want her to eat like Belle.

Together we discussed ways that we could help her improve her table manners.

Sunshine mentioned that a visual chart at the table would help remind her.

Today, I'm excite to share 4 reasons kids struggle with table manners and how to help along with a FREE Table Manners Visual Support for Kids Printable.

 4 Reasons Children Struggle with Table Manners and How to Help

As with all things, there's usually never just one reason why children struggle with table manners.

1. Struggles with Food

Table manners are associated with food, so any struggles related to food may be reflected in manners seen at the table.

If you are in the midst of trying to understand the why behind behaviors, you may want to read the post below with steps to follow to help you understand what's going on with your child.

Food Issues: Are They Behavioral, Sensory Related or Medical? 

In our home we have used so many different strategies over time to help each of our kids cope with their struggles related to food.

Every child has been different in what they need.

If you're looking for ideas that may help your children, be sure to check out the post below.

7 Ways to Help Children When Food Is the Enemy

When in doubt ask your child why mealtime is so difficult. You may be surprised by what you're told. 

Together you can come up with a plan that will help the most.

We were struggling with table manners and mealtime during our Montessori co-op at one point. 

After speaking with the kids to understand what was going on, we were able to come up with a fabulous solution that worked beautifully! You can read about it in the post below.

How to Help My Child Try New Foods

Sunshine struggles with multiple issues related to food. 

She craves textures and flavors, yet does not like her food mixed on her plate. Soups and casseroles are out of the question!

As a toddler, we learned that Sunshine struggled with reflux, had multiple food allergies and has a submucosal cleft palate related to her Cranial Facial Microsomia. 

Once we addressed her medical issues, her eating habits improved immensely.

Sunshine also suffers from Reactive Attachment Disorder, which usually always includes a food component. To read more about Sunshine's story with food related to RAD, read the post below.

Reactive Attachment Disorder and Food Struggles

I will say, we have not had the same struggles mentioned in the post above, since Sunshine has returned.  They are completely different, though some are definitely related to Reactive Attachment Disorder.

Unfortunately, food struggles are not the only reason children may struggle with table manners.

2. Delays in Motor Skills and Muscle Development

Some children are delayed in fine and gross motor skills, making the task of sitting at the table and using utensils appropriately a challenge.

When mealtime becomes too much of a challenge, frustrations mount. At times, it may just feel easier to the child to give up or eat with hands, etc.

Sunshine struggles with delays in fine motor skills and hand and finger muscles. She also lacks coordination when using a fork and a spoon.

Over the years we have worked to help Sunshine with these issues in multiple ways.

We provide a Montessori kitchen where she is able to work independently with child-friendly tools at her level.

A Minimalist Montessori Home Tour: The Kitchen

Unfortunately Sunshine didn't have this set up in residential and did not practice these skills. Before she left residential, she could prepare her peanut butter banana toast for breakfast independently. 

Now she only feels comfortable putting the bread in the toaster and cutting bananas. Her fear of failure at spreading peanut butter is big.

During our Montessori co-op days, and while the kids were younger, we also provided other supports and opportunities to develop fine motor skills at meal time.

You can read about all we did in the post below. Now that we're transitioning from serving dinner in the living room on Montessori mats, where kids don't have to watch Sunshine eat, to practicing table manners at the table, we will be initiating this again.

The three older kids are almost completely independent at mealtime, so they don't necessarily need it anymore.

The Best 5 Tips for Helping Children Become Independent at Mealtime

3. Sensory Stimuli in the Room

Is the room cold? 

Perhaps it's too loud?

Do you have a child who isn't a fan of bright lights or dinner by candlelight?

Are the chairs too hard or too high?

Is a child able to sit and eat at the same time or must he be moving or standing?

Do the sounds and smells of others eating bother your child?

We have experienced every single one of these scenarios at home. They are real!

Thankfully at this point, other than issues that siblings have with Sunshine's current habits, we've problem solved the rest. Lol.

4. Mealtime Struggles related to Reactive Attachment Disorder or other mental health concerns

Once you're able to meet needs related to food, motor skills and sensory stimuli in the room, most children will be successful at mealtime.

However, there are those who won't be. Most often this is related to Reactive Attachment Disorder or other mental health issues related to family relationships.

Mealtime at the table can be a very intimate time for a family that promotes closeness. Those who struggle in these situations are going to have behaviors at the table.

I briefly touched on and shared resources about the history of Sunshine's mealtime habits related to Reactive Attachment Disorder and other mental health issues above.

Mealtime at the table requires Sunshine to share attention, which she does not enjoy.

Eating at the table together as a family requires her to spend time with everyone in the family, following conversations, being kind, and enjoying people's company, respecting what others choose to talk about, which she struggles with.

Dinner (and every other meal with family) requires being in close proximity to other family members, which means keeping boundaries and being close, which is also hard.

Sometimes it's just easier to push people away to feel safe. 

At mealtime in our home, Sunshine does this through eating inappropriately, covering herself in food from head to toe.

Other times it means starting an argument or being unkind with body language and words.

That doesn't even begin to address trauma related to food Sunshine has experienced. 

After all this time, she doesn't trust that she will be fed, or that her food won't be taken away (residential made this issue so much worse), and so she inhales it as fast as she can in the easiest way possible.

This is what we're working on now. 

I am hopeful that because Sunshine helped develop a plan for herself that the FREE Table Manners Visual Supports for Kids will be exactly what she needs to improve manners at the table and help make mealtime enjoyable for everyone.

FREE Table Manners Visual Supports for Kids

Our Table Manners Visual Supports for kids includes two resources.

• I Have Great Manners at the Table Chart
• Table Manners Cards

We will be using both resources with Sunshine as she is unable to read past CVC words. 

Understanding what pictures represent each table manners cue is extremely important.

The true-to-life images used in this printable are of families and children practicing each aspect of table manners. 

We will laminate the chart for Sunshine and have it at the table with her while she eats to refer to.

I will cut and laminate the cards, placing them on a ring to use outside of eating time or on the go, to remind Sunshine of expectations.

Source: I created the Table Manners Visual Supports for Kids. Follow the directions at the bottom of this post to obtain your free copy.

Meal and Snack Time Visual Schedules and Supports for Kids

The FREE Table Manners Visual Supports for Kids works beautifully with our Meal and Snack Time Visual Schedules and Supports for Kids.

We have started using this with Sunshine since she has returned and it helps immensely. Visual schedules make such a difference for her, especially those related to food.

I can't wait to use it while on vacation to help her navigate mealtime on the go!

Don't forget your free printable!

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Navigating the journey of treating children and adults with medication for mental health struggles is incredibly difficult. 

No matter what choice is made, there are consequences. 

Every psychiatrist has different ideas and experiences.

Every individual responds differently to medications.

The development and presentation of every individual is different. 

What may appear to be one thing, can often be another.

Mental health issues aren't "fixed" by just popping a pill or not popping a pill.

After almost ten years of navigating this journey with my children and husband, I would like to share 10 things you need to know about medications for mental health struggles.

Today I heard from Sunshine's psychiatrist. 

A few weeks ago Sunshine had blood work done to check how her body is responding to the cocktail of medications she's on. 

Sunshine is currently diagnose with:

• Autism Spectrum Disorder
• ADHD
  
• Reactive Attachment Disorder
• PTSD
• Mood Disorder (bi-polar)

When she returned home from residential she was on the following medications and supplements:

• Tenex
• Risperdal
• Depakote
• Lamictal
• Adderall
• Trileptal
• Zyprexa
• Hydroxyzine
• Benadryl
• Levothyroxine
• L-Methylfolate
• GABA
• L-Theanine
• Multivitamin

Her current psychiatrist has been concerned about this cocktail of medications and what they are doing to Sunshine's body. (Some of these meds are not usually combined and at such high doses.) 

We have also been concerned.

Results from initial blood work weren't as positive as we'd hoped, even though blood work previously had shown Sunshine had been stable on these meds and doses for six months. 

The not so great results meant another blood draw in a couple of weeks, and weaning off another one of her meds. We had already weaned off all of the hydroxyzine at this point.

Sunshine began weaning from Zyprexa, an antipsychotic med that was prescribed a year before in residential, to help with manic and depressive episodes, specifically the psychosis aspect of things.

She received her second blood draw today, which thankfully showed improvement in Sunshine's white blood cell count. 

The weaning off of Zyprexa made a difference in blood counts, but was NOT a fun process. 

Not having Zyprexa has definitely affected her moods daily. It's our hope that after withdrawal symptoms, she will be doing better.

There is nothing about taking medication for mental health struggles that is easy for adults or children.

I feel it's so important that you know and understand what this process is like, especially if you are experiencing it yourself or with your children, or know someone who is.

 

10 Things You Need to Know About Medications for Mental Health Struggles

1. Just one medication may not be the answer. It may take more.

First, Sunshine's list and doses of medications is not normal. 

Her current psychiatrist at home has never seen a child on so much medication, but has commented she's thankful that because of these medication, Sunshine can be at home with her family.

The psychiatrist at Sunshine's last residential treatment center stated that it can be typical for a child in residential to have a med list like Sunshine's due to the severity of symptoms.

Sunshine started Tenex and Benadryl at age 2. 

She began Risperdal at age 3.

Depakote was added at age 4.

Lamictal was added at age 5 with the thought that Depakote would be weaned and replace with Lamictal.

We have tried weaning Depakote three times. Each time Sunshine has ended up in the pediatric psychiatric ward for inpatient treatment. 

Depakote has ALWAYS been put back in because of this.

Our Pediatric Mental Health Crisis Up Close and Personal

Adderall was added at age 6 in the pediatric psychiatric ward. Doctors have tried to wean it twice. Both times, it was determined Sunshine needs it to function and stay safe.

Trileptal was added at age 8 in Sunshine's first residential placement.

Amen Clinic Brain Scans with FREE Social Story

GABA, L-Theanine, and L-Methylfolate were added after Gene Sight testing and brain scans at Amen Clinic towards the end of her first residential placement.

Hydroxyzine was added in between Sunshine's first and second residential stays.

Levothyroxine was added to help with thyroid issues related to Depakote after Sunshine's second placement.

A child will most likely not have a list of meds like Sunshine, but may need more than one medication to stabilize.

Medications for mood disorders treat symptoms, not the whole disorder. 

The symptoms an individual is presenting with will determine which medications are tried.

2. All medications have side effects that can harm the body, some in very serious ways.

The combination of Depakote and Lamictal puts Sunshine at risk of developing Stevens-Johnson Disease, which is very serious. This is why so many psychiatrists have tried to wean her from Depakote. 

Fortunately Gene Sight testing showed that Sunshine is at a very low risk of developing this disorder. We try to keep her Depakote dosage as low as possible, just in case.

Depakote can lead to thyroid issues and negatively effect platelet levels. Both have occurred in Sunshine. She can only take a certain amount of Depakote before more problems arise.

Depakote can also lead to hair thinning and nightmares, both of which Sunshine experiences.

The combination and dosage of Risperdal and Zyprexa and can lead to Tardive Dyskinesia, which is very serious. 

Risperdal can cause diabetes, which is one reason Sunshine is on a gluten free and refined sugar free diet.

All of these meds can cause issues in white blood cell counts, which Sunshine has experienced and led to the weaning of Zyprexa.

Risperdal and Zyprexa cause weight gain, and have in Sunshine over the years. 

Please know, it's not simple deciding which side effects are worth it, and which ones are not, especially in a child.

3. Medications may not work as hoped, causing more mental health struggles, until they are stopped or another solution is found.

Lithium was tried during Sunshine's third residential stay. The trial went horribly wrong causing an increase in homicidal behaviors and severe aggression.

We now know, this medication is NOT for Sunshine.

Through Gene Sight testing, we learned that Sunshine's body metabolizes Lamictal VERY quickly, which means she needs a much higher does than others to obtain the desired effect. 

Depakote helps slow down Sunshine's metabolism of Lamictal, so that the Lamictal works. Without Depakote, the Lamictal is not effective.

If insurance will pay for it, I highly recommend Gene Sight testing to determine how the body responds to medications, before going through the trial and error process. 

I don't know where we'd be without it!

 

4. It can take a long time to find the correct dose of a medication that works for mental health struggles.

It has taken us YEARS to get to where we are today with Sunshine. 

There is no easy fix. 

As children grow and develop, so do their brains. 

What may work at one point, may not work later on. 

Increases in doses over time can be normal for some children.

Different symptoms show up at different ages.

Psychiatrists vary in what they feel comfortable prescribing and at what doses.

Life happens. Circumstances change. 

All of this effects how medication works with mood disorders.

5. Medications may not always be needed, as individuals grow and learn how to regulate emotions more efficiently.

A child's brain is still developing and growing, which means that over time, as a child matures, she may not need as much medication. 

Weaning a med can be very scary and have catastrophic consequences.

What I'd Wish I'd Known About My Child's Mood Disorder Med Changes

But, in some cases due to various reasons, a med weaning can also go well, after the initial withdrawal symptoms.

Due to the side effects of medications for mental health struggles, we never want on our children on more than what is absolutely necessary to keep them stable.  

Some medications can cause medical complications and must be weaned, like Sunshine and Zyprexa.

If a individual can go without, that's always the best solution.

Now with all of this said...

We have gone through multiple med withdrawals with Sunshine over the years. 

First was an attempt to wean Risperdal. 

We ended up with a mental health emergency that led us to our developmental pediatrician's office and a week of life coming to a halt, waiting for Sunshine to stabilize again.

Next came three attempts at weaning Depakote. As I mentioned above, they all went horribly wrong.

Sitting in a hospital ER waiting for a bed in a pediatric psychiatric hospital bed for a week is NOT fun.

But, this last weaning of Zyprexa has gone okay so far. (Mind you it's been a week since she took her last dose.)

Sunshine is a bit moodier, but she's also sick with the flu.

She is sleeping MUCH better, despite being sick, which is incredible.

There is a clarity in her thinking that wasn't there before, that we're loving.

Behaviors at this point have not increased.

Her blood work is now exactly where it needs to be.

The satisfaction of knowing that Sunshine may not need this med feels so fantastic.

6. Withdrawal symptoms of meds can be quite awful. Wean with care and supervision.

In our experience there are many medications that come with withdrawal symptoms when weaned. 

Depending on how long the medication has been used and how large the dose is, withdrawal symptoms can be incredibly challenging.

Sunshine expressed that her mind felt blank after stopping Zypreza for a few days. (She was on a very small dose.) 

There was a significant increase in agitation.

The withdrawal sent her into a depressive episode.

Be prepared for the worst and hope for the best when a medication is weaned and stopped.

A Plan for Mental Health Emergencies

Research withdrawal symptoms of a medication before the weaning begins. 

Develop an understanding of how long withdrawal may last, so you can understand what is withdrawal symptoms and what an individual looks like without the med.

Prepare for the withdrawal ahead of time knowing that the individual may not be okay.

Be sure to check in with the prescribing doctor or psychiatrist often to communicate what's going on.

7. Documentation of behaviors before and during medication trials (and weaning) is crucial to understanding how the medication works.

In order to understand if a medication works or is needed, it is incredibly important to document behaviors before, during, and after a med trial. 

Medications for mood disorders can effect:

• Sleep
• Appetite
• Weight
• Moods
• Energy Levels
• Aggression
• Agitation
• and more!

Understanding how an individual is doing before a medication is started compared to after it is started, and every time dosage is increased is crucial to helping everyone stay safe.

Serious consequences have come from not understanding how a person is responding to medication including suicidal and homicidal behaviors.

If you need help documenting information, be sure to check out the post below.

How to Document Your Child's Behaviors for Professionals and Specialists

With every medication Sunshine has tried and weaned from at home, we have documentation for a minimum of two weeks before changes, (usually more like a month), and then document everything as we move forward.

This documentation has allowed use to communicate with doctors and specialists more effectively.

We have been able to seek the help we need immediately.

Most importantly, I know what each and every medication Sunshine takes does for her.

• Tenex
• Decreases aggression and impulsivity
• Risperdal
• Decreases mania and improves sleep
• Decreases agitation and aggression
• Decreases depressive episode symptoms, especially psychosis
• Causes weight gain and increased appetite
• Depakote 
• Decreases mania
• Decreases homicidal tendencies and aggression
• Aids in the metabolism of Lamictal
• Causes thinning of hair
• Effects thyroid levels
• Causes nightmares
• Causes constipation
• Lamictal
• Decreases mania
• Decreases homicidal tendencies
• Decreases agitation and aggression
• Does not work without Depakote
• Adderall
• Decreases hyperactivity and impulsivity
• Decreases aggression
• Causes insomnia if given later in the day
• Trileptal
• Unknown as it was prescribed during first residential stay during COVID-19 lockdown
• Zyprexa
• Unknown as it was prescribed during third residential stay in a different state
• Learning about how it works now as we've weaned Sunshine off of it. So far we've learned:
• Causes issues with sleep
• Causes impaired thought process
• Causes white blood cell count to plummet
• Regulates moods
• Hydroxyzine
• Calms behaviors when needed
• Causes irritability
• Causes fatigue
• Benadryl
• Reduces anxiety at bedtime and allows Sunshine to fall asleep
• Levothyroxine
• Improves Sunshine's thyroid functioning
• Helps with mood swings
• L-Methylfolate
• Necessary due to chromosome abnormalities
• Increases anxiety
• GABA
• Calms the brain
• L-Theanine
•  Calms the brain

Knowing this information has been crucial while advocating for Sunshine over the years.

8. Mixing medications for mental health struggles with other medications (such as decongestants) can cause manic or depressive episodes.

I've already discussed side effects of medications for mental health issues, but it is also important to know that something as simple as taking cold medicine can affect how mood disorder medications work, causing manic or depressive episodes. 

Before taking any other medications, be sure to check with a doctor or pharmacist about how they may interact with mood disorder medications.

As inexperienced parents with a young child on medication for a mood disorder, we were not aware of this interaction and definitely learned the hard way. 

We would never wish that on anyone.

9. Some medications for mental health struggles are controlled substances and are monitored closely by doctors, pharmacies, and insurance.

Adderall, a medication that Sunshine needs to function, is a controlled substance.  

This means that this prescription must be sent in monthly by her psychiatrist. 

In some instances, a psychiatrist has been able to send in a script for three months of the prescription, but we still have to call to have it filled at exactly the right time every month.

At pick up we must show ID and sign. 

This prescription can not be picked up early, as insurance monitors use closely.

Controlled substances for adults means random drug screenings. 

If a test comes pack positive for anything concerning, even if it's a false positive, you are unable to receive your prescription and forced to wean cold turkey until the issue is rectified.

We are okay with using controlled substances to help individuals in our family, if it is the last resort, or the only thing that works. Otherwise we try to avoid them.

10. Circumstances beyond your control may completely throw off medication regimens.

Currently, as I write this post, there is a nationwide shortage of Adderall. 

This means that as we go to refill Sunshine's prescription, there is always the reality that we may not be able to receive the medication she needs, which then jeopardizes her stability and the safety of our family.

At any given time insurance companies may change their minds about what medications they will cover, and which ones they won't. 

Medications for mood disorders can be very expensive. At times, switching insurance companies is not possible. 

So often, it is not the fault of the individual who needs the medication, that she is unable to obtain it. 

Trying another in its place is no simple task.

It is so incredibly traumatic for families who are trying to do everything right, to have situations beyond their control pop up like this, resulting in destabilization in the individual or worse.

Conclusion

For many individuals, medications for mood disorders are necessary. Unfortunately there is a stigma that surrounds mood disorders and medications.

It is so incredibly important to understand that these stigmas exist because of so many misunderstanding surrounding mood disorders and medications used to help people.

Asking for help is so incredibly HARD.

Receiving the correct help right away is nearly IMPOSSIBLE.

I can not imagine what it is like to be Sunshine with so many things out of her control, completely dependent on medications to help her function throughout the day. (She takes medications morning, noon, and night.)

I only know what it has been like advocating for her and watching how her body responds to various medications for mood disorders. That's hard enough!

It is so important that everyone understands what the journey is like for individuals who need meds for mental health struggles!

Even after doing all one can, an individual may not find the relief they're seeking for a very long time.

For those who would like to continue to follow Sunshine's journey and/ or receive more resources for mood disorders, be sure to subscribe to our free newsletter by clicking the link below.

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Warning: This post contains information about behaviors at home related to Reactive Attachment Disorder and may be triggering to some.

I received an e-mail from a reader earlier this week. She wrote: 

"How do you stay calm and help your child through this bout of frustration/anger when she won't respond to anything you suggest or try except with a growl or refusal?

How do you cope with a child who gets so angry she throws things or tears her papers or tries to hurt others, [and when] she screams and glares at you with such malice and possible hatred?

Raising a child with Reactive Attachment Disorder is HARD. 

It is perfectly normal for a parent to wonder how in the world other families manage these circumstances, especially when you are just trying to survive.

Today I'm excited to share how I work my way through these scenarios, remaining calm during a Reactive Attachment Disorder fits.

For the purpose of this post, I first want to state that Reactive Attachment Disorder fits are very different than autism meltdowns or scenarios in which children are on sensory overload. 

I am using the word "fit" because that is the word we use at home for these scenarios. You may prefer to call them something different, and that's completely okay.

Other words I have heard used in different scenarios include disruptions, aggressions, threats, behaviors, etc.

Moving on with the post...

How To Stay Calm During a Reactive Attachment Disorder Fit

1. Remember you've tried NOT being calm and it only made things worse.

It is completely normal for a caregiver of a child with Reactive Attachment Disorder to try EVERYTHING to make things better at home. This includes the good, the bad, and everything in between.

You desperately want to find something that works to make the madness stop, and are willing to do whatever it takes.

There comes a point when you either hit a breaking point, or pause to analyze how your responses to behaviors affect the situation. 

In both situations you realize NOT remaining calm does a number on both of you and only causes harm.

Sometimes all it takes is remembering what happened when you weren't calm.

2. Avoid personalizing the situation.

During a Reactive Attachment Disorder fit, you are most likely the target. This means all of the anger and rage is directed at you. 

Your child may say extremely harmful and unkind words, and at times threaten you.

Your child may try to destroy property.

Your child may try to harm you or others.

It is so easy to take these situations personally and in turn either begin to feel negative feelings that are just as strong towards the child, or blame yourself, constantly thinking you're not good enough.

The truth is, Reactive Attachment Disorder fits aren't about the caregiver AT ALL. 

They are all about the child and how the child thinks and feels about herself. 

She will do ANYTHING to push a caregiver away to protect herself and the caregiver from those thoughts and feelings, until the feelings get so big, she can't hold back anymore.

Fits usually start when a child with Reactive Attachment Disorder wants what she wants when she wants it.

Knowing these facts helps me understand that the things Sunshine and Princess say and do during fits are only about protecting me from themselves, even though it may not look or feel that way in the moment. 

And if I ever doubt myself, all I have to do is look and see how Sunshine and Princess did in settings outside of the home, whether it be public school, a day program, visits with respite workers, or residential. 

Let's just say, without going into too much detail, behaviors were much worse.

As hard as it can be, take yourself out of the thought equation during fits. Focus on safety, not personal feelings. Taking these steps definitely helps stay calm during the worst behaviors.

3. Choose NOT to let Reactive Attachment Disorder fits ruin your day.

Early on in our journey as caregivers of children with Reactive Attachment Disorder, it was so easy to allow fits to ruin the day. As we chose to allow more and more days to be "ruined" by behaviors, negative feelings would build up, which then led to feeling completely paralyzed.

She would say and do things that were not cool or okay.

I would then respond in negative ways as a parent and feel horrible about myself for the rest of the day.

There came a point, when I became fed up with my days being sabotaged by these interactions. 

Princess was having a rough time. I decided to say the following.

"You can choose to ruin your day, but you are not going to ruin mine. I am going to choose to have a great day no matter what choices you decide to make. You can choose the type of day you want to have."

I will fulfill my role as caregiver during the day's schedule, but if there is a Reactive Attachment Disorder fit, whether it lasts five minutes, an hour, or four hours, I'll do what I need to do to keep everyone safe, process emotions with all in the home, and then move on with my day.

Yes, Reactive Attachment Disorder fits occur. 

Yes, they take time to work through.

Yes, they affect everyone in the household.

But, I want to enjoy the times when I'm not in those moments.

Remembering this, helps me stay calm in the midst of the madness.

4. Remember that just a part of your child feels the anger, rage, and negative emotions you are receiving.

In our home, we use Internal Family Systems to communicate and work through trauma. This model explains that a person is made up of parts that have varying thoughts, opinions and feelings. 

Both of our girls have identified multiple parts. Sunshine's Devil part hates her and her family. Her Sabretooth Tiger part works with the Devil to attack when necessary. But, that doesn't mean all of Sunshine's parts feel the same way. 

She has many other parts that love her family and would never hurt them. It's just a matter of which part is in charge when, why it was triggered, and how far into the unburdening process the part has gone through when triggers come.

Princess' parts are a bit more complicated than Sunshine's parts. She has one called Violet Witch that definitely struggles in many areas. When that part is in charge, all of us know to beware. Her siblings can identify it when they see it and call it out.

In the midst of Reactive Attachment Disorder fits, I make it my goal to try to communicate with Sunshine and Princess' other parts, if I can. I do not confront, correct, or give suggestions, knowing that these attempts will only escalate things.

Instead, I ask questions to whichever parts are willing to listen and answer, and if they aren't willing, I respect that and move on.

When I remember that only a part of my girls is pushing me away, I can keep a level head in the midst of Reactive Attachment Disorder fits, knowing they aren't as scary.

5. Don't enter a situation you don't think you can handle.

Raising a child with Reactive Attachment Disorder is enough to make even the sanest and most competent person doubt their abilities.

If you are around someone with Reactive Attachment Disorder 24/7 by yourself, dealing with behavior after behavior, you will go crazy.

My husband and I are fortunate enough to both work at home. 

Throughout our day, we take shifts with Sunshine. 

During different parts of the day, each of us knows who's in charge during the day's routines and if there are behavioral issues.

• Renae: Wake-up to 9:45 AM
• Jason: 9:45 AM to 1:30 PM
• Renae: 1:30 PM to 5 PM
• Jason: 5 PM to Bedtime

Neither of us could make it through multiple days in a row alone with all four kids and remain calm in all circumstances.

The only time we join together with Sunshine is during Reactive Attachment Disorder fits because they are so physical. 

We have a baby monitor upstairs in her room so whoever is downstairs can hear her escalate and know when to join in.

While fits occur, we support one another and help each other stay safe, sane, and calm. 

If one of us isn't feeling calm enough to handle the situation, we tap out for five minutes until we can be calm.

Sunshine is not a fan of when we join forces. This method works well for her.

If my husband wasn't working from home, Sunshine would not be homeschooling, but attending a day program instead. I will not care for her along with my other children by myself.

When it comes to Princess, due to the way her Reactive Attachment Disorder works in comparison to my husband's autistic brain, I handle all fits. (She is not physically aggressive.)

He may sit in the room to show support, but doesn't say much at all. 

Princess knows that during or after her Reactive Attachment Disorder fits, I may send her to take a break because one or both of us aren't being kind or respectful. 

She knows when she goes up to her room for a break, she is welcome to come down whenever she is ready for us to resume conversations in a kind and respectful manner.

Most importantly, both girls know what happens if they are unsafe with themselves or others.

Only do what you can handle. 

Once you hit the point where you can do nothing more, ask for help. 

Request in-home therapy services.

Request respite services. 

Enroll your child in school or a day program. 

If behaviors warrant it, seek a residential placement.

Find a way to have back up at home or a break away from the child with Reactive Attachment Disorder.

This is necessary in order to remain calm during Reactive Attachment Disorder fits.

I cannot stress enough how important it is to remain calm during Reactive Attachment Disorder fits. 

It benefits everyone so much. 

You come away feeling better as a parent, and your child can learn that it's safe to feel emotions, no matter how strong they are, in your presence.

No one is perfect.

We all make mistakes.

The goal is to keep trying.

Over the years I have come to learn that a caregiver and a child with Reactive Attachment Disorder grow together. 

The relationship is not automatic. 

It takes time, experience, and so much patience.

But in the end, if the child chooses, and is capable of healing, calm is possible!

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Relationships among people are quite a complicated thing for Sunshine. She has the body of an eleven year old, going through the beginning phases of puberty, yet developmentally she is between the ages of three and six depending on the day.

Studying the human body and relationships has been crucial right now as we strive to help her understand the world around her, her changing body, and her desire to fit into a world that is very confusing.

The month of February, when we celebrate Valentine's Day is the perfect time to do this!

These relationship activities for kids with free printables are a great way to teach children about relationships they see around them and develop understanding of different types of relationships they may witness or be a part of.

Activities contain LGBTQ+ representation, as those are some of the relationships that children see in the world around them. It's important that they understand them.

If you'd like to read our stance on the LGBTQ+ community, you can click HERE to do so.

Many of the printables used in the activities shown in this post come from the resource below. This printable pack was created with the help from a friend and representative of the LGBTQ+ community.

Montessori-inspired Relationships Printable Pack

Please keep in mind, we did not use all of the activities included in this resources on our shelves with Sunshine, but only those that were developmentally appropriate for her at this time.

Relationship Activities for Kids with Free Printables

Types of Relationships Sort

Our lessons started with explaining the difference between romantic love, family love, friend love, and self-love. 

These are concepts that Sunshine struggles with, especially when it comes to boundaries and obtaining consent from others while out and about in the community.

Sunshine sorted cards into four columns, thoroughly enjoying the true-to-life images and diversity that's included. It was a perfect Valentine's Day activity!

Source: The printables for this activity are part of the Relationships Printable Pack.

Relationships Status Sort

Once Sunshine understood the different types of relationships, we started to focus on romantic love introducing the concept of dating, engagement and marriage, learning the sequence in which these occur and the vocabulary that goes along with each.

Sunshine really enjoyed this activity. She did not know about being engaged or the special ring that is given during that process. The activity was extra special with Valentine's Day around the corner.

What was even more exciting is that while this activity was on the shelves, Sunshine learned that her OT is engaged. She was so excited to know and understand what that meant, because she had learned about it.

In this activity, Sunshine sorts out the cards into three columns: dating, engagement and marriage.

Source: The printables for this activity are part of the Relationships Printable Pack.

Same Race and Interracial Marriage Activity

Another aspect of romantic relationships that we discussed was race and ethnicity. 

We just happened to be studying the Civil Rights Movement in the United States at the same time these activities were on our shelves. 

We discussed laws that were passed that allow black people to marry white people. All of this was very interesting to Sunshine. 

It bothered her that laws could dictate who you could and couldn't marry based on the color of their skin.

In this activity there are sorting cards. (You can see them at the bottom of the photo in the middle.) Each time Sunshine selected this work she would sort the cards into two columns: same race and interracial couples.

Once she finished that process, she would select a card and then create that couple and marry them. 

We had so much fun with this activity! Dressing the Barbie dolls in their wedding outfits provided such great fine motor practice.

Sunshine was introduced to the Wedding March, which provided a great timer to ensure that we just didn't end up playing Barbies the entire time.

Barbies used for this activity came from Princess and Sunshine's collections. We've always been very big on promoting diversity and inclusion during play.

Due to Sunshine's struggles with fine motor skills, I made sure all Barbie dolls were undressed at the beginning of the activity. 

This was definitely a topic of discussion throughout the time this work was on the shelves. We put "blankets" over the Barbie dolls to ensure that they were not seen "naked."

Source: The printables for this activity are part of the Relationships Printable Pack.

Relationships Vocabulary Nomenclature and Description Cards

Once Sunshine understood the basics of relationships, we moved on to introducing different types of romantic relationships and preferences. 

A special thanks to Ashley at Diamond Montessori for helping me ensure that these cards represented the LGBTQ+ community accurately and in a way that children can understand.

With all the exposure that Sunshine had to various people and behaviors in residential, I had thought she would already have had an introduction to the LGBTQ+ community, but she had not.

The vocabulary terms, relationship references, and sexual preferences were all new to her, which provided opportunities for many conversations and questions.

I chose to introduce these words to her because we live in a world and day of age, when this is necessary vocabulary to promote love, understanding and respect for all.

While this work was on our shelves, Sunshine happened to run into a transgender person while at our local Walmart. She also ran into a lesbian couple.

Sunshine was so excited to know and understand the situations she found herself in and elated that she knew the vocabulary terms to use to describe what she was seeing.

Source: The printables for this activity are part of the Relationships Printable Pack.

Relationships Vocabulary Syllable Counting Clip Cards

Sunshine struggles with learning new vocabulary. Nomenclature and description cards aren't usually enough.

When it it comes to learning brand new big words, syllable cards help break them down and emphasize correct pronunciation.

For these reasons, I created relationship vocabulary syllable counting clip cards. 

Sunshine loved using the little hearts to mark her answers. To her heart markers made this activity extra special Valentine's Day themed work.

Source: The printables for this activity are part of the Relationships Printable Pack.

Relationships Vocabulary First Letter Sounds Clip Cards

To once more reinforce new vocabulary terms and to practice letters sounds and spellings, I presented these relationships vocabulary first letter sound clip cards to Sunshine.

She loved this work, especially since it included mini heart shaped clothespins I found at our local dollar store for Valentine's Day.

Sunshine would clip the clothespin on to the appropriate letter to display her answer. 

I loved the fine motor practice this step provided.

Source: The printables for this activity are part of the Relationships Printable Pack.

Relationships Vocabulary Writing Strips

After three months of being home from residential, Sunshine's passion for writing has returned! 

These relationship writing strips provide a great opportunity for so much letter formation and spelling practice.

Sunshine has really enjoyed writing each of the words while remembering what they mean. She feels so proud of herself when she writes one of the bigger words.

Source: The printables for this activity are part of the Relationships Printable Pack.

Relationships Flag Activity

After learning relationship vocabulary, I introduced flags that represent different vocabulary terms. The purpose of this activity was to help Sunshine be able to identify flags she may see out and about, understanding their meaning.

Sunshine loved creating flags using paper straws and a stapler, after she colored each of them, using the controls provided.

LGBTQ+ Flag Patterns

Sunshine has shown particular interest in the LGBTQ+ flags. She loves the stripes and colors. 

Over the past couple of weeks, Sunshine has also been showing an interest in making patterns.

I decided it made perfect sense to combine these two interests and add a little pattern fun to our shelves.

When we use the pattern printables, we cut out the patterns and then snip off the last square for Sunshine to add herself as she figures out the pattern presented.

Source: The LGBTQ+ Flag Patterns Printable Pack is a free printable. Click the link at the bottom of this post to receive your free copy.

For those who would like to follow Sunshine's journey and receive more Montessori-inspired printables about relationships, be sure to subscribe to our newsletter below by clicking the link below.

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Relationships Flag Patterns

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