Doctor Anderson approached Timmy. "I think Mr. Rabbit loved getting to ride on the car."
Timmy looked up at the doctor and nodded. "He tell Mthter Pamda and Mooth and dey wan wide too."
Doctor Anderson noted to himself that Timmy had no problems recalling the names of his other stuffed animals, only pronouncing their names. Now that he understood Timmy's regression was most likely do, in part, to his feelings about Adam he was not as concerned. He pulled up a chair and sat facing Timmy. "Timmy, would you like to play some games with me too?"
Timmy nodded again.
"Okay, the first one is called 'All About Timmy.' I'll ask you some questions and you tell me all about you," Doctor Anderson tapped his index finger to Timmy's nose. Timmy giggled in response. "Timmy, can you tell me how old you are?"
Timmy held up four fingers the way he usually did. Only this time he added, "Four thtill baby too."
"Yes, four is very young." Doctor Anderson responded in a way that would neither encourage Timmy nor upset him further.
"Timmy, I'm going to point to everyone in the room that you know and you tell me the name of the person I'm pointing to."
Doctor Anderson wanted to see if Timmy remembered the names of some of the new staff along with the names he was familiar with. Timmy had no problem remembering everyone's name, only in pronouncing them.
Doctor Anderson asked several more questions and Timmy's responses were within the norm for his age.
"Okay, Timmy. Now we're going to play another game. You need to stand up for this."
Timmy got to his feet.
"Do you know how to play Simon Says?"
If Timmy knew, he had forgotten. He shook his head.
"The way the game goes is, I say 'Simon Says,' I say to do something and you do it. After I have a few turns, it will be your turn and you can tell me, 'Simon Says' and I'll have to do what you say."
"Kebin and Tee pway too!" Timmy ordered.
Doctor Anderson looked in Téa and Kevin's direction. They both nodded in approval. "Sure they can play too."
"Thure, more da mewwier," Timmy repeated what Kevin had said quite some time ago. It was obvious that Timmy's long and short-term memory were fine.
Téa and Kevin stood up. Doctor Anderson began. "Simon says 'jump!'"
Téa and Kevin had enough sense to wait until Timmy did it first before they did. They knew they should not be giving him any hint as to how to respond. Timmy jumped up and down. Then they did too.
"Great, Timmy. Everyone is a very good jumper. Okay, now Simon says, 'hop on your right foot.'"
Timmy stood still. He looked confused. He looked down at his feet. It became apparent he no longer knew his right from this left. He finally made a choice. He hopped on his left foot. He was able to balance on it for a normal amount of time.
Doctor Anderson had Timmy do a few more gross motor skills and some fine motor ones as well. Then he gave Timmy his turn. He joined Kevin and Téa and played along as Timmy gave the commands.
"He's good with Timmy," Viki whispered to Sam. Sam nodded in agreement. They were happy that Doctor Anderson was so gentle and playful with Timmy.
Suddenly Timmy started to look uncomfortable. He burst into tears.
"What's wrong? Timmy?" Kevin pulled him into a hug.
"Daddy pumish me. I bad. I make pee pee. Daddy pumish me wike he pumish Andy," Timmy cried.
Kevin looked down at Timmy's pants. They weren't wet. Then he remembered that Adam had been out before Timmy and Pete. Timmy still wore the absorbent brief that they had put on Adam.
Jeff heard what Timmy said. "Timmy, you must be really uncomfortable. Let me get you cleaned up and I'll get some fresh clothes on you."
"Daddy pumish me," Timmy insisted. He placed his first two fingers in his mouth.
Sam rushed over to him. "Timmy, I'm your daddy now. I'm not going to punish you, ever!" Sam took Timmy from Kevin and hugged him tightly. Sam kissed Timmy's forehead. "Never, ever. No punishment. You're my good boy. Daddy loves you."
Steve joined Jeff. "You ready to get cleaned up, buddy?" Steve held out his hand.
"I wan Mommy and Daddy and Tee and Kebin and Dota Hamen go wid me too." Susannah approached Timmy. "Sweetie, I need to talk to Mommy, Daddy, Tee and Kevin. You get cleaned up and then we can all have lunch together. You wanted alphabet spaghetti, right?"
"No! I wan ewewybowy go wid me." Timmy protested.
"Timmy, Jeff and Steve need to help you get clean and changed into something dry. We can't all go with you. You need to follow directions and go with them to get cleaned up. Then you can have lunch with all of us."
"NO!" Timmy stamped his feet.
Susannah turned to Timmy's family and announced, "Timmy is having problems following directions. You are all going to have to leave until he is able to do what we ask." "NOOOOO!" Timmy screamed! He ran over and threw his arms around Téa. "I wan you go wid me," he pleaded.
Téa's heart started to pound. She knew what she needed to do, but didn't know if she would be able to. "Angelito, you need to get clean and dry. I'm really looking forward to having lunch with you. The faster you do that the faster we can have lunch."
"You go wid me, Tee," Timmy whined.
Téa would have been more than happy to go with him. She looked over Timmy's shoulder to Susannah. Susannah shook her head. Susannah appreciated that Timmy had placed Téa in a terrible position, but like Adam's, Timmy's behavior problems needed to be handled right, from the start.
"Angelito, look at me." Téa pulled back and lifted Timmy's face by the chin. "I love you very much. I want to spend the whole day with you. All you have to do is go with Jeff and Steve and get cleaned up. Then we can all have fun together."
"NO!" Timmy screamed again. He plopped down on the floor, cross-legged. He began to weep. "No, I wan ewewybowy go wid me. I wan ewewybowy go wid me. I wan ewewybowy go wid me," Timmy whined over and over again.
"This is ridiculous!" Sam announced and stood up.
"Sam!" Viki reached out to stop him.
Sam brushed off her hand from his arm. He rushed over to Timmy, crouched down on his knees and pulled Timmy into a hug. "Shhhh, Daddy's here. Daddy'll go with you and help you clean up."
"Nobowy wuv me. Dey aw go way foweber," Timmy cried.
"Shhhh. No one is going to go away. I promise. Do you remember the official promise? Do you want Daddy to make you an official promise?"
"No! I wan ewewybowy go wid me," Timmy insisted stubbornly.
Susannah had a feeling that this time it was more than being afraid everyone would leave. He was testing all of them. "No" seemed to be Timmy's new favorite word.
Sam cast looks at Viki, Téa and Kevin. He saw that they weren't going to budge on this. It was killing all of them to say no to Timmy, but they were trying to do what was best for him.
"Timmy, Daddy will go with you. Mommy, Kevin and Téa need to speak with Doctor Hanen and Doctor Anderson. Daddy promises you that they will be there when we get you all cleaned up. Daddy says you can trust them."
"Wike Thimon Thays," Timmy whimpered.
"Yeah, pal, kind of like Simon Says. Daddy says you can trust them."
"You thtay wid me and wath me." Timmy looked at Sam helplessly.
Susannah and her staff saw that Sam had just taught Timmy that he was the one who was most easily manipulated. She knew that even children as young as Timmy sensed that and would use it for all it was worth.
"I'll stay with you the whole time and I'll wash you and then I'll help you change into clean dry things. I think Jeff and Steve may have to help a little, but Daddy will do most of it, okay." Sam stroked Timmy's hair back and kissed him on the forehead.
Timmy nodded and allowed Sam to help him to his feet.
"Are we ready to go?" Sam glared in the direction of the two techs.
"Yep," Steve answered for both of them. "Come on, buddy. You'll feel a lot better after you're all nice and dry and clean. Timmy held onto Sam's hand as the four of them made their way to Timmy's room.
"Let's go to my office and talk," Susannah announced to all of them.
Rachel could see that her aunt was not happy with the way Sam handled Timmy. She did not want to intrude any further. "I can see you're going to be a while. I'm going to the cafeteria. Should I come to your office in about an hour?"
"That'll be fine, honey. I'll see you then," Susannah replied.
*****
Once everyone was seated, Susannah gave Doctor Anderson the floor. She knew he needed to get back to his other patients.
"Timmy's memory seems to be fine. He's oriented to time, person and place. However, there has been a decline in his cognitive skills as well as his gross and fine motor skills. At this point I don't suspect neurological problems. I think most of Timmy's declining skills are a combination of his mental problems, a sensitivity to the meds and plain old sibling rivalry."
"Timmy was always a brilliant little boy," Kevin commented. "Now he can't spell any of the words he used to know. He can't build things like he used to or even walk or talk like he used to."
Doctor Anderson saw the fear and sadness in Kevin's eyes. "Timmy still is a very smart child. I believe he continues to suffer from depression, anxiety, especially extreme separation anxiety. These disorders are causing cognitive impairment that result in a loss of some of his skills. This is common with young children. That Timmy reacts in a manner consistent with real, for the lack of a better word, young children has come as a surprise to me since I was not familiar with DID until now. Nevertheless, this is what I believe is happening. Since a very recent CT scan and MRI were done on Todd's brain, we know that there is no tumor or anything like that causing the problem. I believe that as Timmy progresses in therapy and his specific issues are addressed he will get back some of his skills. As for the medication, that is a problem. If Timmy were out most of the time, I would suggest a change, but since he's not, at this point, and Todd and some the others seem to be benefiting from it, I would not recommend lowering the dosage or discontinuing anything at this point."
"Do you think the epilepsy is contributing to Timmy's loss of skills?" Viki posed.
"Not the seizures themselves, but the antiseizure med may. Again, I can't recommend the Dilantin be reduced or discontinued because we have already seen a decrease in seizure activity in Todd and the other alters who have been out. If Timmy starts to come out more often then we may have to reevaluate his medications." Doctor Anderson turned to Susannah. "Do you plan on telling Timmy about the seizures?"
"Yes. On terms he can understand. I have some picture books that help a young child understand an epilepsy diagnosis."
Doctor Anderson turned back to Timmy's family. "I know Timmy's behavior can be frightening and cause you all great concern, but at this point I think most of it is temporary and I don't believe there are any problems with Timmy's central nervous system that are causing these behaviors. Are there any more questions for me?" Doctor Anderson looked at each of them.
The each said no. They understood that Susannah was the one they needed to turn to for further answers.
"Doctor Anderson, thank you so much for staying to check Timmy out and for the patience and kindness you showed him. I know Sam is very grateful to you too," Viki added.
"Yeah, it's not too many doctors, other than Susannah, who don't make Timmy freak out. You were great with him," Kevin stated.
"Well, he's a great kid. I'm very impressed with Todd and all of his alters. That young man has taught me a lot." Doctor Anderson turned to Téa. "Mrs. Manning. Please remember to take care of yourself. You've already done way too much for someone who sustained the kind of injury that you did. Please go home and get some rest. Okay, that said, I do have to get to my next appointment."
After Doctor Anderson left, Viki, Kevin and Téa looked toward Susannah.
"I agree with everything John said. I'm afraid that Timmy has always been more sensitive to all the medications we've ever used than Todd or the other alters and I absolutely agree on Timmy being jealous of Adam. He must have been watching some of us interact with Adam. In Timmy's mind, his place with all of you is threatened. You can think of it as how you would feel if your mate suddenly showed up with a lover and told you that from now on you would have to share his or her attention and love with them. Timmy sees Adam as an intruder who is there to take what's his. Timmy was suffering from separation anxiety before Adam came into the picture. Seeing what to Timmy is the equivalent of a new baby brother has added to that. Now Timmy not only fears losing you, but he fears losing you to Adam. His fears have just become even more specific in his mind."
"So seeing Adam has caused Timmy to become more disturbed?" Viki questioned.
"No, not in the way you mean. Actually Timmy's reactions are very normal and typical. Children his age often exhibit developmental regression and oppositional behavior, meaning many of the things you saw . . . Timmy's refusal to follow instruction . . . his saying no to everything . . . his aggression . . . the tantrums . . . all of these are classic behaviors of a child Timmy's age when a new baby is brought into the family. Timmy can't vocalize his jealousy or fears or anxiety yet, so he shows them in the only way he can. Timmy does not feel he's getting his fair share of attention. To a child his age, there is no such thing as positive and negative attention. Attention is attention and he'll get it any way he can."
"And Sam played right into that," Kevin remarked.
"Kevin! Sam is going through Hell right now. You know that. I can't even begin to imagine how much the things Pete said to him today reinforced all the guilt he's already feeling. He can't bear to see any of them suffer, especially the children. In his mind he's doing what's right for Timmy and for Adam and for all of them, including Todd." Viki wanted Kevin to show Sam more compassion.
"I know that, Mom. Sam's got problems. But his problems are contributing to Todd's problems and the alter's problems. It kills me not to give Timmy and Adam their way, but I know it won't help them if I do."
"Kevin, I understand that. Oh God, I don't know what to do. Sam just needs some time to get himself together. I can't believe that a little spoiling will do that much harm. Those children deserved to be spoiled after the life they've led."
Téa sat quietly. She could see both sides. She knew Sam was making the problems worse, but she could also sympathize with him. In fact her heart went out to him. She never forgot the kindness he showed her. Téa was forever grateful to Sam for coming to Llanview to help Todd save their marriage. She wondered if she and Todd would have ever gotten back together without Sam's help. Téa remembered how different Sam seemed then. He was so strong and together. Téa wished there were some way she could help Sam and ease his suffering.
"Susannah, do you agree with that? Should we go along with Timmy's bad behavior for now?” Kevin asked.
"The thing I'd like for you all to be able to do is to see this behavior as Timmy's way of communicating his pain, rather than as bad behavior. And no, I don't agree that his tantrums should be given into any more than Adam's. The reason is the same with both children. By giving into them you are giving the message that this is the way to get what they want. Rules and limits have to be set for Timmy and he needs to respect them and understand if he doesn't, there are consequences. Like with Adam, the time to give Timmy extra attention and even rewards is when he exhibits positive behavior."
"Then what about the bottle and the babyish behavior? I mean I did notice that you gave me a warning glance not to make a big deal of Timmy wanting a bottle," Kevin pointed out.
"Toddler regression is handled differently than oppositional behavior. Some children Timmy's age need to be babied for a while when they are first dealing with a new sibling. This is also a normal reaction. Timmy sees that a baby gets all this attention, so in his mind being a baby is a good thing. He may think that you don't like him any more because he's not a baby. Timmy may have also seen some of Adam's behavior and now he thinks that what he needs to do too. On an unconscious level, he may even feel the need to ‘outbaby’ Adam. That might be why Timmy wants a bottle instead of a sippy cup. It's okay to allow him to be a baby for a while. He needs that right now. He wants to go back to a place, not only where he sees Adam is, but also to a place that he might remember as being safer. In this case, we know that Peter started abusing Todd from the time he was as young as two, possibly younger. The only safety and security they may have known were when they were being held and fed by the mother."
"So we don't say anything and just go along with it when he talks baby talk or wants to drink out of a bottle?" Téa asked.
"That would be the best way to go for now. Fulfill his needs to return to being a baby, but when he does act in an age appropriate way, that is when you would say something and make a big deal out of it. Unlike Adam, praise is very reinforcing to Timmy. Once Timmy is not denied what he thinks will be pleasurable, being treated like a baby, he may discover that it is not so pleasurable after all and want to be treated like a big boy again. You encourage and attend to the part of him that wants to grow up, and don't make too much of the part that wants to be a baby. The best way is to do what you've already done. Remind him of all the positive things there are in being a big boy. Point out all the things he gets to do that Adam can't, only don't make too much of even that. Don't lecture him on it or constantly bring it up. Don't tell him that he is favored over Adam or over any of the others. We don't want him to compare himself to anyone. We want him to know that just being Timmy is what is expected of him and he doesn't have to feel he has to be better or worse than anyone to be loved and accepted or to get attention. I think once he gets the attention he craves, he will start to see that being four is better than being a baby. You need to understand that Timmy is not thinking I'm going to talk this way or I'm going to ask for a bottle. These are needs that he now has that need to be satisfied. This is the way he has of reacting to his fear, jealousy, anger and insecurity."
"What happens if Adam comes out at the same time as Timmy? Do you encourage them to play together?" Téa inquired.
"Well, Adam is not a typical three year old and I'm referring to the autism, not to his being an alter. Timmy cannot play with Adam the way he could with a typical three year old alter. Timmy needs to be educated about Adam's disorder in a way that he can understand why Adam acts more like a baby than a three-year-old. Once he is able to grasp that, it might be helpful to him to enlist him in helping with Adam and it would probably be beneficial to Adam as well. At the beginning we would have to watch out for covert hostility. That means that while seemingly giving physical affection to Adam, Timmy could take out his hostilities on him by holding him too hard or squeezing him and in return, Adam may hurt Timmy by biting him or hitting him. As we've seen with Thomas and Andy, they can do damage to the body by thinking they are actually attacking each other. We would need to show Timmy how to hold Adam and then praise him when he does it right and not make too much of it if he makes a mistake. Of course we would watch him closely to make sure no harm is done to Todd's body. The best that we can hope for is that Timmy begins to appreciate being older and being able to become a parent like figure to Adam. This way he will no longer feel he's in competition with him."
"Susannah, what about Timmy losing his potty training? Is that more of a cause for alarm?” Viki questioned.
"No. This is also a very common part of regression. He might have seen that Adam still uses what Timmy perceives as a diaper, so he might interpret that as part of what gets Adam extra attention, again, this is not really on a conscious level. It may also be that Timmy was not toilet trained during the time of his life that he wants to get back to. Please don't be overly concerned about this. Timmy will surly pick up on that and either begin to feel ashamed or realize that this is a way to get to get a rise out of you. When he realizes he's wearing an absorbent brief, he may hate it and let go of this or he may find security in wearing what he perceives as a diaper. As with Adam, I promise you we will check him frequently and keep him as clean as possible. In Timmy's case we may take him to the bathroom many times during the day to encourage him to use the toilet, even if he has wet himself. We want him to continue to associate feeling he has to go or going with the bathroom. When he does let us know he needs to use the bathroom . . . that is when we will praise him and reward him with a sticker or some small reinforcer. It's really not that much different from the ABA we do with Adam. If this continues, I will test a urine sample just to make sure there are no physical causes. I’m sure there aren’t, so please don’t start worrying about that."
"How long does this kind of behavior usually last?" Kevin hated to see Timmy so unhappy.
"It's hard to say. It differs with every child. A reasonable time with a typical child would be two to six weeks. With Timmy we will have to base it on how many times he's out and how much therapy I'm able to do with him. In either case, when some time has gone by and the child is still acting like a baby, it is sometimes helpful to give him a special time every day when he can be a baby. We might put aside a half hour twice a day or even fifteen minutes two or three times a day. We would call that 'Timmy's special time' or 'Timmy's baby time.' During that time, whoever was with Timmy would give him all his or her attention. In a typical situation, that would mean having someone else looking after the baby during this time, not taking any phone calls, not doing anything that takes attention away from the child. During the child's special or baby time, if he wanted to drink from a bottle, or be held . . . rocked . . . cuddled . . . tickled . . . sung to . . . whatever baby activity he craved, he would get during this time. We would set a timer. When the timer goes off it's back to being a big boy again. Often just this small period of time in the day is enough to satisfy the need to be babied. It is sometimes helpful to schedule this for a specific time in the day . . . say after lunch or after a nap or anytime that it works out for the child and the adult doing the babying. This way the child knows he has this to look forward to. He can act his age most of the day, knowing that he will get his time to fulfill his need to be the baby and he'll know when it's going to happen. This helps him feel secure. Susannah could see Téa, Kevin and Viki looked worried. "It might not come to this. Timmy may stop this behavior on his own. Why don't we play it by ear and let Timmy's needs guide what we do."
"Susannah, if it comes to it you can count me in. If this is what Timmy needs now, I'll be there to give it to him," Kevin promised.
"So will I. Giving him love and attention is easy. It's saying no to him that's the hard part," Téa declared.
"Oh Lord, yes. That is the hard part. Sam isn't the only one who feels like his heart breaking when it comes to disciplining those children. When a child is so sick and has been hurt so badly it's very difficult to say no to them or to deny them anything," Viki lamented.
Téa smiled. "I know what you mean. When I see a big smile on any of the children's faces or hear their laughter it's more gratifying than anything I've ever known in my life."
"It's a high all right," Kevin added. "To be able to give someone who has suffered so much and been so unhappy for his whole life even a few moments of happiness . . . it's like nothing I've ever felt before. I hope someday I get to tell Todd how grateful I am to him for giving me the opportunity to know that kind fulfillment. This may be the first time in my life I've ever been able to get real pleasure out of doing something for someone that didn't benefit me in some way."
"Honey, you have done a lot of unselfish things in your life." Viki didn't realize Kevin had such negative feelings about himself.
Kevin smiled sadly at Viki. "Mom, I know you like to think that, but if you look back on things I've done for most people, there was almost always something in it for me. Hell, even now there is still something for me. I love spending time with Timmy and Adam and Tom because it makes me feel good about myself."
"There's nothing wrong with that, Kevin. Feeling good about what we do with our days' and about ourselves is a good and a healthy way to feel. That your pleasure comes from helping someone is great! Relationships should be mutually beneficial. I'm guessing that when Todd is well and finds out that he was able to help you while you were helping him, he will feel good about himself too." Susannah saw that once again Kevin was being very hard on himself.
"There's something else I want to point out," Susannah announced. "In this case, Timmy acting out is encouraging in one respect. We know that Timmy would have been severely punished, most likely tortured, if he had acted this way in front of Peter. Timmy's behavior is showing us that he trusts us not to hurt him or punish him. We want him to understand consequences, but to realize that those consequences will never be someone hurting him. He throws tantrums with us because he feels safe. When Todd was really Timmy's age and younger, he could never act out in the normal way most children do. He could not yell back, cry, or even say no."
"Is it similar to the way the children are now able to cry and struggle and pull away when medical procedures hurt or frighten them. We assume they never could cry out or try to get away from anything painful when Todd was little. If they had struggled or cried they would have been hurt even more," Viki stated and wiped a tear from her eye.
"Yes. It's very much the same thing. They suffered in silence their whole lives. Now they need to get some of that out," Susannah confirmed.
They were all startled when the phone rang. "Yes." Susannah sighed. They could tell that she was not happy with whatever the person on the other end of the phone said to her. "Is Timmy still in his room? . . . all right, bring her to my office quickly. I don't want her out in the hallway or in any lounge area in case Todd or Pete comes out." Susannah turned back to Todd's family. "Nora has shown up and she's insisting on seeing me. I don't want to chance Todd or an alter that would be upset with Nora's presence coming out and seeing her. I'm sorry. I did want to discuss Pete with you also, but I would prefer Sam be present for that. If any of you want to ask any further questions or need to talk about this or anything more, can we do it later?"
They all told Susannah of course. Viki also told her that she would make sure to explain to Sam everything that Susannah had explained to them about Timmy. Viki rested her hand on Susannah's arm. "I suspect that Nora is still upset about what happened with Pete and Bo and about Rachel working with Adam. Would you like me to stay and try to help put Nora's mind at ease?"
