Dear Dr. Papolos,

I’m writing with an update on Josh. Pre-ketamine, January would usually begin his steady downward spiral, which would sometimes end up in hospitalization by spring.  Last January, Josh was barely able to go to school, melted down many times a day and could not tolerate any group activity.  He would frustrate by imagined competition and perceived a power struggle with almost anyone that he interacted with.  Anything said to him was at risk of misinterpretation.  Even the simplest statement could be interpreted as “yelling” when he was simply being asked to do something (i.e. put something away or move on to a new activity).  To avoid conflict, it was necessary for those interacting with him to act as if it was them that made the mistake and not him that did something incorrectly.  Additionally, he was suffering from severe speech and language deficits and slow processing of information.  He required very extended amounts of time to gather his thoughts and express himself.  The hardest part of all this was that Josh was very aware of his disability, since he is a very intelligent and perceptive boy.  Still by last January, and 11 years old at the time, Josh was still not able to read or write.  He would sabotage his work when he thought he was going to be wrong – ripping up his paper, drawing on tables, scratching himself when angered, causing his nose to bleed, and, on occasion, attempting to push down furniture.  Home life, as you can imagine, was no better.

This January, now on ketamine since July, the old Josh is unrecognizable. He is on home-based, one-to-one school instruction in order to start to catch up on academics. He trusts his tutor enough to read out loud for the first time. He appears to be up to the second grade level. Josh is off risperdone and half way off Geodon, leaving only lithium and propanolol.  As a result, his processing is quickening, and he’s able to communicate more easily and fluidly.  Most telling of his progress is that Josh has not melted down in months.

We are able to speak freely and comfortably with him without him feeling criticized.  He can manage delays, smiles easily and is a delight to be around.  Our conversations are comfortable, and he is able to share how he feels.  Just Friday, we heard from his tutor that they had the first conflict in a while.  Rather than go into a rage, Josh listened to feedback from his tutor and apologized.  This is the first apology we have ever heard of him making on his own.

Josh still has a long way to go, but we are now confident for the first time in his life that his future holds promise and we are excited about where this new path will lead.