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But by early 2003, it was clear that David was beyond the reach of both his family and his school.
"I remember once, he was sitting in the TV room with Molly, and he was taking these sharp pencils and sticking them in her ear," Susan recalls. "He was defiant of me and Paul. He refused to do anything we told him to. He wouldn't go to church. He wouldn't do anything. He was menacing, and it got to the point where I couldn't leave him alone for a minute."
The Mallamos' oldest son found evidence that David had started fires in the basement. Obsessed with Star Wars films and Harry Potter books, he became increasingly disconnected from, and frustrated by, the world around him. He lied, destroyed his books and ran away three times over an eighteen-month period. He ran twice from Children's Hospital, after Susan took him in for routine visits with his longtime pediatrician. Every incident rocked the household a little more. The police would visit. The older Mallamo children were resentful of David and angry with their parents for bringing him into their home.
"The girls had always loved him and protected him," Susan says. "They respected him; there was a kind of curiosity there at first."
"But after the behaviors got really horrendous, they started asking, 'Why did you do this to us?'" Paul says. "The police were coming here; there would be these horrific disruptions, huge explosions."
On January 15, David had his biggest explosion yet. Teachers at Dunstan called Lakewood police to report that David was in the throes of a dissociative fit that was beyond the experience of even the school psychologist. As David was moved from a classroom into a staff resource room, he screamed at teachers, kicked doors and banged his head against tables and walls, then fell on the floor in a fetal position and began wailing. Police took him to the emergency room, where he was placed on suicide watch.
He was later moved to Colorado Christian Home, a residential treatment center where he'd been evaluated the previous year. David was fourteen years old.
The school psychologist called it an "acute psychiatric incident." For the Mallamos, it was the last straw.
"By this point, we were at the end of our rope," says Paul. "We had the safety of the family to think about. It felt like a hopeless situation, but we knew he couldn't come back here. His behavior had spiked. He was out of control, and we were just desperate to get some help."
They wanted David to stay in the treatment center until he'd gotten that help.
But in late January, the Jefferson Center for Mental Health determined that David's problems might not be the agency's problem. In a letter to the Mallamos, JCMH said it couldn't determine "whether David's current behavior is organically driven, a willful choice on his part, or directly related to a covered mental illness."
In other words, JCMH was positing that David was primarily damaged in his brain, not his psyche, and that his behavioral problems likely stemmed from real physical damage from prenatal exposure to alcohol or drugs. This theory shifted his primary diagnosis out of the realm of mental illness and into the quagmire of organically based disabilities -- thereby placing it outside the agency's jurisdiction as a provider of mental-health services covered by Medicaid. Until a neuro-psychological test proved otherwise, the JCMH letter said, the Mallamos' request for residential treatment center placement for David was denied.
David's pediatrician believed such an examination would be inconclusive, invasive and traumatic. The doctor never performed the test, and the Mallamos and JCMH reached an impasse.
"You've got a kid who is lighting fires and threatening to kill people," says Paul. "He's been evaluated and diagnosed upside down and every which way for most of his life, and time and time again they're coming back with mental illness. How can you tell me that, all of a sudden, because there's a suspected so-called organic component, there's no mental illness?"
Two weeks after David's outburst at Dunstan, JCMH therapists concluded that David was stable and should be returned to the family home. When Susan insisted that he needed more time at Colorado Christian Home, she was given a choice: She could take David home, or she could turn him over to the Jefferson County Department of Social Services. If she chose the latter, she and her husband would be served a dependency and neglect petition for effectively abandoning their child to social services -- the very same charge used to first remove him from his biological mother's care a decade earlier.
"We were told that David would receive the best care from social services, that it would open up a whole new range of options," says Susan. "What we found was exactly the opposite."
Eleven months later, the Mallamos' decision to give up their child still haunts them -- because it's a decision they believe they should never have been forced to make.
A conclusive determination as to whether David has fetal alcohol syndrome or another toxic-exposure-related disorder has never been made. That's partly because such an assessment is, to a large degree, a speculative science: There's no single test or diagnostic system that can completely isolate fetal alcohol syndrome to the exclusion of all other disabilities and mental impairments.