antidepressants after 1 week - IQ/executive function drop?

Discussion in 'General Parenting' started by agee, Mar 19, 2011.

  1. agee

    agee Guest

    I feel like I only come here when I'm in crisis. Apologies for that. Maybe one day I'll have my stuff together enough to give advice rather than plead for it.
    difficult child started Lexapro a week ago because of anxiety-ish symptoms. His dr. gave us a sample months ago because of his anxiety reaction any time we were going on a trip, or to a family party, etc. The way his anxiety expresses itself is extreme rudeness and constant provocation. He does that stuff anyway, but if it's triggered, it's 100 times worse.
    Or at least that's how I'm interpreting it. After a disastrous 45 minutes in the car on the way to a family get-together, where my husband, other son and I were screamed at the entire time, I asked him later that night why he acted that way and he said he was nervous and worried and felt like something terrible was going to happen all the time. That's where I get the anxiety from.
    So we start the Lexapro (10 mg). difficult child took Prozac in the past with no result (prescribed for "depression" - which was really extreme rudeness). He's only been taking it a week. Thursday was an amazingly good day - his Occupational Therapist (OT) said they had the best session ever, he played well with our homeschool play group, and everything went great. Then Friday everything went to hell. Every single thing he did was pushing the boundaries we've set up. Stealing stuff from us, lying, running away, hiding his food to get ice cream...and the kicker is that he went into our neighbor's house (she's away but her door is unlocked; we're in the country) and stole some stuff from her. He did this while we were on a walk and he was out of my sight for 5 minutes.
    So today he is seeing the consequences - he's had to work for us to try to earn the money to pay back what he stole (he destroyed it after he took it), and he's been grounded from the boat trip we were going to have as a family.
    He's refusing to eat. Claims he's hungry, dying of hunger, but won't eat when what he's asked for is put in front of him.
    Screaming, crying, wah wah - and claims that he has NO IDEA why he's being punished.
    Oh, help.
    Could it be the antidepressant? It seems like it's way too early for it to have any effect. Or is it the seasonal change working on his "issues of a cyclical nature," as his dr. says?
    Oh - and his dr. recently suggested we take him to a fetal alchohol clinic. Which we're in the process of doing. Apparently they've suspected it for the whole year and a half we've been going but only now decided to let us in on it.
    Help.
    A
     
  2. agee

    agee Guest

    Oh yes - of course I will talk to the dr., but OF COURSE it's the weekend.
    It always happens on the weekend.
     
  3. pepperidge

    pepperidge New Member

    Hi Agee,

    Both of my kids exhibited major acting out (far more impulsiveness, some stealing etc) a couple of days after starting anti depressants. They don't have bipolar, but something more akin to emotional dysregulation. My older son who has more depressive type mood issues has been helped a great deal by Lamictal. A-Ds apparently "relax" whatever minimal executive functioning they had. If it were me and you noticed this much worse behavior I would be thinking about discontinuing the anti depressants immediately. My third grader on 10 mg of Lexapro was knocking over desks in his classroom after two or three days. It was bad. Once we d/c the anti depressants (and this happened on Zoloft, Prozac and Lexapro) things went back to "normal". Is Depakote helping? I have heard that fetal alcohol kids are hard to medicate. psychiatrists I have have been skeptical about the negative effects but we have behavior data from school and our own observations so I think my kids' deterioration in behavior was definitely due to the ADs.


    I have a kid with a fetal alcohol diagnosis. We have tried a whole bunch of different medications with him because of his tendency to get really nasty. He wasn't able to tolerate stimulants when in grade school but now that he has gone through puberty he is on Concerta which seems to help. He did better with Abilify when younger. It is very slow progress on the nastiness front. (not to mention the impulsive front). I am slowly learning how not to trigger incidents (we write down lists of things he needs to do for example because he doesn't like it when we change the game plan --oh, I forget that you had to do such and such before you watch TV). We have found punishment not to have great benefits. What we have found is to try to find great adults for him to interact with (coaches, etc). But it is a really long haul. I think one mindset that is useful is to realize that you need to change the environment around them so that they can be successful, rather than expect that they will be able to conform to what is commonly expected. For example, we have to be more vigilant than most parents I think.

    Please pm if you want to tlk more about FA at any point.
     
  4. agee

    agee Guest

    I just wrote a long response and the *(&!! computer ate it.
    Really, that's all I need today.
    First, THANK YOU @Pepperidge for your quick and helpful response.
    We will take him off the Lexapro tomorrow and hopefully we'll get our only somewhat rude and executive-functioning impaired child back. Anecdotal evidence works for me - I just didn't think it was even possible for ADs to impact behavior so quickly, but I guess it's true.
    Oh my gosh, yes. The vigilance is constant, and since we've started homeschooling (which has been good for HIM, but pretty awful for ME) it's much worse since he's at home so much and when we're not doing "school" I have to work and he gets into all kinds of stuff.
    For the most part I was feeling like we were in a good spot with-the parenting of this kid, but the past few days have been so awful. I agree that consequences have little effect - working towards a reward (or having that reward taken away, or having a chance to earn it back) is much more effective. But stealing from our neighbor is such a big deal to me that I can't help but give a consequence for it, whether or not he had any control of himself. Does that make sense? I generally try to follow Ross Greene's advice and let stuff go, or address it in the moment as a correction but don't punish as it doesnt' do any good, but this is a really big deal and I feel like I need to at least try to make sure he remembers that it's totally unacceptable.
    B+E at 8...what will happen at 15?
    I feel sick.
    About the medications - he tolerates some stimulants okay. We've tried - literally - all of them. Dexedrine and Vyvanse have worked the best, with Dexedrine having the least impact on mood but a huge drop-off-the-cliff response when it wore off. Vyvanse wears off more slowly, and he's at a good dose right now. We were able to drop dose with little impact once we quit school.
    Depakote does help. He was a bundle of screaming, weeping rage before it.
    And about the FASD- I'm just hoping they'll give him the diagnosis. He kind of has facial features, and his last IQ test showed borderline intelligence (but no one involved considers it very accurate as he doesn't *act* borderline intelligence) but he is of very average height/weight and because he was an international adoption we have no proof of maternal alcohol consumption. Although honestly, because he was adopted from Russia I think that should just be a given. He and all siblings were removed from custody due to neglect. It stands to reason there was alcoholism or mental illness or something going on in their home.
    I'm hoping for the diagnosis. so that we would have more answers and information, and also so we'd qualify for Medicaid. That would be a HUGE financial burden off - half of our yearly health insurance goes towards him. It would also give me more to show school, if we ever go back. And get him classified as developmentally delayed instead of mentally ill/behaviorally emotionally disturbed.
    Anyway, I could go on all day. I just wanted to say thanks. It helps.
    A
     
  5. pepperidge

    pepperidge New Member

    I just typed a long answer--but my child did the same thing going into a neighbor's house and eating kids' candy while they were away. It is funny now. All the instances of stealing were while they were on ADs. And in my kids' case the disinhibition lasted the whole time they were on it (weeks in one case) before we figured out what was going on.

    I would suggest that you think about consequences that try to teach --like writing an apology or doing a chore for the neighbor. We try to think restitution and perspective taking--how does it make the other person feel. It is a very long process but it is to try to get the cognitive ability to inhibit behavior developed. It takes years. School is now doing it to--son has a check in with Special Education teacher every day --sets a goal (like not poking anyone so his friends will want to hang with him). Idea is to make kid aware of consequences of behavior but really it takes years of repeated learning.

    Boundary issues are common I think--they just don't think about it being some one else's stuff.

    I think it is good that you are pursuing a diagnosis. It will help. I would ask about doing neuropsychologist testing--my son has average IQ but slow processing speed. He functions best in a small learning environment with minimal distractions. Which of course is hard for school to provide but he has had some pullout work in reading writing etc and some work with aides in classroom and has managed to keep up with his peers pretty well.

    good luck.
     
  6. agee

    agee Guest

    Which is exactly why he spent the morning working. The thing he stole was new, and in the box. and had a price tag of $10 on it. He worked to pay it back. He lost TV and a boat trip because those are privileges and special treats and this is really the worst thing he's ever done. I can't see giving him privileges and special treats when he's essentially broken the law.
    This is not a neighbor we even know. I've spoken to her 2x in 5 years. And he hid what he took, which tells me he knows the difference between what is his and what isn't.
    We've had complete neuropsychologist testing. Hence the borderline IQ, Executive functioning problems, etc. He's been seeing psychistrists and neuropsychs for almost 5 years now. But they cannot diagnosis. FASD for whatever reason, so now we go to a new round of specialists.
    It never ends.
     
  7. Malika

    Malika Well-Known Member

    Hello. Could you say a bit more about the "odd interactions with people and animals"?
     
  8. agee

    agee Guest

    I should probably change that as it's not very descriptive. Basically, he's very socially immature. He's 8, but he's just come out of parallel play. He will play with others but plays much, much better with kids younger than him - another reason why homeschooling was a good move. The kids in his class were leaving him in the dust, socially, and he was on the bottom of the social structure.
    And the odd interactions with animals - what this used to mean was that he wasn't very empathetic with them. It was like he thought our pets were his toys, instead of separate conscious beings. I think probably the way younger children might relate to animals.
    It all goes along with his developmental delay. He's slowly but surely catching on to these things, but it's oh so slow.
     
  9. pepperidge

    pepperidge New Member

    Agee,

    HOmeschooling may be just the thing. I need the break to regroup and deal with the rest of the day. My experience is with my son is that he needs to be taught a lot of positive social skills constantly and that he craves social interaction but at the same time is very socially immature. So school/friends has been hard. But Special Education teachers can help a lot. Given that he tends to be less nasty with others than with me, I have really sought out positive social experiences for him. Difficult but worth it. I don't know what your school district is like but I would really investigate whether there are any options that would be good for your son. Ultimately if he can you want him to develop those social skills.
     
  10. agee

    agee Guest

    Our school system was impossible to work with. This is why we pulled him out. I will spare you the essay, but suffice it to say we were not willing to wait until he was 2 years behind grade level in order to allow him Special Education. services. School was constant frustration, for him and me. I can't explain the weight off my shoulders once we finally pulled him out.
    Also, are you concerned that he's not having social outlets because he's homeschooling? This is not the case at all. Instead of his only social contact being a frustrated teacher and a bunch of 8 year olds who think he's annoying, he goes to classes with other homeschoolers (mixed age, which is great because he's really good with the younger kids), attends homeschooler playgroup, has friends over, interacts with lots of adults (grandparents, neighbors, karate coach, tennis coach, me + my husband, etc). I would much rather him learn social skills from the people we've chosen to surround him with than the kids he's thrown in with at school. That was actually the first thing I saw when we pulled him out - all the snotty, sassy one-liners that the kids in school use to talk to each other left his lexicon. Now we just have the tried-and-true swear words left. I'll take it.
    All that said, homeschooling is really hard on me just for the thing you mentioned - I need a break from him to regroup and he is a lot less nasty with others than with me. Uh, also I have to work - I work out of the house and my schedule is flexible but there are lots of things I'm behind on and I don't know when I'll catch up.
    We are looking into a private school nearby (they say they want out-of-the-box thinkers) but it's unclear how we'll afford it. That's why I mentioned Medicaid in my earlier post about FASD; taking him off our health insurance will allow us to contribute hugely to school. But we'll have to see. And they might not take him. So meanwhile we do our thing at home. Our regular public school will be the last, last choice for him, ever.
    A
     
  11. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hi. Im so sorry. I learned a lot about Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) because we didn't know if our son had it or not. We even took him to a special clinic for Fetal Alcohol Syndrome (FAS). It is renowned throughout the country, but fortunately happened to be near us.

    If he has Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE) or anything on the fetal alcohol spectrum, he will not learn about cause and effect...he will not really understand it or retain his lessons. He will need to be watched to save him from himself, so to speak. medications can help certain symptoms, if they can tolerate the medication, but can not change it. Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) is brain damage due to birthmothers indulging in alcohol while pregnant and it affects the child permanently. I'm not trying to be harsh, trust me. I'm passing on what I learned (just the messenger) and perhaps, if he does have fetal alcohol spectrum, explain why he seems to do the same thing over a nd over again and not learn from consequences or not even understand why he is being punished. My son does not qualify for the fetal alcohol spectrum, but he is on the autism spectrum and that is probably because of his birthmother's alcohol/drug abuse. Alcohol is actually worse than the other others, so I was told. On the other hand, we don't have any history on her, other than she abused drugs. All we know is this one fact.

    I urge you to read "The Explosive Child" and to choose your battles. See an expert is Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE), as you are doing. Make sure it is a very good one...we had so many bad ones...ugh. And...jmo...lower your expectations until you know wht is going on and what to expect so that both your child AND you can relax a bit. See first what he is capable of retaining and understanding. Hey, you're doing an over-the-top good job as a parent. You are doing ALL that you can do. Give yourself a break and don't worry too much until you have answers. And be sure to take time for YOU. Hugz :)
     
  12. HaoZi

    HaoZi Guest

    I don't think Medicaid will take him if you have access to private insurance.
     
  13. agee

    agee Guest

    Both my child's psychiatrist and another parent I know whose child has FASD said that he could get Medicaid, and both know we have private insurance. I'll have to double-check, but I think it's the case in our state.
    I have read it - I referenced him in my 2nd note. Believe me, I choose my battles every minute of every day. Believe me. But stealing from our neighbor was definitely a battle I was willing to choose. Do you all really think I was too harsh? Working to pay off the debt, no TV, and no special boat ride? I should've just pretended nothing happened, even if it was just the medications?
    A
     
  14. pepperidge

    pepperidge New Member

    Agee,

    I think you did right. I think that sometimes we need to get their attention particularly when it matters as in stealing. I think you instituted logical consequences. What would be wrong would be to assume that the punishment itself will necessarily prevent future incidents (which you probably don't). Time will tell. And it sounds like you didn't impose long-term consequences (like no TV for a month which would probably lose it meaning to the kid).
    While I agree with alot of what MWM has to say, Fetal Alcohol Effects (FAE) is a spectrum disorder. There are very severely affected kids and not so affected kids. One should not generalize. I believe that some at least from my experience are capable of cause and effect thinking--they need more reinforcement and teaching perhaps that a "normal" kid would. Also I think that it is in adolescence that you begin to see what kind of gap you are dealing with in terms of development delay or lack of development. My son is doing pretty well, but believe me we have been through our share of very difficult times and adolescence is definitely a challenge.

    It is good to have lowered expectations in the sense that you are more vigilant etc. But unless the child is severely affected there will be some growth and some progress. What you don't want to do is set the child up for failure by having expectations that they simply can't meet.

    I hear you about public school. The one thing my experience has taught me which you also seem to be practicing is the need for good mentorship and role models. I kind of have this mental picture of my son surrounded by good role models shepherding through childhood keeping him on the straight and narrow. It is so vital to help these kids maintain any shred of self esteem because the world just sees them as screw-ups--they don't present as kids with severe mental illness or handicaps. I am sorry your school system is such a disaster. One thing I would urge you to do is to try to find a school advocate--there are state wide resources. It sounds as if your school system is quite far behind actually. And with a diagnosis it should be easier to get services. but maybe not worth it right now.

    We have shed so many tears and waged so many battles. It stinks but we have seen growth so hang in there.
     
  15. agee

    agee Guest

    @pepperidge:
    Thank you. I really needed that.
     
  16. HaoZi

    HaoZi Guest

    Agee, irregardless of what doctor says, call the Medicaid office and ask them. Shoot, the docs here don't know even for sure if they take Medicaid, you have to ask their office staff, forget about them having any idea of what you have to do to get on it.
     
  17. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Actually, pepperage (sorry if I spelled your name wrong), there ARE different levels of Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) (agree) and I think more has come out since we had to deal with this in our son (he is, after all, almost eighteen now). Sixteen years is a long time ago. I by no means meant to give up...sorry if I came across that way. I just think that it is a good idea to see where he is at NOW and go from there. My son probably does have some effects and almost certainly is on the autism spectrum because of the drugs and alcohol. He is not mentally retarded nor does he not understand right from wrong. In fact, he is very well behaved.

    Our biggest problem (his, really) is with executive functions. We don't know if that is the alcohol or the autism or both, but his executive function skills are his biggest problem and, of course, they impact everything. Good luck and lots of hugzzzzzzzzzz ::)
     
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