back from Residential Treatment Center (RTC) and regressing

[Liahona]

Hi, I've got a question about my difficult child 1. He did great in the Residential Treatment Center (RTC). His aggression improved almost overnight. They did have a few problems there but nothing like the constant aggression I saw towards his siblings before he went in. He spent a year there learning new social skills, learning how to get his emotions out, lots of family therapy. He got out the end of Feb and his aggression is increasing towards his siblings. He got a new therapist when he got out of the Residential Treatment Center (RTC) and difficult child 1 isn't opening up to him. Sometimes he will use his 'new' social skill of going to a different room to calm down (we've actually been working on this for years.) The behavior chart doesn't work (they've never worked with him, but I still try. At least he gets rewarded for good behavior with it.) He does feel bad after hurting someone. He doesn't distinguish between hurting someone that is an accident and when its on purpose. Last time he hurt someone he put himself in time out for it. Any ideas would be helpful.

 

[timer lady]

My tweedles were both in Residential Treatment Center (RTC) several times. One of the things I mentioned to Residential Treatment Center (RTC) therapists & staff was that a home is in no way prepared to provide the level of structure (which many of our difficult children need) that a Residential Treatment Center (RTC) can provide. Just doesn't work that way.

Both kt & wm regressed (hence the several placements) back to unsafe & unacceptable choices/behaviors. For my children, it took a lot of time for the skills learned to sink in enough for them to live out in the community.

Saying the above, I had to implement a level of structure each day. I had to lay out (very specifically) consequences for negative behaviors ahead of time. I learned the magic "carrot" to dangle in front of kt & wm each week to keep them on track. The tweedles knew the "line in the sand" for hospitalization & Residential Treatment Center (RTC) placement (tho it was never used as a punishment ~ more of an incentive).

AND I have services in the house that help me with all of the above for kt. (wm, because of unsafe/aggressive behaviors toward kt & myself lives in a therapeutic foster home.)

Liahona, it may take more than 1 stay at Residential Treatment Center (RTC). In the meantime your difficult child will have to practice his skills daily. I spent hours with wm practicing various situations. We role played ~ wm would become me & I would be wm acting out after he told me "no". wm was actually red faced after that one. I did my best to wear the boy out; lots of activity. Bike riding, running laps with the dog, basketball, etc.

Please keep us updated - others should be around with other suggestions. Please take care of you.

 

[Liahona]

Thank-you for responding. I haven't tried the role playing. difficult child 1 is with X this week, so that gives me some time to talk to his therapist and the after school program that is teaching him social skills. Maybe I could make small posters with what to do in his hardest social situations, get his case manager to laminate them, put them up around the house, and role play them each day.

Because of kidnapping threats from X and X's weird interest in my other kids we don't get out of the house much. Also, we don't get out of the house much because I start contracting just doing simple things around the house. Getting difficult child 1 to exercise is hard; he doesn't like being away from me and he doesn't like exercise. I might need to ask for outside help on that one.

I worry that a family environment might not be the best for difficult child 1. That would be hardest on him. While at the Residential Treatment Center (RTC) he would be very homesick and he already talks about having kids when he is older. I'm really not ready for that idea yet.

 

[Marguerite]

He is still young. With the various diagnoses, his social maturity and impulse control are likely to be a huge issue. Here, we have to cope without Residential Treatment Center (RTC). We have other sorts of things we can maybe use if we are desperate, but it is difficult. As result, I have had a ringside seat in watching the struggles of my own kids as they move through impulse control and aggression issues. Sometimes when the conditions are closely controlled, it's easier to behave. But back in the family situation, the problems come back.

if he knows what is wrong but cannot prevent himself fully from hurting others due to impulse control issues, then punishment (even self-punishment) is only going to reinforce "I am bad at heart; I can never be good." T the same time, the others need to be safe.

What can work better, is modelling good behaviour as well as watching him closely to teach him to remove himself BEFORE he does something he regrets. At 11 it is a tall order, but it is time for him to learn this.

I cannot tell you to send him back to Residential Treatment Center (RTC). I have no experience there. But I can tell you that a kid with impulse control issues and aggressive tendencies can be helped and can learn (eventually) self-control. But it also requires close supervision until the brain catches up to social requirements.

That is the Aussie perspective, anyway.

Marg

 

[BusynMember]

A lot of our kids do really well with the constant structure of Residential Treatment Center (RTC). Home is very different.

I have been in a psychiatric hospital three times to try to get stabilized. I always felt more security once there as I could leave my problems at home and only had to concentrate on myself and getting well. Also, almost every minute of your day is accounted for with only the evening for any free time and THAT would often turn into an informal therapy session amongst the patients.

After release it is much harder. I don't have any answers, but wanted to offer a perspective from one who has kind of been here.

 

[Liahona]

Thanks for the responses. I try to protect difficult child 1's self-esteem, but that is prioritized after safety. His after school program is going to send me what they teach about anger on Tuesday.