First appointment and frustrated

[Squishybottoms]

Ok not really a First First Appointment but first with a psychiatrist. Been seeing a counselor for our son who is 5 and has been diagnosed with ODD and ADD. The counselor recommended this psychiatrist so that we could look into getting my DS on medication before we try behavior mod. He has a lot of tics. Snorting, throat clearing, lip chewing, finger sucking, pacing, he just cannot stay still no matter what.

We go to this appointment and despite the fact that my child is demonstrating all of these behaviors we get put on hold so that they can run labwork and an EKG which he will be sedated for. WHY??? We've already had him tested for lead poisoning which he does not have.
The psychiatric claims that there could be a rare physical reason for it which they would evaluate on the EKG. But that might not even happen for awhile.

Meanwhile my child is suffering at home, at school, and in his extra curriculars. This is ridiculous. We are calling his pediatrician to see if she can intervene. Hopefully will get a call tomorrow.

So frustrated at the process being so slow. I'm sure others would judge me for jumping to medication but I've worked in the schools and in hospitals, I see how some people benefit from a combo of medications/and then behavior mod.

I'm tired of seeing my child struggle just to exist. He seems to want to jump out of his skin and his ODD behavior is like a knee jerk response to everything in his environment because of it.

Just needed to vent.

 

[Wiped Out]

Welcome Squishybottoms,
Glad you found our corner of the world (sorry you needed to though). I know how hard it is to wait when the process goes so slowly. At the same time I can understand the psychiatrist wanting to be able to rule out anything physical. It would be nice if they could get it scheduled ASAP so that if everything physical is ruled out and he recommends medications it can happen soon.

 

[smallworld]

First, welcome. I'm glad you found us.

Second, I think it's great that you found a psychiatrist (psychiatrist) who's willing to look into physical causes before pulling out the prescription pad and writing out orders for medications. You need to know 1) what condition you're medicating and 2) whether your child has an underlying condition that would preclude certain medications.

Is the psychiatrist ordering an EKG (for the heart) or EEG (for the brain)? Generally, kids aren't sedated for EKGs, but perhaps it's necessary given how active your son is?

I also have some other questions:
Does the psychiatrist agree with the diagnoses of ADD and ODD?
Has your son ever undergone neuropsychological testing?
How does your son do in school, both academically and with peers?
Any sensory issues (for example, sensitivity to clothing tags, loud noises, food textures)?
Any speech or developmental delays?
Any mental health or substance abuse issues in the family tree?

You should be aware of two things:
First, ODD is not a helpful diagnosis. It is generally a description of behaviors for which there is an underlying cause. When the underlying cause is identified and treated, the oppositional behaviors typically improve.

Second, tics should be evaluated by a neurologist. True tics are often part of Tourettes Syndrome. They are frequently made worse by the stimulants prescribed for ADHD. Sometimes tics are mistaken for stims performed by children who are on the Autistic spectrum. So again, it's wise to have the movements evaluated by a professional who can tell you what exactly they are.

In the meantime, you might want to grab a copy of The Explosive Child by Ross Greene. It has helped many of us here parent our extra-challenging children.

Again, welcome.

 

[jal]

If the psychiatrist is considering a stimulant for the ADD, they can use the EKG to rule out any heart issues/abnormailites.. I would be pleased the psychiatrist is being thorough. 2 psychiatrists we had never ran an EKG. The third one that I liked the best did before prescribing.

 

[graceupongrace]

Squishy,

Welcome. You'll find a lot of good advice from caring people here!

I understand your desire to get help for your son as quickly as possible. But the thoroughness on psychiatrist's part is actually a good thing. I also would caution you that medications, if psychiatrist does prescribe them, are not a quick fix. The process of getting the right medications (or combination of medications) and the right dosage involves a lot of trial and error. Doctors, wisely, want to use the lowest effective dose. So they start with a very low dosage and gradually titrate up. And the Rx will likely change over time as your son grows and his symptoms evolve. The whole process takes a lot of time. I wish someone had told me that when we started down this path, so that I could have done a better job of managing my expectations.

The other thing is that the medications alone don't solve the problem. But they do provide a "biological pause" that enables kids with ADHD to focus and to think before acting, rather than just acting on impulse. Ideally, you'll have a combination of medications and therapy. (It sounds like you're already thinking along those lines when you mention behavior mod.)

Good luck with the tests and let us know how it goes. And feel free to vent any time!

 

[BusynMember]

Sounds like he has a lot of tics. Has he ever been evaluated for Tourette's Syndrome? That's not really so rare. A neurologist would be able to diagnose that.

Tourtettes Syndrome causes a lot of co-morbid psychiatric problems...Obsessive Compulsive Disorder (OCD) the most well-known. Bipolar is common with it too. I would maybe worry a bit about medications if he has tics. Some medications can make tics worse. If it were me, the first place I'd go is to a pediatric neurologist. I'd worry about the medications later, although I don't judge anyone for medications. My son tried them at age three. But in retrospect, if I could do it all over again (ain't hindsight great?) I'm sure I would have waited, because he my son was misdiagnosed a lot when he was young and he got some pretty bad side effects from medication he didn't need.

Good luck, whatever you decide to do.

 

[tictoc]

Hi,
My 7 yo son has Tourette Syndrome, ADHD, and Obsessive Compulsive Disorder (OCD) (among other things). I understand your frustration, but I do think it is great that your doctor wants to rule out other causes for the tics before prescribing a medication. Even with a Tourette's Syndrome diagnosis, we have been to hell and back several times with bad medications.

As for the tics, someone already mentioned the need to separate true tics from stims. It is also helpful to try to separate Obsessive Compulsive Disorder (OCD) traits from tics. That can be very hard to do in a young child, but that does have some impact on what medications to use. I don't think my son can tell the difference, but I hope that some day he will.

And, yes, it is so hard to watch your child tic constantly. At one point, my son had eight separte tics going on almost constantly. His body never stopped and he cried because he couldn't stop. His tics are now well controlled with medications, but we still struggle with Obsessive Compulsive Disorder (OCD) and ADHD.

Your dr. might have ordered an EKG if he is considering stimulants for the ADHD. If this is what your dr is thinking, I would urge you to get a second opinion. For kids with both Tourette's Syndrome and ADHD, Strattera is usually the first medication choice, followed by clonidine or Tenex.

Tourette's Syndrome can be very hard to medicate effectively when there are co-morbid conditions. Medications that are effective for ADHD (ie, stimulants) can make tics, Obsessive Compulsive Disorder (OCD), and generalized anxiety much worse. So, I think it is good that the psychiatrist is taking his time to figure things out.

At this point, I'll recommend two books (I have a whole list, if you want more): "Children with Tourette Syndrome: A Parents' Guide," by Tracy Lynne Marsh," and "Straight Talk about Psychiatric Medications for Kids," by Timothy Wilens. Also, visit the Tourette Syndrome Association website at www.tsa-usa.org. It has a number of articles you can download about tics and other conditions commonly associated with Tourette's Syndrome.

And, finally, how is your son doing in school? Does he have a 504 or IEP?

Good luck and please post again to ask questions and let us know how you are doing. My son was diagnosed about a year ago and it has been the hardest year of our lives, but it is beginning to get better.