frustrated, concerned and stressed

Discussion in 'General Parenting' started by devira, May 8, 2008.

  1. devira

    devira New Member

    Hi everyone,
    I was searching the internet, a little desparate for help, when I came accross this website. I am at my wits end... and I am seeking any coping skills and managing suggestions.

    I have a 7 yr old boy who is currently labeled ADHD - combined. The school wants an updated diagnosis, my psychiatrist is trying to not give it to them yet. He is not officially labelled anything else at this time. He has all the signs of ADHD, ODD, CD and possibly manic.

    I spend every morning and evening close to tears, my house is a disaster, because he throws stuff around, breaks things and adamantly refuses to pick up anything so he leaves a trail everywhere he goes... I cannot keep him safe, he just walks out of the house (no shoes, no shirt, alone) when he is oustide he does not follow any rules, he finds anything he can that I would not want him to play with... or he will just disappear so I cannot keep an eye on him... it is really dangerous what he chooses to do... in the house it is a fight over everything... if I let him do what he wants with no rules or guidance or requests he is OK, but i will find marker and bowels on my walls, wholes in the drywall, food and garbage all ove rmy house.

    He is only seven years old, noone has any suggestions for me, and I cannot keep on with wondering what next... I have another child who is afraid to be in the same room as him. My psychiatrist is going to try new medications to see if that makes a differnce, bu the has no suggestions for the interim.

    I know there is no quick answers, My son does not care about rewards or punishment, I just want to keep him safe and the rest of us sane
     
  2. smallworld

    smallworld Moderator

    Welcome. I'm glad you found us, but sorry you needed to.

    I have a few questions for you that I hope will help us help you:

    Has your son ever had a neuropsychological evaluation? Is it the current psychiatrist who gave the ADHD diagnosis?
    Is he taking any medications? If so, what and at what dose? What medications do you expect the psychiatrist will suggest next?
    How does he do in school, both academically and with peers?
    Any developmental or speech delays?
    Any sensory issues (for example, sensitivity to clothing tags, loud noises, food textures)?
    Any mental health issues or substance abuse in the family tree?

    In the interim, you might want to get your hands on a copy of The Explosive Child by Ross Greene. It has helped many of us on the board parent our extra-challenging children.

    When you get a chance, please go to "User CP" at the top left side of this page and create a signaure similar to mine below. It helps us keep everyone on the board straight.

    Again, welcome.
     
  3. 4sumrzn

    4sumrzn New Member

    Hello & welcome!!!! Smallworld has some very good questions for you & those answers will help everyone give you suggestions & advice. I just want to let you know that you sounded like you were describing many things my daughter does as well. You are NOT alone & you have found a wonderful place. Once again, welcome!
     
  4. trinityroyal

    trinityroyal Well-Known Member

    Hello Devira,

    Just wanted to add my welcome.
    The answers you provide to Smallworld's questions will help us to point you in the right direction with regard to what has worked for us, etc.

    In the meantime, know that you're not alone. Many of us have been there done that.
    Glad you found us.

    Trinity
     
  5. devira

    devira New Member

    thanx everyone... here are my answers to smallworld

    My son has been evaluated by rating scales, observations, tallies and IQ testing (not sure which ones) but that is all they have done at this point.

    No, Ira was 4 when my pediatrician (father) and I decided to try strettera in small doses.. he was literally bouncing off of walls. The difference was immediate. The rating scales were not quite appropriate at the time, but have supported that decision going forward. I have seen several different psychiatrists since then... all giving the same diagnosis. This is the first one, who is willing to look at other possibilities and new methods of treatment... it just takes long.

    Medications -- Ira takes 50mg og vyvanse in the morning and 30 mg afterschool... he was showing violent and uncontrollable outbursts so the psychiatrist suggested 100mg of tegretal in AM and PM... this was a miracle. It had an instant change for the better... now we are discussing changing to ?respiradol. but I am not sure if he means alone or with some combination.

    School -- Ira tests in the exceptional category in most subjects (when done one on one with-school psychiatric.) in class, he refuses to do any work unless teacher sits with him one on one. Somedays his work comes home and it is amazing, other days you would think a three year old did the work. He is better in the morning than the afternoon, he has no concern of consequences, rewards, danger, or others feelings. He can read with me, but pretends in school that he does not know how. The teacher is also frustrated, but I am lucky the school is fantastic. (we have a staffing next Thursday)

    There are no real delays, only a refusal to show what he knows and/or can do

    Ira was adopted, his birth mother used crystal meth during pregnancy and he was born addicted to a drug, I will need to pull the records to verify which one... it had a five day withdrawal. I know nothing about his birth-father.
     
  6. TerryJ2

    TerryJ2 Well-Known Member

    Welcome Devira,
    sounds like you're on the right track. You already know which medications work (at least, to a point) and that your son is bright, and that his bmom used drugs. The psychiatrists should have all taken that into consideration.
    While you're waiting for the next appointment, I'd strip the house of any dangerous things while your son is at school, especially his room. I would even take pictures off the walls. You have to consider this a heightened form of baby-proofing. It's just more sophisticated. Some of his behavior can be controlled with-training and some of it cannot. I would back up and try to remember what he likes to do and what he can do well, and use that to encourage and reward him, even if it sounds juvenile. Sometimes you'd be surprised what works.
    We tried sticker charts with-our difficult child but it didn't last long because he'd "cheat" and add his own stickers for doing little things like NOT burping at the table, and it got to be ridiculous. Have you tried any behavior therapies?
    I would also suggest allowing your dauther to stay overnight at grandparents and/or friends, even on a school night, to give her peace of mind. That's what we've done with-our daughter and it has helped her a lot just to know that we care and are trying.
    How does he react to change? Our son does NOT transition well. As a pre-teen, he is just learning to do it "normally." He no longer throws himself on the floor and screams or kicks me as though it's my fault if his friends can't play because they're sick. (Just one of many examples.) We have used a cpl diff methods to help with-transitions, so if that's one of his issues let me know and I'll explain.
    Good luck. I feel for you!
     
  7. Christy

    Christy New Member

    Welcome. I'm glad you found us and sorry that you have a reason to go looking. You will find tons of support and advice here. And, it is a great place to share experience with others who understand.

    Good luck and let us know how things are going,
    Christy
     
  8. devira

    devira New Member

    Ira has problems with transitions at home and school, so I would love some suggestions, screaming tantrums and power struggles is what we usually have now.
     
  9. Andy

    Andy Active Member

    Tommorrow morning, walk into his room when it is time to get up - give him a great big hug and say, "Good morning :) I love you so much! Did you have a good night?" That is going to really throw him off but in a positive way. "I feel like today is going to be a wonderful day! Here are your clothes. When you are dressed, I would love for you to join me for breakfast. See you in a few minutes."

    Stay as calm and positive as you can. Give as much positive feedback to him as you can find, "You are so quick in getting dressed - wow - because you are done so soon, we have a few minutes extra to play an alphabet game - let's see how many "a's" we can find in two minutes." Be willing to be flexible and take the time needed to help your kids stay calm with positive things to focus on.

    If you have a morning schedule, have son create a visual chart. Give your son a poster board and magazines - he can cut and paste pictures to go with each item - (bathroom, brush teeth, get dressed, make bed, breakfast, find shoes, find coat, find backpack, get into vehicle, buckle up). Each morning he can follow "his" schedule. He can "see" what will happen next.

    This doesn't work for all kids so don't be discouraged if he is not interested - just another idea for you to try.

    You stated he is not interested in rewards. I am thinking he just doesn't want to work toward one. However, you can still "reward" with words and hugs and instant "treats". You are ready for bed already? Let's read a book (or play a game, or do an art project, ect) with the few minutes left before bed time.

    Be stern when you need to, however, be positive when you can.
     
  10. Andy

    Andy Active Member

    Do the teachers let Ira know when there is about 5 minutes to switch gears? Sounds like he needs a heads up that a change is coming.
     
  11. 'Chelle

    'Chelle Active Member

    Hi devira :bigsmile:

    With the transition thing, we always need to give our difficult child extra time to get ready for changes, and it really helps if he knows what the change is. At home I always give him at least a 15 minute heads up that we're leaving or time for bed etc. then 10, then 5 - even now at almost 15 years old he needs it. At school, he now has a schedule in high school and the teachers don't have to give him heads up about what's next. Earlier on in grade school, it was good if the teacher would give him a schedule for the day in the morning, so he would know that he would be going from math to reading to spelling etc. It made it easier because he hates english type subjects, and if he didn't remember or know that after math was working in his journal it could cause a meltdown. Having the schedule he was prepared for what was next. Didn't make him always write in the journal, but he didn't have a meltdown because it was "sprung" on him.

    A second evaluation, and/or an evaluation by a neuropsychologist could be a good thing. If more/something else is going on than ADHD, it's good to know so that you know what direction to go in regarding therapy and medications.

    Welcome to the site, hope you find the advice and shoulder to vent to that you need. :flower:
     
  12. smallworld

    smallworld Moderator

    I think you have to carefully consider the connection between Ira being exposed to drugs in utero and his current behavior challenges. I'd recommend locating a specialist who treats kids who are exposed to drugs and the resulting problems they deal with. I suspect such a specialist could be found at a children's or university teaching hospital in the Chicago area.
     
  13. devira

    devira New Member

    Thank you everyone... I started reading the explosive child last night... it at least gives me hope... The psychiatrist I am going to is the head of one of Chicago's medical schools child psychiatric unit. I hope that means he knows what he is doing, and understands the in-utera drug issues.
     
  14. ohollydolly

    ohollydolly Optimist losing hope!!!

    Welcome.... I just wanted to tell you that it took us years and many docs to get a diagnosis. Alot of docs (at least here in CA) refuse to label children as bipolar. (which my child is) You have to keep pushing them for help. Even getting 2, 3 or even 10 opinions. I swear I was ready to give up and just knew all these problems were because we were bad parents and we did something wrong!! Obviously that was wrong and we finally did get a diagnosis. Helps a little but everyday is a challenge. I wish you all the strength & calm days you can get.
    XOXOXO Holly
     
  15. Sara PA

    Sara PA New Member

    Eighty mgs of Vyvanse is 10 mg more than the maximum recommended dose of 70 mg/day. The recommended dose is 30 mg/day. Did his violence and uncontrollable outbursts start or get worse after he started taking the Vyvanse, especially at that very high dose? These are the psychiatric adverse reactions to Vyvanse:

    5.2 Psychiatric Adverse Events
    Pre-existing Psychosis
    Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder.
    Bipolar Illness
    Particular care should be taken in using stimulants to treat ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder and depression.
    Emergence of New Psychotic or Manic Symptoms
    Treatment-emergent psychotic or manic symptoms, e.g. hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple shortterm, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) or stimulant-treated patients compared to 0 in placebo-treated patients.
    Aggression
    Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the post marketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment of ADHD should be monitored for the appearance of, or worsening of, aggressive behavior or hostility.


    It is entirely possible that a good part of the problem is the Vyvanse.

    by the way, Strattera is an antidepressant. It sounds as if it induced mania almost immediately. That is a fairly common psychiatric adverse reaction to antidepressants. Keep that in mind if anyone suggests an antidepressant again.
     
  16. devira

    devira New Member

    OMG, this is so frustrating, I have changed to this new Psychiatrist, because my previous Dr. was not listening to me... and just kept on upping the dose. The problem is that his medications work great until noon, then he slowly returns to his out of control state (now). I am not saying with medications he is a "perfect" child, but he can function in school and has no social issues. The defiance never goes away and neither does his need for one on one etc...

    My first dr started slow and increased until we were at a functional dose. Bu he was a pediatrician and said that Ira's needs wer truly out of his professional knowledge. But even he just upped the dose when things got harry...

    My second doctor said that adderal XR was not working well for him because it did not last through the school day, instead of changing medications she made his dose so high he spent the entire school day as a zombie (the teacher preferred that and never said a word to me, but the time he was home, his affect was normal.) I returned to my pedicatrician...

    My Third doctor, current doctor knows what he is taking, he is aware of the violence and did not want to change medications until the evaluation was done. In the mean time, we are seeing such extremes.

    part of me thinks I should stop all his medications and let him de-tox... maybe what he needs is a fresh start... the other part of me is scared to death of being with him without the medications, he will really hurt himself and possibly others.


    Why is it that when you tell your doctors that you believe the medications are having an adverse effect they think we do not know what we are talking about... ARGH! The only person who really gets hurt hear is my son.

    Penny
     
  17. looking4hope

    looking4hope New Member

    Hello and welcome!

    Your difficult child sounds like so many others here, and mine. Initially diagnosed as ADHD and then the behavior escalates. My difficult child did it about the same time -- 7 years old, but not quite as severe. Rewards and punishments did not work until his medications were stabilized, so that is your first order of business. Unfortunately it took two psychiatric hospital stays for that to happen, but once it did, I had my old son back.

    If you can, get a referral to a neuropsychologist who can do a much better evaluation. Like your son, my difficult child does well academically, so that isn't the problem. He would also not do his work unless it interested him (mainly science and math), although he could do all of it. He read better than most of the 8th graders I teach when he was in 2nd grade, so that tells you something! Anyway, since I've been through it, I can tell you that he needs to get a correct diagnosis before you can start working on the behavior.

    Keep us informed on his progress, and good luck!
     
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