Horrible day - need advice

Discussion in 'General Parenting' started by UpandDown, Feb 10, 2016.

  1. UpandDown

    UpandDown Active Member


    I have posted here before about my 16 year old son who is struggling with adhd,anxiety and depression. At least that is what we believe is going on but its ever changing and so hard to pin point. However, to make a very long story somewhat short he has a therapist that he trusts and confides in very much. That is a huge positive in an otherwise very frustrating lonely cycle of therapists and doctors. She advised me that my son really seems to need to get back on medication for attention and focus. She felt very encouraged that he wanted to do this. She is a Phd not able to prescribe medications so I took him back to his psychiatric nurse. I should have taken him to a dr but it takes months and she is quick to get in with. He outlined for her that he wanted to try again the medications for adhd and she was very quick to argue with him and say that she though that was a terrible idea and that she felt strongly that he needs to take the medications for mood first and then deal with focus later. He was calm and explained that he hated the way those medications make him feel and that he wasn't willing to. She was extremely condescending to him and unprofessional. She asked us where we have been getting adderall since our last visit 3 months ago. I told her that he had not had any. She was very accusatory and then even asked us why we went to see another dr. She is nurse so over the holidays during a particularly bad spell, we took him to a clinic that specializes in anxiety. We had given the dr her name so they could discuss treatment. This dr apparently called her but she never returned the call. She told us in this session she was very busy and thats not her responsibility. Her attitude was completely hostile and accusatory throughout the session. I tried to jump in and advocate for him saying he has a right to speak for himself about what he feels. I could see him trying to disconnect even started playing a game on his phone. Suddenly my son had enough and let her have it. He was very disrespectful to her and completely let her have it. It was awful and intense and she told him to leave that she wasn't about to work with him ever again etc. Thankfully he got up and walked out. I should have left at that moment too but I was furious. I calmly told her that his disrespect was way out of line and that I did not condone it. But that surely she has something more in her arsenal in working with angry teens other than what I had just witnessed from her. I was not rude in any way, but I let her know that she was unprofessional and condescending and unhelpful. That he needs help not accusations. That was she just witnessed from him is exactly why we are there. Lack of control and anger. She looked at her chart and said, oh yeah he needs help alright. He has an eating disorder(news to me), anxiety disorder, ODD, and on and one she went. I questioned how she could so coldly outline a whole list of disorders without offering a drop of help. I also let her know that not returning the phone call from the dr was not very helpful either. Somehow that really angered her and she told me to leave her office. I immediately got up and walked out of her office. The next thing I know she is yelling to her staff to call the police and that I am never to step foot there again. That they needed to call 911. It was the most bizarre thing I think I have ever experienced. I never once raised my voice or called her names or acted hostile. She kept telling me I was rude. I did ask for a refund and made sure that I stayed right there while her husband and son (who are her office staff) scrambled to get me one. Her husband actually told her to be quiet and stop it and turned to me and said I am sorry. I calmly said, thank you for the apology because I definitely deserve one and that was it. I was awake in and out of the night filled with anger and sadness over this. How in the world can this be someone in the helping profession? This experience has probably cemented that my son will not EVER go back to a psychiatrist. We had a good long talk afterwards and he told me she made him feel worthless. How in the world does one find a Psychiatrist that actually will listen to him?
  2. InsaneCdn

    InsaneCdn Well-Known Member

    Well, this wasn't a psychiatrist. This is a psychiatric nurse.
    For starters, I'd be reporting her to her professional association.
    And then, I'd be heading for a real psychiatrist. See if the therapist can recommend one.

    In the mean time... if what he wants to start with is medications for attention end focus, many family doctors are able to prescribe those, especially if he already has a diagnosis, and is on a waiting list for a psychiatrist.
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  3. ksm

    ksm Well-Known Member

    Does this psychiatric nurse work under the guidance of a psychiatrist that is responsible for her prescribing Rx to patients? I think they have to be... At least where we live. I would find put who she works under and sent them a registered letter with what happened. KSM
  4. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Be careful. Adderrall is a huge street drug, very abused, as well as it helping some people, but don't let anyone think you are getting it from various doctors or places. Yes, I know you are innocent, but this is one controlled substance that is greatly overused by teens...cut into pillcrushers and snorted alone or with other drugs. My daughter was a drug abuser once and said Adderrall got $10 for one pill off the street and that's why health care professionals are suspicous...you know one bad apple ruins it for everyone.... All ADHD are misused as well as used correctly. So just watch how much info you give out. I'd also be sure the ADHD medications are HELPING your son because teens DO abuse them. I am not in any way saying your child would...just be sure he needs it a nd if he does go to one doctor and one pharmacy to get it.

    I am on Clonazapan, which is also a controlled substance, and I am very diligent about only getting it from one doctor and one pharmacy. I feel like a drug addict every single time I am asked to show my ID to prove I am me when I pick up my medication, but I also know it is because many people abuse it, even if I do not.A
    As IC said, see a psychiatrist, not a nurse for your initial visit if you switch providers. And make sure, as ksm says, t hat if you do choose a nurse that there is a psychiatric above her, monitoring what she does and ask his/her name.

    Hugs and hope that things will improve. Seems you are very determined to help your son while he is still a minor. Good on you!!!!
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  5. UpandDown

    UpandDown Active Member

    Thank you for your advice ksm and insane. Somewhere out there, I think that

    is exactly what happened, that she felt we were up to no good. And what I took away from that whole experience was a very fearful, overwhelmed, protective feeling. I need to keep his personal information safe sometimes even from the very people that claim to want to help. No more finding names in the insurance list and just going to the first one who has an opening out of desperation. I will interview the next dr myself before even bringing my son in. He is way too fragile and hurt to be put through this again. Its heartbreaking that he was very honest with her and let her know all of his struggles and she was so awful to him. Its going to be a long climb back up to him being open again. The really really good part here is that he has a wonderful, compassionate therapist with whom he can talk about this. That is the part that I keep trying to focus him on. That there are people who love him and care about him and truly want to help.
  6. confuzzled

    confuzzled Member

    can you call the therapist he likes and ask her whom she works with/recommends? very often they have people they like and ones they dont and are happy to reach out for a client (sometimes this also speeds the process up). I would also have her document what you've said here so she is aware of it.

    the best thing I ever did was to finally find our own psychiatrist after years of using the "insurance company list"--the one we use takes NO insurance and isn't particularly cheap, but most insurances have some out of network benefits (you submit the claims) that reimburse you for some portion....I think mine reimburses me 80% or so. once mine was stable we just really go 4X year for medication checks--really, nothing has changed in forever and even this is overkill but its sort of the psychiatrists rules. it was WAY easier and quicker to get an appointment with this dr, she was WAY better at treatment than the ins. losers and I wasted WAY too much time being too cheap to pay out of pocket (until I was desperate, really). its something worth seriously considering if you can swing it financially.

    lastly, I don't know which mood stabilizers your son tried but there may be better options, and in some cases they really do need to be on board to be able to use stims. I completely understand that he doesn't like they way they make him feel, but I do think its worth exploring if the Adderall alone is a issue for him. I would also talk to him about the chance that another doctor may choose a different stimulant and that's ok too....some docs get a tinge nervous at Adderall in a teenage boy due to the chance of abuse--even though he has history with it. its probably a good idea to discuss the chance of changes--I might try to convince him of a fresh start at help and to stay open minded...I know its a long shot, but when he calms down you may be able to rationalize with him. maybe :).

    In any event, I hope today is a better day!
  7. GoingNorth

    GoingNorth Crazy Cat Lady

    Actually, if he does have a mood disorder of any kind, or if that is suspected, the correct protocol is to get his mood stabilized on medications for that, before prescribing stims for ADHD.

    Especially as mood disorders and/or anxiety can mimic ADHD.

    ADHD stims are also contraindicated in patients suffering from anxiety disorders.

    SWOT, it isn't only "kids" who abuse Adderal; it is also hugely popular with adults of all ages who are into abusing stims. Not only is it snorted, it is also injected, which like injecting pills of any kind, is a good way to lose an arm.

    I personally was misdiagnosed as having ADHD and put on methyphenidate early on in my journey towards a bipolar diagnosis.

    I nearly lost my mind. The only thing that kept me from going to the ER was that I could keep telling myself that "It's RItalin. It only lasts 4 hours, max." until the darned stuff wore off. And then I crashed into a horrible depression that lasted a couple of weeks.

    on the other hand, my late husband, who was diagnosed with ADHD during medication discharge outprocessing from the Army, was prescribed Ritalin then. It was a godsend for him. He preferred Ritalin because of the short effect. He could take it PRN for when he needed to concentrate and be sharp, without dealing with the stimulant effect all the time. Other than that, copious amounts of coffee and strong English style tea kept him going because he couldn't take Ritalin if he wanted to be able to eat or sleep.
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  8. InsaneCdn

    InsaneCdn Well-Known Member

    Which is sort of ironic because... caffeine is a stimulant. And good stout tea, like good strong coffee, has a pretty good dose of it. The only advantage is that caffeine has a half-life of about 2 hours (as compared to 4 hours for Ritalin)
  9. GoingNorth

    GoingNorth Crazy Cat Lady

    Oddly, he could drink a pot of coffee and go to sleep. Ritalin kept him awake.

    The only thing that i can figure is that he'd been drinking strong (Viennese) coffee since childhood and was "used" to caffeine. I got him started on the English style tea when he was in his late teens, so he'd had some time to get used to that, though early on it was pretty funny as while he could swill coffee all day, two mugs of "my" tea gave him the shakes. It may have been the theine in the tea that nailed him.

    I've become sensitive to caffeine since menopause and can only tolerate one or two mugs of my tea when i first get up. I can have no caffeine after 2PM if want to have a hope of sleeping that night.

    I still drink PG Tips (Thank You Amazon) with milk and sweetener. I don't like hot coffee, but like some cold coffee beverages (the caloric ones)
  10. Copabanana

    Copabanana Well-Known Member

    Up until this point, I believe she acted reasonably. I would be careful too with the abuse potential of Adderall, especially with an untreated mood disorder.
    Even here, she is still on track. It is her job and her responsibility to account for all medications, legal and otherwise that her patient may be consuming.

    She would be responsible, legally and ethically if her patient died or become ill from duplicative medications that were prescribed. Anna Nicole Smith, whose psychiatrist and physician were charged as responsible for her death, is an example of somebody made vulnerable by her caregivers.
    Now, this is absolutely beyond the pale.

    She could responsibly request that he leave but she can never ethically declare she will never work with him. By her own diagnosis, he is mentally ill. She is responsible for his treatment as long as she is his provider, of record. To behave punitively as she did is without defense. I would think of submitting a complaint to her licensing board in your state.
    This too is horrible. Blaming the patient, and attacking the mother. Deliberately and cruelly trying to hurt and disarm you.

    I admire that your son left.

    Cut your losses. Report her if you feel that this might protect other patients.

    I think your son handled this well. I would explain to him that she overreacted and that he handled it well to the extent that he left, and advocated for himself. With your son, I would not talk about it again, unless he wants to.

    That he has such a good relationship with the psychologist will likely insulate him from any lasting effect of the PNP's misbehavior. As long as you do not build it up and are able to let it go.

    Unfortunately having a profession does not guarantee good or ethical behavior.

    I am sorry this happened to him and to you.

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  11. UpandDown

    UpandDown Active Member

    Copa, thank you for breaking it down for me. It helps me to look at each part of her response as I try to dissect where things went so terribly wrong. I do agree with you that she was doing due diligence when she asked the questions she asked. I certainly think she could have asked in a way that was not so accusatory but so be it. I even told her that I appreciated her not prescribing something that could potentially make him worse. I am considering reporting her because it is the right thing to do. But every time I rehash it in my mind, I get upset and I am not sure i am willing to throw another second at her. You are so wise, I absolutely need to let it go and not build it up. You give wonderful advice here and i am very thankful for it. I read lots of posts but don't feel like I have a clue how to support or give advice to others as I am so overwhelmed.

    I honestly think the advice that I read about children that are over 18 is the advice that would best work for us. We have tried so many things and advocated and worked on our son's behalf and he won't lift a finger to help himself. When pushed to try in school or get a job, his reason to not do anything is because he is unhappy and a life time of school and work make him him terribly unhappy and he would rather die. He thinks that if he gets rich all of his problems will be solved. So, we try to dig and find out why school is so hard. Ok, its adhd and anxiety. So we take him to doctors for help and he refuses to take their recommended medication. He is constantly doing it his way and none of it has ever worked. And we spin and spin trying to set him up to succeed. The articles and advice on detachment is what rings most helpful to me. Yet, he is still a minor and the advice is for children over 18. However, all of his wisdom about how he doesn't need to do school or get a menial job come while he is living in a nice warm house with food and a car to drive. When I explain to him that the reality is that you have to work and do things that you may not love to be able to support yourself, he just tells me that it makes him so unhappy he would rather kill himself. Yet, he has never even had a job so how would he know. I am rambling. I am so very tired and just don't get him.
  12. InsaneCdn

    InsaneCdn Well-Known Member

    Or is it?
    Just playing devil's advocate a bit here. But... both adhd and anxiety are extremely frequent co-morbid diagnoses. In other words, if you have one of those, there is a high chance that you are also dealing with something ELSE.

    For example. It took us 10 years to get from "adhd" to... Auditory Processing Disorders (APD) (auditory figure ground), plus dysgraphia plus fine and gross motor skills challenges (there's a longer list of diagnoses, but these are relevant here). Meanwhile, "adhd" had morphed into "adhd plus anxiety plus attitude"... and he hated school (which is part of "attitude").

    Another few years later, and now that he is an adult, we're getting "umbrella" diagnoses - yes multiple - that actually cover every other label he's ever been given. Diagnoses he should have had at age 6 and 14. Diagnoses that would have changed his whole life, provided supports, gotten him appropriate accommodations at school at an appropriate age...

    Meanwhile... my son KNEW at age 6 that the reason he couldn't get his work done was because "it's too noisy in class, Mom - I can't hear the teacher". Which was as a result of his Auditory Processing Disorders (APD), which wasn't diagnosed until age 12. All the while, teachers treating him like it's all "attitude" and generating a hatred of school.

    Add in bullying - from students and from teachers - and... it might not be so simple as "adhd and anxiety".
  13. GoingNorth

    GoingNorth Crazy Cat Lady

    Explain to me, why, if he isn't working or attending school, he needs a car? That's the first thing to go, in my opinion.

    He has NO reason to get a job or even make any moves torward being self-supporting. Not only does he have everything supplied to him, he's got it better than he'd have it trying to live on beginner's wages.

    And not being able to handle the "idea" of having to work for the rest of his life? Pooooor baby. That's part of being an adult.
  14. UpandDown

    UpandDown Active Member

    My son does go to school, its that he is not trying very hard in school. He drives himself to school and to dr appointments and that is it. And he pays for the gas for his car. I do believe that if he had to work a job to provide a roof over his head, food, etc. he would quickly realize that he has a pretty good set up. However, he is 16 so kicking him out is not a very realistic option. I agree, having to work is a fact for most of us adults.

    Insanecd- I wonder the very same thing. What are we really dealing with here? I have read up on Auditory Processing Disorders (APD) and that is something that I would like to explore better. Thank you for your thoughts.
  15. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    By the time they are legal adults, it falls upon them to find out if anything is wrong with them. We can't do it for them. And guessing is just not a good thing.

    Hugs for your hurting heart.
  16. pigless in VA

    pigless in VA Active Member

    :welcomecat: Welcome, UpandDown. Is your son also on anti-depressant? I'm sorry that you had such a horrible experience with the nurse. I'm really glad that your son has a therapist he trusts; that's huge for a young man.

    What does he like to do for fun? Is there any chance of getting him involved in sports or music?

    I think school is really tough for kids struggling with depression, anxiety and focus. It makes it hard for them to find a place to succeed.

    My son has a friend on the autism spectrum who struggled with anxiety in middle school. His parents got him involved in martial arts which has done a world of good for him. He is now also into strength training. He isn't the best student, so having him involved in an activity where he could excel was key to helping him feel better about himself. I keep hoping he will talk my son into participating in track, but no luck with that yet.
  17. UpandDown

    UpandDown Active Member

    Thank you pigless. No, unfortunately my son will does not like the way anti depressants make him feel and refuses to take them. He used to play competitive sports but has slowly stopped doing them. It is very very sad as they were a wonderful outlet for him for years. He even excelled there so its hard to understand. Today has been a good day though as he is off from school due to weather and has been shoveling driveways for money and is now sledding with an old friend. I am trying hard to reframe my thoughts and be happy when things are going well and not worry every second of the day away.
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  18. pigless in VA

    pigless in VA Active Member

    Snow shoveling is good outdoor exercise. I see that a huge plus.

    My son refuses to drive. I have yet to solve that particular issue which totally confounds me.
  19. detachingmother

    detachingmother serenity

    New here, but thought I'd jump in here for a quick sec.

    Oldest Son has had many problems. One of which involves Adderall use.

    I would actually suggest staying as far away from that as you can, if there might be better options.

    As others have pointed out, it is abused ALL the time by teens. My son started dabbling with that. Adderall is not just a stimulant, it's a very strong amphetamine. In my son's case, it didn't take long for him to figure out Methamphetamine would be stronger and work what he considered "better" and "faster". These two chemicals are very similar in make up. With the "meth" part of the amphetamine amping up the effects.

    What happened with Son, one of the things, is that he was diagnosed with ADHD, then prescribed Ritalin, Ritalin made him like a "zombie", so we discontinued and just tried to cope. Then later as he got into his teens, he discovered Adderall and I truly thought his intentions were to self medicate and I did not even have a clue how serious this drug was/is...(a few docs prescribed for him, but he found it on the street --at school too). At first he said it helped him focus, but then he became addicted. In a very real serious way. This WAS ABSOLUTELY his gateway drug that lead to METH use. And from there, everything in his life unraveled in every conceivable way.

    By the time he was approaching 20, I feel his brain has been irreversibly damaged, and not in a minor way. Although I can't say how much of it is genetic disease (schizo/bipolar). It's a case of which came first? The chicken or the egg? We will never know.

    I don't know, if I had it to do over again, I would have done many things differently, and keeping SON as far away from Adderall as possible would have been one way. I am sure some other's can relate to this.. I know I am not alone on this one. He was diagnosed with ADHD around 9 or 10. Not sure if it was misdiagnosis or what, I don't pay much attention to labels.

    I mean, I am not saying this will undoubtedly happen to your son, but be cautious with any "amphetamine" type drugs, prescriptions too. Personally, I feel like there are some cases where it helps, but way too many where it does irreversible damage to a young developing brain. A young man's brain isn't developed completely until well into the 20s.

    I might be just sensitive to this, and hopefully it doesn't seem like I am projecting, but I would look hard to find other ways to help with the focus.
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  20. UpandDown

    UpandDown Active Member

    detachingmother, thank you for your honesty. I am very sorry to the pain you have been through with your son. I appreciate so much that here I can get honest advice from others. Every medicine seems to have warnings so its hard to know when to REALLY be wary. I did not know this about adderall and find it very very scary. The nurse practitioner who ended up being so nasty is actually the one who first gave it to him and her only really warning was that it might ramp up his anxiety. The last thing I need is to get him started on something that could lead him further astray.

    Ironically, just last week he was given a 30 count bottle of vicodin after having a necessary surgery. I kept a close eye on it and gave it to him for 2 days as he was in a lot of pain. I was so worried about the vicodin as I have heard so many stories of abuse and addiction to that one. Once I could see that his pain was tolerable with ibuprofen, I flushed it down the toilet. I don't even keep cold medicine in my house anymore. He has taught me to be very very careful and I am feeling kind of foolish that I could have handed him something that could be so dangerous.
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