How Do You Know When You're Ready For Residential Treatment Center (RTC)?

[Bunny]

I know that some of you here have your kids in an Residential Treatment Center (RTC). How long did it take for you to get them there? Did you have to jump through all kinds of hoops to get the placement?

I have to say that when difficult child is good, he can be absolutely angelic. He's a straight A student, all honors classes. His teachers all love him and I have had more than one tell me that they wish they could have a whole classroom full of difficult child. Then he comes home.

Sometimes when he doesn't get his way he's okay with it. "I understand, Mom." But then there are the other times. He tries to beat the **** out of easy child, he threatenes to beat me up. He tells me that he's going to tell the guidance counselor that I don't feed him so that the police will put me in jail. He's threatened to beat the **** out of me with a hockey stick. He's hit me, hit his brother. I don't like to leave easy child alone in a room with difficult child because difficult child will hit him or pinch him and when easy child says that difficult child did it, difficult child says that easy child is lying and. There are just points where I really don't want him here anymore because he's getting bigger and stronger (he's only an inch or two shorter than me) and we are rapidly approaching the point where I won't be able to protect myself if he gets really angry.

The therapist has seen him lose it while in his office, so that is someone who can back me up about the violent behaviors. husband does not want me to send difficult child away. He feels that difficult child is our son and that it's our job to raise him, and for the most part I agree with him, but I don't think that it's fair for the rest of the family to have to live under the threat that difficult child is going to completely lose control and hurt someone.

Afterwards, difficult child is usually remorseful. One time he was so upset about the way he had acted and the things that he said that he was throwing up. Some people tell me that the fact that he's remorseful is a good thing; that it's the kids who have no remorse that are the ones that you really have to worry about.

Pam

 

[zoo_keeper]

I don't have any meaningful to add, just wanted to let you know I'm going through this difficult decision as well. At times I can't imagine sending difficult child 1 away. But at other times, like now that he is in the hospital, I see how peaceful life would be if we did send him to an Residential Treatment Center (RTC). Its so hard sometimes

 

[buddy]

mine is also remorseful at times, sometimes I think he just doesn't know and is worried about what will happen. Either way any kid who can't control their voilence is someone to worry about (I get it that there are more issues if they really dont care). I am sure I could face this same decision and I dont even have anyone else in my home. For me I think when I feel I have no more to offer him to make progress forward and IF there is a place that really can do it better. Having him in hospital makes me doubt that since he is reinforced by any attention and so behaviors will increase no matter the good behavior programming. It is a super hard question and I will be happy to hear, but I suspect the answer is simply when you can't do it anymore.

 

[keista]

Are you saying he has ZERO behavior issues in school? He's a really good rule follower when the rules are clearly laid out and he knows what to expect? Then only at home where structure is much vaguer, he has a lot of problems?

I'm gonna go out on a limb here. Have you had him evaluated for Autism Spectrum Disorders (ASD)? Yes, I'm seeing it EVERYWHERE these days mostly because I quite possibly missed it in my own daughter - I'm waiting on the official reports, but having thought about it in now is making perfect sense to me as a diagnosis for her. BUT, to me, it seems like a legitimate possibility when there is such a disparity in his behaviors between a structured and non structured environment.

His teachers all love him and I have had more than one tell me that they wish they could have a whole classroom full of difficult child.

I've heard this more than once from my son's teachers. You know, I've even said it myself "Wish my girls were just like son, Asperger's and all"

 

[AnnieO]

You're ready when you are seriously considering it, looking at the options and have to keep the rest of the family safe. That's been my experience. If husband isn't on the same page, you're going to have a battle... Ours lasted 2.5 years... Ugly, ugly.

If medications and therapy aren't working, you have to move to the next level. That could be a PHP, or Residential Treatment Center (RTC). Has he ever done inpatient? I'm not too familiar with your story, but...

 

[Bunny]

Are you saying he has ZERO behavior issues in school? He's a really good rule follower when the rules are clearly laid out and he knows what to expect? Then only at home where structure is much vaguer, he has a lot of problems?

That is EXACTLY what I am saying. I have spoke to teachers through the years and when they have asked me what he is like at home and I tell them what goes on, they look at me like have two heads and am from Mars. One teacher even went so far as to tell me that I must be mistaken because he is so good in class.

I have had his evaluated for Autism Spectrum Disorders (ASD) and they have told me no. I trust the doctor. He really seems to know what he is doing, so if he says no to the Autism Spectrum Disorders (ASD), I believe it.

difficult child has never been in a psychiatric hospital or in an Residential Treatment Center (RTC) facility. But there are days when I really and truly feel like I just don't want him here anymore. I don't trust him to behave and not lose it over really small things, which is what usually triggers his meltdowns. The other night it was over a glass. His father put the one he was using in the dishwasher and he lost his mind over it, screaming at me that I took his glass away. When I told him that I didn't touch his glass his reply was, "I'm blaming you, anyway." Really, what else is new?

Maybe I'm just looking for some peace, because I know that when he's not here, that is what I have. Peace. I keep saying that I only have six more years until college, only for him to tell me that he wants to go to culinary school (he LOVES to cook). That's great, but culinary school is not a four year degree, and I was sort of counting on not having him in the house for four school years. Terrible, I know.

I don't think that I am there yet. To the point of moving him to an Residential Treatment Center (RTC), I mean. Some days are good with him. Some days are bad. Some days are just days, if that makes any sense.

Thanks for your point of views. I appreciate it.

Pam

 

[Liahona]

I sent difficult child 1 to Residential Treatment Center (RTC) when I could not keep the rest of the kids safe. The therapist wanted him to go at age 6. I sent him at age 10. It sounds like difficult children behaviors are getting to that point really fast. Most of the places have a waiting list and can be hard to get in to. If I were you I'd start looking into Residential Treatment Center (RTC) now. Then even if you never use that option at least you were prepared. We got difficult child 1 into one because we are very poor and could use the state run Residential Treatment Center (RTC). We could've also gone through X's insurance. We ended up sending him to the state one. It helped me to tour the place and to ask questions. I think there is a list of questions to ask the Residential Treatment Center (RTC) in the archived section. I was relieved to see all the security measures in place to help keep difficult child 1 safe while he was in there. They also did family therapy.

 

[keista]

I don't think that I am there yet. To the point of moving him to an Residential Treatment Center (RTC), I mean. Some days are good with him. Some days are bad. Some days are just days, if that makes any sense.

From what you've written, it sounds like he would benefit from the structure of say a boarding school. Which leaves me wondering if you've tried implementing any sort of structure at home mimicking the school setting. Not just an authoritarian "These are the Rules" and that's that, but some sort of schedule and house rules that the whole family has some input on.

Things like bedtime, showers, homework time, TV and computer time can be negotiated, but parents have the final say. In return, if he gets bugged by small things like his glass being taken away, then it is NEVER to be taken away by anyone. In return, difficult child has to put it in the dishwasher himself when he is done. And you go through as many things point by point as you can. It can always be amended as issues crop up. Of course, there are also clearly spelled out consequences for things like hitting as well as rewards (nothing major but earned TV or Computer time maybe) for "getting caught" doing good things.

In our house, one BIG issue was over a small thing like how sandwiches were cut - triangle or squares. One of the kids would get in a rut of say, triangles all the time, so I would automatically cut them that way. Well, of course, one day a kid decides she wants them in squares. UHG! So I learn to ASK each time. And yes, this happens with my youngest DD2 who I *think* is a true easy child. The difference with her is that she won't have a full tantrum over it - just moderate disappointment. With son, when he was younger, the tantrum was so intense that he REFUSED to eat the *ruined* food.

Anyway, just something to think about. If you're already working with a therapist, they can help you get this set up. If you don't already have a therapist, you might want to look into one.

 

[Wiped Out]

Good question, Bunny. Sure wish I had an answer. In my case I think there was a point about 1 1/2 years ago that we probably should have sent difficult child to an Residential Treatment Center (RTC). He was manic and violent most days (he was hospitalized 3 times in 3 months). We probably have had other points where we should have considered one as well.

 

[crazymama30]

When medication increases don't help enough, the other kid (s) are suffering, behavior in several areas of life are majorly impacted.

My difficult child will most likely be in an Residential Treatment Center (RTC) by the end of the week. Does he still have good moments? Yep, he sure does, and that makes it harder. But for him, right now, the good moments never out number the bad ones.

 

[beachbeanb]

I think there is a list of questions to ask the Residential Treatment Center (RTC) in the archived section.

Liahona.....where is the archived section? Thanks!

 

[Liahona]

http://www.conductdisorders.com/forum/f5/

Here is the link for the archives. I'll look for the Residential Treatment Center (RTC) thread. If I find it I'll post the link.

 

[Liahona]

http://www.conductdisorders.com/forum/f13/residential-care-center-how-get-236/

This is a thread about how to get into Residential Treatment Center (RTC). Still looking for the one with the questions. The links in there don't seem to be working.

 

[Liahona]

Here it is.

http://www.conductdisorders.com/for...ential Treatment Center (RTC)-need-input-200/

 

[soapbox]

Pam...

When did he get the diagnosis of anxiety? and of ODD?

Because...
Way too often, ODD is just a list of symptoms with some other cause... and can't be addressed without finding and addressing the original problem.

Plus... anxiety is often a secondary diagnosis - not that it can't be primary, it can. But more often, its because "other stuff" exists, and isn't being dealt with...

The picture of him holding it together at school... and then being a problem at home. Hmmm... sounds a little familiar, from years back. What I'm thinking is, you might be dealing with some hidden disabilities that are subtle, and that are not affecting school performance - BUT in working through his school day he may be coming home with "burn-out".

Burn-out can be daily - or intermittent. It may be worse on the weekend/holidays, because difficult child finally relaxes and then can't cope with the fatigue/anxiety/any other emotional or mental red flags.

By any chance, are evenings worse than mornings?
Does he have trouble going to sleep? or hard to wake? or seems to sleep "enough" but has dark circles under his eyes?
What are his favorite activities?
What are his least-favorite parts of school?

 

[Bunny]

His main diagnosis is anxiety with ODD. We were hoping that once we got the anxiety under control that the ODD symptoms would slowly disappear. That's happened, to a point. I understand that he comes home from school burned out, or as it's been explained to me, wound up like a tight rubber band. And I agree with you that it can be intermittent. Some days he's fabulous! The best young man I could ever want. Other days, well, I suppose you all know what those days can be like.

What he now says is that he "chooses" to hold himself together at school because at school he feels liked and respected and at home he says that no one loves him. No one. Not me, not his father, not his aunts and uncles, not his grandparents, not his brother. But I find it ironic that he only sways this when he doesn't get what he wants. When he gets his way, he's loved. When he doesn't get his way, no one loves him.

I don't think that evenings are worse than the morning. Actually, I think that the afternoon are generally his worst time, if I had to pick one time of the day. He's goes to sleep pretty easily, and he gets up to go to school easily, for the most part. I think that like all kids, he has a couple of days a year when he says he doesn't want to get up, but he usually gets up and gets ready without too much of a hassle. Dark circles? He has them this morning, but I think that could be because he's sick.

His favorite activities are cooking, baking, video games, playing hockey in the driveway with his friends and brother, and playing army,

His least favorite part of school? I'm not really sure about that. He's in all of the honors classes that he can be in.

Pam

 

[soapbox]

You are sounding like a milder version of what we dealt with...

Might want to consider Occupational Therapist (OT), Speech Language Pathologist (SLP) and auditory evaluations...
1) Occupational Therapist (OT) for motor skills and sensory issues - these may not be debilitating, because he is "coping", but if its taking everything he has to hold it together for school, then interventions and accommodations can really cut the edge.

2) Speech Language Pathologist (SLP) is going to sound strange, but it may be your gateway... there are APDs that are NOT about "language", but about making sense of what we hear in the presence of background noise. ("auditory figure ground" is one of the terms for this...) If he is putting huge efforts into "catching" what the teacher is saying, and his problem isn't at the most severe end of things, he may well be "coping" at school, but coming home super brain-tired and not in a frame of mind to "listen". Usually, these evaluations start with Speech Language Pathologist (SLP), who can then recommend advanced auditory testing...

3) if its never been done, should have hearing checked - even minor hearing loss can cause the same problems as Auditory Processing Disorders (APD)

Any of these would account for the variability of his mindset when he gets home.
They would also account for the attitude... If he is dealing with these sorts of issues, HE doesn't know what is going on, because "he's always been this way"... what he does know is that he is facing unreasonable requests at home. Kids expect us to know what they are going through... in this case, perhaps NOBODY knows (yet). Getting interventions and accommodations can make a huge difference in how much is "left over" at the end of the school day.

But... you probably won't get any of this through the school system, as he is doing well there...