Ideas for helping difficult child 2 de-escalate

[flutterby]

difficult child 2 has been diagnosis'd with Bipolar II and ADHD. In my mind, the ADHD is in question because I don't think he's properly medicated - although he is better on his medications than without; just still not stable. His medications are Symbyax (sp?), trazadone for sleep, propranolol for tremors, and Adderall (the Adderall is as of today..he was taking Vyvanse but it was too much. It would keep him up all night if he took it too late, like noon. Although it did seem to help keep him calm).

Anyway....

As is typical with BiPolar (BP) II, difficult child 2 has *a lot* of anger. Just about anything can set him off, some triggers more than others and we are aware of what those are. However, he is really, really trying to control his anger. He told me yesterday that he doesn't want to live that way anymore.

But, when one of the big triggers set him off, I feel so helpless. It seems that I can keep him calm - or calmer - than can his mom. Typical kid thing. My daughter does much better with his mom than me. You know how it goes. (We've talked about trading kids and when they quit honeymooning, trad back. ) I am trying to help him de-escalate during these situations and also talk to him about why he reacts that way, trying to help him find some insight; as well as talking about how his actions/behaviors effect him, as well as others. It seems he has physical reactions to these triggers - complains of chest pain, neck pain and intense headache - when it happens. When it gets to that point, about all I can do is to keep him from yelling. But he's still pacing like a bull, Know what I mean??

Anyone have any tips? My daughter gets set off, but it's not near as extreme and she doesn't shoot herself in the foot so much with it. Like the time difficult child 2 got mad and threw his medications into the yard because he wasn't taking them anymore to spite his mom - his target that night. Cutting off his nose to spite his face.

He does actually hear our words. He has to process it and within a couple of days, he's ready to talk about it and work toward it. He is making progress. Very tiny baby steps. But, progress nonetheless.

But, the anger sets off the impulsivity and the self-destructive behavior. He's way more a danger to himself than to others.

He had been here since Monday night. Went home tonight (Friday night) and is coming back for the weekend. To use Cookie's words, he's a child born in my heart. But, I'm always so exhausted by the end of the day.

He has the most beautiful heart. I'm seeing the person that I know he is. I haven't seen that in a long time and was afraid I wouldn't ever again. I want to do everything I can, along with his mom, to help him be the person I know he is.

Any suggestions are appreciated.

TIA.

 

[smallworld]

Heather, if he truly has Bipolar Disorder, he needs to be medicated properly or he's not going to be able to get any better. That means a first-line mood stabilizer (Lithium, Depakote, Lamictal, Trileptal, Tegretol) plus an atypical antipsychotic (Risperdal, Zyprexa, Seroquel, Abilify, Geodon). He's on NONE of those medications. In fact, he's on medications like antidepressants (Trazadone, Symbyax) and stimulants (Adderall) that will rev a kid with BiPolar (BP) up instead of calming him down.

Some thoughts:
Get him into a psychiatrist who understands medicating kids with BiPolar (BP).
Push for getting him off antidepressants and stimulants.
The ADHD sx should only be treated AFTER the mood is stable (and often there is no need once the mood is stable).
There are other options for sleep medications including APs, Benadryl and Melatonin.
Why is he getting tremors?

You can check http://www.thebalancedmind.org/sites/default/files/treatment_guidelines.pdf for medicating kids with BiPolar (BP). It's really important to follow these guidelines or you're likely not to make progress. Believe me, I know because I've already gone through it with two kids (and we're working on the third).

 

[ML]

I hope you can find the right medication for him. I know that for our AS kids medications can sometimes help manage symptoms but they're simply an augment whereas with BiPolar (BP) kids the medications are essential for balance the chemistry.

He is lucky to have you for a second mom.

Love,

ML

 

[totoro]

Well I know for me and for K, and I hate this and most people around me, (husband) hated it...
We needed the triggers to be taken away as much as possible in the beginning.
I need and I see it in K a lot, to have the triggers be gone.
I then can get stable, medication wise, mentally, etc.
The big thing is the feeling of control not in a controlling way, but like you have control of yourself and your environment because for most of us we feel very out of control a lot of the time.

The rages, the agitation, the inability to sleep...
It is all loss of control, which causes a lot of the issues and lead to alot of the instability.
This is what we have found at least.
Then once K or I am stable, we both take criticism and can handle much more stress.
The triggers are easier to identify, we both can be told that we are getting elevated and not freak out so much.

K obviously is still learning a lot. but even last night, her medications are starting to need tweaking, but we have been working on her triggers a bunch, so her being tired is a huge trigger.
I was trying to explain to her that she needs to slow down when brushing her teeth. husband is also out of town.
She started slamming things, went into her room locked the door. screaming hitting herself. i had to walk away, then i came back in she was screaming at me, but I just grabbed her and made her talk to me.
I took her kept saying what did we talk about with your psychiatrist?

Finally she heard me, she was able to control her anger, but sunk into depression and finally fell asleep.
It is a start... and she is still emotional this a.m. which is common. So I have to watch her and try to watch the triggers.
Right now she is in a mixed state which stinks, so I am gingerly being strict, but not pushing it. She wants everything NOW but can't focus... and is depressed also.

So these are the times going to a movie or video games... and trying to get her to go for a walk.
I basically have to have tons if ideas.

I don't know about ideas for a teen boy! YIKES

You are awesome for doing this!

 

[flutterby]

Thanks, ladies.

His mom and I are fully aware that difficult child 2 is not properly medicated.

These are the medications the psychiatrist in the court ordered Residential Treatment Center (RTC) put him on. He came home to his mom's in mid-December, but was still in legal custody of Children's Services. They did not enroll him in school, did not get him mental (or medical, for that matter) health treatment, or get him into the outpatient (rehab) program they were court ordered to do. There was a termination of custody on Feb 26 and the judge sent difficult child 2 home with his mom, but dad still has legal custody. In order to get difficult child 2 into mental health, dad has to sign the papers saying it's ok since he has legal custody. He won't do it. Mom is in having custody papers drawn up to revert custody back to her, but that takes time.

Thursday night was difficult child 2's last pill. Their family doctor agreed to see them on Friday, but was only willing to continue the medications the Residential Treatment Center (RTC) psychiatrist had rx'd. I understand that.

In the meantime, difficult child 2 is on probation with the threat of going to juvie for any mishap. So, while we are all aware he is not properly medicated, and since the juvenile justice system gives no leniency for that (even though Ohio is supposed to be better about that), we have to help him de-escalate as much as possible given the circumstances.

We don't live in a perfect world.

Re the tremors, he's always had them.

 

[susiestar]

The situation stinks. Any chance of dad losing custody due to medical neglect? Not taking your child to the psychiatrist, or allowing him to go to the psychiatrist, when he has bipolar and other problems is medical neglect if anything is.

Since he is 16 any change in custody will likely be up to him if neither parent is declared unfit. So even if medical neglect isn't an issue there should be no problem getting custody changed.

Maybe this next thought is out of line, but who would know if he saw a psychiatrist if no one told him about hte legal custody issue until later? Would a doctor even know if ANYONE had custody if no one told him? I have never been divorced, but I also have never had anyone ask me if I had legal custody so I have no clue here. I think our docs all just assume you would not be taking a child to the doctor if you didn't have custody. I could be wrong.

Anyway, the mom needs to make the custody change ahppen ASAP if this kid is on these medications.

Whatever is going on, you are making a very positive influence in this kid's life. I am glad he has you.

 

[flutterby]

I stated earlier that mom has an attorney who is drawing up custody papers. Dad said he would sign them. We'll see. She couldn't do anything until Feb 26 because that was when TOC with Children's Services happened. Her hands were tied until them. Children's Services was actually recommending that difficult child 2 be sent home with dad. What a joke they are. Had the CW done her job - or even filled out the forms that mom sent to her to be completed so she could get difficult child 2 into school and mental health and outpatient rehab - he would already have a psychiatrist.

Mental health will not see any minor without proof of custody/guardianship. Period.

So, the situation being what it is, I really need advice on how to help him de-escalate until he gets in with a psychiatrist. Even when he does, it takes time for the new medications to take effect.

This is not something we can just let slide until that happens. The judge told him she has him under her thumb. If he violates, he will go to juvie until he's 18; possibly 21. Wrong medications or not.

 

[Stella]

One tip i have used for de-escalation - reverse pyschology!!! One of difficult child's triggers in boredom, so she will come home from playing outside once her friends are gone in and will start screaming "there's nothing to do" over and over until she's worked herself up into hysterics. Nothing I suggest ever appeases her, even If i suggest us doing something together. So...now when she comes home like that I will say "Well you're not watching TV because I am watching something at the moment". Straight away she will shout "NO, I AM" and she will grab the remote and sit down and watch TV for half and hour before bed-time. This has become a routine for her now but it works perfectly in getting her to calm down before she goes to bed!! She thinks she has gained control so she's happy with that when really I am getting her to do what I want which is calm down!!!!

I do think distraction is the key. I have tried ignorning but as somebody on here said in another post - ignoring can be dangerous and her anxiety level just builds and builds until I answer her and can cause a huge explosion.

Reverse Psychology for the ODD difficult child - try it!! lol.

 

[SearchingForRainbows]

I think Totoro and Stella are on to something - I know from personal experience with difficult child 1, he needs to feel in control of everything and complains of boredom frequently when he is escalating.

Does difficult child 2 have something that he really enjoys doing? For example, when difficult child 1 is about to lose control, playing video games usually stops the outburst. This isn't a solution as difficult child 1 will get furious when he has to stop playing the games when he is unstable. However, on a short-term basis, as a band aid approach, if difficult child 2 enjoys computer games, maybe you could let him play them whenever he needs to if this helps him stay in control.

Another thing that might help is to remove as much pressure as you can from his life for now. Don't get after him for the small stuff. Ignore every single behavior you can. Always remain calm no matter what you're feeling inside when dealing with him. Don't expect anything from him as far as chores, etc. Let him feel like he has the upper hand as much as possible. All of these things help difficult child 1 keep it together when he is about to "lose it."

Of course things will have to change once he is properly medicated. Until then, my best advice is to ignore everything you can, praise him for anything and everything that even remotely resembles good behavior, and NEVER try to reason with him if he is escalating. If he is impossible to ignore, then respond calmly but don't disagree with his opinions on anything - Just try to remain neutral.

Please update. I know how tough it is to live with an unstable difficult child who is bipolar!!! (And, by the way, difficult child 1 doesn't have ADHD but looks like he does when he is unstable.)

I hope difficult child 2 is able to get the help he needs soon!!!

Lots of hugs to both of you... WFEN

 

[DammitJanet]

Would it help to talk to me? If so, let him call anytime.