iep and medications update

[klmno]

The psychiatric hospital has taken difficult child off zyprexa and starting him on seroquel tonight. I'm comfortable with that since many here seem to have had good luck with it. Any side effects or other info I should know about seroquel??? If this sits well on his system, he should be released from psychiatric hospital Mon, maybe Tues.

We went ahead with the iep meeting today. My ed spec/ advocate "disappearred" for some reason- I had left a couple of voice mails for him and I haven't heard from him and he didn't show up. I have no idea why. Anyway, I guess the happennings of the last week has maybe made a couple of people at the school get their heads out of the sand and realize that there is more going on than bad behavior issues. The principal seemed to "get it" and seemed on board with everything, which surprised me. The other surprise, which wasn't as nice, is that when I was explaining that conversations about rewards/punishments/consequences only serve to add more stress to difficult child and that difficult child does already know what is expected of him- that is not the problem, the case manager was "not hearing me" and insisted on keeping something in his iep or bip about having a talk to difficult child about the importance of good grades and the need for difficult child to complete and turn in all his work. I really stressed this a couple of times, along with my concern about difficult child coming back to school the middle of next week and having make-up work to do and getting this "talk". I tried to explain that engaging difficult child in problem solving was very effective about 85% of the time and it also helped him to identify problems, and let someone else know what was going on with him- this helps build trust in others, confidence in himself, and taking more responsibility, rather than stressing out more, giving up, acting impulsively, etc. The principal and teacher got these concepts. The case manager said "well, we can talk with him and negotiate things sometimes". I don't see CPS as "if you do this, I'll do this" sort of strategy- at least not the point of the strategy. I don't think this guy gets it at all and he's going to be the one working with difficult child most of the time- several times a week.

Does anyone have any suggestions? The asst principal, also a male, didn't seem to get it so well either. Is it a male thing? I'd gladly take them a copy of The Explosive Child if I thought that would help.

 

[gcvmom]

Other than a dystonic reaction, which some of these neuroleptics can cause (difficult child 2 had this happen on Zyprexa) -- that's all I would be worried about. I think you'll know within a couple of days if it's going to work or not.

That case manager sounds clueless. It's really down to the teacher and the school administration for executing the IEP, so I think as long as you have their buy-in on what difficult child needs, you can just nod your head to the CM and blow off whatever they say -- but that's just my opinion and I could be dead wrong here. Hopefully others will chime in with their wisdom. Maybe you can have a private meeting with the principal to talk about your concerns about this CM guy? Perhaps he can be an ally and get the point across better??

 

[klmno]

Thank you! I visited difficult child tonight and he said psychiatrist said he should be released Monday- that will mean he'll have 3 nights on seroquel first. Are blood draws required for seroquel? (Not that it matters much-- difficult child is on lithobid and depakote too)

Also, difficult child had complained soooo much about that ankle bracelet (from the monitor) bothering him and I thought it was the embaressment of it. Yesterday and today he has complained about the wristbands that the hospital put on him- he keeps saying he can't sstand them and they bother his skin. He never seemed to have sensory issues before- can this come with mood stabilizers?

 

[Christy]

Good luck with the serequel. I hope your difficult child is returned new and improved on Monday.

In regards to the sensory issues, I was thinking of posting a similar question. My difficult child had an occasional sensory issue when he was younger but not enough for me to think Sensory Integration Disorder (SID). He recently returned form a psychiatric hospital visit (medication change consisted of adding clonodine and trileptal, and increasing serequel slightly) with huge sensory issues. He refused to wear all but two pairs of underwear and spent an hour or more getting dressed in the morning becuase he suddendly hated anything to touch his waist. It is getting better, only happens once in awhile now but I am wondering if it was at all medicine related since he did not have these issues in th past.

 

[klmno]

That's interesting, Christy. Hopefully, some others can shed some light on this question.

I'm sitting here now thankful that I haven't signed that IEP yet. I'm thinking that the "talks about importance of grades" is not a good idea for difficult child just returning from psychiatric hospital and it's going to have to be taken out of his iep.

 

[TerryJ2]

Best of luck with-the new medications and his release in a few days.
Gosh, between the two of you, I realize that only two kids doesn't make a pattern but *I* see a very strong coincidence between the medications and the sensory issues.
Take care.

 

[LittleDudesMom]

Couple thoughts. It will take a little while for the seroquel to take effect. It made my difficult child sleep better at night, but it was a little more difficult for him to get going in the morning at first. It also increased his appetite. It was a great medication, at a low dose, for my difficult child. It seemed to lengthen his fuse a little. I'm thinking it was about two weeks before we saw the medication really kick in.

You know, I really believe that, as parents, we know our children best. My difficult child has a case manager in middle school this year. She is ok, a little too "nice" and "kinda in his face". She meets with him once a week just for a little "how's everything going difficult child?" kind of talk. His successes this year are mostly due to his fabulous 1:1 and his great teachers who are willing to "think outside the box", and his desire to make a positive impression at his new school.

Personally, I would meet with the case manager and tell him that, upon your son's return to school, he will be in an adjustment period. Not only with his coming out of the phos, but with his removel from a medication and the start of a new one. It will create more issues with difficult child if cm were to make a huge deal out of talking with difficult child about responsibility, etc. difficult child needs to make this transition without anxiety. It would be better for cm to meet with difficult child upon his return and just "let him know I'm here if you need me". Have cm offer his office as a place for difficult child to go when he is overwhelmed. Have cm begin this transition as an ally for difficult child.

No talk of consequences, the importance of school work, etc. Just a welcome back I'm here from you. Insist upon this. Tell him that difficult child is very fragile right now and you are willing to work with him regarding the make up work. Insist on a low key transition period.

It is totally understandable that part of difficult child's IEP are behavior goals. At difficult child's age, this means his awareness of these issues and his cooperation to meet those goals. So it is not out of the norm that the school would want to keep this stuff in his IEP. But, I would make sure that, at least initially, a hands off approach needs to happen. Intervention only if needed.

Any conversations with the principal or the cm should be part of the IEP notes attached to the IEP (parent input). In reality, this is all related to the IEP meeting and should be included. It is important that your recommendations become part of the record. No signing off until you know your input becomes part of that record.

Good luck,
Sharon

 

[looking4hope]

My difficult child was switched from Zyprexa to Seroquel in October. What a difference! He's much calmer, and doesn't go from calm to raging in 60 seconds flat as often. It still happens, but it has gone down from several times daily to once every week or two. What a difference!

As far as the case manager, I would hand her "Parenting a Bipolar Child" by Faeeda & Austin. It has a lot of practical advice, and is much more reader friendly than other books. There's a lot of advice for any difficult child with mood disorders. I'm sorry she's so clueless and unprofessional, after all, if a sp ed case manager doesn't understand something, they should take it upon themselves to learn about the disability so they can be effective.

 

[klmno]

Thanks everyone! difficult child said he wasn't so jittery today and he thinks it is the seroquel helping (although he has only had one dose). I guess another kid up there was telling him that he's on lithium and it made him jittery too, until he had seroquel added. difficult child said "Mom, I don't feel so alone anymore!" That made my day! He has priviledges to go out of the wing, just not off hospital grounds, so I took him pizza, wings, decaf/diet soda and we had a little "picnic" this afternoon. He still seems very emotionally fragile to me though.

I think I'll pick up that book- I'm going to the bookstore this weekend to get my mom a book, so I will look for it. I had been thinking about taking the school cm and principal a copy of The Explosive Child. Another one I liked- New Hope for Child & Adolescent Bipolar. The cm had started off this meeting saying how he used to be a counselor for ed kids and had worked at a psychiatric hospital before. I find it harder to communicate when someone believes their previous experience has made them an expert, but it is still obvious that they don't get it. It seems like they aren't very open-minded to new ideas or strategies, so what do you have to go through to get them to see that the conventional behavior management just won't work with some kids, and with some (like mine), it makes things worse?

Keep the ideas coming - I might try them all!!