just when i thought things couln't get worse

Discussion in 'General Parenting' started by dirtmama, May 3, 2010.

  1. dirtmama

    dirtmama New Member

    per new psychiatrist, we have switched from abilify to risperdal. and went with-out concerta yesterday and this morning.(not pretty) i was thinking his abusive/manic/aggressive behavior maybe rebound. but after the morning of not being able to send difficult child to school. sending brother to grampa's house for the day(for his own saftey). he's been touching me in a sexually inappropraite way, my butt and breasts and licking me/ throwing things all over the house...etc the doctor suggested this morning to put him back on the concerta...but i thought i could make it through the day (if these are symptoms of with-drawl) i figured we were 1/2 way through what she said 24-48 hrs rebound. but i can't do it. i gave him the concerta (even though i think it's evil//part of the problem) cuz i just can't do it.:sad-very: gotta go!
     
  2. Jody

    Jody Active Member

    Gosh, I am so sorry. i wish you weren't going through this. I cannot imagine how you feel, I hope he starts acting better so you can get a break from it. Many, many hugs.
     
  3. susiestar

    susiestar Roll With It

    i am sorry the day is so rough. It really sounds like it is time to ask the doctor about inpatient help. Having to send his brother away to keep him safe is a red flag that he NEEDS more help than you can provide. It does NOT mean you are a bad parent, it just means that his needs are so great that he needs more than ANY family home can provide.

    The sexually inappropriate behavior is often a sign of bipolar. Have you read The Bipolar Child by Papalous? It may be very helpful for you. If he is bipolar then he NEEDS a first line mood stabilizer, like lamictal or lithium or depakote. He may even need two mood stabilizers, and an antipsychotic to deal with the anger and aggression. I am pretty sure abilify is NOT a first line MS, and concerta may very well be sending him into more mood cycling.

    You probably should ask your doctor about mood stabilizers for this. I am so sorry the day is so hard!
     
  4. dirtmama

    dirtmama New Member

    thank you and i agree. i just couln't handle him anymore. he eventually tried to (treatened to) stab me with- a pen. the concerta helped and i went to get his brother this afternoon. could a stimulant help (some) a person with- bipolar? i see his symptoms show through....but at least he's a little more safe. i think the psychiatrist may recommend a different stimulant like vyvance(sp?) and i'm so leary.we go back to dr on wed. i really know what she's gonna do. i'm absolutley terrified and exhausted and sad.

    i thought stims make bipolar people more aggressive? or does it just depend on the person?
     
  5. dirtmama

    dirtmama New Member

    he just chucked a rock at my 5 y/o and now he has a big welt on his back. easy child said difficult child is gone to the dark side(star wars). we said a prayer together (i'm not religous) and it made me cry. we will bring him back to the light side some how.:sad-very:
     
  6. smallworld

    smallworld Moderator

    You might want to take a look at the Treatment Guidelines on the Child and Adolescent Bipolar Foundation website at this link:

    http://www.thebalancedmind.org/sites/default/files/treatment_guidelines.pdf

    In general, kids with BiPolar (BP) need a first-line mood stabilizer (Lithium, Depakote, Lamictal, Trileptal, Tegretol) plus an atypical antipsychotic like Risperdal to achieve stability. Stimulants like Concerta and Vyvanse tend to destablize kids with BiPolar (BP).

    How much Risperdal is he taking? Is it broken down into morning and evening doses?
     
  7. klmno

    klmno Active Member

    Ewww....what a rough thing to deal with. Keep in mind- abilify might work very well for some, but some kids have exploded on it. My son and one other boy I heard about both pulled knives on their mother within days of trialing it- coincidental or not- it just seeems like some even cross bigger lines on this medication.
     
  8. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I would not personally put a violent kid on a stimulant of any kind. I agree he could use a first line mood stablizer. Has he ever had a neuropsychologist assessment?

    Sorry things are so tough now.
     
  9. Marguerite

    Marguerite Active Member

    We had really bad problems when we put difficult child 3 on Strattera - it really was Jekyll & Hyde. I can understand the comment about "the Dark Side".

    However, difficult child 3 is brilliant on dexamphetamine. So are the other two difficult children. We did try Ritalin, it was good for difficult child 1 for some time, but then we began to have rebound problems as he got older and the dose got bigger. When we were given the option of Concerta, difficult child 1 refused it, remembering his rebound problems. So he has stayed on the privately compounded dexamphetamine we have.

    difficult child 3 had never had Ritalin, he was put straight onto Concerta. We thought it seemed to be working byut not so well - turned out the dose was too low. But we had begun to notice some rebound, even on Concerta (we'd been told rebound would be less or even nonexistent on Concerta).
    One weekend we had gone away to visit family, and difficult child 3 forgot to bring his Concerta. Luckily I had spare (old) dex medications in my bag, and I rationed them out over the weekend; despite the lower than usual dose, he was coping so much better, behaviour was much better all round.

    So for us - no more Concerta, it causes rebound for us and also he needs a stronger dose than the doctor gave him. No more Strattera - three days and he was almost psychotic. Certainly he was behaving irrationally and attacked me physically.

    We did try Risperdal - it seemed to smooth things out for both boys, but difficult child 1 couldn't tolerate much, it sedated him. He also doubled his weight (lost it again when he came off it). difficult child 3 didn't seem to gain the huge weight on Risperdal, but it didn't seem to make enough difference to justify the huge expense, so we dropped it.

    Every kid is different - you just don't know how your child will be.

    It IS possible your child is not bipolar but just suffering problems from the medications. But keep notes on everything, keep good records and use these to help doctors understand what happens.

    Marg
     
  10. dirtmama

    dirtmama New Member

    thank you all for the input, i really value your thoughts. we've been slowly increaseing the risperdal up to 1.5 mg 2xday. but today i had to back down to 1mg 2x to make the script last until tomarrow psychiatrist apt. we didn't really notice any improvement with- the risp. i hope i don't get a call from school 2day. i could tell he wasn't quite right still this morning. (beyond his regular unpredictable self) . i hope the psychiatrist has some kind of plan on wed. i am so scarred for my baby. and easy child is going through :censored2:. he hasn't had a neuropsychologist evaluation as of yet. (therapist is helping us push for it) we are seeing this new child psychiatrist for the 2nd time (wed). another 2hr session. i am a nervous wreck.
     
  11. Marguerite

    Marguerite Active Member

    Dirtmama, the more you describe this lad of yours, the more it sounds like a mix of my boys. Very much a classic Pervasive Developmental Disorder (PDD). I'm not saying it could only be Pervasive Developmental Disorder (PDD), but that in my opinion, it all could possibly fit under the Pervasive Developmental Disorder (PDD) umbrella.

    medications won't necessarily fix it. The best medications can do, is help. Maybe. And hey, we take whatever help we can get. But the child has to learn to adapt with what's left.

    Also, the child needs to adapt, but often can't manage it if his brain simply isn't ready yet.
    For example, difficult child 3 had an English teacher in Year 9 who was very demanding. A very nice lady, a bit hyperactive herself I suspect, but convinced that difficult child 3 COULD do the work because his vocabulary is so advanced (ironic, considering his early language delay had difficult child 3 diagnosed as retarded). But in fact, the problems autism brings to Theory of Mind meant that difficult child 3 could NOT do the work at the level his teacher demanded. We lost a lot of opportunities with other subjects, while difficult child 3 bent over backwards to please his English teacher and neglected his other subjects. He still could not please his English teacher. Despite requests to simplify the questions, make them less open-ended, he was expected to handle questions like, "In the text, what does Jim think Bob believes was really going on?"
    A classic Theory of Mind problem; difficult child 3 could handle it, JUST, if I helped explain it. But then he would 'lose' it again. It's really bad when your kid puts in all the work, tediously, then can't understand what he has written. Learning outcome - zero.

    So we made a decision - give difficult child 3 a year off English. And now here we are after that break, and with a different (and more supportive) English teacher. We still cross paths with the previous English teacher (who is now the head of the English department) and she really does care about difficult child 3; but she doesn't understand him.
    And now difficult child 3 is handling the work a bit better. Still a lot of room for improvement, though.

    Basically - by giving difficult child 3 a year off, we gave his brain another year to hopefully mature a bit more, hopefully enough to help him get through.

    Now difficult child 3, as a toddler, was remarkable. Non-verbal but clearly gifted. He was learning to talk by learning to read (I found out later, it's called hyperlexia). We followed his abilities and used them to help his deficit areas as much as we could, so when he showed capability with reading, we taught him the words he needed most - STOP, GO, EXIT, DOOR, CAR, TRUCK, TRAIN. At the same time he showed ability in use of computer, so we found an old computer in the trash, literally, and set it up for him. We figured it was already trash, what damage could this kid do? And using that computer, difficult child 3 learnt even more.
    Then we noticed his ability with music - he was teaching himself to play tunes on the piano, so I showed him music notation. As a toddler.

    So as a toddler, difficult child 3 could pick up a text and read it aloud. He didn't know what it meant and would read aloud words he could not speak. He barely knew his own name. But he could also read numbers, count into three digit numbers (forwards and backwards with equal ease) and read sheet music to play piano. He could reprogram anything electronic (and then put it back how it was). But when given his first IQ test a couple of years later, he failed it because they asked the questions verbally, and his verbal understanding was still very limited.

    Medication won't fix this. But starting him on stimulant medications (at age 3) gave his language acquisition a huge boost - he was finally able to pay attention long enough to recognise the purpose of the spoken word in communication.

    difficult child 3 will always be autistic. But he is adapting so well (as his older brother has done) that a lot of people meeting him casually do not realise he has autism. difficult child 3 called this (when he was 8) "pretending to be normal." Like his brother, he values his autism for the talents it has given him, the special abilities he values in himself. Yes, there are also problems, but not from his point of view.

    He's hard work, but eventually it does pay off. It just takes a lot longer and you still get surprised by the deficits when you thought they were no longer an issue.

    Marg
     
  12. TerryJ2

    TerryJ2 Well-Known Member

    Wow, that's amazing! I am so sorry. I can hardly imagine what you're going through.
    I know the feeling of wanting to put him back on concerta--not much of a choice!
    Best of luck. Let us know what happens, and how much of it he remembers.
    {{hugs}}
     
  13. dirtmama

    dirtmama New Member

    i will definetley mention Pervasive Developmental Disorder (PDD) to the dr. as i've been meaning to. we saw her yesterday and did the "history" session. she was surprised that 3 mg risperdal had no effect and upped it to 2mgx2 for the final harrah...to say we gave it a full chance. also weaning from the concerta this time, which we should have done before i guess. i'm nervous, i don't want a replay of last weekend. i know easy child can't take it. (but i do have a plan thankyou gramma) hope i don't get a call from school as we knocked down concerta from 54 to 36. i guess we'll see. oh , she said that she wants to be sure before dxing but it's looking like if it's not severe adhd then it's bipolar ...just depends on how he reacts to the medications. she also mentioned intuniv...sounds like a logical alt in the future. i won't let her overlook possible Pervasive Developmental Disorder (PDD), though. oh any advice on containing an out of control and violent difficult child (he's only 54 lbs). i can certainly take him but have a hard time keeping him in his room for a 5 min breather, he won't stay in there at all when he's like that...with- his doorknob and lock broken. any suggestions???? husband is talking about working on sat...:faint:
     
  14. dirtmama

    dirtmama New Member

    also, she ordered an sleep deprived eeg
     
  15. Marguerite

    Marguerite Active Member

    That does not necessarily follow.

    I've always believed, and I saw a doctor on TV say this today (again) - if ADHD medications work on your child to help him focus, then it's almost certainly ADHD (or has an ADHD component). If the medications don't work, it reduces the chances of it being ADHD.

    medications have a paradoxic effect on kids with ADHD - they work! Give these medications to you or I, they pep us up. Give them to a kid with ADHD, they steady them.

    I'm really concerned at the weaning off of Concerta, but still expecting things to not go pear-shaped at school. The fact that things ARE likely to go pear-shaped with the reduced Concerta, is a big red flag for me, that stimulant medications are needed therefore ADHD should still be on the table.

    Doesn't mean it's the only thing, though. Remember, my kids have ADHD plus the Pervasive Developmental Disorder (PDD).

    Marg
     
  16. dirtmama

    dirtmama New Member

    marg, i mis-paraphrased her words---sorry. she (psychiatrist) also said that adhd may indeed still be in the mix...i believe so. the stims do have some positive effect. (54mg for a 50lb boy helps him a bit with- focus @ school but doen't keep him in his seat)
    but even with- the weaning he's going ballistic when they wear off. (manic-like symptoms) so i guess we are at least ruleing out if its a bad rebound?? the risperidal is doing absolutly nothing even at 2mgx2, except he falls asleep as soon as his head hits the pillow. if an adult behaved in the manner he is...they would certainly be hospitalized. oh one other thing, this manic-like behavior has come on gradually since the beginning of the school year. time to batten down the hatches for this weekend...ugh. difficult child has therapist apt 2night @ 5...he should be in rare form for that. at least therapist will get to see what we are dealing with-. i am afraid of misdiagnosis though marg--i see the aspie characteristics clearly but that is while he is fairly tame--it's like part of his eccentric personality. honestly i haven't seen that boy in at least a month and boy do i miss him. i am not doubting you in any way. i think it's a piece of this puzzle. i know you have alot of experience with- all of this and i always look forward to reading your posts. you seem very wise.
     
  17. Marguerite

    Marguerite Active Member

    Sorry, but you don't 'wean off' medication that basically works on a daily basis. If it works, it works. If it doesn't, it doesn't. If you cut back below the therapeutic dose, it doesn't work so well or doesn't work at all. If you're worried about addiction or decide it doesn't work, or choose to discontinue it - you just stop it.

    I don't get the doctor's requirement to 'wean it off'.

    So of course he's going to go ballistic - if the medications were helping hold him together and keep his impulse control happening, then cutting back on the medications will be not good. It really is like a diabetic being denied insulin - symptoms previously controlled will return with problems just as severe as before. The child cannot control his behaviour as well, without medications. And if he is accustomed to the medications helping him, then even weaning off will be confusing him and causing behavioural problems.

    Depending on the severity of the problems, I would be keeping him home so the school doesn't suffer, and so he doesn't get punished by the school for his inability to control himself.

    I would also be getting another opinion, because a doctor who thinks like this I don't feel really understands ADHD or the way the medications work, and that is a big worry.

    I normally won't be so blunt in expressing my concerns, but I've seen a lot of damage done by people who still have a lot to learn, and for so much of it, we've already been there and learned these same lessons the hard way. I hate to see kids damaged, even short-term, because either a doctor or a school doesn't understand that under these circumstances, the kid really can't help it - and the kid feels like a failure, a loser and dangerous. They are scared of themselves and their own out of control tempers.

    Marg
     
  18. dirtmama

    dirtmama New Member

    difficult child has been moody, up and down like a roller coaster. from tears to hysterical laughing in seconds flat, at times even during the day. then there is the beyond silly//agressiveness//hysterical behavoir in the am and at night. last sat we took him off the concerta completley and it wasn't "hyper" it was mean..abusive to brother and me. also swearing and the laughing, not "happy" laughing. i had to send little brother some place safe. i gave up when difficult child was touching me innapropriatly and licking my chest. and was uncontainable..violent and manipluating. i understand that it can be a shock to his system to go off the stims. but this is not my hyper, hard to handle ahhd kid i started with-. honestly the adhd symptoms are the least of my worries at this point. besides all this he does still have major impulse control issues on 54 mg. he has no friends at school (bless his sweet lttle heart:() and steals everything not nailed down; goes into neighbors house (my sister in law thank god) when she's not home and steals things, steals at school, ski areas and stores. i wouldn't say concerta is effective for his impulse control. it helps him focus and calms him down a bit thats the extent of it.
     
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