Need Advice ASAP

[pwalz883]

Hi,

I am new at this so hopefully this goes ok. I have a 11 year old son who I love to pieces, but I feel like I am at my wits end with him right now. He was diagnosed as Mood Sympton Disorder not otherwise specified and ADHD. He is on Abilify as well. He has been on his medicine since December of 08. We have taken him to a Neuro psychiatric and still we just have basically a generic diagnosis with the Mood Sympton Disorder and the doctor keeps asking me is there any bi-polar in the family which I really dont know if there is or not.

We have problems at school with learning issues and the school is starting to help us with that. He lies about homework and we have to have the teacher sign his planner and they are not following through with that on their end either.

When he first started taking the Abilify we thought we were seeing some changes but then he would go back to behavior of meltdowns/outburts which consist of cursing, hitting, spitting, lieing, out right being defiant, breaking his toys, just disrupting out entire home basically. The doctor has changed his dosage 3 times now and we are right back where we were. Last night it turned into a screaming fit throwing match just because we wanted him to take a shower, somthing simple should have been easy but turned into my husband and I feeling defeated and worthless and it lasted for probably 1 hours.

We feel so helpless and like we are not getting the help that we need. Does anybody else have any advice or do you think we should try a different doctor or is the normal? Which I really hope this is NOT normal behavior. We have a 9 year old daughter and it kills me to see her go through this with us. Usually she shuts herself in her room till the blow up is over. I keep saying he is bi-polar or something more than Mood Sympton Disorder not otherwise specified

HELP!!!!

 

[JJJ]

Welcome,

You are no longer alone. We have all been there. The best suggestion I can make is to educate yourself.

The Explosive Child is the first book you should read. It will help you eliminate some of the meltdowns.

The Bipolar Child will give you a better handle on if it is bipolar or not. diagnosis doesn't matter that much unless it is hindering treatment. While I think Abilify got approved as a 'mood stabilizer', it is not a first-line choice and your son may need a first-line mood stabilizer (talk to his psychiatrist).

An IEP is another must at school. We have a Special Education section on this board. If you post a more detailed description of what is happening at school and what the school is doing to help, we can help.

Welcome,

 

[gcvmom]

First, welcome!

Now you don't say specifically so I have to ask is a psychiatrist managing his medications? If not, you should take him to a pediatric psychiatrist.

Second, don't despair about Abilify not working. There are other medications in that category that he may respond better to. And don't be alarmed if he needs more than one type of medication to manage the symptoms. Very often a mood stabilizer, typically an anti-epileptic medication like Depakote, Trileptal, Tegretol, Topomax, etc. is needed to support these kids.

With respect to the family history, if there is ANYONE on either side of the family tree, even a generation or two down the line that has or had a problem with drugs or alcohol, then you can strongly suspect bipolar or some type of mood disorder. However, it's not a requirement to have it in your family tree to develop it. Also, if someone just has depression, or anxiety or panic attacks or... whatever, that can also lend itself to someone having a predisposition for problems that look like bipolar.

Finally, he can have many of the symptoms of bipolar, but until there is a majority and it is observed repeatedly over time, they cannot definitively give him that diagnosis. In our case, my difficult child 2 has had various symptoms on and off since the first grade, but they didn't really come to a head until this past year, and this summer our psychiatrist finally checked the bipolar box on our superbill. Up until then it was Mood Disorder-not otherwise specified. We've tried dozens of different medications over the years, and it's only been in the last year that we think we've finally found the combo that works best for my son.

If you aren't satisfied with the doctor he's seeing now, take him for a second opinion. You're entitled to that at the very least. You're entitled to a third, fourth or twentieth opinion if that's what it takes to get the answers you need to help your kid.

 

[BusynMember]

I always opted for second opinions. I'm a big fan of having somebody else take a look when the treatment plan for a disorder is not working. And I do like neuropsychologist evaluations, but not all NeuroPsychs are equally as good. My son was tested for ten hours. A two hour neuropsychologist evaluation, in my opinion, would be lacking. Can you tell us about your child's early development? Any obsessions? How are his social skills with his same age peers? Can he make good eye contact with strangers? Does he know how to hold a give-and-take conversation?

I wouldn't accept one evaluation or opinion as gospel unless my child was improving greatly. Of course there are other medications to try, but I'd get a second opinion before I tried any other ones as medications can make certain disorders worse. My own son was misdiagnosed over and over again, bipolar being a big one. He doesn't have it. I have it and I had it as a kid. That's maybe why I questioned it more than some people do. But even for myself I like to hear what other professionals think before I leap.

in my opinion keep on getting opinions and see what "clicks" with you; what your gut tells you is right or wrong. Bipolar and Aspergers often seem very similar. Be careful. Good luck and welcome to the board !

 

[Wiped Out]

Just wanting to add in my welcome! Glad you found us.

 

[Christy]

For a minute there, I thought you were describing my son. Dealing with a difficult child is a constant struggle to find the right medications, therapy, school setting, etc.. You've found a great place to learn from others who are in the same boat. Medication is unfortunately a lot of trial and error and what works for one person does not for another. Have you tried any other medications? Additional testing such as a neuropsychologist evaluation completed by a team of specialists at a hospital and educational and psychological testing done by the school system may help you to better understand your difficult child and shed some light on finding the best treatment. Also, the books recommended by JJJ are a great place to start educating yourself about your child's condition and how best to parent him.

Good luck and welcome,
Christy

 

[rlsnights]

Welcome to CD. I'm a newbie here myself although not a newbie when it comes to difficult child's.

No it is unlikely that what you are describing is normal. Sounds very similar to what we experienced when our difficult child 2 was 11.

At this point our son has a Mood Disorder not otherwise specified diagnosis too. This is because his symptoms do not fit neatly into any one diagnostic category. There's nothing wrong or right about a given label. In our experience the main reason for having an "accurate" diagnosis (accurate in the sense that the description that goes with that label actually fits your child's symptoms well) is that it serves as short hand for doctors and insurance companies and other professionals and that it may (only may) suggest an appropriate treatment approach that often works for people with that same set of symptoms.

You've been given some suggestions for books to read. They're good suggestions.

Practical ideas you can put into practice immediately that may help and that we have found helpful include:

1) Provide as much predictable structure to the day as possible. Set times for bed, rising, meals, play time are all helpful.

2) Practice Low Expressed Emotion in your home if you're not already doing so. That means avoiding words or actions that could be perceived as critical or hostile; educate yourselves as much as you can on mental illness in children; this will help you feel more sympathetic and less angry/blaming when he loses control; understand that your difficult child may not have much control over this behavior and it may be as distressing to him as it is to you; do not blame yourselves or him - try to step outside that trap and just focus on finding what works to help him stay in control or to contain him with compassion when he loses it.

3) If you're not doing so already, keep a daily record of his moods and problem behaviors. This may help clarify whether there is a rhythm to his behaviors that may give you some insight and tools to reduce the blow ups. For tips on doing this you might want to check http://www.gcbf.org/resources/moodcharts.html for help figuring out what to chart.

4) Try not to let your son get really hungry or thirsty, really tired, really hot, really cold - avoid physical stress that might make it harder for him to stay in control of his emotions.

5) Avoid over-stimulation and environmental stress - too many friends over for too long, loud noisy places, too long in the sun, a long time riding in the car, too long a school day, limiting the kind and number of shifts you and others expect of him in a short period of time if he is inflexible and has trouble changing from one activity to another, expressing anger in his presence, even if it's not directed at him, can be triggering.

6) If there's a particular time of day that he usually blows up try to figure out if there's something about that time of day that may be triggering his blow up and try changing the routine or the circumstances in some way - have dinner earlier or make sure he has play time before doing homework or keep him company in a quiet, compassionate way that doesn't force him to pay attention to you if he doesn't want to but that does let him know he's not alone and you're available to talk or play or just be with him.

7) You may want to try some non-verbal things to help him release tension when you see him getting started; we have found that our son can reduce his tension and sometimes really calm down by working his large joints - shoulders and hips. At the first sign of trouble we suggest tug-of-war, wall push ups or jump rope, sometimes all it takes is a big tight hug that squishes his shoulders. Some kids like to be tightly wrapped in a sheet or blanket and then heavy pressure applied to their bodies. Our son also finds having his back scratched hard helps him feel a lot better. You'll have to experiment and find what (if anything) works for your son.

8) Pinch hit with your spouse - when one of you is getting really angry, trade off and let the other (hopefully calm) spouse deal with things for a while.

9) Know that this is a process and life will almost certainly get better once you (and your son) get a clearer understanding of what triggers him and what helps him calm himself and then learn to do those things at the first signs of trouble.

10) Seek a second opinion from a skilled and experienced child psychiatrist if possible. If you live in a large urban area you should have several to choose from; if you live in a rural area you may have none without traveling a long way. If it's an option, consider seeking a consultation from a reputable university-affiliated child psychiatric/neuro-psychiatric program that specializes in diagnosing and treating child-onset mental illness like Stanford.

11) Take care of yourself - eat well, get a full night's sleep when possible, get some exercise to reduce stress, - and simplify your life especially focusing on eliminating activities in the evenings that may be stressful to your son like watching TV until bedtime (try reading to him or bubble baths instead), sports teams like soccer if doing them disrupts the daily routine by delaying dinner or bedtime, going out to eat etc.

12) Accept that for right now your son may need as much undivided attention as you and your spouse can give him. That means you may not get to read the paper in the morning or spend time on the computer in the afternoon and evening. It may mean that you (or your spouse) give up some activities like social groups or golf so that your spouse isn't left alone with both kids. These are likely to be temporary measures but can be very helpful.

13) Try to find a way to get regular respite from your child. If there is another family that you can trade short playdates with - do it. Your child is likely to be a perfect angel at their house. Swap boys and girls - have their daughter over while your son goes to their house and vice versa. Ask an aunt, uncle or other trustworthy adult who's good with kids and whom your child knows and likes to give your child some one-on-one time. You might explain that difficult child is going through a rough patch (if you haven't told them what's been happening) and could really use some extra attention right now. Or you can tell them honestly what's going on and ask for their help in this way. If possible make this a regularly scheduled event - every Sunday afternoon, Uncle X will spend 2 hours with difficult child at the park or going to a movie - whatever. Don't use too much of your respite time talking about your difficult child - use it to relax, do something fun you like to do, spend time with your daughter one-on-one.

14) Follow through with the school and ask for a full Special Education evaluation. See the Special Education section of the board for advice on that subject. School may have become a major source of stress and making some changes there may have a huge impact on his behavior outside of school.

Many hugs - glad you found your way here.

 

[pwalz883]

Ok I double checked today and made sure that his DR is a pediatric psychatrist. Today was a VERY bad day today. I am just SO frustrated and I feel like a failure sometimes especially when I let my emotions get control over me. I will start with some of the advice that I have been given and appreciate all the support. The school will not test him for an IEP due to they are still going off of the neuro psychiatric report which by the way says to have an IEP done for him but they just wont do it right now. He is falling asleep in class and today he blew up because I asked him to do homework before he went outside to play and boy was that a mistake it was a BIG blowup. It seems that everything I tell him to do he says no and then I try to reinforce and be the parent and I pay for it for the next hour of being called names, yelled at and screamed at. I feel like someone runs me over with a bulldozer most days. I have a call into his doctor right now to see about differents medications. Please pray for me and my family.

 

[cfa3]

pwalz883 - I know how you feel. Our son is super high maintenance, very explosive, can be aggressive etc. We dont know if he has bipolar or not but whatever he has it is major. Anyhow, that is some excellent advice above from RLSNIGHTS! I would say that you need to buy The Explosive Child by Ross Greene ASAP. I dont usually talk that way as I think different things work different poeple, but I dont know anyone with kids like ours that books hasnt helped. It may not address all your child's issues etc, but what that book does so well is teach you how to respond to your child so as to prevent the dreaded explosions and outbursts. It literally teaches you a dialogue to use with your child. I know it has helped us. Its only one facet of the story of course and I kind of feel like the book makes it out like it is the cure all, but that one facet is so important and those explosions really can be decreased by talking to your child a very particular way. Good luck! The book is not a hard read, I recommend it!

 

[rlsnights]

The school must either conduct a full Special Education evaluation or tell you in writing why they do not suspect a disability within 30 days of your written request for an evaluation.

If you have only asked for an evaluation informally (i.e. verbally) it is time to do it in writing to the head of Special Education with copies to the principal of your son's school.

Under IDEA 2004 they are legally required to initiate an evaluation or tell you their reasons for not proceeding. Clearly they have every reason to suspect a disability. They are giving you the run around if they told you they "won't" do it right now.

You have to pick your battles. If pushing him to do homework when he first comes home = explosion, perhaps it would be better to give him a snack, give him a set time to play and then start homework. Also, I would only ask him to sit and work for 15 minutes at a time. Use a timer and set it for 15 minutes (or less to begin with if 15 minutes is too much) so he will know on his own when the time is up.

If possible sit at the table with him and do book work of your own. Keep him company without being intrusive.

Also, if his sister needs much help with homework I would set it up so they are not doing homework at the same time.

That's good that you're working with a pediatrician psychiatrist but that doesn't necessarily mean he/she is a good psychiatrist or making the right treatment recommendations. If he/she doesn't want to make any medication changes or only wants to keep increasing the current medication I would be very blunt and ask for the doctor's reasoning and what his/her plan is - what's the next step, what would trigger a change in medications, etc. With this information you can be a better judge of whether you agree with the psychiatrist and you will also be in a better position to know under what circumstances the psychiatrist needs to hear from you or would make medication changes.

You're not a failure. You are facing a tough situation for which you could not have prepared. You are doing the best you can. When you lose it (as we ALL have done) do your best to pull back and get calm again ASAP. If you have to take a time out yourself and can do so safely, then do it. Lock yourself in the bathroom and wash your face, go outside and focus completely on your surroundings - a flower or leaf or the clouds - anything to help yourself calm down and take a step back. Try your best to see his behavior as a symptom not a personal attack.

With our son, NO in reaction to requests usually means that he is anxious about something. He is often anxious that he isn't going to get to play. Play is a BIG stress reducer for our son - partly because it's a physical release of his tension. Water is also a great stress reducer for him - even washing the dishes helps him calm down. Taking a shower, having a bubble bath - if your difficult child's a water kid then try that when he's starting to simmer.

If you can tell that he's going to blow on you before you even make a request like "do your homework" I would switch plans mid-stream. There is no homework god that will throw lightning bolts if your son doesn't do his homework right away - or even at all. in my humble opinion you want to focus on helping him to stay calm and in control. This is WAY more important than doing his homework in my book.

Why?

1. Every time he melts down it almost certainly increases the likelihood that he will have another one. It is creating a path in his brain that gets triggered more and more easily when a given combination of events occurs, in this case, he has been in school all day doing his best to hold it together, he wants and needs to go play, you are telling him he has to keep holding it together even though school is over, and you are telling him he doesn't get to go play. For him it doesn't matter that he will get to play in 20 or 30 minutes. That is a lifetime to him. For us, reducing the frequency and intensity of the melt downs helped immensely more than fighting the melt downs after they happened.

2. You do not want to reinforce the power struggle between you and your child if at all possible. That's why you pick your battles. Save your "I'm the parent and you will do what I tell you" mode for times when there really is no other way to get the result you want and the issue is VERY important - for example not playing with fire. Even then, it is often possible to get the result you want without engaging in a power struggle. You must be a detective and figure out what works with your child best. Is it a snack? A back rub? The ability to choose when he does his homework (now or 30 minutes from now?) within a time frame you set up - you get the idea.

 

[hearts and roses]

Just sending lots and lots of hugs. Come and post here any and every time you feel overwhelmed and beaten up. You need support and you will get it here for sure.

Not only would I look at his medications and tweak them a bit, but reading the Explosive Child will help you a lot. To understand, choose your battles, manipulate situations and perhaps change your daily routines a little. All of those things help more than you realize. Something simple like eliminating tv or other stimulation made a huge difference in our home when my girls were younger. Even now! Regular bedtimes, routines, meals, etc. And having full cooperation with any other adults in the home makes a huge difference as well.

Anyway, just mostly wanted to offer a big welcome and send some hugs your way. So many of us could have written your post. You are definitely not alone, sweetie.