Question for Parents of ODC Kids

Discussion in 'General Parenting' started by Bunny, Nov 21, 2010.

  1. Bunny

    Bunny Guest

    Good morning! I was wondering if I could pick your brains, please. My difficult child, who is 11, was diagnosed over the summer with general anxiety disorder and ODD. I had him seem by a psychiatrist about two years ago and he said that he thought difficult child had Obsessive Compulsive Disorder (OCD). At the time I thought he was too young for medications, but something about the Obsessive Compulsive Disorder (OCD) diagnoses nagged at me, plus I really did not like that doctor. Anyway, the new psychiatrist that we started seeing over the summer said the he really saw nothing in difficult child that would point him to an Obsessive Compulsive Disorder (OCD) diagnoses and he gave difficult child Celexa to help with the anxiety. We were hoping that if we could get the anxiety under control the ODD behaviors would be controlled as well.

    Fast forward to now. This week we've had two MAJOR meltdowns where he lost privledges. Both time he said that if we didn't give them back to him RIGHT NOW he would kill himself. difficult child has a history of saying the worst things he can think of while he's in the middle of a tantrum, and husband and I chalked it up tp that. The therapist, agreed with me, but I am going to call the psychiatrist on Monday (he's been on vacation for the last two weeks) because these threats are something new.

    husband wants him off the Celexa completely. difficult child thinks that the dose is too high. I think that in some ways the Celexa has helped, but that it's not the only piece to the puzzle here. I'm beginning to wonder if he needs to be medicated as if he has Obsessive Compulsive Disorder (OCD). Alot of his tantrums occur when things don't go the way he had it mapped out in his head. He wants things to go his way and if they don't, watch out! It's going to be a long day! He is extemely rigid and it's very hard to him to change once something is done a certain way. You can never do it a different way because that was not how it was done the first time.

    My question is: what medications do kids who have Obsessive Compulsive Disorder (OCD) generally take? Are they anti-depressants? How effective are they? Is there anything out there that can help with the anger that he feels when he does not get his way?

    psychiatrist thinks that this might be a behavioral thing with difficult child, but the therapist and I are really beginning to think that this is not correct. I'm so confused. Any advice would be appreciated.

    Pam
     
  2. HaoZi

    HaoZi Guest

    Not sure on the Obsessive Compulsive Disorder (OCD), but I will tell you my kiddo reacted BADLY to Celexa, i.e. more and worse meltdowns, extreme violence, suicidal thoughts to self-injuring behavior. Upping the dosage made it WORSE. They switched her to Risperdal and the days between the two medications she was doing better. The risperdal kicked in and she then escalated to the point where she ended up in the psychiatric hospital for a week.
     
  3. Josie

    Josie Active Member

    Kids with Obsessive Compulsive Disorder (OCD) take SSRI's or Anafranil to help. Celexa is an SSRI, but I don't think it is usually one of the first ones used for Obsessive Compulsive Disorder (OCD).

    When we did our trial of SSRI's for my daughter's Obsessive Compulsive Disorder (OCD), we started with Zoloft, then Luvox, then Paxil, then Anafranil. She had already tried Prozac and Lexapro before for anxiety. Some of those medications seemed to help her Obsessive Compulsive Disorder (OCD), but we thought she was having side effects to them and had to try a different one.

    I think it would be worth trying other SSRI's for your son.
     
  4. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    If your child says he feels bad on it, believe him. Whether you feel they are helping him or not, he is feeling worse on them and that will add to meltdowns. I've been on many medications that plain out made me feel worse. Being an adult, I just discontinued until I found medications that not only worked, but didn't give me horrible side effects.

    Having said that, any child diagnosed with anxiety and Obsessive Compulsive Disorder (OCD) in my opinion should see a neuropsychologist for possible autistic spectrum disorder, high functioning, since those two symptoms are HUGE with kids on the spectrum. Autism Spectrum Disorders (ASD) kids need everything to always be the same way or t hey lose it...it is not ODD or disobedience, although it looks like that. How was his early development? And how does he relate now to his SAME AGE peers? Does he not understand how to hold a give and talk conversation on a wide variety of topics? Does he obsess over a few narrow topics and bore everyone? Is his speech like a Little Professor with big words? Or was he speech delayed? Any sensitivites to loud noise, food or material textures, big crowds, new people (shyness), change of routine? Can he transition well from one activity to another or does that cause a meltdown?

    I would look beyond Obsessive Compulsive Disorder (OCD)/anxiety. Sounds too vague. JMO. Take care :)
     
  5. smallworld

    smallworld Moderator

    Only four medications are FDA-approved for the treatment of Obsessive Compulsive Disorder (OCD) in children: Anafranil, Prozac, Zoloft and Luvox. However, other SSRI antidressants (like Celexa) are sometimes prescribed for Obsessive Compulsive Disorder (OCD) if the psychiatrist feels it might work. The interesting thing about Obsessive Compulsive Disorder (OCD) is that it is an intense anxiety disorder that typically needs to be treated with higher doses than a generalized anxiety disorder would require.

    On the flip side, there are many children who respond poorly to SSRI antidepressants (including all three of mine). So you do need to be aware of that possibility.
     
  6. Bunny

    Bunny Guest

    He was evaluated by a neuropsychologist and he said he is defaintely not on the spectrum. I specifically questioned that. He was a very early speaker and can talk about almost anything, both with adults and kids his own age. He's a fantastic eater and is very willing to try all kinds of new foods, regardless of how they look oe their texture. Food is really one of the few things that is NOT a problem in my house. As for big crowds, in the beginning he gets shy, but once he warms up, he's great. Moving from activity to activity sometimes causes issues, but that has gotten better as he has gotten older. For the most part his meltdowns are basically about him not getting is way, or things not going the way he has them mapped out in his head.

    Thanks for all of your input. LAst night husband gave him half of the dose of medications. Like I said, my first call tomorrow will be to the psychiatrist.

    Pam
     
  7. Josie

    Josie Active Member

    In case you don't already know this, Celexa needs to be tapered off. Be aware that there can be symptoms from withdrawal.

    My daughter tapered off Lexapro (a next generation Celexa) and had withdrawal symptoms later and longer than her psychiatrist predicted. We went slower than he suggested but still did it. She's been off medications for years so I am sure, in her case, it was withdrawal and not her needing the medication. We made a significant change in her diet and I was pretty sure she wouldn't need it anymore, so I am not suggesting that other people ignore their psychiatrist, by any means. Just know that there can be effects from stopping it.

    When she was taking it, if we forgot to give her a dose, her behaviour was scary. Worse than anything before or since.
     
  8. Allan-Matlem

    Allan-Matlem Active Member

    Hi,

    I believe that medications need to be constantly monitored , but we must not forget to look at what happened , the ' transactional nature of the scenario - a kid who lacks the skills to act appropriately when the demands placed on those skills outstrip them. Punishment , consequences, withdrawing priveleges just set up kids for more failure. Kids do well if they can - they would prefer to do well than fail. What was the problem that set up the behavior , what were the kid's concerns , your concerns , what are the missing skills

    Allan
     
  9. smallworld

    smallworld Moderator

    I agree with Hope on weaning medications gradually. My daughter has serious withdrawal effects from weaning from another SSRI. It was as if she had the flu for two weeks (headache, nausea, dizziness, fatigue). Just be aware that it can and does happen.
     
  10. HaoZi

    HaoZi Guest

    Coming off the Celexa kiddo was advised that nibbling something like crackers would help the withdrawal (it did).
     
  11. Marguerite

    Marguerite Active Member

    Regarding treatment of Obsessive Compulsive Disorder (OCD) - with our kids, the doctor said that treating for anxiety should hopefully reduce the Obsessive Compulsive Disorder (OCD) which our kids were using as a strategy to cope with their anxiety. In other words - if you're feeling anxious, you take refuge in sameness, predictability and repeating little rituals.

    difficult child 1 was the first - he was put on Zoloft. At about the same time difficult child 3 was started on Zoloft (at age 5) and had a bad reaction; he didn't sleep. it did help him on Day 1, but the cumulative lack of sleep over the next few days was horrible in its effects on him. Other antidepressants were tried with difficult child 3 - Luvox (allergic reaction) and one other which also made him hyperactive. Strattera was horrible - he became aggressive, violent even, verbally not making a lot of sense but merely repeating the same thing over and over (not echolalia; more like he couldn't let certain ideas go) and we immediately stopped the Strattera. It had only been a few days. It took a few more days for these problems to ease off, but even by next morning, he was 'sane' again, enough for us to talk about it.

    difficult child 3 stayed off antidepressants for the next five years and only a few months ago was put on an antidepressant that finally seems to be helping without causing problems.Only a few months before that, maybe six months ago, easy child 2/difficult child 2 was finally put on antidepressants to help her deal with anxiety and Obsessive Compulsive Disorder (OCD).

    difficult child 1 has at times tried to wean off his Zoloft, believing he didn't need it any more. But his Obsessive Compulsive Disorder (OCD) began to become a problem again - when ready to go out, if he was ready early he would use up the remaining time walking around the house checking to see if he had his wallet, his kets and had locked all the doors and windows. Having checked this, he would walk around the house again checking to see he had his wallet, his keys and had locked doors and windows... over and over until he finally left. And he would then worry the whole time he was away, that he had forgotten something or left something unlocked.

    Our kids have decided it's not called Obsessive Compulsive Disorder (OCD). Instead it's called CDO, because that way all the letters are in their correct alphabetical order!

    Marg
     
  12. susiestar

    susiestar Roll With It

    I would ask to try another SSRI, pref on that is approved for Obsessive Compulsive Disorder (OCD) treatment. IF your child is NOT tapering off of celexa while onto another SSRI medication, there most likely WILL be withdrawal feelings that are HORRIBLE at the worse, bad at the best. You should google celexa withdrawal to see what to expect (don't mention it to difficult child or suggest that he google it because they can talk themselves into it). There is a way to help with the withdrawal. One small dose of prozac every week or so, for about a month, will help combat the withdrawal. Prozac stays in the body longer than any other SSRI medication. So it will give the body just enough to handle the worst of the withdrawal with-o his body developing a need for the prozac. I know how strange this sounds, but I have used this four times in the last decade and it has made a HUGE difference each time. It also helped my oldest two times when we tried to take him off antidepressants totally to see where he was with-o them. WHile this helped Wiz with the withdrawal, we learned he will likely need antidepressants for life, probably more than one, to keep from becoming suicidal. it is who he is.

    Obsessive Compulsive Disorder (OCD) treatment WILL require higher levels of medications than other conditions. I used to know why but cannot remember right now. It is something in how their brains work. Lower levels did very very little to help with the obsessions, but at the higher doses it was quite amazing.

    What kind of evaluations/testing did your neuropsychologist do? It IS possible for a neuropsychologist to look at testing and see no autistic spectrum disorder when another neuropsychologist would see one, or for them to see different types of Autism Spectrum Disorders (ASD). It is NOT an exact science and OFTEN what shows up is partially a function of the age and mood of the child. It is incredibly common for our kids to go through many YEARS of different diagnosis's based on many different types of docs, testings, and evaluation before the one that is the best fit is found. We do NOT mean to upset you by saying that your son sounds very much like someone with asperger's. He just does, to us. Of course we don't see the entire situation, or see his test answers and results. We also do not live iwth him or have the instincts that you, his mom, have.

    It is also very possible to have aspie "traits" and not have aspergers. I have quite a few of them myself. I will likely never be sure if they were there as part of who I am or if I learned them growing up, but I am quite sure that if I were a child today and got evaluated then I would be diagnosis'd with at least aspie traits if not full blown aspergers. A LOT of that would also depend on what year I was evaluated. No question that in 5th grade I would have been diagnosis'd as an aspie if for no other reason than I refused to speak to ANYONE, not even the priest and teachers. Just plain refused. It wasn't a new school, I had been there since 1st grade. The work wasn't hard, I just refused to speak. I sang in the choir, but that was IT. My parents never knew because NO ONE told them and I spoke just fine (and constantly, lol) at home.

    How long was your son's neuropsychologist testing? For the most reliable results there should have been 10-12 HOURS of testing, broken up into chunks from 2-4 hours at a time. It is a real hassle, esp if you must bribe, cajole, reward, etc... to get your child to cooperate. with-o the extensive testing there are a LOT of things that can be missed, including learning disorders, auditory processing problems, memory problems, etc... About 3 years later we needed to have the testing redone because some things we hadn't known came to light. Wiz was in a psychiatric hospital at the time, and the neuropsychologist who came did 3 hours of testing, missed ALL of his learning disabilities including dysgraphia which shows in EVERYTHING he handwrites (and a substantial part of the testing had some handwritten element to it), and gave a completely wrong picture of my child. Wiz was painted as a sociopath (antisocial personality disorder) due to being "unfeeling" which somehow supposedly showed on his testing. I knew, as soon as I read the report, that it was about 2000% wrong and the doctor just did it wrong - all of it. Even the staff at the psychiatric hospital were shocked by the report and could clearly tell it was wrong. The neuropsychologist got to these very serious results in less than 3 hours of testing, so it was easy to see how he got it so terribly wrong.

    Anyway, that is why many of us have mentions aspergers several times. I will say that it is rare for a doctor to completely rule out something as firmly as your doctor seems to have. They known that those are usually the times that they end up in later years to be proven wrong. Or that is what the best of our various docs have told me anyway.

    The anger and rage that he feels when things do not go the way he has planned in his head (which can happen even if he gets the end goal that he wants, if the middle steps are not exactly what he has in mind, if I understand correctly) can be helped by some different things. Risperdal and other atypical antipsychotics will help with the rage and aggression. Treatment for the Obsessive Compulsive Disorder (OCD), esp the right doses of the right antidepressants, will help with the rigidity and obsessions. He also needs to have help learning to handle things that don't go exactly as he thinks they will. Change the order of things, with-o notice, and help him learn that it is NOT a bad thing, or a good thing, every time. It just is.

    We had a sp ed teacher for 5th grade who taught the kids to "roll with it". It was her phrase to get the kids to not have meltdowns, or even snits, if things changed, even changed suddenly. She did this by making changes in their routines. Occasionally at first until she had their trust, then frequently. Some parents got upset, but she explained that the WORLD makes changes with-o notice and kids need to learn to deal. When they first STARTED to get upset she would help them talk out what the change meant. the best possibility, the worst possibility, some in between possible outcomes. Over time they learned that it really was NOT as big a deal as they expected, they just had to stop and take a minute or two to regroup and then move on.

    We had a therapist who lead us in a group for adhd kids and parents (kids with other tdocs in one room, parents with her in another with a one way window so we could see how the kids reacted to and handled certain things. She stressed that this type of training was incredibly important for our kids. Without it, they would just get mroe and more rigid, and less and less able to cope with the real world, with school, with jobs, and with spouses and children of their own. Not to say we had to make every day devoid of routine. Routine is crucial, but changes in it need to be able to happen with-o major meltdowns.

    There are very few kids with problems like ours who can become really comfortable with changes with-o several different kinds of help. they NEED to experience it and talk it out the way our teacher did, and the way we were trained. They often NEED medications to help so that they CAN process it and not make unsafe choices, and they often NEED more than just mom and dad to help them do all of this.

    The therapist was about 2 yrs before the teacher. She had us start small, with running a couple of errands with our difficult child. Tell them where we are going (grocery, dry cleaners, drug store). Do the errands in a different order. Go to the dry cleaner first, for example. Or add in a stop at the drive thru for a drink or snack. When the fuss starts, ask why it is a problem. really LISTEN. Stop and sit and talk, even if you stay in the car, if possible. Or skip one errand and go home. Just a small change like this.

    We were told to do this when our child was not exhausted. we also learned that he MUST have enough protein in his system and MUST not be hungry or there was NO learning that was going to happen. He just wasn't capable. At first the unexpected only happened after we had a snack with protein, even if it was getting a pre-cooked chicken or chicken tenders or string cheese at the grocery store. High levels of protein made a HUGE difference, and many of our friends/his classmates learned the same thing. The other really KEY item was to make sure that not all the unexpected things were fun. They didn't have to be hated, or horrible, but if they were all fun he didn't learn to cope with surprises that were not fun. We all know that not every surprise is fun, but it is important to help our rigid kids learn this.

    i hope this helped some.
     
  13. DaisyFace

    DaisyFace Love me...Love me not

    Perfect example! Running errands was a HUGE problem for my difficult child...and if you said "grocery store, dry cleaner, drug store" you had better darn well do them in that order or there'd be a problem. She used to get very upset with me if there was any change at all. Meltdowns, rages...UGH!

    I also suspected Aspergers - but doctor after doctor after doctor has ruled it out.

    So--I don't know. Sometimes, you have to find what works and worry about the diagnosis later.
     
  14. hearts and roses

    hearts and roses Mind Reader

    My difficult child had/has Tourette's which at different times manifested itself with symptoms of Obsessive Compulsive Disorder (OCD), anxiety and depression - sometimes separate and sometimes together. The thing about medications is that sometimes they work how they are supposed to and sometimes they work the opposite. Or, sometimes the patient needs a higher dose and sometimes lower. My difficult child responded well to Zoloft and Celexa (both SSRI's and at separate times over the course of 5-6 years) for her Obsessive Compulsive Disorder (OCD) and depression. Clonidine and, then separately, risperdal were added to her rx to help with anxiety and tics, but they both also helped with the meltdowns that were caused by the SSRI. The higher the dose of SSRI, the more dramatic and horrible and longer her meltdowns. Like I said, the clonidine and later risperdal helped to counter balance the symptoms caused by the SSRI. My difficult child's medication regimen really helped and worked without too much tweaking, however, it did need tweaking here and there. Ironically, even with my difficult child's history, her psychiatrist always tried to INCREASE the SSRI, even though she had a history of worsening when the dose was increased. We almost always ended up back where we were in terms of dosage. We didn't try many drugs and eventually, difficult child completely balked at the idea of taking medications altogether and stopped. It was horrible and difficult for a couple of years there without her being on medications, but she's seemed to mature and evened out finally.

    I think part of your difficult child's behavior and outbursts are a combo of hormones as well as his diagnosis. It took me a while but eventually I trusted my gut more and more while working with the 'professionals' - this helped to make better decisions for my kids. Hugs~ I hope you find the right solution for your guy.
     
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