Re: Behavioral vs. medication Management

Discussion in 'General Parenting Archives' started by Fran, Nov 7, 2003.

  1. Fran

    Fran Former Site Owner

    This is only my experience and my thoughts, so take it for just that. No science to it.

    Behavioral management might work alone if you can so tightly control his world and his interactions as to make each situation work exactly as you have taught.

    The society expects more and more from a child and rightly so, this is our civilization and our standards. The disability of my child became more evident as the expectations increased.

    Having helped my difficult child over a behavioral hurdle was great but a new issue would evolve also.

    In my son's case, there would have been no behavioral management without the medications. He wasn't any day at the beach with medications but he was able to marginally function.

    I don't have a lot of personal faith in a kid like mine managing without the use of tools and supports. Medication is one of them.
  2. addie

    addie New Member

    Sorry - speaking as one who did not believe in medicating a child, ever ....

    The answer to #1 is no, given your child's behaviours.

    The answer to #2 is that the initial success is wearing off. We all have those successes when we try something new .... in my experience, they don't last for long.

    I find I have to separate kids into psychological (which can often be treated by behaviour mod) and psychiatric, which needs medications to create a window in which to work on behaviour mod which will later allow you to wean the child off the medications ... one hopes.

    Even with psychological cases, sometimes medications are needed to start settling them down into routine and structure, acknowledgement of and compliance with the rules. But those kids can come off medications sooner.

    Just MHO .... and I now am a believer in medicating if it improves the quality of a child's life.

  3. kris

    kris New Member

    may i ask what medications you've trialed to date?

    i agree with-both addie & fran. medications are a tool that most of our kids need. most, initially, respond well to new beh mod plans, but with-o medications it's almost impossible for them to maintain the effort.

    fran's point of higher expectations bringing more conflict into their lives is very true. you've already experienced this with-the the school expecting him to be there on time & all only gets worse from here. unless a child is in an Residential Treatment Center (RTC) it is impossible to so tightly structure their day so that there are no surprises. surprises bring regressions great & small.

    what you are attempting to do is admirable, but in my opinion you will most likely need medications for the long run.

  4. Cass

    Cass Member

    The answer to question #1 is I believe it is possible.
    My difficult child is now 15yrs and after keeping notes over the years and now looking back its amazing what I have discovered.First off if you could see the difference in my difficult child from a year ago you would not believe it is the same kid.After sticking with him through every little or big issue after helping him learn how we deal with things rather then have a major meltdown after talking him through his major mood changes or just leaving him be to settle down he has really come a long way.
    Ok back to what I discovered in my notes I discovered that the times I had so much difficultie with him all the times I just felt so lost and drained and almost lost hope were the times he was on medications.It appeared that he was a totally different and a unmanagable kid when he was medicated and when this happened they tried a different medication.
    Since he has not been medicated I have worked very hard with him and also proffesionals to steer him down the right track.Yes he still has his moments but not even close to how he would have reacted last year,it can be very tiring but it is so worth it.Its rewarding actually for all the time and work I've put into him,rewarding to see my son happy and successful.
    It appears to me that your son is the same age I started trying my son on medications and boy do I regret putting him through that.
    I understand that there are some kids out there that may need to be medicated but I honestly believe there are some kids out there that are over medicated.
    Its a hard choice to make when it comes to your own child but you know your child best so you will know what works for him and what doesnt.
    My opinion is after trying everything possible and you don't succeed then try the medications,but thats just my opinion.
  5. Allan-Matlem

    Allan-Matlem Active Member

    medications help deal with the pathways to explosiveness and being inflexible but medications don't help you to think through a frustrating situation - this is an aquired skill - ( my words ) - from the explosive child by Ross Greene
    Yours Allan
  6. SRL

    SRL Active Member

    Thanks for your input so far. This is exactly what I need to hear--a variety of experiences and thoughts.

    The medications that my son has been on so far have been Celexa and Zoloft. The first time he was on Celexa was because his anxiety tripped over from just the unfamiliar situations/routines into the everyday: water in the tub, separation, fire in the grill, etc. It gave him almost immediate relief from the anxiety. I thought I saw an increase in both hyperactivity and difficulty in anger control right up front but it coincided with the beginning of summer vacation and sibling tensions were running high so I just watched it. He was on for 9 months and the edginess just got worse and worse. We were in a similar situation to this one in which there were some stressors (previously unidentified sensory issue--odors--a real fun one to deal with :rolleyes: and then all of the Christmas hoopla). The doctor wanted to increase it and add Straterra to counterbalance and instead we took him off and things were greatly improved. There was a small increase in anxiety but nothing that he/we couldn't handle.

    I am livid over this next part: we saw a new developmental pediatrician early this summer. Had a 90 minute initial appointment and received made recommendations for school but since everything was smooth she didn't recommend any followups but would remain available should further needs such as medications become necessary. But when the medications became necessary she wasn't available for the necessary 60 minute time slot nor would she prescribe over the phone. (We could have a discussion about doctors whose load is so great that they can't meet the needs of their patients but let's not--it would only irk my ire more). I decided to trial Celexa again at the lowest dosage and it didn't do much for the anxiety but the side effects returned. My pediatrician even put pressure on the doctor to see him but all they did was move us up to the top of the cancellation list. He gave us a few more options and we wound up with a child psychiatric here in town who prescribed Zoloft. That medication was bad news for him as everything went over the edge: hyperactivity, obsessiveness, anger, aggression, and ironically an increase in separation anxiety and aversion to leaving the house to go places. For the first time ever I felt like I had a child who was not emotionally well on my hands; he was totally incapable of working through situations in the manner in which we might have been able to previously. Once we took him off the Zoloft things have improved considerably in all of those arenas but the ODD. Oh, the Zoloft nipped the anxiety enough in a few days that he stopped saying things like he was worried or scared when he got to school and since he's been off the fear part of going to school has diminished. Now he just mostly hates it . (Whose bright idea was it to coop active boys up in school anyway?) The only remaining anxiety reaction I'm observing is that when he is entering the school if there are people in the hallway that normally aren't there it bothers him. This week he did make MAJOR strides, running into the school ahead of me and opening the doors instead of hanging back and even talking about going to school.

    It has seemed to me that my son has the tools to handle the anxiety situations once he gets over the initial hurdle, which I see as a major point in his favor. I've asked about situational anxiety medications and two doctors were not in favor of using them for children. Ironically when I called to the developmental pediatrician (to hear we'd have to wait) the nurse said she thought a situational anxiety medication might be indicated. I've checked out the options and we're going to give this DP another shot because she has had a far clearer understanding of his condition than anyone we've seen before. I'm not pleased with what has happened but I'm going to see if scheduling recheck appointments would prevent anything like that from happening again.

    So you can see why I am feeling gunshy about jumping into medications again. As with Cass, our worst times have been when he has been on medications and going off of them has brought significant relief. In both cases they have brought the temporary relief from the anxiety he needed but left us with even more dificult problems to manage.

    I'm not opposed to using medications if they are necessary so let me ask you this. For those of you who feel that they are a necessary part of a behavioral management plan, do you think there are any advantages disadvantages to starting them later when behavioral management fails? Is controlling the situation for a temporary period while the child gets over the hurdle and adjusts a negative thing? I'm not being contrary --just want to get a better grasp on this issue since decision day is approaching.
  7. mose

    mose New Member

    Have you considered the school and teacher is the wrong match for your child.
    Kids have ridiculous demands put on them that do not match the real world for some of them, such as sitting still behind a desk all day,
    learning subject after subject for five hours straight.
    What human does that!

    During childhood we put our daughter in a school that matched her temperament. Our home life was suited to her temperament. I had a very hippie point of view about my daughter: she did not have to conform to the school, we found a school and teachers that conformed to her behavior and met her needs to create the most suitable environment for her to learn. This worked for her.
    She still had panic attacks sometimes at night, but nothing we couldn't handle.

    That's how she stayed off medication until she was 15 years old.
    Then all hell broke loose. :eek: :eek:
    Through the magic of medication, this has made her brain chemistry normal and able to function beautifully again.

  8. Sheila

    Sheila Moderator

    Our difficult child was not able to respond to behavior mgmt without the medication (stimulant). Waiting just put more pressure on him and us.

    The primary problem we were dealing with-at the time however was ADHD. The stimulant is quick in and quick out, so in our case we were able to see the effects of the medication immediately (not having to wait until the medication built up to a therapeutic level over time, and not having to be too concerned about the time required for the level to fall if it was the wrong medication).

    It may not help you, but I'll tell you about difficult child's anxiety.

    difficult child had a horrible 1st grade experience behavior-wise. Every day it was something. The day before school started in 2nd grade, we went to "Meet the Teacher Day." I had pre-purchased his school supplies through the school and they were wrapped on his desk -- two huge bundles. The fact that it included two reams of paper, 2 large kleenex boxes, reams of construction paper, etc., didn't matter. All difficult child could see was he thought was "too much work." He didn't understand that it was to be used over the whole year. He became overwhelmed and literally crawled up my body so he could be carried like a toddler and started sucking his thumb. This behavior from a kid that was going through the "don't hold my hand anymore, I'm too big" phase. I knew we were in trouble. Things went downhill from there.

    I eventually started charting behaviors. It didn't take long for a pattern to emerge. Attending school was the culprit -- miraculous recovery on Friday afternoons, nosedive on Sunday afternoons. The more pressure put on him to conform and perform, the worse his anxiety symptoms became.

    difficult child was going through the IEP evaluation process at the time, and the school wouldn't do much to help with-this. It was their opinion that his behaviors were "willfulness" and "policy" must be followed (discipline guidelines). Additionally, they were dragging their feet with-the evaluation process.

    difficult child's anxiety got worse and worse. He really was doing the best he could to please everybody -- he just couldn't. I waited too long to blow my top. As a result, by the time I got some action from school, difficult child's anxiety was over-the-top.

    As much pressure as possible was taken off difficult child -- school and home. It took about 3 weeks for him to regain his footing after school was out for the summer. About a week before 3rd grade started, his symptoms began to start up again.

    He matured a lot over the summer. That factor, together with-his 504 plan which was then "officially" in effect, helped him to quickly regain some confidence and the symptoms dissapated.

    Looking back, I feel that anxiety most likely factored in to his poor first grade experience, but nobody caught it. If not, I don't think he'd have had the reaction he had at the beginning of 2nd grade. Because of his survival skills (long story) he presented as a very "has it all together" little boy and the visible symptoms came on subtly over time.

    Because of the way things happened, we never medicated difficult child for the anxiety. I regret that I didn't catch on earlier to what was going on.

    I keep a sharp eye out now -- I know his anxiety symptoms. When he moves out of his bed and onto the floor to sleep starts biting his nails and cuticles until they bleed, it's my first red-flags that something at school is out of sync. I start charting again and send an email to the teachers suggesting that it would be a good idea to be monitor him more closely. So far, so good.

    If it ever happens again, I won't let him get passed a certain point without trying medication. I can't define that point, but I'll know it when it happens.

    I also feel that a lot of his various therapies have worked together to reduce his anxieties. For instance, occupational and Sensory Integration Disorder (SID) therapy helped his visual motor skills, helped him write without pain, reduced his sensitivity to clothing and the environment in general, etc., etc. It's not such a continuous struggle to perform to expectations because of underlying problems, and he doesn't have to concentrate so hard on the actual mechanics allowing him to focus on getting a task done.

    As more supports and therapies came on-line, things got better overall.
  9. Fran

    Fran Former Site Owner

    My one regret is that I did not know or start difficult child on mood stabilizers at 5yrs old instead of stimulants.
    I was probably not able to "hear" how seriously hyperactive/chronically manic my difficult child was. No one suggested it.
    20/20 hindsight tells me that if difficult child had better control he may have avoided all the social isolation and disasters "we" experienced. He might have been able to "hear" the teaching that was going on and had a chance to master some of the lessons that he has yet to master.

    I didn't know what I was dealing with. I knew deep in my heart that the doctors. were only giving me the tip of the iceberg at 5 to 8 yrs old. I knew I didn't want to hear or believe all of it yet. I did keep doing research but didn't really push for a more definitive diagnosis or more serious medication. It was a huge leap from the norm for me to agree to ritalin. No way was my bruised ego ready to deal with mood stabilizers. I can just imagine the collapse of my mothering world.
    I did find that I became a better more effective mother when I took the "road less traveled" and kept my child's well being the priority instead of an image of what a mother should be doing.

    So I'm the wrong person to ask about medications. I should have used more and stronger and earlier. I didn't. I have to live with that. It is a choice each of us makes when we are ready. The goal is the improvement and success of our children.

    If my difficult child has long term effects. I will have to live with that guilt also. Being a parent is not for the faint of heart.
  10. addie

    addie New Member

    Ditto what Fran said - if I had known then what I know now, it would have been more, stronger, earlier.

    We did all the behaviour mod stuff; we had a behaviour consultant come into the home and the school. We tried the one medication they always give first ... ritalin. We could not even keep her on it for the ten day trial - it was a disaster.

    So she was unmedicated for years - and those years only compounded the problems that we perhaps could have dealt with more deeply and permanently than we have been able to by finding the right medication (for her) later on.

    I too wanted situational medications .... but by the time they would have taken effect (injections were not allowed) - she was over the rage attack. So it would not have helped.

    It's a hard decision to make ... I try very hard not to medicate, to control by some other method so I can teach .... because teaching is a MUST. But so very often, as I already said, medications are needed to give you the control which gives you the opportunity to teach. The child needs to be able to listen and understand.

    I'd like to go back to what you said about token economy ... toys, in your case.

    This may sound very radical but I find while that never worked with younger kids, if I get older kids who smoke it works very well. I do not supply cigarettes directly or indirectly, but the gov't mandates the kids get $10 a week pocket money - many of them spend this on ciggies. I take the ciggies and dole them out at 5 a day. If they do that which they are not supposed to do, they lose one. It is quite magical ... I guess I am turning an addiction into a tool.

    But younger kids are not addicted to tokens, toys, etc.

    A benefit of what I have done is that with my current crop, *TWO* kids have stopped smoking!!!!

    (NOW how do I control them; how do I practice behaviour management without my carrot?)

    I believe in the theory of behaviour management ... but one has to have a way to make it work.

    Sorry - I ramble.

    But to respond to what you asked ... if you leave medications till after all attempts at behaviour mod have failed .... will you have wasted a lot of valuable teaching time?

  11. kris

    kris New Member

    my son was much older than yours but i found klonopin was a very effective situational antianxiety medication for him. what i wonder about is how much more difficult is it for him to cope when he's not medicated. you can try to shield him from the pressures of school & pressure from the teacher, etc., but i think it may prolong the process uneccessarily.

  12. SassyGirl

    SassyGirl Active Member

    I discovered after 3 years of having my son on anti-depressants (Zoloft, Celexa, and Luvox) that he has a mood disorder and that anti-depressants increase his edginess and aggression.

    We took him off all stims (he has ADHD/executive functioning issues) and anti-depressants. He is now on one medication, an anti-psychotic.

    While I do not think your son needs an anti-psychotic, the a/d's apparently do not work for him. You might try a low dose of mood stabilizer and see if this helps his issues. Definitely would not recommend any more anti-depressants.

    As far as behavior mod? The most I ever got out of it was a week from difficult child. Then he could not continue to "hold it in" any longer. It was a struggle for him to "be good." I think it still is. He is out of synch with the world and it takes a lot of effort to appear and act what society feels is "normal."

  13. <I'm not opposed to using medications if they are necessary so let me ask you this. For those of you who feel that they are a necessary part of a behavioral management plan, do you think there are any advantages disadvantages to starting them later when behavioral management fails? Is controlling the situation for a temporary period while the child gets over the hurdle and adjusts a negative thing? I'm not being contrary --just want to get a better grasp on this issue since decision day is approaching.>

    Our situation is not the same but am curious about the responses. difficult child is on medication, zoloft, for anxiety and depression. Recently diagnoses ODD, she is now in a program that stresses behavorial modification as the treatment and will wean her off the medication as time passes and she learns new behaviors. The hope is that eventually she doesn't need the medication. The medication was never meant to be a long term solution. She was never prescribed anything for the ODD.
  14. DeeRW

    DeeRW Active Member

    I have never medicated my difficult child. Not because I don't believe in them but because her issues were truly behaviorial, not chemical except to a very mild extent. That being said, if she had had mental health issues that were chemically based (ADHD, bipolar, etc.), I would not only not have hesitated, but insisted she be properly medicated. It is not fair to expect anyone (child or adult) to cope with a medical issue without the proper tools to fight it. Just as I wouldn't hesitate to give my difficult child insulin or antibiotics as needed, I wouldn't have hesitated to have given her the necessary psychiatric medications.

    One thing I've seen with behavior modification is that if the problem is chemical, a difficult child might be able to control for a while on sheer force of will and desire, but ultimately loses control and the explosion is far worse than had the child not been trying so hard.

    So, given your son's diagnosis's, I would medicate. Obviously, I would start out on the mildest possible medications until the right combo was found.
  15. SRL

    SRL Active Member

    I probably saw an example of my son doing well in a controlled envinronment yesterday. He has done incredibly well the past few days and if nothing else we are all glad for the breather. Yesterday afternoon he went to a friend's house and did great there--played nicely and watched a movie (Finding Nemo). He walked through the doors and I could just see the change in him. He was back in the heightened state: aggitated, negative, lots of physical motion. Shut himself in his room and everytime I tried talking to him closed off his ears and started chanting "I'm not listening." It took a couple of reminders of the incentive and then he took the bait and went into a settling down routine. Normally he would come home from a play date in a slightly aggitated state and need a little cool down time (usually snack and show) for debriefing.

    Mose, the teacher/school match is one that I have given much thought to. Right up front my husband indicated he thought the teacher may not be a good match for him in terms of temperament. We wouldn't have any recourse within the school if that's the case because for the most part she's been flexible to his needs--individualizing, good homeschool/communication, etc. Our choices for schools outside of the public school district are extremely limited. He's a very kinesthetic learner so sitting in school doing paperwork is more painful to him than the average boy. From the time he was little I knew there just wasn't going to be a school setting that he fit into well.

    Allan, your comment about medications helping deal with the pathways but not helping one think through an explosive situation is something I've thought much of. The past few days have been the first time my son has been calmed down and receptive to talking about some of the issues we've been dealing with in a rational way. The ultimate goal here is to get/keep the child in a calm state in which you can teach/train which in my son's case may be able to be accomplished behaviorally--for how long I don't know. Does it make a difference whether that calm state comes about via medications or other means? Either way the calmed state is being achieved via external means.

    Addie, toy-type incentives do work well for my son because he has obsessive tendencies. It's what's kept him walking through the doors of the school when all else has failed. Sometimes I thought there was absolutely no hope of convincing him to go and if I had the right incentive it would often work more as a distractor than anything else. The Zoloft gave him a minor help in dealing with the school anxiety but it was really the continued attendance that got him over the hurdle (along with a few adjustments at school such as an aide walking him in and unloading his backpack so all he had to deal with is getting through the doors.)

    For those of you who feel its important to find the right combination of drugs early, have your children been on those drugs long term once you got it right or have those medications necessarily had to change as the child has grown older?

    Thanks for taking the time to explain your thoughts and experiences with me. I'm going to continue on this week with the incentive plan, in part because we're exhausted from dealing with this behavior and partly because I do want to see how he continues to respond. But I'm listening...
  16. Fran

    Fran Former Site Owner

    There is no doubt that medications and dosages have to change, just as the incentive plan has to change. My difficult child is not the same year to year.

    I want to be clear that none of this treats all aspects of my difficult child's disorder. We had to use behavior mod or my version of the "carrot and the stick" in addition to medications. I did repetitive teaching and more teaching over the years. We used incentive and alternative teaching methods and anything that we thought might give him some help and wouldn't hurt him.

    The way my difficult child's behavior and learning oppositionality displayed itself at 7yrs old was very different than at 13yrs old. To say I was at the brink of despair is an understatement.
    It seemed nothing worked. Even with 7 medications and tons of behavior mod and tons of intervention and tons of nurturing and reading and researching and the best minds in the country. Then ....puberty helped his brain and emotional development to become more civilized(for lack of a better word) He started to get the reason we must function in a society. He started to get that there are rules for his protection and mine.

    Of course, puberty brought the explosiveness you would expect. It was the dark before the dawn.

    I do think that going with the least invasive is the safest method to go with when a child is this young. As long as you are having success you keep going in that direction. Once you come up to the brick wall, you change directions.

    Believe me when I say that I had no idea that I would be dealing with these incredible medications and psychiatrists when my difficult child was younger. He was treated by a neurologist,until 11yrs old. Somehow, that made me feel safer, more comfortable. That was my own mind blindness. It was about my comfort more than my difficult child's reality.

    But I am part of the equation of our household and everyone in it gets a piece of the pie.

    You are a caring, loving,nurturing mother who obviously loves her child and wants to help him. It will be a process of trial and error for a long time. You will try what works and what doesn't. I have thrown thousands of dollars out the window in an attempt to help difficult child. I had to. How could I not try something that would help my son?

    Gather your info, keep researching, look at results, balance your difficult child with the rest of your home life and make the best decision you can. You answer to no one but yourself,husband and difficult child. You have to please no one else or impress anyone else. It is a very freeing concept to let go of the controls that sometimes start along the journey with a difficult child.
  17. isabel

    isabel New Member

    I can only speak from experience with my difficult child. Except when he was a toddler, trying to potty train, and a few isolated days or weeks when he was younger and not on medication, no behavioral modification worked for him.

    As he got older and was on a mood stabilizer, a beh. mod. system worked for a few months and then again later for a shorter time period.

    Without medication, my son cannot function, period. With medication, it has been a constant trial and error to get the right combination -- we still don't have it right.

    The behavioral modification systems? If he isn't stable, which is usually the case, to some degree, he cannot follow through on a regular basis.

    The systems can be a tool. But in my opinion, depending on the particular disorders of the difficult child and the difficult child him/herself, they are not stand-alone solutions.
  18. SRL

    SRL Active Member

    Well, over the past few days the results of launching an all out effort in reversing my difficult child's pattern of overreactivity have been interesting. Overall we've had some of the calmest days in two months. difficult child's been happier and 3 out of the other 4 of the rest of us have been happier. The exception is older easy child brother who has a magnetic attraction to difficult child and is a very powerful irritant. Because of it has been told to leave difficult child alone more times than I can count. Even if difficult child wasn't a difficult child this would likely be a problem. Siblings will be siblings, after all. :rolleyes:

    I've been watching patterns very closely and have found transition times within the course of the day to be problem spots. In the past these everyday transition times rarely caused such problems but now they are. Today I saw it again with him being fine on a trip to the library and bookstore with me and within ten minutes of being home things going bad again. I am seeing is a pattern of increased activity level and heightened aggitation starting about the same time in the evenings.

    He's still highly irritated but I've noticed that his reactions aren't as strong. Aggression is reduced. He sounds off and heads to his room, maybe with only one door slam instead of three (two just to make the point). When I've checked on him he's still been angry at me and wanted me out, but on the plus side he's usually been sitting on his bean bag chair listening to his nature sounds machine I bought for calming purposes. This is drastic improvement for the kid who was hiding under the bed and in places where I couldn't find him a few weeks ago. He's been easier to distract from the angry mode so it's not lasting as long. And today I walked downstairs to find all three kids coloring at the table together and there was no flareup at all. Given what life has been like around here, it was a Kodak moment.

    Things have improved, but still I have concerns. Irritability is still there, as is rigidity. Disregard to authority when angered is high and since I'm the usual authority around here, that means me so I'm the one who is usually "stupid" and gets the tongue sticking out treatment. (A few weeks ago he even wrote a poem about how mean I was. I knocked the wind out of his sails by telling him how good his rhyming was and how nice his printing looked.) Fairly cooperative when not angered, so that's good. Where the incentive system is really breaking down is because he always thinks he's right, so when a time comes that he doesn't earn an incentive he gets worked up. In those cases I've been offering a smaller incentive for the remaining portion of the day and while he's not thrilled, he usually bites. Quality of life is improved, but it's not fixed.

    Reading back over the replies to the other thread (on Primary Zone) I decided to do a little digging around on bipolar as that suggestion was made. I'm reading through "The BiPolar Child" and still don't know what to think. There are definitely some indicators but I'm having a hard time coming to any conclusions. Many of the indicators can be explained by the presence of autistic-like tendencies and executive function difficulties. The things that are causing me to stop and ponder were his poor responses to the two SSRI medications he was on. Plus he has a bipolar grandparent on one side and a family history of ODC/Anxiety on the other. He also has a first cousin with tic disorder/possible Tourette's/ADHD/ODD.

    I think the possibility exists that he is bipolar, but if so it doesn't appear to me to be typical--maybe more along the continuum of the already identified disorders. I'm used to the diagnositic quagmire by now. He hasn't been typical for anything but Executive Function Disorder so far but I know it's wise to tune in because treatment/interventions from the atypcials can be very beneficial.

    I know the kind of intensive approach we're trying is unrealistic for the long haul, but I do suspect if I pulled it out now there would be a rapid deterioration of behavior. The incentive approach has really helped behavior in the mornings. There's not been any difficult behavior to speak of then, afternoons are a mix, and evenings toughest. Whether he can handle keeping it together at home while continuing to manage the school anxiety/resistance issue remains to be seen.

    Thanks for sharing your experiences and thoughts...and for listening to me think out loud. I've a lot to digest in short period before our apt on Thursday and this helps me a great deal.
  19. SRL

    SRL Active Member

    Our appointment with the developmental pediatrician got moved up to yesterday which was helpful because it means one less day of missed school...and because I only had to spend a few hours with the pit in my stomach instead of two days. I've spent a lot of time digging into bipolar the past few days and wasn't at all convinced it fit my difficult child. I saw overlap of many symptoms but lack of some major earmarks (such as cycling and true depressive states). By yesterday I'd pretty well landed on the position I have always maintained and that is I have a kid with a naturally happy-go-lucky disposition who by virtue of his neurological makeup is oppositional. I am going to continue to log for awhile anyway just to cover my bases.

    After doing my reading here I walked in thinking the doctor would probably strongly recommend medications and was surprised when that wasn't the case. She said it was no surprise that he was still rebounding from the anxiety plus reactions to two unsuccessful medications. Said that the second medication (Zoloft) should never have been used given his reaction to the first because it was more broad spectrum and was certain to cause problems if the first one did. She stressed that my son has such a unique profile that medications would be tricky at best and cautioned against turning again to someone inexperienced to deal with that aspect.

    Since he's made such good progress in settling down these past weeks she recommended continuing on using behavioral strategies. We left it that I would make a followup appointment in two months in which time we would look to strategies addressing Executive Functions/Frontal Lobe Disinhibition plus NLD. She feels now that he is settling down transitioning him back into school full time (or near full time) by second semester would be realistic. My opinion is that will depend upon how he weathers the holiday season. Whoever dreamed up all of this holiday hoopla sure didn't have a kid like mine!

    I had to LOL because I walked in thinking I was going to walk out with a prescription and need persuading to use it and instead I walked out wondering if I shouldn't have asked for one (that feeling courtesy of the big fit he threw about going, no doubt). I have some doubts thinking I could have left with something that potentially could help us/him but I know if I'd opted for medications I would have just as many doubts and aprehensions. I have decided if he shows signs of deterioration in the area of opposition and/or if it becomes too difficult for his siblings, I'll reverse the decision. I continue to see some very hopeful signs, especially in the areas of major reduction in the amount of escalation and self calming when irritated/angry. Yesterday after making it clear to us that he wasn't going to the appointment he headed back to his room, closed the door and started drawing. 3 or 4 weeks ago that would have been door slamming, hiding under the bed or other location, namecalling, coming back out and slamming the door and outbursting for emphasis, etc. One thing that remains to be seen is whether the trend of his being so quickly oppositional can reverse, because that has become more pronounced over this period. I honestly don't know the answer to that.

    One of the things I think I will never grow accustomed to is the invasion of privacy that accompanies having one of these kids. I'm generally a candid individual but having someone ask details of our handling of our child and question/criticize never sits well with me, especially when it generalized from such a limited amount of exposure. It's not that I don't have things that can be improved upon or that we can't benefit from the insights of others, but it's never any fun for me...ditto with the school too.