Sabotaging his own discharge?

Discussion in 'General Parenting' started by wethreepeeps, Mar 3, 2008.

  1. wethreepeeps

    wethreepeeps New Member

    difficult child is 9 now, and has been in a sub acute program in the psychiatric hospital since November. Many medication changes later he had been very stable for the last few weeks and they were planning to discharge him last week. So after hearing that he'll come home on Wednesday, he starts to act out again, flooding the bathroom by stuffing paper towels in the sinks and turning them on, refusing to get in bed, cursing at staff, etc. He told his social worker, "why should I go home, I'm just gonna be bad cause I can't stop and they'll make me come back here." So we have a family session where we outline for him that the only thing that will get him sent back are violence to himself or others, or threats of violence. This seems to do the trick, he straightens his act out, and we plan for him to have a weekend pass and then formally discharge on Monday, today.

    The weekend pass goes okay but not great. On previous passes the changes in him have been remarkable and we had a pleasant time being together. He wasn't perfect, but the issues that came up were nothing I couldn't handle. I really felt we were all ready for him to come home at this point. But this weekend, he wasn't violent or even defiant, really, but very negative about everything. He didn't like anything I cooked (stuff he'd always liked before), he was constantly bored, and he kept using his "mad plan" to come and tell me he was angry about things that had happened *years* ago. More than once he said he was angry because he was bored, and that when he was bored he could only think of "bad" things to do.

    Really, this is actually amazing progress. He's never been able to verbalize his feelings on this level before, so while I'm worried about the things he's expressing, I keep giving him a lot of positive affirmation for coming to me and talking about it instead of getting violent.

    Then Sunday around four pm he started getting very silly and hyper, rolling in the floor laughing and making animal noises, crawling around the house on his hands and knees, that kind of thing. This later afternoon hyper period was a long-time pattern that we seemed to have finally broken in the hospital, so I was very worried to see it come back. I tried to ignore it, got dinner on the table, and as he was walking past a wall that has multiple family pictures, he stopped and remember something negative about every picture. "I hated this shirt" "remember I cried in the car and you made me go anyway?" "remember santa didn't bring me a gameboy for christmas that year?" and so on. He then sat down at the table and very calmly said, "I just really want to stab myself."

    So I call psychiatric hospital and speak to the social worker on call, and they say to bring him back for the night and we'll reevaluate his situation today. She said it's not unusual for kids to have tons of anxiety about coming home and being able to function at school and within the family again and try to sabotage their discharge, because the hospital seems safe and controlled.

    How do I help get him past this? Does anyone else have experience with a situation like this?

    difficult child: 9year old boy, ADHD, Pervasive Developmental Disorder (PDD) not otherwise specified, PTSD, ODD, rule-out bipolar. Suspected prenatal drug exposure, adopted at age 3. Current medications: Adderal, Seroquel, Trileptal, Tenex

    easy child: 11 year old girl terminally ill with Dystrophic Epidermolysis Bullosa
     
  2. Coookie

    Coookie Active Member

    Hi There,

    While I don't have experience with this exact thing, I do have experience with the self sabotage. My difficult child did/does that when anything good comes his way. If he does something good he would/will turn it into something bad. :( It is almost as if he doesn't think he deserves the good.

    My difficult child is older but it has been a pattern for many years and I still do not have an answer. He refused help... "The problem was husband's and mine"... He received a lot of positive reinforcement from us but it didn't seem to make a difference. :(

    You sound like you have a good support system at the hospital and I'm sure others will be along with ideas but I would ask his docs this question also if you haven't.

    I will hold good thoughts for your difficult child, Reactive Attachment Disorder (RAD) is a tough thing to deal with.

    Hugs
     
  3. Star*

    Star* call 911........call 911

    Well, sadly I have tons of experience with this sort of thing.....and yes...he's sabotaging himself on purpose but may not even know it.

    My son did the exact same thing - flooded the entire Residential Treatment Center (RTC) by stuffing a roll or 2 of toilet paper in the commode....they had to take up the carpet and rent a dryer for the walls - he was sure to do it before they went on a field trip and the toilet ran for 31/2 hours - when they came back ? Water was running down the sidewalk. They figured it was my son - and then he confessed to it for the same reason as your son.

    I dont' think much of ANY Residential Treatment Center (RTC) that tells a child a potential discharge date. It causes too much stress. Telling them the night before or the day of is sufficient to avoid a huge meltdown - and they will cry and carry on because they didn't get to say goodbye to friends - but you have to remind them that those children are not friends - merely peers that are also there to work on their lives.

    That said - it hink it would be good to make sure you have a discharge plan in place. A lot of parents think that once the child is able to maintain in an Residential Treatment Center (RTC) that coming home will be a slight transition - it is a HUGE transition. HUGE - MONUMENTALLY HUGE....because of the same reasons he got sent there in the first place....
    1.) A home has only 2 parents sometimes only 1 who have to work 8-10 hours a day...then deal with a difficult child. Residential Treatment Center (RTC)'s have a rotating staff of 10 that work 8 hour shifts, go home - and most don't have to deal with kids - they unwind, relax and then go back to their job - taking care of your kid is your life - it's only a job to them.
    2.) Residential Treatment Center (RTC)'s have a HUGE amount of structure in the fact that from the time they get up there is scheduled events. At home - it's looser, and in no way could you ever re-create the structure or level of supervision an Residential Treatment Center (RTC) does - again they are PAID to do this - you are tired, cranky, have bills, have no money, have to deal with work, other stressors, and for the Residential Treatment Center (RTC) staff it's a job. NOT an adventure.
    3.) Even if you do not work - at are a stay at home mom - you and your child can't spend 24 hours a day together - it gets old. AT an Residential Treatment Center (RTC) there are other forms of therapy to keep them busy other people, other kids to play with- etc. You can't recreate this at home. Try as you may - it will fail.
    4.) You dont' have the funds that an Residential Treatment Center (RTC) has - your threats of "a write up" are not posted for ALL the kids to see, this is peer pressure. You won't have that with siblings.
    5.) Residential Treatment Center (RTC)'s have a psychologist and psychiatrist on call 24/7 - if you don't have one before he's discharged GET ONE NOW. Make weekly appointments for the psychologist...and get in to see a psychiatrist - once a month for medications if necessary.
    6.) Residential Treatment Center (RTC)'s have written rules - that are not 10 pages long (oh so I'm thorough?) If you have written rules at home - make them simple. Make the consequences part of a decision-family-team meeting and allow your child to have input in what a consequence should be - and stop with the WEEK long punishments. They don't work. 3 days tops. Unless it is serious like stealing, hitting or running away - and if they run away or attack physicall - call the police. Send that message that that behavior will not be tolerated.

    7.) While trying to be as parental as you can - dont' forget to be human. Don't forget praise and love.....loads of it. Catch him doing good. Tell him about it.

    8.) You've both had a break from each other - try to keep to the Residential Treatment Center (RTC) schedule at first as much as possible - ask what they were feeding, get a sample menu. Try to do that at home if possible. No going out to McD's - that would be a reward in a group setting - so make it one at your house.

    And last but not least - in most situations like Residential Treatment Center (RTC)'s the other kids there are LIKE your son. They ALL misbehave or have issues - he's found other kids he's like- so he didn't feel singled out like he does in regular school. Keep that in mind when he does go back to class.....and how hard it is for him to adjust. If you have an IEP in place - call BEFORE he goes back to maybe having a teacher come to the hosue 1/2 days before plunging all the way into full day school - or see if he can go 1/2 days in the afternoon or 1/2 days in the morning - to transition. That can be paid for by the school district AND the bus transportation too....teacher as well. You just have to know to ask for it.

    And then don't forget to take time for you - and continue in some sort of parenting class. The best thing I ever did was effective communication classes. It teaches you HOW to speak to your kid - other people -anyone. But it helps you learn how to avoid those trigger responses we give because we as parents are hurt - and human.

    Learn what your trigger responses are that escalate an argument ??? You've won 1/4th of the battle if not more.

    Hugs - Tell the Residential Treatment Center (RTC) NO telling him when he gets out or how long he stays BIG NO NO.

    His anxiety level is going to be through the roof - at the Residential Treatment Center (RTC) he was on task for the first time in "forever" probably to him - when he looses that security? Look for fall out - but if you've prepared yourself with communication skills and de-escalation practices - it helps a LOT.

    Star:D
     
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