Should I Hospitalize My Son?

Marguerite

Active Member
difficult child 3 had the language delay, but his older brother did not. And easy child 2/difficult child 2 was advanced in her language development. But it is all useful information which the neuropsychologist will be able to use.

I'm going to describe a fairly typical difficult child 3 rage as actually happened only about an hour ago - I figure the example could help you see not only the type of raging you can get with these kids, but also the way the Aspie thinking can greatly aggravate things and also responds to a different way of handling.

We just got back from Grandma's (we have dinner there every night, she lives a short walk away) after difficult child 3 had a rage. Grandma did not like what she saw; it began when a TV show was coming on that we felt difficult child 3 needed to see, and for once difficult child 3 seemed ready to watch it. He began chattering about the topic and what he knew about it, as the program was starting. I was trying to hush him down by saying, "OK, be quiet now please because the program is starting and we want to listen," but husband just couldn't handle it and shouted at difficult child 3 to be quiet (he later said, because he felt I was being ignored and disrespected, difficult child 3 was talking over the top of me telling him to be quiet).

That part of the problem is twofold - husband is really tired and stressed lately, plus he is also a bit Aspie in a lot of ways and tends to get reactive when stressed. Plus - difficult child 3 will NOT stop talking, especially in the evenings when he's a bit more tired plus ADHD medications are wearing off. When he talks, he HAS to finish what he is saying, has to finish his thought, even if I have indicated I know what he's saying. And husband does the same thing! Also, often what difficult child 3 is saying is only of interest to difficult child 3, and he WILL go in in meticulous detail about stuff we really don't want to know. So of course, difficult child 3 wasn't going to shut up fast, but I had 'primed the pump', so to speak, for him to shut up eventually. But husband reacted perhaps a bit too fast, and that set off the fuse.

So of course, difficult child 3 got upset at being shouted at, stormed off swearing, in GRANDMA's house and this meant that Grandma was unhappy and wanted to resolve this. She is very old school and I was now REALLY concerned, because she began the "Don't talk to your father in that tone" routine.

All of this began to escalate, and could have got very ugly except husband realised he had to back off, Grandma thankfully is sufficiently hard of hearing to not hear EVERYTHING difficult child 3 was muttering, and I then went out to difficult child 3 and told him to quiet down and to stop banging Grandma's stuff around, since it was Dad he was mad at and not Grandma.

Thankfully difficult child 3 watched the TV show (on Grandma's spare TV) and calmed down a fair bit. Then he decided it was time for him to go home (we let him go on his own when he wants to) but Grandma decided to make an issue. She said, "You owe your dad an apology and you owe me an apology."

Now, in difficult child 3's mind, no way did he owe his dad an apology - his dad had shouted at him first, that was uncalled for and he has to put up with too much shouting already. Therefore, difficult child 3 began to explain to Grandma, his swearing had been justified. Now with mother in law being a fair bit of a difficult child, this had the potential to get out of hand again, but it was Grandma's house so I couldn't tell her to not say anything. She has a right to have her say in her own home. But I did get to interrupt and say to difficult child 3, "What Grandma is trying to say - Dad didn't swear at you. And Grandma was not involved at all, but your response to her when you swore in her home upset her and that is what she wants an apology."

This pulled the problem (from difficult child 3's point of view) back to issues I knew he WOULD accept. So he thought about it and probably would have apologised to Grandma, only she again raised the subject of difficult child 3 swearing at his dad. So once more, difficult child 3 began to justify his response because he still felt indignant at being shouted at.

Now, in our experience - if we keep hammering him when he feels justified, we get nowhere. We have to gently show him that he is NOT justified. and the angrier he has been, the more he is likely to feel justified.

After difficult child 3 had walked home, we talked about the problem with mother in law. She began to get apologetic (the classic passive-aggressive response of someone who lifelong, has felt a need to have her say but then apologise for it). I think we managed to explain to her what was working, and what never had a chance to work. Again she tried to bring it back to "I never heard you talk to YOUR father that way," to husband. But that is a big part of the problem - we try to apply old standards to these kids and it just doesn't work. If anything, it makes things worse.

husband & I left soon after. In the few minutes it took us to walk home, we talked about how to handle it. husband is tired at the moment, not coping in other areas. There are a lot of things difficult child 3 wants to talk to him about, but it needs husband to be awake enough to focus. He didn't think he would be up for it tonight.
But as it turned out - they had to talk, there was a small crisis in the workshop and difficult child 3 was the witness who reported it to husband. They sorted out the problem together, handled "bloke stuff" well between them and any differences in other areas are now resolved.

What I'm trying to say - this situation tonight could so easily have got way out of hand with plates thrown, glass shattered and difficult child 3 screaming how he wants to die. Because we've had many of these 'mini-rages' since we used to have the much bigger ones, each time it's not so bad, it paves the way for the next one to not be so bad either. But it could so easily be once more tipped over into danger and serious aggression. Tonight we were lucky - mother in law could so easily have said something to trigger difficult child 3 and it could have got very nasty, fast.

Don't get me wrong - we don't walk around on eggshells. We don't let him do this and ignore it, hopping it won't get worse if we don't deal with it. No, we deal. But we do it in a way other people might not see as valid. But that's because I know this kid has a bigger conscience than people credit. It's just tat in some areas, he won't acknowledge fault until HE can see it. And sometimes that takes lateral thinking. Once he realises he was wrong (and this includes without us having to say a word, sometimes) he will voluntarily come to us and apologise. But he has only learnt to do that, because WE first set that example. WE had to be the heroes in this.

Some parents will say, "I am the parent. He was in the wrong. He has to apologise to me first, for breaking the window, before I apologise to him for shouting at him about it."
The trouble with this, is how can such a kid learn to apologise, if he's never shown how to or shown that it is the right thing to do? If we're always waiting for him to do it first, and WE never go first, how can he learn to?

The other part of apologising - we have to learn to do it unconditionally, so THEY can learn to apologise unconditionally.
In tonight's example - husband needed to apologise to difficult child 3 for shouting at him, but to not also say, "I only shouted at you because I thought you were disrespecting Mum." Such a statement added on devalues the apology and turns it into yet more criticism.

The way you want it to go - "I'm sorry for shouting at you."
Nothing more.
The fear is, that this tells the child that everything he said and did was justified. In actual fact, it needn't say anything of the sort.

Sometimes apologies can be piecemeal. Little bit by little bit. difficult child 3 began to apologise to Grandma. "I'm sorry I said what I said, but you don't know what I have to put up with, when it comes to shouting."
Nope, son, that is not how you apologise to Grandma.

Maybe tomorrow in the car, when he is calm and relaxed, he and I can roleplay the situation and practice how he could have apologised to Grandma. because however angry he is with his dad, there was no excuse to make his apology to Grandma conditional. If we roleplay it, we keep it calm and not blame-based. More a case of "There's nobody here to hear us, let's practice how it could have gone, so you have a better idea of how to handle it next time Grandma tries to have her say."

We do better when we avoid blame, fault, cause etc. Sometimes bad things just happen. Too often we focus on blame, when such a focus then 'infects' our interactions with our kids and especially if they are anxious, they get upset and fear being blamed when something just happens.

ON the subject of experts getting this wrong - difficult child 3's school counsellor, who seemed so effective in so many ways, was standing on the office steps with me just after we'd had a Learning Team Meeting. From our vantage point we could see a playground full of children all in school uniform of blue shirts and grey trousers. We could just pick out difficult child 3, on his own, walking along the painted lines tat marked out the basketball court on the bitumen. All around him were other kids also playing, running, chasing, talking, strolling, interacting - all but difficult child 3, who was carefully putting his feet one after the other as he walked along the white lines. His eyes were down as he watched where he put his feet. But from where we were, all those kids looked alike in their uniforms.
At this point the school counsellor said what I think must have been the stupidest thing I've heard form someone who SHOULD know better:
"Isn't it wonderful to see him blend in so well. You must be so pleased now that he is no longer autistic."

EXCUUUSE ME??!?

Autism is a diagnosis for life. A person can adapt, can learn to blend in, but is always in some measure apart, always having to work hard to seem like everyone else. And that supreme effort needs to be acknowledged. It can be Olympic medal standard effort and deserves recognition and praise, not being ignored.

School was horrible for difficult child 3. People describe it as an essential place to be for a child who needs lessons in social skills; but actually, school is perhaps the most unnatural place socially your child will ever have to deal with. difficult child 3 has done a great deal better socially since leaving mainstream. Studying at home is actually NOT bad for him socially as we were warned; it actually puts social interactions much more in his control and therefore reach. He is more relaxed, therefore more adaptable and more able to cope.

If your child is coping with school - great. But chances are, he's not doing too well and this often adds to the problems especially the raging. Just one more hassle for the child to have to take into account.

Marg
 

Tiapet

Old Hand
You are very welcome! :) Your new boyfriend sounds like a keeper. After my divorce from ex I landed a peach of a boyfriend! He and I were friends for about 2 years prior to my divorce so he knew about my difficult children. I warned him on top of it in so many ways to try to scare him good to be sure HE was sure he wanted to get into this relationship when the time came. He still wanted in. Although he hadn't lived it and the difficult children were not quite as bad as they are now, 6 years later he is still with me, putting up with the verbal abuse, physical abuse, etc. that they now dish out to HIM as well. Yes, it's trying on him and he is frustrated as all get out and he will say you told me it was bad and I knew this but never thought it would be get this bad. He loves me and because of that, he continues to deal with it. If your new boyfriend is like this, he too will continue and since you say he has a BiPolar (BP) son, then he also has a background history that has prepared him. Sounds good to me.

Fear can be a motivator or a paralyzer I've found. When you look at the overall picture (and you have to), you have to see the end results of doing nothing. I think you are beginning to see this. Great! :) I'm so glad I could help you, that is what I and so many of us are here for. What this place is for!

Just keep coming back everytime you need that boost to help you over the wall. :)
 
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xlagirl

Guest
Hi Marg,

It very well could be just Asperger's that we are experiencing over all. I guess I just really want him reevaluated to make sure that's all we are dealing with, in addition to his ADHD and sensory processing disorder (SPD). I am still learning about Asperger's (since his diagnosis at age 5) by reading books, and reading online. It would be nice to find a specalist in this area to help us learn more and provide coping skills and social skills to him. I am currently searching for a new doctor and therapist from him.

Interesting that you mentioned your son having issues with food. My son has that too. At age 3-6 he would only eat a limited selection of items. He would eat only McDonald's chicken nuggets (no other fast food nuggets), he would eat diced tomatoes, fruit, salad, pinto beans, and fries. Then finally at age 7 he started tasting new things and his menu has really expanded. He still has issues with textures (sauces and creamy items) and he wouldn't eat ketchup until we tricked him and told him it's tomato sauce, and he loves tomatoes! So he will use ketchup now on the side to dip his fries in, but we still call it tomato sauce! He will not eat eat burgers unless they are completely plain, with only the bun and meat. He will not eat off a plate unless the food is not touching! LOL....

He has to stay on a strict routine throughout the day otherwise he does not do well. We have a morning routine for getting ready for school, and also for the rest of the day when he returns home from school. Dinner time and bedtime always seen to be the worst. His medications are wearing off, he gets really hungry and restless. That boy can sure eat a lot! Right after dinner, 15 mins later he is ready for his snack. Then another snack right at bedtime. Many of his rages are started by me eaither refusing more food/snacks, or us not having what he wants to eat. Like I said, he takes his food very seriously!
Before medications were in the picture, he was so skinny and ate like a bird! But now, he eats so much and never feels full. I know it's a side effect of his medications. He has gained about 50-60 lbs over the course of about 1 1/2 years.

The story about your difficult child 3 at Grandma's house was really interesting to read. Gosh, I wish for things to be at that point someday. I know your son is older and has more coping skills than mine does at this point. If that were to happen at my mother's house, things would have went very differently. My son would have had a full-blown rage and my mother is old school and doesn't get the whole Asperger's thing and she would have threatened him with punishment and she wouldn't have backked off. It would have escalated very fast and I would have had to struggle with him and drag him outside the residence while he's punching, spitting, kicking, and screaming.
Mine is a fighter! Just the word "No" sets him off most of the time! Once he starts getting upset, there is no redirecting him. I try all the skills that I have learned from the therapists, and nothing works for him. When I try, he will yell and say "Shut up!", "I don't care", "I hate you", "your stupid", "your not my mother", "I hope you die", "I'm gonna kill you", "shut up!", "kill you", "i'm outta here", "stupis A**", and soooo on.

You basically just have to ride it out. It doesn't stop until he goes through all the cycles of the rage. It starts off with back talking, then cussing and kicking the doors and walls. Then it progresses to the violence.

It really wears me down! And I a exhausted~! Honestly, I've been doing this for a lot of years..... and right now, I'm trying to find the inner strength to keep going. :(

I really like this..........
This is a kid with determination, right? Well, the best controls applied to such a kid, are the controls he already has. A determined kid is a kid with the potential for a vast amount of SELF control. All you have to do is become his facilitator, stop being his disciplinarian and help him learn to manage himself. He will probably be better at it than most people, and learn it faster.

Thnak you for your help.
 

TerryJ2

Well-Known Member
Your boyfriend sounds wonderful! He's a keeper!!!

Best of luck, Xlagirl. Your decision does not come lightly.

Our experience with-difficult child at psychiatric hospital was not as dramatic as with-Tiapet. difficult child raged in the a.m. b4 school and went after husband. easy child was so upset, she couldn't pay attention at school. She told the school counselor. Counselor knew our therapist personally, got easy child a lunchtime appointment. easy child encapsulated everything for therapist. Therapist made phone call to us, then to psychiatric hospital to prepare for difficult child. We packed a suitcase (something I learned from this board), picked up difficult child and drove to the hospital. He was feeling so awful about the a.m. rage that he didn't dare open his mouth in the car, until he saw the sign for the psychiatric hospital and then he said, "Is this where I'm going?"
We said yes, and he gave a big sigh, said he didn't want to go, but walked in with-us anyway.
He seemed so small and vulnerable all of a sudden, it broke my heart.
on the other hand, they did a pretty good evaluation and started him on clonidine, and when we had our first family visit, he smiled for the first time in wks. He was so happy and loving I thought, I knew there was a real kid in there somewhere!
The psychiatric hospital gave a discharge diagnosis of "mood disorder, not otherwise specified," which is a mishmash basket of terms that doesn't mean diddly squat, but they also forced us to get a psychiatrist to do medications once difficult child was released, so we would have someone coordinate all the medications instead of the pediatrician, neurologist, whatever.
I figured out Asperger's on my own, but took difficult child to a local dr who specializes in spectrum disorders and had him run a whole slew of tests (incl a psycho educational test to see if difficult child was at grade level).

When you take your difficult child in, you can certainly tell him it's because of his rages, but tell him that it's not because he's bad. It's to help him learn to be calm and learn more about the way his mind and body work. Tell him it's a hospital but he probably won't have many needles (that's the first thing kids want to know!). They will probably draw blood but that's about it. The rest is talking and listening. He'll be relieved to hear that. Tell him you can visit in a day or two and that the hospital visit is just for a short time. You want to give him enough info so he's not anxious but if you give him too much info, you'll ramp him up. It's a fine line.

Best of luck! Many hugs.
 
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xlagirl

Guest
Hi MidwestMom,

You mentioned that Asperger's kids often don't need medication's. Oh gosh, I don't think we could get through the week without the medications. His pre-medication days were really tough! He was raging 2-3 times at school each day, and another 1-2 times per night at home. It was really bad! This started at age 2, but we just called them meltdowns for age 2-4. He was the most unhappy kid that I have ever seen. Back then, you could not even get him to smile. And, nobody could touch him. He hated to be touched, especially by strangers!
Back then he had very little eye contact with people, and he was very clumsy! He had many head injuries throughout his life. Plus he was born with external hydrocephalus (which there was no surgery from). So with each bump on the head meant another trip to the E.R. for a brain scan.
He grew out of it. His brain finally grew and absorbed the extra water.

At age 5 he was diagnosis with AS, ADHD, and sensory processing disorder (SPD) and his peditrician perscribed medication for him. I did not fill the perscriptions! I was thinking, "I'm not going to drug my sweet little boy just because he's a little different".
His troubles in school were already escalating from just meltdowns (like in pre-school and pre-K) to pure violence against other kids, faculty and self-injury! So at age 6 I took him to a new doctor and I agreed to start him on medications. =(
This did help slightly in 1st grade, but I was still being called daily by the principal or his teacher to come and pick him up from school.
This is when his first IEP came in to the picture, and then began all the testing by the school psychologist and college interns, etc.
They took him out of mainstream classes, and put him in Special Education. class. They assigned a full time aide to be with him at all times. He was still having many rages at school, so then they cut his school day down to half-a-day! =(
No daycares would take him for half a day. Each one I tried would kick him out within the first couple days!
So now I am a stay at home (single) mom! ugh! I tried working from home fore a while, but it never worked out with my son home.

Public school finally gave up on my little guy.....
The school he is in now, is very rough. They have classes for autistic kids, and for the severly emotionally disturbed.
He does not qualify to be in the Autistic classes because the kids in there are academically-delayed and most are not very auditory. So my son is in the class with the emotionally disturbed. Since going to this school, his "bad word" vocabulary has really grown. He still gets in fights and rages at school, but they have techs that walk around with walkie talkies and they run to each situation and do restraint. They also use a "special" room for putting the kids in to when they are raging out of control.

I know many of you will say to get him out of that school! But I have nowhere else to to put him. I want him to have a good education, and I have thought about home school but I just don't think that I could do it. I'm already wore down, and he doesn't listen to me at all. To find the patience to get through schooling him would be unrealistic at this time.


Hi Tiapet,

I think your right, the boyfriend is a keeper! It is still so new, but he seems like he's in for the long haul. Time will tell! =)

I am looking at the big picture, as you said. I know we need some intervention right now, and fast... but in the long run we will all be happier and have better days.
I did talk to my son about going in to the hospital (when he was calm, post rage) and he actually said "mommy, I do think that I need to go in the hospital, but I only want to go for 1 day." LOL....
I explained to him that it would have to be for more than 1 day, and I explained why. Then he said "How are they going to know when to feed me, and how will they know what I like to eat?" LOL....
He was more worried about the food, and that he might not get enough to eat and enough snacks!
So, we talked a little more about it and he seemed okay with it but he still didn't want to stay more and a couple days.
He hates to be away from his home, and away from his normal routine.

I'm on the phone today trying to get hi in to a new doctor. I'm finding that there is such a LONG wait to get an intake appointment. Geez!

Take care
 

Marguerite

Active Member
I just wanted to stress, re the incident at Grandma's - first, difficult child 3 is older. Second, Grandma thankfully didn't continue pushing his buttons; as it was, I was on tenterhooks expecting a full-blown rage. We used to get really serious raging every evening, sometimes several in a row. Once you get one rage, the kid is on a hairtrigger for more. Third, we've been using "Explosive Child" methods for a few years now and the long-term benefit is, he has learnt to be more tolerant.

The issues with food etc are undoubtedly sensory integration issues, which are classic findings in Asperger's.

I do get you on needing to re-evaluate and make sure the isn't something else as well. But a couple of points - first, this is not very exact part of medicine and "seek and ye shall find" applies. What I mean - it depends on which kind of specialist your child sees, but whatever diagnosis you feel belongs, you can ensure is given, if you just see the right person (or the wrong person). You are right to keep challenging the diagnosis - we all need to do that. But keep an open mind, always, on the result. difficult child 3's current specialist is typical - if we need reports for school or for welfare, the doctor says to me, "What do you want me to write in my report?"

Very disconcerting.

Marg
 
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xlagirl

Guest
Hi Terry,

OMG, Thank you for sharing your story about taking your little one to the hospital for the first time. Just curious, how old was your difficult child and your easy child at that time?
It really helps me to hear your story and how you all survived it!

I will take your advise about what to say and what not to say about going to the hospital. That is GREAT advise!
He will scream when he finds out they will draw blood from him. Good luck holding him down for that one! = )

Today I made a lot of progress.....
I called his current psychiatric and told them how things have been going at home (but I never got past the gatekeeper/recpt).
She told me to just take him to county ETS (emergency treatment svc) 24hrs a day if I needed him assesed.
I know for a fact that it's AT LEAST a 5 hr wait to see a doctor there. Plus they only have inpatient svcs for children over 13 yrs old. So, after his assesment, he would need to be transported to an out of town hospital about 1 hr away. Not saying that I wouldn't go that route, because I may have to.... but there's another option.

I spoke to my difficult child's school today, and the Vice Principal was very helpful and gave some great advise on how to handle this.
He said that he will call for an emergency IEP and request a AB27-26 assesment for mental health svc. They said this will not only get us help quicker, it will also open the door for in-home coaching for my son, and Theaputic behavioral services.
I am really looking forward to all that!

Thanks again Terry
 

Marguerite

Active Member
On the subject of blood draws - difficult child 3 has had HUGE problems with this. We have found (experience with difficult child 1 as well) that we need to NOT use force except where absolutely vital in the short term as immediate safety.

difficult child 3 was cooperative with blood draws - no mistake. But he would be in such a panicked state over it, that he simply couldn't handle it emotionally. One blood draw I recall with shudders; we arrived to have this done (preliminary to surgery on his wrist) and I said to the nurse, "Can he have something local? He is very anxious."
The nurse was very no-nonsense, said, "We haven't got time for that. Goodness, he's a big boy now, shouldn't need to be coddled."
I did try to quietly tell her, "He is autistic and has severe anxiety," but the woman was not hearing me.
We went into the room, difficult child 3 sat in the chair with his arm out and went white as a sheet. The nurse was an expert but it didn't help - difficult child 3 was in such a state of shock that his blood vessels clamped down and no blood could be drawn. To complicate the picture, difficult child 3 began to dry retch, and then fainted.
So we moved difficult child 3 to a couch and the nurse tried again. Other arm this time. Last chance. Time passing. Finally she got a needle in while difficult child 3 was conscious and not vomiting. We had to coach difficult child 3 to breathe, and on each exhale, a few more drops were gathered.

The whole experience only reinforced difficult child 3's fear, and it made the job even harder, to get blood for later tests.

What we have done since, on the advice of a friend who is also a doctor - we bought emla cream from the pharmacy and applied an emla patch before any blood draw. We told difficult child 3 that the emla was designed to stop the needle hurting.
Now, I've been told that blood technicians really hate it when people use emla, because it's one more thing they have to clean off. Also it can affect the blood vessels and make it easier for the technician to make a mess of it. But we've never had any problems, other than the emla not having quite taken effect. However, we've now had enough blood draws with few problems, for the very negative experience to be now a fading memory.

Whatever services you can get - go get 'em. Use whatever you have to. But do your utmost to avoid needing force, because it's ability to get results is very limited and rapidly diminishes from there. You do not want to be left with absolutely no options. Better to start now, trying to go a gentler alternative route.

Marg
 
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xlagirl

Guest
Hi Marg,

Thanks for clearing that up about the incident at grandma's house.
You also mentioned.....
we've been using "Explosive Child" methods for a few years now and the long-term benefit is, he has learnt to be more tolerant.
and I will be picking up a copy of that book from the library soon! Thank you for sharing that with me!

And yes, I will keep an open mind when it come to seeking a new diagnosis.
I'm looking at it as a second opinion really.... My son has changed so much in this last year I just want to make sure that he is getting the best treatment he can.

((HUGS))
xlagirl
 
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