I do hear you about trying to talk to him when unmedicated - I totally agree, it is a pointless time. difficult child 1 when unmedicated is belligerent, aggressive, scary in fact. And totally unreasonable. He HAS learned that what we see is not what he sees, in terms of his moods. There have also been too many times when I have stopped talking to him mid-sentence and said, "You haven't had your medications yet, have you?" and been right. So he has learned - I must be noticing SOMETHING. When he was in high school (your junior high) he did try to "do without" his medications and would not take them and lie about it. He would also have caffeine in various forms (because he wanted to fit in and be like all the other kids). He finally had to accept that life was miserable when he was drinking cola/eating guarana bars/skipping medications and JUST MAYBE it would be easier to cope with life, if he tried it my way. There were times, especially on weekends when it mattered less, when I let him do it his way and bought him some cola and let him drink it.
We didn't have a video recording of him but believe me, I did consider it! It would have been part of a scientific experiment with him. With hindsight, I really wish we had set up video cameras. Many, many times I wish we had it.
Being logical and discussing all this WHEN HE IS MEDICATED is a good start.
What we did with difficult child 1 - we set an appointment with him to discuss things, just as if we had an appointment with his psychiatrist. We chose a time on the weekend when he was medicated but also not in a rush to go anywhere and we gave him advance notice so if he DID say, "This had better not take long, I have to go over to see Johnny," we could remind him that we DID have an appointment which had to take priority.
We also kept it short - knowing he has a short attention span. We also took obvious notes, minuting our meeting. A mind map is a good way to do this.
And we listened to his concerns/complaints and also made it clear we were taking them seriously (even if we felt they were rubbish) and we took pains to ensure ALL concerns were not only discussed, but were explored.
Example:
Us: We are concerned that you either haven't been taking your medications properly, or something is interfering with your absorption of medications. Or the dosage is too low. Have you noticed anything? Have you been properly compliant?
difficult child 1: (getting VERY defensive) I take my medications in the morning like I'm supposed to. I NEVER forget! And I NEVER drink cola. I know better than to eat those energy bars. Why do you think there is a problem?
Us: (staying calm) What we see, and what we're told, is what we have seen in the past when we know your medications aren't on board for whatever reason. So if you are fully compliant, then maybe we need to have your dose increased. But we must be SURE that all your current dose is getting on board, before we take this step, that's why we must ask you these questions.
difficult child 1: (now realising that we could be making him take even more, perhaps not a good idea if he isn't being truthful) Well, there have been a few days when I forgot. And Brett offered me some of his cola the last few days, I didn't want to offend him...
US: OK, so maybe that had an effect. So what do you think we need to do? What do YOU want?
difficult child 1: I really hate having to take medications. I hate being different! I want to be normal! I hate it when kids call me a freak, or a druggie. I hate it when the teacher asks me in front of everybody if I've taken my medications.
Us: That's understandable. We all want to fit in. Why do you hate taking pills? Is it because you're taking medications in general, or is there something else?
(at this point he could say that he hates how it makes him feel - there could be a reaction you may not have been aware of. Or he could simply say he hates the IDEA of having to take medications all the time).
We've given him the example of a person with diabetes, or epilepsy. As long as they take their medications as directed, they can be symptom-free. But missing their medications can be really dangerous for them.
Another possible direction things could take -
difficult child 1: I really don't think energy bars make a darn difference. I don't think cola does, either. Maybe I don't need such a high dose after all. I just want to find out if this is true...
Us: That is actually very sensible, it's a good idea to find out. However, you shouldn't experiment on yourself without having an independent observer. In the past we used to take you off your medications (with the doctor's approval) without telling the teachers, to see if they noticed. What you need is something similarly controlled, where someone else can report honestly. How should we do this?
difficult child 1:We could ask the teachers again...
Us: No, not in high school. You don't have the same teacher all day every day, so you don't have enough observation from the same person over a period of time. Too many teachers, too little time, too many variables.
So after some discussion to and fro, we work out a compromise - we will observe difficult child 1 ourselves, maybe using video cameras to record what we see so difficult child 1 can view the footage himself later on while medicated. At the same time we will make our own recordings in a diary, so we can show it to him also. And our part of it - we will do this at home on a weekend, but we will buy him cola, we will buy him the guarana energy bars and we will also hold back his medications - over three different weekends. We will do it as a scientific experiment and he has an important part in writing up and conducting the experiment. It is HIS research as much as ours. We then put the data together and show it to the psychiatrist at the next appointment.
The important thing - keep this discussion short, maybe break it up into successive sessions if you need to. Keep difficult child fully in the loop, give him some control of the process as well as ownership of it. Work as a team to help everybody understand as much as possible.
And DISCUSS IT WHILE HE IS MEDICATED!
Making an appointment to do this is important. An agenda can also help - he will feel important and he WON'T feel ambushed, if he knows ahead what is to be discussed. Take minutes, keep it all impartial as if you are having a business meeting. Any shouting - make sure it's only difficult child and ignore the emotion and just listen to the words.
We did something like this when we had to put difficult child 3 on a very restricted 'elimination diet" - we HAD to have difficult child 3 on board which meant he had to understand why as well as how, and to also approve it. He hated it, but he was VERY cooperative and motivated because he realised that the better he cooperated, the sooner he could go back onto a normal diet once we all had the data we needed.
Your difficult child is very smart, which makes it even more likely that he will value this process and feel more in control and therefore more cooperative.
Good luck!
Marg