Your description of your son rang some alarm bells for me. Raging and explosive are not really typical of kids with ADHD in my experience. Agitated depression, maybe. ADHD no. ADHD is about impulse control - lack thereof. That can manifest as frustration and lead to explosions but the length and "quality" of the explosion seems different to me when I've seen it. It's not violence directed at others. It's more like intense frustration being expressed physically. I am close friends with a couple of families with hard-core ADHD kids and they can get frustrated and they can lose control but I don't think any of us would describe it as raging. Generally it stops very quickly and removing the source of frustration or removing the child from the frustrating situation has an obviously calming effect. Perhaps others with more personal experience with that will chime in and have something different to say.
What I can say is that my son rages. He sometimes rages for 3 hours or more. Slamming things around, breaking things, threatening verbally and physically. He can go from fairly calm to exploding very quickly but we can usually see it coming at least for an hour ahead of time. Not always, but usually. When he gets agitated, irritable, impatient, clumsy, bullying, anxious - we pay attention. If he didn't sleep the night before we are walking on eggshells for at least one full day, cell phone in hand and we reduce our expectations of him enormously in hopes of preventing a rage. I've had him beating on the security door with a pipe trying to get at me when he was in a mixed mood rage. And he had them even when he was your son's age.
Mistakes in diagnosis that result in rxing of inappropriate medications can lead to raging and other strange behaviors. If this behavior is really new since a medication change, I personally would call the psychiatrist and say we want him off this as soon as possible. As in, if he doesn't need to wean, we're not giving it to him again.
If it's not new but seems to have strongly intensified, I would also call his psychiatrist and make sure he's aware of the change. Point blank ask if this could be caused by the medications in which case what's the game plan.
If he's not being seen by a child psychiatrist, I would strongly urge you to find one to consult. An adult psychiatrist is OK but a child psychiatrist is really much better because they have the training to recognize developmental stages and problems. And adult psychiatrist generally does not have that training.
If he's not being seen by a psychiatrist - well, you need an emergency consult. No GP or pediatrician should be even attempting to diagnose and manage medications for a kid like this. My 2 cents.
Sorry - you didn't ask for this advice but it's important to have as good a handle as you can get on the causes of the behaviors so you can have some reasoned basis for treatment and interventions.
I'm wondering if he's getting worse because the kids at his school are now aware of his explosive behavior, and I imagine there's some degree of "egging on".
I'm not sure about egging on happening intentionally. But kids are very sensitive to differences and they may be excluding him from things (last to be picked for four-square for example) that set him up for an explosion. And yes there may be one or two who are bugging him on purpose. Are you thinking this is happening in the classroom or during less well supervised times like lunch, before/after school and recess? Those are classic times for difficult child's with impulse control and trouble shifting activities to have major trouble.
I assume that he has an IEP or at least a 504 plan. Has an FBA (functional behavioral analysis) been done? If not, this situation cries out for one ASAP. It may help you answer questions like that and turn up others you never dreamed to ask.
Given that the school he is in has worked hard to accommodate him, I think that might be the place to start.
*Unless* you truly believe he is a danger to other kids/adults or to himself.
If you think that is true - even if you think it's "just" a temporary response to medication changes - then I think you need to discuss your concerns openly with the principal and work together with them to decide what to do about it. You do not want your son to carry the burden of having seriously hurt another child. For one thing, it may reduce the less restrictive placement options very quickly. If this is your neighborhood school I would be especially protective of his standing with the families there.
As for the special school. I would go visit the school as soon as you can arrange it and see what it's like there. These kinds of school vary widely, from classroom size to teaching/therapeutic approach to grounds environment. One I visited here is in a park-like setting, it's classrooms are downright peaceful for the most part and there's a clear expectation that academic achievement is important. Another school is much more urban, there's a much more disruptive population of kids, the program is very behaviorally-oriented with dedicated staff for vocational training - etc.
I would call for an IEP team meeting within the next week or two if possible. In the meantime, go check out the other school. Make sure the psychiatrist knows what's going on and, if possible, has seen your difficult child on an emergency basis.
Keep us posted,
Patricia
