Two doctor appts in one day, meltdown and rough going

[TerryJ2]

difficult child had a rough therapy session this a.m. The therapist read him the riot act again, and told difficult child to quit rubbing his hands all over his face, to sit up straight, quit texting, make eye contact, and pay attention. He said he's too old for this kind of garbage and the impression he's giving people is that he doesn't give a r&t's *** and if he ever hopes to get a job with-that attitude and body language, he can forget it.
therapist asked me to leave the room, which I did, and read magazines while therapist set things straight.
When I went back to the room, difficult child was sitting up straight, made eye contact, and gave yes and no answers. Woo hoo!

8 hrs later, we had an appointment with-psychiatrist. Unfortunate timing, but sometimes it works out that way.
We talked about difficult child being very rude and moody and being generally an angry boy, immediately assuming the worst, lashing out verbally (an improvement from physically, but the urge is still there), and black and white thinking that makes it impossible to carry on a conversation with him.
It seems like he's backsliding.

difficult child had a fit and said he has done his best and that he is clearly not wanted and can't get his act together fast enough not to get kicked out.
Say what? He's the one who's always telling us that he hates us and wants to move out!
He's stuck on something in his head, and I told him not to catastrophize ... for example if we tell him he's too old to tinkle on the toilet seat, not flush, and not wash his hands, it's simply a task to learn, not a reason to move out, although combined with-all the other stuff, particularly the meanness and attitude, we have considered an Residential Treatment Center (RTC).T
He started to cry and said he was trying his best but that this was the best he could do. The psychiatrist asked him why he thought that was the best and he said that's just the way he is and it takes him yrs to make changes.
(Not true.)
difficult child got so angry that he was yelling and the dr told him he could not yell in his office. difficult child yelled,
"I don't CARE!"
The psychiatrist got a good dose of the other side of difficult child today.

The dr said that the Abilify isn't doing what he had hoped it would do, and he is thinking about lithium.
I told him there were no manic episodes and he said it does not only have to be used for bipolar; it can be used for other mood issues.

husband is dead set against that. Honestly, all I could think of is my slim, athletic teenager ballooning into the size of a float in the Macy's Day Parade, with-glazed eyes. T
hen again, some days, that may be better than living with-a snarly, po'd smelly kid whose favorite words are "NO!" "Shut up!" and "Get OUT of my ROOM!"

The psychiatrist is going to talk to the therapist and see if he is missing anything but he said he hasn't seen any real changes in behavior in the last yr and a half.

psychiatrist must have scared difficult child because when we left, he held open the door for me, and when we got home, I brought him some lemonade and he said "Thank you."

 

[whatamess]

Terry, I'm sorry things are so rough! That therapist sounds like he doesn't know a thing about Autism Spectrum Disorders (ASD). Berating a teenager with Asperger's isn't going to help him navigate the world. Lagging skills and Ross Greene come to mind. Have you ever filled out Greene's ALSUP (assessment of lagging skills)? http://www.livesinthebalance.org/paperwork Pinpointing the skills that need to be addressed is a first step. Don't mean to overstep, just giving my thoughts. I really feel for you and your difficult child.

 

[Liahona]

Even though it was a rough time its always nice when someone else sees "it".

Does weight gain always happen with lithium?

Sorry you had a rough time.

 

[DammitJanet]

Cory actually lost a ton of weight on lithium. He went from 260 down to about 200 and then he has lost another 30 or so pounds after giving up all psychiatric drugs.

 

[Ktllc]

Gosh... I don't have any experience with teens, but I know for a fact that with V's issues, I would never be able to say

told difficult child to quit rubbing his hands all over his face, to sit up straight, quit texting, make eye contact, and pay attention.

without sending his brain in a scarre/panic/goofy/defiant mode. Just too much at once.
Of course I don't know the whole story, but I would not flood him with all the remarks all at once.
For technicallity (washing hands, wiping toilet, etc), which I agree with you are no reasons to move out, have you been able to work a plan with him such as little post it to temind him? Would he accept to brainstorm with you at all and com up with an acceptable solution?
I can so see those kind of issues piling up on V when he gets older. Already he forgets everything and then forgets to look at his visual reminders! (time to move them and be smarter on where I put them maybe...). I have myself a hard time to take all of it with a smile, so I am not critisizing but it might be very well be harder for your difficult child than it appears.
on the other hand, it is quite nice that both Docs were able to see what you are dealing with. I feel for you and wish there were some obvious and simple fix...

 

[TerryJ2]

Thank you all.

It was mostly the therapist who read difficult child the riot act and it really did help him to get his act together.

By the time we got to the psychiatrist, difficult child was already very defiant. So it's so hard to tell if it's anxiety from his Asperger's or an emotional overlay or something entirely separate. He is so high functioning that the psychiatrist told difficult child he looked and acted like a typical teen 15-yr-old who was totally defiant. And difficult child said he was a child in his mind and just didn't remember things. The psychiatrist said that he may be behind in his mind, and have difficulty with-his thoughts, but his behavior said "Teenager." Teen friends, girlfriends, cigarettes, trying pot, video games, acting out with-parents, etc is all teenager stuff, not kid stuff.
difficult child countered that he just didn't "see" the toilet and other messes (which, if he lived alone, would get codes compliance in there, pronto, because there would be bugs and rats) and the psychiatrist said that he could learn those things and that having us tell him to learn them would not take that long.
difficult child countered that it was the anger that mostly made him act like a kid and he thought it would take him a cpl yrs to get it under control.
The psychiatrist wanted to know why difficult child gave it that arbitrary timeline.
And on and on.
Very rigid thinking.

difficult child is doing well this a.m.

I told him about my dad, and my b-i-l, and told him that when he gets a chance, he has to try on his dress clothes to make sure they fit. He was very good about it and despite what he says, he has matured, at least in regard to death. He used to say, "So?" and now he actually makes eye contact and his voice gets quiet.

 

[TerryJ2]

by the way, I know several people with-Asperger's and none of them are like difficult child in regard to anger and general surliness. It's hard to make generalizations, but seriously, difficult child is sooooo angry and I pointed out to the psychiatrist that anger and depression are often the same and he agreed but because of difficult child's volatility/lability, he was worried about my safety, and did not think that a regular antidepressant was the way to go.

 

[confuzzled]

if i remember right, he's on a very low dose of abilify, right? if he responded initially, it may be worth exhausting it to see if more helps--its generally accepted that 30mg is the max dose. personally, we found that it was a fabulous honeymoon at any dose but by week 6 or so the mood/behaviors/irritability was back x10. we had great luck once we added in a mood stablizer (lamictal) and were finally able to reduce the abilify (this summer, i may completely wean, we'll see). so that may be the psychiatrists thinking with lithium, but boy, thats a pretty big gun to try first.

He started to cry and said he was trying his best but that this was the best he could do. The psychiatrist asked him why he thought that was the best and he said that's just the way he is and it takes him yrs to make changes

i think this sounds VERY honest. i think he's telling you, loud and clear, he's having more difficulty than you assume he is. i think a lot of it DOES sound pretty typical teen, but this part seems really important to me. maybe he really does feel like he'll never live up to some impossible expectation....i think (even if its irrational and in his head--difficult children tend to put more internal pressure on themselves than we realize) it might be worth asking how you could help him try to do his best and what he needs from YOU to be successful, Know what I mean?? in our minds as parents, we *think* we know, but it never fails to amaze me just how much we dont. logic would say how in the heck do you live to teendom and either not know or cant, but there are actually things they dont know AND cant...the key is to figure out how to make it a know and a can.

i wouldnt be a teenager again, let alone a gfgteen for all the tea in china....its a horrid age

 

[TerryJ2]

We've asked him and asked him. Especially the teachers and counselors at school. How can we help you? What do you need?
But it always comes down to us doing all of the work and him just sitting there, either doing nothing, or being defiant.
We haven't found the key yet.
I am not sure that the Abilify did the trick. I don't see huge changes. Frankly, I see backsliding. And the psychiatrist did note that hormones do come into play, which is one reason he wants to consult with-the therapist.

I looked up lithium, and noticed this: Lithium is used to treat mania that is part of bipolar disorder (manic-depressive illness). It is also used on a daily basis to reduce the frequency and severity of manic episodes. Manic-depressive patients experience severe mood changes, ranging from an excited or manic state (e.g., unusual anger or irritability or a false sense of well-being) to depression or sadness.

The unusual anger or irritabililty is what jumped out at me.

I suggested Effexor and the dr didn't think that was good enough. But Effexor can work for both anxiety and depression.

We have tried others, but difficult child had horrid reactions--headaches, sweating, rapid heart beat.

 

[confuzzled]

oh--and one last thing i wanted to add....

one of our most dramatic SE's of abilify (outside of the horrors of wt gain, high cholersteral, etc) was the effect on short term memory. i have no idea if its a documented SE, but holy mother, it is not only dramatic, but from a parenting standpoint, *ANNOYING*. even at the lower dose, it still interfers with memory....mine does have a variety of executive function issues, but in our case, i can definitely pinpoint it to abilify.

just my experience, but it is conceivable that its happening on your end to.

 

[TerryJ2]

Hmm. Good point. I just wish difficult child were more self aware so I could ask him instead of having to watch him and create my own conclusions.

 

[TerryJ2]

I found this online, and I really like the social phobia part, and the Obsessive Compulsive Disorder (OCD) part. The warning for not using it on teens is almost idiotic, since Prozac isn't approved, either.

Among the licensed uses for Effexor XR are the treatment of depression, generalized anxiety disorder (Generalized Anxiety Disorder (GAD)), panic disorder, and social anxiety disorder (also known as social phobia). The medicine has not been approved for use in children or teenagers. Some off-label Effexor XR uses include the treatment of attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, diabetic neuropathy, and obesity.

 

[buddy]

i think this sounds VERY honest. i think he's telling you, loud and clear, he's having more difficulty than you assume he is. i think a lot of it DOES sound pretty typical teen, but this part seems really important to me. maybe he really does feel like he'll never live up to some impossible expectation....

I have been wondering about this lately too and I know that I (and it seems this way in your posts too) do try to let him know I dont expect perfection, he is not called on every single issue {except when I am pmsing sometimes...(...... } , but he is using new words like its too much pressure, etc. It is at odd times so I wonder, then I think well maybe this little thing is just the straw that broke the camels back.

I dont know if you remember, but Q is on Lithium. I haven't thought it has helped. But I am afraid to stop it now because at least I have times I can turn him around. When we were one pill higher than now he couldn't sleep because he was up all night peeing. Now that is gone. The weight gain is amazing. We went swimming and I am so used to seeing such a skinny kid, now he has a gut. The intense feelings when he is thirsty is annoying. Now that we have zyprexa too, I am sure that is making the food issue worse. yuck. I hate medication issues.

 

[TerryJ2]

No, I didn't recall that he was on lithium. Sorry about the weight gain, frequent urination in the beginning, and the thirst. Since it is metabolized with-salt, I can understand that.

difficult child is walking in the door right now.

Gotta go.

 

[helpangel]

Terry, I'm so sorry for all the difficulties you are having right now. Seems when it rains it pours, your not alone it's monsoon season at my house too.

Angel didn't gain weight on lithium but yes they do need a lot of water to process it and more water means more bathroom visits.

On the off chance he does have bipolar some of the medications he's on could be "fueling the fire"; of my 3 kids only one could take stimulant medications - how long has he been taking the concerta? Omega3 is very activating for Angel also. Summer is right around the corner if not doing ESY might want to try a trial off concerta while school is out.

 

[BusynMember]

Well, you're in a vicious circle. Kids on the spectrum have a terrible time trying to express themselves, even if they have good vocabularies. He may not have a clue how you could help him and may well think he can't do it. I don't get much more out of Sonic. Probably less.

I don't think therapist understands Autism Spectrum Disorders (ASD) either. It's a pervasive developmental disorder. His age is really immaterial. He is probably years behind his chronological age. Doesn't make him mentally a teenager just because he tried pot or has a girlfriend.

 

[TerryJ2]

Funny, that's the same thing that difficult child argued. But the dr said he was behaving like a teen, dressing like one, putting forth the attitude like one, so difficult child needed to be aware that that is the image he is projecting.
It's too bad our visits are so short.

 

[welcometowitsend]

Terry - I don't have anything to add here. I am, however, very interested in the conversation because your difficult child sounds so much like mine (without the pot smoking so far).

So thank you for posting this as it is helping me too.

 

[TerryJ2]

husband and I have decided to stop the Abilify on our own ... it doesn't seem to be helping and there is no point in elevating difficult child's liver enzymes and cholesterol for nothing. So we will titrate down. difficult child couldn't care less, of course.
I also wish he'd quit drinking RED Gatorade and Powerade. I'd reward him but he is so in the moment that a future reward for a momentary thrill is useless. I've learned that one the hard way. He has to learn it the hard way, too.

 

[TerryJ2]

So, I met with-my own therapist today and she was not at all surprised that the psychiatrist recommended lithium. She has met difficult child and has also heard me talk about him and about how his explosions remind me of an alcoholic, ramping up, exploding, and then being apologetic. And then I remembered out first neuropsychologist, who was actually a psychiatrist, not a psychologist, and how he intimidated me and said, "WhatEVER gave you the idea that he has Asperger's?" and then asked me all sorts of questions about whether difficult child falls off of chairs laughing, and then kicks down doors in anger (yes, but ...) so I finally said, "I can see where you're going with-this."
But after all these yrs, I think difficult child could very well BOTH have a mood disorder AND Asperger's.
And when the medications don't work, wth, try something else.
I have to just get up and keep trying. Soldier on, as they say.
When all is said and done, and if and when it included Residential Treatment Center (RTC), Boot Camp or foster care, I will be able to say I did my best.
Right now, I am just trying to be open minded.