13 year old in psychiatric ward for first time

Discussion in 'General Parenting' started by Otto von Bismark, Sep 29, 2011.

  1. Hi all, I have been a lurker for a little while, but now it is time to come out of the shadows, I guess, as we could really use some help. I am putting background in black, and questions in red, so skimmers can get right to the point. I think this will be a long post.

    He is 13 years old, 7th grade, diagnosed at age 5 ( by public school) with Asperger's. He is currently in the adolescent psychiatric unit. We found out on Saturday that over the past two years, he has killed three hamsters and a guinea pig .. all at friends' homes. No remorse whatsoever, except for the fact that he got caught and his life is now different.

    On Sunday, he told us that he wanted to stab himself with a knife, and told us that he had attempted this previously. This was all news to us. We went into the ER on Sunday and he was admitted that night.

    He also developed public masturbation two years ago, which we tried dealing with through therapy, and with a plan at his school, which is a Special Education private school.

    He lies constantly. Other than those things, no fights or violence toward other people, and no drugs, or face-to-face defiance.

    His psychiatrist at the hospital talked of conduct disorder, sociopathy, etc... and suggested that the autism might be misdiagnosed.

    On the same day we talked about sociopathy, we got his test results from standardized testing at his school from last year 6th grade, and he is now working at around a second grade level! This, also, was a shock, since he was low before, but never that low.

    Here is what our plan is :
    We really need expert testing, on a comprehensive scale. I am thinking, neuropsychological, educational, and a good psychiatric diagnosis by someone who is expert in differential considerations. We may have multiple problems, as he has never really seemed 100% Asperger's to me, he is nearly impossible to teach or correct (rewards, restrictions, grounding, spanking, visual schedules or charts, role-playing, etc...). He had a cyanotic episode at birth and I have long suspected brain damage somewhere but can't seem to get anyone on board with me.

    The hospital psychiatrist put him on 100 mg of Zoloft because he says it might help with his impulses. After some research, that seems like a high dose, plus I am worried about side effects. Should I question this medication and dosage? He also called yesterday and said he feels wonderful on the drug, and has no desire to kill animals or harm himself -- after two doses. Hmmm....either placebo, mania, he is trying to say what he thinks will get him out of the hospital, or his brain is so serotonin starved that it is actually working within in two days.

    Does this sound familiar to anyone? Anyone have anything to offer. We are pretty broken up right now. Thank you.
  2. InsaneCdn

    InsaneCdn Well-Known Member

    Hi, and welcome.

    First... if you're using your real name as your login, please contact site admin (runawaybunny) by PM, and she can help you change that - we keep our identities hidden here, to protect ourselves and our kids.

    Next... you're on the right track, in my opinion... absolutely this calls for a comprehensive evaluation. That does not necessarily invalidate the Autism Spectrum Disorders (ASD) diagnosis... it might be that plus other stuff, OR something else (or multiple things, as you suggested) entirely. And yes, you do need to get to the bottom of ALL of it.

    Are you in the States? or somewhere else? (don't need city etc. - sometimes "state" or general area like "south-west" or "mid-atlantic" if US, or country otherwise) This makes a difference in what we can suggest... I'm in Canada, for example - US members are more familiar with US law.

    Who did the original evaluation?
    Any medications?
    IEP or equivalent at school?
    Motor skills... both fine and gross?
    Sensory issues?
    Ever had Speech Language Pathologist (SLP) testing? auditory testing? Occupational Therapist (OT) testing? These are supplemental tests that often give clues... and/or pinpoint hidden problems. SLPs and OTs also have therapies to help...
    What is the family situation... who all lives together, how are they related?

    When you get time, its nice if you create a 'signature' - how-to instructions in Site Help and Resources, or just go to your profile, click on "create signature" (or something like that - haven't been in there recently), remember to save it, AND click the option in your profile to "show your signature"...
  3. buddy

    buddy New Member

    so sorry for you all... heart breaking to see our loved ones go through so much. Sounds like you are checking so much out. Are you comfortable with the hospital. docs or are you searching for someone that meets your needs specifically? Just curious. I have not had to do this (yet) but I worry about it. My son killed 2 hamsters when very young, he panicked when they moved and threw them and they hit the wall. Huge mistake my sister made telling him he could go and play with them...he was young then and she didn't have her defenses up as she does now. I know he loves animals but am not sure he can control his impulses around them (he is fine with our dog...at least as much as any of the kids I have been around are with pets I guess...but he was not so kind with our cat...couldn't understand that a cat's eye's squinting did not mean he was angry....he has terrible time reading facial expressions.). I hope you get the help you are seeking. hugs and open ear (well, eyes in this case) for you...
  4. DDD

    DDD Well-Known Member

    Just want to add my welcome. Fortunately I have not dealt with those complex issues although I have raised a 20 yr. old with multiple dxs. He has Aspergers, ADHD and has also been diagnosis'd with Schizoaffective Disorder and BiPolar (BP). I'm not convinced on the later two but he is stable on the medications and is functioning fairly well.

    Most of us have had difficulty finding the best help for our difficult child's. Many have turned to Nationally known Children's Hospitals who specialize in child and adolescent psychiatric evaluations. in my humble opinion finding experts who you thoroughly trust is extremely important. Also, many of us have gotten and advocate for complete neuro/psychological evaluations to supplement care by a child/adolescent psychiatrist with lots of experience and compassion.

    I'm sorry you all have to face such complicated and sad circumstances. on the other hand the sooner you know what you are dealing with, the sooner he will have the best support system. Good luck. DDD
  5. Nope, that's not my real name. Otto Von Bismark was a Prussian political figure. : )

    We are in the South Eastern US.

    The original evaluation was by his public school when he was five years old. We tried to have further evaluations but they were not covered by insurance and we didn't have the 3 grand that it seemed to cost down here to get it all done.

    medications: Other than the zoloft which he has been on for 3 days -- no medications

    IEP: We have abandoned IEP as we are now in a private Special Education school. They gave him a very high "matrix number" when he was in public school, so we now qualify for a very good state scholarship to help with tuition costs. They also said he had Asperger's Syndrome.

    MOTOR SKILLS: He has enough motor problems, both fine and gross, for my husband to suspect very mild cerebral palsy ( he works with CP kids so he knows), but the PT and Occupational Therapist (OT) we used to get in elementary school just worked on proprioception and handwriting -- putting him under the autism umbrella. Very clumsy now, no sports, spills things, terrible handwriting.

    Auditory testing: they said he was normal with the exception of auditory memory -- he got a zero percent on that part of the test. They said they had never seen that before and had nothing to offer.

    Speech Language Pathologist (SLP) : somewhat hyperlexic, no other Speech Language Pathologist (SLP) issues that stand out. He reads brilliantly, but doesn't comprehend well.

    Other medical -- born with midline defects -- cleft palate, hernia, had multiple aspiration pneumonias, very bad shot reaction, and turned blue 1/2 hour after birth -- choked on mucous from unnoticed cleft palate.

    He lives with me (bio mom), my husband (stepfather) and two older sisters (full siblings). His dad and I divorced when he was 1. : (
    His dad lives in another region of US, with new family, but he does come to visit and my son goes to visit him. We have a great marriage, overall happy family, but as he gets older, the dynamic is changing because his behaviors are getting worse and his sisters, (15 and 17) are unable to tolerate him. They have caught him masturbating many times in public areas of the house, plus, unfortunately, he rattles on and on and talks about minutiae and relates poorly to what is really going on, so it is hard on everyone, let alone him.

    My kids and I seem to get side effects for medications very easily, and we seem to be very sensitive to medications. I could fill a post or two on those adventures. We have used a lot of biomedical interventions with our son and many have helped, but things seem to be changing markedly with adolescence. Also, he has about a seven second attention span but we don't do ADD medications because he has possible Long QT Syndrome. Docs can't decide if it is definitive diagnosis or not.

    I will create a signature today. Thank you for your reply. It seems as if even the smallest acts of kindness are suddenly very meaningful.
  6. InsaneCdn

    InsaneCdn Well-Known Member

    Some parts of what you write, would be consistent with Autism Spectrum Disorders (ASD) - but that doesn't make it "the" correct diagnosis. Other things might also account for some or all...

    For example -
    The rattling on and on about trivia... and hard to relate to what is going on... and motor skills issues... can all fall under the Autism Spectrum Disorders (ASD) umbrella.

    BUT... if all you have to go in is school evaluation - you don't really have an evaluation at all.

    Which means, there will be undiagnosed needs, and/or mis-diagnosed... and proper interventions and acommodations are therefore not in place... which is enough to drive any kid to insanity. And yes, it gets 100x worse when puberty kicks in.

    Chance of brain damage at birth... definitely possible, and you need to know.

    Speech Language Pathologist (SLP) evaluation - not thorough enough, but some testing is relatively new... please get Speech Language Pathologist (SLP) re-tested privately by someone who knows about both Central Auditory Processing Disorder (CAPD), and about auditory filtering/focus/discrimination issues (difficulty homing in on the important sounds when there is background noise).

    Occupational Therapist (OT) therapies are good... but you really need to know what you are dealing with. Occupational Therapist (OT) evaluations are usually not that expensive even if you have to pay for it - test out both sensory issues AND motor skills issues.

    And then... somehow, you have to get a neuropsychologist, or a complex-needs team, or something... for an absolutely comprehensive evaluation.
  7. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Has he ever had a genetics test?

    There is a disorder (I THINK it's called velocardial facial syndrome) that causes a lot of strange behaviors and mental health issues and kids with cleft palate MAY have it. At any rate, it's always a good idea to have a genetics screening. That would also rule out Frangile X, which mimics autism.

    Here is a link about velocardiofacial syndrome you may want to look at, but only a blood test can rule it in or out:

    in my opinion you son does have autistic traits, but it sounds like more than that and, like you, I'd be wondering about brain damage at birth, which is something they can't SEE but could still be CAUSING stuff. I would definitely take him to a NeuroPsychologist that has nothing to do with the school district.

    I think 100 mgs. of Zoloft is also high. I know I got manic and ended up in ER on only 50 mgs. I felt great too at first, until it swung me way too high and my heart raced so face they couldn't even count the beats. I don't know why they don't start slowly, especially with a child.

    Keep us posted. Welcome to the board.
  8. InsaneCdn

    InsaneCdn Well-Known Member

    Welcome to the board... we know what you mean. Even if "all" we can offer is a soft shoulder... the people here on this board do "get it" when it comes to feeling isolated and alone and no where to turn... we've all been there at some point, to some extent!
  9. keista

    keista New Member

    Welcome to the board!

    It all started to sound EXACTLY like son, but then it got different - very different.

    I"m stuck on the Asperger's diagnosis. It definitely sounds like possible Autism Spectrum Disorders (ASD), but not Asperger's, but again it could be Asperger's co-morbid with something "more serious" I say this only because a criteria for Asperger's is average or above average intelligence. Having it identified at a relatively young age and having good school supports usually results in at or above grade level functioning despite any other issues. IOW he can be failing classes, because he forgets to hand in or do homework, doesn't follow through with projects etc (although the supports should be helping with these things) BUT that intelligence gets them through on the standardized tests. Of course, that's assuming that he had proper supports in the testing environment. It's a bit semantic picking it apart, but then again no, since not all Autistics respond to the same interventions and supports the same way - depends where they are on the spectrum.

    Anyway, my son was pretty much diagnosed by the school as well. At 13 entering 7th grade, he got hit with depression - HARD. He was Baker Acted (involuntary commit) by a school resource officer for simply expressing his suicidal thoughts - no real threat. At least for that day, that completely pulled him out of his depressive funk - what kid doesn't want to ride in a police car, get a tour of the local lock up and then ride in an ambulance? He had a BLAST. He wasn't even kept for 24 hrs. Unfortunately as soon as he had to head to school again, he was down again. His Aspie self was just having an insanely difficult time transitioning to middle school. I got him on medications (Abilify) and we instantly had a "functioning" kid.

    A few questions about the psychiatric unit he is in. Is it just crisis stabilization or is it for longer term diagnosis and treatment? If it's just crisis, I would take what they say with a grain of salt and then move forward as quickly as possible for full evaluations or finding a long term treatment center if you think he needs it. If it is a potentially long term place, then push for any and every evaluation they are willing to do.
    The big problem if this is just a crisis unit is that, in my experience, all they seem to concern themselves with is what's happening at the moment. My DD1 went to a crisis unit this summer, and their suggestion was MDD. Yes, thank you, that is NOT what she has. No, we can't rule it out 100%, but currently absolutely, possitively, NOT her diagnosis. AND their only medication suggestion was to add an SSRI. This was AFTER I told them that we've tried 3 different ones and she had a BAD REACTION to 2 of them an intolerable side effects to the third. So anyway, how you deal with this psychiatric hospital depends a lot on if it's crisis or long term.

    So yes, I think your plan is good, and if you don't think the medication and dosage is right, question, question, question! Unfortunately with ALL of these medications, with both children AND adults, it's like a **** shoot. You need to wait and see. Hope you get luck, if not, spot issues as soon as possible, advocate for changes when necessary. Last January, DD1 complained of feeling like a guinea pig with all her medication changes. I don't blame her, but even though she was on some bad ones, I feel, overall, she's better off now for having been on them. Despite the bad reactions, some of them also had positive resuts (yeah, at the same time - how messed up is that?) and during these positive times she got to experience "normal", so now she knows how things "should" be (by the way she's had mental health issues since birth but were only truly problematic and identifiable starting at age 7)

    Welcome again. :notalone:
  10. Liahona

    Liahona Guest

    Welcome! I was wondering how they would diagnosis a brain injury? Would they do an MRI?
  11. Thank you all so much. I have so much to reply to and so many questions, I may not hit all of them in one post. In fact, I will use this to give you an update on where we are. We have been busy -- my son got out of hospital on Thursday night. They did no testing of any kind...it seemed to be a crisis mgmt. place. We were not allowed to leave until we had psychologist and psychiatrist appointments set up. Kind of like not leaving with your new baby unless you have a car seat.

    He has been very strange since he got back, partly because of the medications and partly because he learned that it was okay for him to talk about his feelings -- We have tried for years to make sure he knows that he can safely talk about his thoughts with us, but now he knows, I guess, since he said the worst of the worst and we still love him and haven't rejected him). Every night he tells us how much he wants to kill himself. It is heartbreaking.

    It could be medications, in part. He was prescribed 25mg of zoloft, not 100. The 100 was the dose the hospital doctor would like to see him at. Started at 25.
    Our new psychiatrist, not the hospital one, told me briefly, after informal consult, that he would never had but him on Zoloft, and that the butchers at the hospital we were in can't be trusted. Nice. Until he can see him (late October) he told me to cut the zoloft in half, to minimize side effects.

    Zoloft side effects: mania, hyper by day, suicidal by night. Strange replies to conversations, answers really fast and in a weird tone, talking about how much he wants to play sports (he has strength and coordination problems and has always hated sports), when searching for my cell phone, which I told him would be around the kitchen, I found him searching through all the drawers in my bedroom! He also is up until midnight, and wakes up around 7 am. He has always needed 9-10 hours of sleep. Add this to a few hours at a time where he is completely silent. This is a chatty child who is never silent.

    One thing I like to see is that he will also sits in his room with his radio on and reads comic books, and occupy his own time. This is a child who usually will do NOTHING unless I suggest it, and he follows me around the house constantly, unless I give him a direction to do something else.

    I do not like Zoloft. He talks about suicide every day, which could be autism and him getting fixated on something, or it could really be his feelings, or it could be the medication. We have to assume that they are very real feelings and we are treating it as such. I don't know what good going into the hospital again would be. This is difficult. Is it possible to have a suicidal kid who just has feelings and will not act on it? We have removed knives, vitamins and medicines, and he is supervised 24-7. Is that doing enough until we can see the next doctor on Wednesday?

    Thank you for your help, people. I have learned so much from these posts, and am grateful.
  12. buddy

    buddy New Member

    I'm not a dr. but with my son , former clients, and training what I have seen is...(very simplistically and MHO of course)
    Yes, they can do imaging tests like MRI, CAT scan etc. and many things can show up certainly. many small things dont. A PET scan can show how the little nerves/neurons in the brain are activated and excited under different physical conditions and cogntive tasks. That has helped diagnose many things now like even ADHD. (not fool proof as with anything) But, generally the medical history matching with the symptoms is what allows them to diagnose the brain trauma. That is what is unique about a good neuropsychologist. Their job is to really match how all of the different areas of the brain typically function with the known effects of damage to those areas. If they know of red flag events like lack of oxygen, even babies who have a bowel in utero which could signal distress, etc. they can investigate better....share everything with them! And of course knowledge of a physical injury to a specific part of the brain or evidence of a mass injury like loss of oxygen to all tissues or high pressures, etc. ( which can compress the whole brain) can help guide them in what to look for. They will explain what typically happens to people with injuries like that and what supports they may need. Then you are armed better for the future. If there are current symptoms, they can help connect the dots and help you to explain to the professionals working with you how it is a neurological deficit and needs to be addressed as such. If there is not any image or dr. report of specific injury, they can tell from the symptoms if it may be connected to the kinds of things reported in the medical history you provide, and the same kinds of ideas and instruction can be given to the other professionals. Of course there is much more to it but for me both as a mom and an Speech Language Pathologist (SLP) these have been the huge advantages of using a neuropsychologist. In general, they really are the best for understanding any neurological disabilities including autism and traumatic or acquired brain injuries among many, many other things. by the way, as an aside, difficult child and I now have an Ed. Pscyhologist who is just as good as that, is both an educational psychiatric and expert in brain injury. Also, just a good guy period...so it has been really nice for the last 3 years that way. He is the one who actually attends ALL iep team meetings AND reviews AND planning sessions. difficult child's waiver pays him to but he wouldn't have to go that far. There are some good ones out there.

    (specific example: along with the brain injury my son has to frontal/temporal lobe...and high pressures he had for a long time....the mri now shows he has a shunken hippocampus. Neurologists are not overly concerned...but neuropsychologist helps explain that this is the are where certain memory functions are and some emotional regulation is... it was discussed more specifically than that, but you get the idea of how beneficial it is.)

    Some treatment methods would be the same no matter the evidence of brain trauma for certain conditions. But there are also some specific cognitive habilitation methods that work best for brain injury and these sometimes get lost in the school systems. (very hard to separate those and it is super frustrating for school therapists behind the scenes, they wont usually admit that in meetings or in front of bosses obviously.) Schools are geared to work to help bridge the gap between disability areas and school functioning and it can be more problem solving than really rehab/habilitative except for kids with severe physical and develpmental disabilities...those look closer to outside rehab services sometimes. (of course if I had been your Speech Language Pathologist (SLP)...no problems ever!, tee hee just being a brat here!)

    For us the main advantage is no one can claim that difficult child's behaviors and challenges are from lack of significant consequences/bad parenting, or that he is just seeking attention or being a rude child. Believe me, we hear that every year. There is not one single chance that they can claim his behaviors are not a "manifestation" of his disability (the due process term used if this is in question).
  13. keista

    keista New Member

    Yes, it's possible, but don't hang your hat on that. The precautions you are taking sound about as good as you can get. (don't forget scissors, pointy tools like screwdrivers and power tools.)

    It's great that he's talking. Keep him talking. Get him to monitor his own moods. Wanna die, REALLY wanna die, am thinking of doing something about it, get me to a hospital NOW! Of course find a way that works for you and him together. Because yes, there can be degrees of intensity. I've been through them myself, and so have my kids. Son talks, DD1 doesn't. Talking indicates self-awareness and self-awareness makes a child an equal partner in the treatment team. Especially important if you have to do medication trials.

    What I do for myself, my kids, and my friends is to try and separate the depressive thoughts from the actual thoughts of the self. If looked at as an actual disease (which it is), and as the cause of this symptom (suicidal or even negative thinking) one can realize that these are not their true feelings, but feelings imposed on them by a mental illness. This is not a magic bullet perspective, but brings a small amount of comfort, and allows for the hope that since it is caused by a disease (or bad medication) then eventually the "feelings" will pass or subside with treatment.

    by the way how exactly did he kill these animals? Was it accidental - dropping, throwing, sitting on - or intentional - stomping, on, purposely throwing of smashing? With Autism, remorse, as any other emotion is a tricky thing. He may not be expressing it in any conventional way, but that doesn't mean he's not feeling it. Just one more thing to try and get him talking about.
  14. We suspected it for a long time. We eventually had him tested and it was negative......THANK YOU, THOUGH! Awesome idea.
  15. Thank you. So very helpful.

    He squeezed them to death.
    Please keep in mind that if we had ANY idea that he was doing this, or having the feelings he is having, he would not have slept over at his friend's house ,or even gone to anyone's house without us there at all times. His friend's parents, amazingly compassionate people by the way, didn't tell us about the first two, which happened over the course of several months, because they really did think it was a quirky coincidence, and didn't want to accuse him of anything that horrible if they weren't sure.
  16. keista

    keista New Member

    Squeezing could still be accidental, especially given Autism Spectrum Disorders (ASD). I just wouldn't want anyone labeling my child with scocipopathy (kind of a "give up" condition) when these actions are not necessarily malicious in nature. I'm aware it was just in "discussion" phase, but from Dr's perspective, you give symptom/behavior they think worst case.

    If he was being malicious, then he was being malicious. I'm not looking to make excuses for him, but again, given Autism Spectrum Disorders (ASD), the way he expresses his emotions is not always an accurate representation of what he is really feeling. So if you haven't already, try and find out what his motivation at the time was. It is also possible that it was misguided curiosity. I don't know what his maturity level and impulse control abilities are.
  17. Liahona

    Liahona Guest

    Just so you know antidepressants can increase the risk of suicide in young people. Zoloft is an antidepressants.

    You might choose something different but if this were my child I'd be calling the dr telling him that I'm taking difficult child off the medication until we can talk about it at the next appointment. (I was not sure if your appointment is this week or late Oct. If its late Oct definitively.)

    Glad he can talk to you about this.

    Buddy thanks for answering my question.
  18. buddy

    buddy New Member

    That's a great point. My kiddo has demonstrated repeatedly he has no judgement over how strongly he touches things, including not registering how hard he can bang into things himself which can cause injury to HIM. Also we always have to read the underlying message when he says things....."I dont care!" means I need to stop talking about this right now, I am too stressed about what is happening. When he says something really provocative to staff like..."I have special needs and nothing will happen" he means I HOPE nothing will happen...HE has never not had a consequence and he will even list them all out so he fully well knows something will happen but it pisses staff off because they think I am letting him get away with things. He has more consequences every day than most kids have in a full month or even a year....that is why we have to struggle so hard to catch good behaviors and to pick and choose battles. He can't be expected to be perfect.

    Yeah, he has even killed animals (just the hamsters when he was little, but he did hurt our cat a few times) and will even talk about it as of he is happy, but only when he is worried about them.... Eventually he says what he means but in the mean time people can be really shocked.
    OMGosh, I forgot about the elementary staff who were horrified when he kept asking about eating people. They made such a big deal that he eventually did get in trouble. He had heard about it on tv some dumb show and started perseverating like he always does, especially if it gets attention. Oh geepers...did they really think he was going to eat people? He was like 9 and so very delayed....
    a friends kid drew pics of air planes flying over the school and bombing it...he was fully Autistic....and they were worried about terroristic theats....OMGosh, the kid had just moved back from Iran! He was upset yes, but not a terrorist. Really do have to dig with these kiddos.
  19. This is all very insightful.
    He said it was deliberate. He told us he waited until people were asleep before he went into the room with the hamster. He planned on killing it, and he said the only reason he felt bad was because he got caught, and if he didn't get caught he would do it again and not feel bad about it.

    His maturity level is about what a seven year or eight year old is, and his impulse control is poor. But he did seem to act in a pre-meditated way. He has hurt our big dog....his answer when questioned was, "because I wanted him to feel pain." This is the nicest dog on the planet, so I had to question whether this was autism speaking and what he really meant was "I wanted to SEE if he could feel pain." When we found out about the four dead animals...serial killing of them, if you will, I have to consider other, more frightening things.

    We had a meeting with his school -- they were wonderful, gave us a lot of tips and we made a plan for the short term, to get him back to being in school. They recognized the psychiatrist we will be going to and recall him as being a terrible pill guy,and a lot of kids who go to him are on a huge cocktail of drugs. But there was a cancellation and we can be seen tomorrow, instead of at the end of October, and this is the guy who said he WOULD NOT have put him on Zoloft. So I think we will take the appointment and help get him off the Zoloft for tomorrow.

    I am so glad you guys are here. We are exhausted. His sisters are sleeping with their doors locked, we are worried about the night time suicide fixations, so we can't sleep. One day at a time, right?
  20. Liahona

    Liahona Guest

    Have you put an alarm on his door so if he opens it it goes off? This helps us sleep.