13 year old in psychiatric ward for first time

[Otto von Bismark]

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

This forum is full of mind readers. My husband just looked those up. What do you tell the child who has the alarm on his door?

 

[BusynMember]

Because we adopted a child psychopath (well, they wouldn't call him one, but they used all the standby diagnosis...conduct disorder, severe reactive attachment disorder, brain damage), we learned a lot about kids at high risk for psychopathy. There are three very serious behaviors that, if you see together, are big red flags. Our kid had all of them.

1/Pottying inappropriately, possibly all over the place, possibly just inappropriately in pants when old enough to know better.

2/Cruelty to animals/killing animals. If your child deliberately did it, Autism Spectrum Disorders (ASD) or not, I'd call it a red flag. Most Autism Spectrum Disorders (ASD) kids do not kill animals. That would not be a normal part of Autism Spectrum Disorders (ASD).

3/Fascination with fire/setting fires (big or little), fire play, getting into matches, etc. Our adopted son used to light matches and singe his carpeting in front of my other kids to scare them and threaten to burn the house down, with all of us in it, if they told us (parents) that he was sexually abusing them (which he was).

I have heard these three markers from many respected experts, including one from Mayo Clinic. His desire to hurt animals is disturbing. Please don't ignore it and rehome any animals you may have. Our adopted son (who no longer has contact with us) killed two of our animals that we know of and possibly more. And he acted very loving around the animals when we were there...it was when we weren't...

I am not sure how you can treat a child with psychopathic tendencies. Our son was so dangerous that we didn't even try. The other two kids had been badly hurt by him and we just wanted him out of the house. He had been with us for two years. There has to be some professional who can work with these high risk kids though. Their brains are not done forming. If this child had not sexually abused the younger kids, we would have tried to help him, even if he had to live elsewhere, like an Residential Treatment Center (RTC), but we couldn't...because he did. I wish YOU better luck.

Now about Zoloft: If your son is suddenly suicidal (never spoke of it before) I'd consider the Zoloft as the cause. Any SSRI has a black box warning that it can cause suicide in kids under 18, and it can cause suicidal thoughts in adults too (but adults can express it better). Why doesn't psychiatrist try to wean him off of it slowly to see if that would stop the suicidal thoughts? Both Prozac and Celexa made my daughter feel suicidal. Be careful!

Finally, the alarm on the door. I don't lie to my kids. I'd probably say, "It is not safe for you to wander around the house at night alone right now. We want to keep you safe so this alarm will let us know when you get up, so that we can be with you."

Good luck!

 

[buddy]

Our adopted son (who no longer has contact with us) killed two of our animals that we know of and possibly more. And he acted very loving around the animals when we were there...it was when we weren't...

Yeah, I agree.... this can probably help clarify why we were talking about Autism Spectrum Disorders (ASD)...huge difference is when my kid did it, it wasn't a sneaky thing...it was a panic when they moved and he screammed and threw them. However because he frequently say things that make him sound "tough" and like he doesn't care he will have times now when he says he doesn't care or whatever. Yet, when he is calm and in a real talking mode, he starts his questions...MOM, do you think I will ever learn not to be afraid when I hold an animal? etc... When he hurt the cat it was petting/patting too rough or when he thought the cat was looking at him mean (we were teaching him facial expressions and he put people rules onto animals for a long time, still does sometimes). He desperately wanted the cat to love him like it loved me and got frustrated when he couldn't figure out how to do that. I had the cat 19 years and by the end my kiddo had figured most of it out and knew how to wiggle fingers to get him to come and I would find them cuddled for hours at a time on the weekend during NASCAR races.
It does sound very different. (BUT I still supervise him around any one's animals....that was an awful experience even if it was 9 years ago!)

 

[Liahona]

I have alarms on all of the kids doors. This way if I don't hear difficult child 1's door (he is downstairs and everyone else is upstairs) I'll hear the other doors opening. I tell difficult child 1 the truth. I don't lecture him about it, but at 11 years old with the cognitive abilities of an 11 year old he can take it not watered down. With my other kids I tell them 'so I'll know when the door opens'. It is the truth at their level. I'm sure as they grow up and realize that not everyone grows up with alarms on their doors there will be more questions. And then I'll again tell them the truth as much as they can understand.

 

[keista]

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.

There are always two side to being a "terrible pill guy" It is very possible that all his patients need tremendous pill cocktails simply because he gets all the worst most complicated patients.

 

[Otto von Bismark]

I have alarms on all of the kids doors. This way if I don't hear difficult child 1's door (he is downstairs and everyone else is upstairs) I'll hear the other doors opening. I tell difficult child 1 the truth. I don't lecture him about it, but at 11 years old with the cognitive abilities of an 11 year old he can take it not watered down.

What exactly do you say to him? You mean you will hear him opening the doors of the other children? Right now my daughters are sleeping with their doors locked. He has never hurt people, but after last week, they now do not trust him.

 

[Liahona]

I tell him that because he tried to hit his sister with the piano bench and because he has gotten out of his room at night in the past I can not trust him. I also point out that his siblings can't get into his room into his stuff without me hearing the door open. He likes that part.

My kids are a lot younger than yours. They can't lock their doors from the inside. And mine does have a history of trying to hurt them. Mine is also hurtful to animals, but he hasn't killed any.

With your son I might say something like 'I'm putting this on your door because you have said you want to hurt yourself and most of the time these thoughts come to you is at night when everyone is asleep. I love you and want you to be safe. You can not wander the house at night. I can't even let you wander the house even once (in case he hasn't before and protests that he won't).'

 

[Otto von Bismark]

There are always two side to being a "terrible pill guy" It is very possible that all his patients need tremendous pill cocktails simply because he gets all the worst most complicated patients.

Very true. And I am sure a fair number of them are at my son's school. It really is a wonderful, accommodating little school with an amazing system in place for helping a variety of special educational needs, while at the same time making it all seem normal.

This just goes to show you how we are so flummoxed we don't know who to believe, what to think, and are at that info gathering time where nothing really clicks yet. We are suspicious of everything, including medications and diagnosis, hoping for the best, (misunderstood Autism Spectrum Disorders (ASD)) expecting the worst, second-guessing our entire parenting history, and not getting any sleep.

We seem to be falling into shifts. I stay up way too late, and my husband gets up far too early, and in this way, we seem to be keeping a sort of watch.

Tomorrow the psychiatrist to hopefully get off the zoloft.
Wednesday the clinical psychologist to get a testing plan in place.
Note to self: buy a door alarm.
Thank you to you all...

 

[InsaneCdn]

Keista: There are always two side to being a "terrible pill guy" It is very possible that all his patients need tremendous pill cocktails simply because he gets all the worst most complicated patients.

Ditto. You have to know what the "practical" history is. Finding success with hard-to-treat kids by fine-tuning a number of different medications? That's different than just "thowing the medicine box at the kid". There's some older logic out there that doesn't believe kids could possibly need anything over trace dosages of medications... Not that I believe kids in general need major doses of medications... but I do know, first-hand, that medications is exactly like so many other areas of parenting... you can't go by the book - you MUST go by the baby. medications... is a fine line between benefits and side-effects, and the final judge is the body of the person taking the medications.

Hopefully, you've gotten the kind who are really up do date, know the need to find that "sweet spot" and are prepared to put the effort in to work with you.

Good luck!

 

[Otto von Bismark]

With your son I might say something like 'I'm putting this on your door because you have said you want to hurt yourself and most of the time these thoughts come to you is at night when everyone is asleep. I love you and want you to be safe. You can not wander the house at night. I can't even let you wander the house even once (in case he hasn't before and protests that he won't).'

Perfect. Loving and honest, and necessary, without condemnation or judgement. Thanks.

 

[Otto von Bismark]

Ditto. You have to know what the "practical" history is. Finding success with hard-to-treat kids by fine-tuning a number of different medications? That's different than just "thowing the medicine box at the kid". There's some older logic out there that doesn't believe kids could possibly need anything over trace dosages of medications... Not that I believe kids in general need major doses of medications... but I do know, first-hand, that medications is exactly like so many other areas of parenting... you can't go by the book - you MUST go by the baby. medications... is a fine line between benefits and side-effects, and the final judge is the body of the person taking the medications.

Hopefully, you've gotten the kind who are really up do date, know the need to find that "sweet spot" and are prepared to put the effort in to work with you.

Good luck!

Thank you. Let me ask you all about how a doctor might go about diagnosis for ADD.
We took my 17 year old daughter to this same psychiatrist last week for help with considering first time ADD medications....we have had the appointment for about 6 weeks, long before the stuff with my son hit the fan.

He asked her a few questions, took a 10 minute history from us, then when my daughter asked about adderal, which a friend of hers used as an older teen with much success, he shut her down completely, and told us she was too skinny for a stimulant, and he refused to consider anything other than Strattera. We took home a sample, and read up on it. I didn't really think about her needing an SSRI, and I understand a reluctance to give a stimulant for someone with ADD and some anxiety, but I was thinking we would get some guidance on diagnosis before walking out with an SSRI twenty minutes after we went it.

Now, this could be completely normal. He could be so very good at diagnoses that he can do it in his sleep. I don't know how this type of thing works. Is it normal? Can we judge anything about how he will be with my son by how he was with my ADD teen?

 

[InsaneCdn]

Now, this could be completely normal. He could be so very good at diagnoses that he can do it in his sleep. I don't know how this type of thing works. Is it normal? Can we judge anything about how he will be with my son by how he was with my ADD teen?

Nope. NOT normal - as in, not even remotely possible to get that far. Now... ADD/ADHD is not nearly as complex as many other disorders out there.

My diagnosis as an adult was 4, 1-hour appts, plus one more to go over the results. Primary reason for all that? was to rule out all sorts of other possibilities. THAT is normal.

My kids... did NOT take 4 hours! But it did take... teacher reports, parent reports, observation by a child behavior specialist (in this case, pediatrician. psychiatric nurse practitioner with 30 yrs experience...), and then 30 mins with developmental pediatrician. who nailed the diagnosis. THEN we started talking medications, and mapped out a whole "start here for these reasons... if you see x, y, or z, or if you do not see A, B, or C, come back in two weeks and we'll look at the next couple of alternatives"... The kids were young - one in grade 1, the other in K.

Hard to be accurate based on ONE other case... but... I sure wouldn't take his recommendations "hook, line and sinker".

 

[flutterby]

I read your original post, but I haven't read the responses. I'm tired and this is a long thread...sorry.

Given your son's complex history at birth and since, I think I would go for a neuropsychiatry evaluation as opposed to neuropsychology. You can google the term and it will explain it more. I've never recommended that before, but I think it makes sense in this case. They may be hard to come by so you'll probably want to look into a teaching hospital for one. If you're in the SE, Emory University might be a good bet.

I also wouldn't put much stock in a diagnosis made by the school. They just don't have the expertise.

 

[keista]

In my experience, psychiatrists don't really diagnosis. Well, they do, but how much can they really diagnosis in a 1 hour intake appointment and then 15 every month? They go by what the parents say, sometimes what the kid says, and their experience. You go in thinking it's ADD they will probably agree. You go in thinking it's the purple people eater syndrome, they will probably agree, at least at first, untill they get to know you better. The reason? YOU are focusing on that diagnosis, so pretty much everything coming out of your mouth is supporting that diagnosis. This is why your daughter should be referred for further evaluations.

HOWEVER, if you are pretty sure she has ADD I'm not surprised at the psychiatrist's pick of medications especially if your daughter asked for the stimulant herself. Unfortunately kids do abuse/sell/trade these, so a teen specifically asking for a specific drug is bound to send up red flags for the doctor.

Ultimately, you as the parent have the right to refuse to give your child any medication. If you really don't feel it's right for her, then ask for an alternative, or ask the psychiatrist to convince you that this is the right one to try first. If the psychiatrist refuses these requests, you can go shopping for a new psychiatrist.

 

[Liahona]

He might have not wanted her on a stimulant because they can cause weight lose. difficult child 1's BMI dropped drastically on Concerta.

And you would want to make sure to put the alarm on the outside of the door frame instead of the inside. I completely didn't think of that putting mine up. Thank goodness husband did.

 

[Otto von Bismark]

What kind of alarms do you use?

by the way, I am concerned about stimulant and weight loss. She just lost two or three pounds in five days on Strattera, and it's not even a stimulant -- this may not be the one for her. Her rationale for stimulant is that she doesn't have to take it outside of school or on days off, since she doesn't have behavioral problems, just attention. She thinks she can just eat more on days she doesn't take it, but I am not sure it works like that. She says she has zero appetite on Strattera, all the time.
We are also those people who seem to get a lot of drug side effects, so this could be a battle ahead, for both kids.

Last night -- no suicide talk from son. This was 3rd day of 12.5 mg dosage. He slept through the night.

Does anyone keep journal of behaviors, conversations, drug side effects, etc? I am thinking I should start doing this.

 

[InsaneCdn]

Does anyone keep journal of behaviors, conversations, drug side effects, etc? I am thinking I should start doing this.

Yes you should. It is very helpful to the psychiatrist etc. - AND to yourself for finding patterns.

Her rationale for stimulant is that she doesn't have to take it outside of school or on days off, since she doesn't have behavioral problems, just attention. She thinks she can just eat more on days she doesn't take it, but I am not sure it works like that. She says she has zero appetite on Strattera, all the time.

I'm not as familiar with Strattera. We're a stims family...
Specifically, the "ritalin" family, is well known - Ritalin, Concerta, one or two others, plus the generics...
How these impact appetite... depends on the person. (sorry, no easy answer).
Three of us on the ritalin group... three reactions.
Me - You know, I really wish I could get the appetite suppression side effect! Nope.
DS - Takes the edge off, but not excessively. Certainly never lost weight on it.
daughter - Definitely suppresses appetite, but not enough to lose weight - probably slowed weight gain by a little.

All three of us are 7-days-a-week - yes, its just for attention, BUT... there's stuff to do on the weekends too!
Having said THAT - I do know people who take 5mg generic ritalin in the morning on school days only... and its enough to give them what they need.

Is you daughter physically active? Sports, swimming, that sort of thing?
If she isn't, then it seems like the appetite suppression factor may be a concern - but adding physical activity helps if not already active (exercise generates healthy appetite).

She's also old enough to learn how to skew her calories... add snacks into the day that are high in both food value and calories - things like trail mix. Never eat a low-calorie item when a higher-calorie item is available! Notice - its not about adding junk food just to get calories... its about maximizing both calories and food value.

Stratterra takes several weeks to build up in your system, so the psychiatrist probably would not consider reviewing so soon. So - try the snacks and exercise route and see if that helps at all.

 

[Liahona]

We get the alarms at Lowes over by the lights.

 

[Otto von Bismark]

I just wanted to report that we saw the new psychiatrist today. After 15 minutes, he prescribed my son with Abilify.
Kept tossing around "bi-polar" term, which is a first I have ever heard or considered that with him.
He does not have any kind of mood swings, nor did he ever seem depressive, until he was put on Zoloft.

I stopped the Zoloft yesterday, after the previous night's suicide talks. His school counselor called me to come get him yesterday because he told her he was having suicidal feelings.

I am supposed to start him on the Abilify -- 1/2 of a 5 mg dose tonight. I have been reading about side effects. We are the poster children for side effects in this family, so I just don't know. I think I will start reading about Abilify. Clinical psychologist meeting tonight -- this is the guy who is supposed to be really good.

I will keep you posted. Husband out of town, getting door alarm from Lowe's today. Thanks for everything, you guys.
At least we are off the Zoloft.

 

[buddy]

Everyone does things differently but we tend to do things one at a time with a break inbetween (unless emergency of course). So you are first coming off the zoloft... Any way to give it a break to see if coming off that medication evens difficult child out? You seem to be saying your gut thinks it is the medications that caused bi-polar kinds of symptoms.... Just wondering???