Hi, all. This is my first time posting. I appreciate any insight or just sharing of your own experiences.
This is a LONG post.
Diagnosis Backstory: My 15 yr old son has a couple of current diagnoses, depending on the doctor. He saw a psychologist over the summer who did a full assessment and diagnosed him with ODD, with some possible antisocial traits.
He then began seeing a children's psychiatrist as well. I already had this in the works as I'd had my son on a waiting list to get in before starting with the psychologist for therapy, but the psychologist also recommended he see a psychiatrist for possible medication.
The psychiatrist diagnosed him with ADHD (something I've strongly suspected since he was small), trying to rule out ODD as well as other conduct disorders. The reason he was trying to rule out ODD is because my son is typically well mannered, pleasant, and stable in the home environment. He's a teenager, so of course there is some exception, but by and large his behavioral issues occur at school. They have, however, in the past year also begun to show themselves in sports settings, to the point that he hasn't been able to stay on his sports teams.
Very importantly, also a high probability of bipolar. We have a very strong genetic link on my mother's side and his biological father also has BiPolar (BP), as well as his oldest brother.
Behavior & home background: The issues at school go back to elementary, beginning maybe around 2nd grade. He would be defiant almost just for the point of being defiant. He would escalate situations to the point of running out of the school. He was in trouble a lot and even suspended a few times. He was not so much getting into fights with other students or violent, just general defiance and non-compliance. I did not know anything about IEPs, 504s, or Behavior Intervention Plans (BIP) and no one at the school discussed it with me. His 5th grade year was better, because he was in a program to mentor pre-k students with learning challenges and flourished in that environment. He did pretty well that year.
I was working to get him help with therapy and a diagnosis, but it was very difficult due to him being on state insurance at the time. The counselors were unfortunately never very effective, and any diagnoses always seemed very tentative. He did have a tentative diagnosis for ODD at that time.
From the age of around 4-5 years old through about 12, he would, every once in a while, have a major meltdown at home over something fairly small or even seemingly non-existant. It would often start with him becoming extremely frustrated over something - it could be discipline related or not. When he'd have these meltdowns, he would be inconsolable and may say things like "you want to kill me!" or suggest he wanted to hurt himself. He once screamed that I was a terrorist trying to kidnap him in the parking lot of pee-wee football practice when he suddenly did not want to practice that day. When he was about 12, he had a meltdown and screamed that I was a prostitute that just had sex all the time. Looking back, it's funny. I mean, it's not, because I absolutely broke my heart to see him hurting and struggling like that, but as many of you know, when things calm down, you have to laugh to get through it.
As I mentioned, the meltdowns were not very frequent - maybe once a month at the very height, down to a few times a year as he got older. They eventually just sort of stopped happening for the most part - either with him getting older or my change in parenting style, or a combination of both. I have learned how to help calm him from the time he was very small. I give him his space, I speak softly, I make sure he knows I am there to help him, I don't let anything he says escalate the situation - all the things most of us have learned to do for our dear children who struggle like this.
For the most part, my son has been a kind and loving child at home. Of course, he's had his moments, but I feel we have a good relationship and we have a pretty calm home environment. He has typically been obedient and respectful at home. I have not often had issues with him in the home environment. School, as I said, has been a different issue.
I had separated from his biological father when he was only 1 yr old, and later divorced. His bio father was abusive and my son has never had a relationship with him. I've tried to be open with him just to always make sure he knows he was loved and nothing was his fault. The truth his, his bio father is just not a good guy, as some people just aren't, and it wasn't safe for him to be in my childrens' lives. I know despite this, there would always still be a longing and confusion of my son for the place of his father in his life.
We moved to another city in 2015, the summer before he was going to start Jr. High, and created a new home with my then fiance, how husband and stepfather to my older children. He is everything I could have every prayed for in a father figure for my children, plus a lot more. He is calm and grounded, responsible, amazing work ethic and responsible provider, very soft spoken, not easily rattled. While this was a very positive blessing in our lives, I know change is hard for my son, and regardless, he will have his own feelings and issues around the concept of a father and HIS father.
In middle school, the issues just got worse. He was constantly in detention, ISS, or out of school suspension. At one point, he had a meltdown in the hallway after a disciplinary issue with a teacher and basically destroyed his school tablet (provided by the school) by smashing it repeatedly into the floor. He did not involve anyone else, but the school did file charges on him for destruction of school property. They had an officer come on campus to arrest him a day or two later, and was sent to the alternative school. We dealt with the charge through a program for juvenile first offenders and avoided the court system (if you can call that avoiding the court system), so the actual charge was never filed with the court. I'll save my thoughts on this for another post, or another comment perhaps.
Through all the phone calls and meetings, through all my requests for resources, for helpful programming, for assistance, they never once mentioned an IEP, 504, or BIP. Granted, he did not have a recent confirmed diagnosis at this time. But it was in the process - I had much better health insurance by this point and was working on getting him access to better treatment in our new city.
Putting him into a different school hasn't really been much of an option. Although we have a good combined income, private schools in our area still are financially practical for us at this time. And he would need a private school to address his specific issues. Intellectually, he is above average for the most part (even though his grades are mostly horrible the past couple of years), and the charter schools nearby don't seem acceptable academically. I work full time with a long commute in order to keep a higher salary, and my husband works afternoon to late evening, so home schooling has not really been a possibility either.
He is now in 9th grade. The issues with non-compliance and defiance with teachers has continued. At one point, I was getting calls at least a few times a week, if not every day or every other day. The difference is, the high school has resources and are doing everything they can to work with me and with my son. They are aware of both his ADHD diagnosis with his psychiatrist and his ODD diagnosis with his psychologist, as well as other possible diagnoses they are trying to rule out/in. He now has a 504 plan with a BIP. I do not know if he will be able to stay in the traditional school setting, but we are certainly trying our best. There may be a possibility of him attending an alternate high school in our school district at some point (not alternate in terms of behavior, but more for non-traditional students) that would possibly be good for him as it's smaller and a different structure, but they don't consider students until after they have completed one full year of high school. I'm also not sure if they would consider him with his disciplinary history, though his current counselor felt it may be a viable option if things don't improve (she's familiar with the school and would have to make a recommendation). She's been AMAZINGLY SUPPORTIVE.
He also has a couple of teachers that are total cheerleaders for him - adore him and see so much good in him. For others, once he develops an oppositional relationship, it's like GAME OVER. It's very hard for him to come back from that and have a compliant relationship with them.
I have made appointments for him to see a new therapist that another parent recommended, but he refused to go a few weeks ago right when it was time for us to leave for the appointment. I had discussed it with him in advance and I didn't think it would be an issue. The therapy aspect is extremely frustrating because, going back to him being much younger, they would either see him for months then I'd realize they didn't even know his name, wouldn't ever talk to him without me in the room, would say he seems to be doing well and they can just discontinue for now, would tell me to go see another type of specialist and they would pick back up with him down the road, etc. It's incredibly frustrating! Some of them have been very kind and I know they have good intentions, but they're never even scratching the surface! So it was very disappointing to me when he refused to go recently. I made a second appointment and the dr's office ended up calling to reschedule it. Truthfully, it seemed at that point my son still wasn't going to agree to go, so I didn't bother rescheduling. I knew he had a follow up with his psychiatrist at the end of this month so I figured I would talk to him about the issue. I also offered to try to find someone who does tele-therapy, if my son would agree to try that instead. He didn't say yes but he didn't say no. It's all still up in the air, which causes me a lot of anxiety.
MEDICATION: So here we are. Going back to this past summer, his psychiatrist, after diagnosing him with ADHD, decided to try him on Intuniv. He started with 1 mg, followed soon after by 2mg a day. The efficacy was hard to gauge accurately at home, as we didn't have any big issues there for the most part. School started and before long, he was getting into plenty of trouble again and we didn't see any real improvement. He was going to agree to move him up to 3mg, but with some reservations because of side effects. But instead, due to the nature of his explosive outbursts at school, he decided to try him on Depakote. I was concerned, but I 1). do my research; 2) trust my doctor; and 3) try to keep keep an open mind in terms of what may actually help my son. We titrated up very slowly to 750mg a day, so the side effects he did have (fatigue and some stomach upset) usually passed after a couple of days, although he is usually at least a little tired on it. We had briefly gone up to 1000mg a day (half in a.m., half in p.m.) but his psychiatrist quickly took him back down to 750mg as he had issues with loss of appetite and severe fatigue on the first couple of days.
We had the longest streak of no calls from school in the past few weeks - I think we made it about 2 weeks. He was still having some issues here and there, but there was a definite improvement. When I met with his teachers recently for the 504 plan meeting, most of them said that he had been a different kid in the past couple of weeks. He was tired a lot in class, but his behavior was much better and one or two even commented that his focus was better.
Then today, really the whole week probably, we're back at it. He cussed a teacher for all his worth today and threatened that he'd put his hands on him were he not a teacher. This started because the teacher apparently has a new policy of all backpacks and phones must be left at front of class at the start of class. My son refused to comply and it ended with him cussing the teacher out and leaving the class, saying threatening things to the teacher once they were in the hallway.
The school now has to determine if the teacher followed the BIP laid out in the 504, as this is one of the teachers that did not attend the 504 meeting (he didn't say why, just sent an email basically saying "can't make it"). He was supposed to follow up with me to go over the plan after the meeting, but never did. All that said, I hold my son completely responsible for the level of escalation he took this to today. Still, they have to review everything before they determine was his punishment will be. I asked his Assistant Principal (also very supportive!) what the range on it could be as I was concerned about the fact that my son threatened physical harm to him, and she only mention in or out of school suspension. My main concern was if police could become involved. She did not mention it, so I'm hoping that won't be an issue.
I know this is so long. I just feel like it's so important to give backstory and so many details are important.
I don't even know what I'm asking. I guess I just want to hear from anyone who can relate, get any advice you may have or learn something from your own experience.
I'm sure there's info that would be helpful that I haven't included. I need to get ready to leave work soon so really need to wrap this up. If you're even still reading at this point, please know I'm hugging you across the miles!
This is a LONG post.
Diagnosis Backstory: My 15 yr old son has a couple of current diagnoses, depending on the doctor. He saw a psychologist over the summer who did a full assessment and diagnosed him with ODD, with some possible antisocial traits.
He then began seeing a children's psychiatrist as well. I already had this in the works as I'd had my son on a waiting list to get in before starting with the psychologist for therapy, but the psychologist also recommended he see a psychiatrist for possible medication.
The psychiatrist diagnosed him with ADHD (something I've strongly suspected since he was small), trying to rule out ODD as well as other conduct disorders. The reason he was trying to rule out ODD is because my son is typically well mannered, pleasant, and stable in the home environment. He's a teenager, so of course there is some exception, but by and large his behavioral issues occur at school. They have, however, in the past year also begun to show themselves in sports settings, to the point that he hasn't been able to stay on his sports teams.
Very importantly, also a high probability of bipolar. We have a very strong genetic link on my mother's side and his biological father also has BiPolar (BP), as well as his oldest brother.
Behavior & home background: The issues at school go back to elementary, beginning maybe around 2nd grade. He would be defiant almost just for the point of being defiant. He would escalate situations to the point of running out of the school. He was in trouble a lot and even suspended a few times. He was not so much getting into fights with other students or violent, just general defiance and non-compliance. I did not know anything about IEPs, 504s, or Behavior Intervention Plans (BIP) and no one at the school discussed it with me. His 5th grade year was better, because he was in a program to mentor pre-k students with learning challenges and flourished in that environment. He did pretty well that year.
I was working to get him help with therapy and a diagnosis, but it was very difficult due to him being on state insurance at the time. The counselors were unfortunately never very effective, and any diagnoses always seemed very tentative. He did have a tentative diagnosis for ODD at that time.
From the age of around 4-5 years old through about 12, he would, every once in a while, have a major meltdown at home over something fairly small or even seemingly non-existant. It would often start with him becoming extremely frustrated over something - it could be discipline related or not. When he'd have these meltdowns, he would be inconsolable and may say things like "you want to kill me!" or suggest he wanted to hurt himself. He once screamed that I was a terrorist trying to kidnap him in the parking lot of pee-wee football practice when he suddenly did not want to practice that day. When he was about 12, he had a meltdown and screamed that I was a prostitute that just had sex all the time. Looking back, it's funny. I mean, it's not, because I absolutely broke my heart to see him hurting and struggling like that, but as many of you know, when things calm down, you have to laugh to get through it.
As I mentioned, the meltdowns were not very frequent - maybe once a month at the very height, down to a few times a year as he got older. They eventually just sort of stopped happening for the most part - either with him getting older or my change in parenting style, or a combination of both. I have learned how to help calm him from the time he was very small. I give him his space, I speak softly, I make sure he knows I am there to help him, I don't let anything he says escalate the situation - all the things most of us have learned to do for our dear children who struggle like this.
For the most part, my son has been a kind and loving child at home. Of course, he's had his moments, but I feel we have a good relationship and we have a pretty calm home environment. He has typically been obedient and respectful at home. I have not often had issues with him in the home environment. School, as I said, has been a different issue.
I had separated from his biological father when he was only 1 yr old, and later divorced. His bio father was abusive and my son has never had a relationship with him. I've tried to be open with him just to always make sure he knows he was loved and nothing was his fault. The truth his, his bio father is just not a good guy, as some people just aren't, and it wasn't safe for him to be in my childrens' lives. I know despite this, there would always still be a longing and confusion of my son for the place of his father in his life.
We moved to another city in 2015, the summer before he was going to start Jr. High, and created a new home with my then fiance, how husband and stepfather to my older children. He is everything I could have every prayed for in a father figure for my children, plus a lot more. He is calm and grounded, responsible, amazing work ethic and responsible provider, very soft spoken, not easily rattled. While this was a very positive blessing in our lives, I know change is hard for my son, and regardless, he will have his own feelings and issues around the concept of a father and HIS father.
In middle school, the issues just got worse. He was constantly in detention, ISS, or out of school suspension. At one point, he had a meltdown in the hallway after a disciplinary issue with a teacher and basically destroyed his school tablet (provided by the school) by smashing it repeatedly into the floor. He did not involve anyone else, but the school did file charges on him for destruction of school property. They had an officer come on campus to arrest him a day or two later, and was sent to the alternative school. We dealt with the charge through a program for juvenile first offenders and avoided the court system (if you can call that avoiding the court system), so the actual charge was never filed with the court. I'll save my thoughts on this for another post, or another comment perhaps.
Through all the phone calls and meetings, through all my requests for resources, for helpful programming, for assistance, they never once mentioned an IEP, 504, or BIP. Granted, he did not have a recent confirmed diagnosis at this time. But it was in the process - I had much better health insurance by this point and was working on getting him access to better treatment in our new city.
Putting him into a different school hasn't really been much of an option. Although we have a good combined income, private schools in our area still are financially practical for us at this time. And he would need a private school to address his specific issues. Intellectually, he is above average for the most part (even though his grades are mostly horrible the past couple of years), and the charter schools nearby don't seem acceptable academically. I work full time with a long commute in order to keep a higher salary, and my husband works afternoon to late evening, so home schooling has not really been a possibility either.
He is now in 9th grade. The issues with non-compliance and defiance with teachers has continued. At one point, I was getting calls at least a few times a week, if not every day or every other day. The difference is, the high school has resources and are doing everything they can to work with me and with my son. They are aware of both his ADHD diagnosis with his psychiatrist and his ODD diagnosis with his psychologist, as well as other possible diagnoses they are trying to rule out/in. He now has a 504 plan with a BIP. I do not know if he will be able to stay in the traditional school setting, but we are certainly trying our best. There may be a possibility of him attending an alternate high school in our school district at some point (not alternate in terms of behavior, but more for non-traditional students) that would possibly be good for him as it's smaller and a different structure, but they don't consider students until after they have completed one full year of high school. I'm also not sure if they would consider him with his disciplinary history, though his current counselor felt it may be a viable option if things don't improve (she's familiar with the school and would have to make a recommendation). She's been AMAZINGLY SUPPORTIVE.
He also has a couple of teachers that are total cheerleaders for him - adore him and see so much good in him. For others, once he develops an oppositional relationship, it's like GAME OVER. It's very hard for him to come back from that and have a compliant relationship with them.
I have made appointments for him to see a new therapist that another parent recommended, but he refused to go a few weeks ago right when it was time for us to leave for the appointment. I had discussed it with him in advance and I didn't think it would be an issue. The therapy aspect is extremely frustrating because, going back to him being much younger, they would either see him for months then I'd realize they didn't even know his name, wouldn't ever talk to him without me in the room, would say he seems to be doing well and they can just discontinue for now, would tell me to go see another type of specialist and they would pick back up with him down the road, etc. It's incredibly frustrating! Some of them have been very kind and I know they have good intentions, but they're never even scratching the surface! So it was very disappointing to me when he refused to go recently. I made a second appointment and the dr's office ended up calling to reschedule it. Truthfully, it seemed at that point my son still wasn't going to agree to go, so I didn't bother rescheduling. I knew he had a follow up with his psychiatrist at the end of this month so I figured I would talk to him about the issue. I also offered to try to find someone who does tele-therapy, if my son would agree to try that instead. He didn't say yes but he didn't say no. It's all still up in the air, which causes me a lot of anxiety.
MEDICATION: So here we are. Going back to this past summer, his psychiatrist, after diagnosing him with ADHD, decided to try him on Intuniv. He started with 1 mg, followed soon after by 2mg a day. The efficacy was hard to gauge accurately at home, as we didn't have any big issues there for the most part. School started and before long, he was getting into plenty of trouble again and we didn't see any real improvement. He was going to agree to move him up to 3mg, but with some reservations because of side effects. But instead, due to the nature of his explosive outbursts at school, he decided to try him on Depakote. I was concerned, but I 1). do my research; 2) trust my doctor; and 3) try to keep keep an open mind in terms of what may actually help my son. We titrated up very slowly to 750mg a day, so the side effects he did have (fatigue and some stomach upset) usually passed after a couple of days, although he is usually at least a little tired on it. We had briefly gone up to 1000mg a day (half in a.m., half in p.m.) but his psychiatrist quickly took him back down to 750mg as he had issues with loss of appetite and severe fatigue on the first couple of days.
We had the longest streak of no calls from school in the past few weeks - I think we made it about 2 weeks. He was still having some issues here and there, but there was a definite improvement. When I met with his teachers recently for the 504 plan meeting, most of them said that he had been a different kid in the past couple of weeks. He was tired a lot in class, but his behavior was much better and one or two even commented that his focus was better.
Then today, really the whole week probably, we're back at it. He cussed a teacher for all his worth today and threatened that he'd put his hands on him were he not a teacher. This started because the teacher apparently has a new policy of all backpacks and phones must be left at front of class at the start of class. My son refused to comply and it ended with him cussing the teacher out and leaving the class, saying threatening things to the teacher once they were in the hallway.
The school now has to determine if the teacher followed the BIP laid out in the 504, as this is one of the teachers that did not attend the 504 meeting (he didn't say why, just sent an email basically saying "can't make it"). He was supposed to follow up with me to go over the plan after the meeting, but never did. All that said, I hold my son completely responsible for the level of escalation he took this to today. Still, they have to review everything before they determine was his punishment will be. I asked his Assistant Principal (also very supportive!) what the range on it could be as I was concerned about the fact that my son threatened physical harm to him, and she only mention in or out of school suspension. My main concern was if police could become involved. She did not mention it, so I'm hoping that won't be an issue.
I know this is so long. I just feel like it's so important to give backstory and so many details are important.
I don't even know what I'm asking. I guess I just want to hear from anyone who can relate, get any advice you may have or learn something from your own experience.
I'm sure there's info that would be helpful that I haven't included. I need to get ready to leave work soon so really need to wrap this up. If you're even still reading at this point, please know I'm hugging you across the miles!
