4 yrs of Residential Treatment Center (RTC) 1 year of transiton

[C130family]

Hello friends, It has been a long while since I posted here. I only come here when things are getting out of hand and I need some good clear headed advice.


We did 4 years of Residential Treatment Center (RTC). Now after a year of transition with wrap around services and weekly family counseling we are back where we started. Now we are looking at private institutions. Even though they are expensive, I guess It will have to be done to give my difficult child a chance.
This time we will go with a Christian based Residential Treatment Center (RTC) since that is a component that has been missing in the past.
He is defiant, Verbally abusive and threatening to Me and my wife. We have no way of enforcing the rules around here as he just tells us to F off and does as he pleases.
He got into trouble with the law after he assaulted me 3 months ago. If this continues he'll hurt one of us and wind up in YDC. That is unacceptable to me. The State probably does not see this as severe enough to return to a state funded Residential Treatment Center (RTC).
So I guess I'm ready to fork over $60K for a private institution.

 

[smallworld]

Welcome back!

Has anyone taken a good look at your difficult child's medications? If he truly has bipolar disorder, he needs to be treated with a first-line mood stabilizer (Lithium, Depakote, Lamictal, Tegretol, Trileptal). Both antidepressants like Luvox and stimulants like Concerta can make kids with BiPolar (BP) much, much worse. While he's on an atypical antipsychotic (Risperdal), it's at such a low dose that it's unlikely to do much to curb his anger and aggression. And it's unlikely to do much against the bad side effects Luvox and Concerta can cause. You might want to check out the BiPolar (BP) treatment guidelines at http://www.thebalancedmind.org/sites/default/files/treatment_guidelines.pdf

Before you fork over a tidy sum for a private Residential Treatment Center (RTC), I'd recommend getting your difficult child evaluated by a top-notch child/adolescent psychiatrist in your area. If his medications could be straightened out, he might be able to feel and do better than he is now.

Good luck.

 

[BusynMember]

I agree with smallmom. So far putting him in RTCs hasn't changed him. I think he needs to be stabilized to be in control of what he does. That's a lot of money and I'd get a second and third opinion first. Antidepressants PLUS stimulants are not the best for kids with bipolar. I have bipolar myself. in my opinion, he hasn't had the greatest treatment. I wish you luck.

 

[Sara PA]

"Hostility" is a fairly common side effect for kids taking antidepressants.

While there is no official acknowledgement that stimulants can cause aggression and hostility, they do come with the warning that people taking them should be "monitored for the appearance of or worsening of aggressive behavior or hostility."

It wouldn't be the first time a child was made worse by the treatment he received.

 

[C130family]

The medications listed in my profile are not correct. It has been a while. Guys, I have a Psychiatrist a Family Therapist, In -home Therapists who visit once a week, Weekend respite once a month. So as far as tweaking the medications Ive given up. I really don't think it is the issue. He just will not put forth the effort it takes to remain in our family. Everyone around him is working hard to be patient and loving while he just rip us apart. The wife threaten to take the other two boys and Go home.
The situation ***** and I for one am sick of trying to be creative with logical consequences that will help him.
Please let me know if there are any Residential Treatment Center (RTC)'s that are Christain that you would recommend.
Really at this point I've been in this deal long enough to be pretty wise. I know when enough is enough.

 

[smallworld]

Because we do not allow names of treatment facilities to be used on the public forum, please PM any Residential Treatment Center (RTC) recommendations directly to C130family.

 

[BusynMember]

We can't tell you what to do, but I disagree that, if he has bipolar, he has control of himself and can choose to behave in an acceptable way to fit into the family. Yes, it's been a long time (but he hasn't lived at home) and he has a psychiatrist, but there are other psychiatrists and he isn't on good medications. As one with a serious mood disorder I do think the medications are the key to stability. If you wish to find another place for him, I"m sure you can, but religion will not cure a child with bipolar. THey need mood stabilizers. He's on an antidepressant and a stimulant. They would make anyone with a mood disorder unstable. If you still wish to only send him somewhere, then check the internet and good luck

 

[klmno]

Just my 2 cents here, but it appears that this has to go in one of 2 directions-

Either your difficult child is bipolar, or at least has some serious mood disorder, and is on wrong medications. If the problem is a mood disorder, your son is not in control of all that people tend to think they are. (I understand the frustration and it is difficult sometimes- ok a lot of times- to remind myself that the apparent defiance is not in difficult child's full control. The "proof" though, is that accurate medications makes it all but disappear completely.)

Or, your difficult child is not really bipolar and doesn't have a mood disorder that is causing this behavior. If you are sure that the behavior and other problems are in his control, then it is not something that medications without other behavior management will solve.

medications won't solve "bad behavior" that stems from malicious intent. Behavior management won't cure mood disorders.

If the diagnosis is the big question here, why not start with an MDE or at least a thorough re-evaluation by a psychiatrist and psychologist (Phd) for a lot less money than a private Residential Treatment Center (RTC)? This route would ensure that your observations and input are listened to and taken into serious consideration, I would think moreso that an evaluation done away from home by an Residential Treatment Center (RTC).

Obviously, there is nothing wrong with faith or Christian support. But it might take a little more medical treatment than that to treat the problem.

Just speaking for myself, I would want to make sure the diagnosis was accurate first, then make sure that the treatment, whether it included medications or not, was appropriate and proven to be effective.

 

[slsh]

Dad,

Sorry to hear things are status quo. I would recommend checking out strugglingteens.com for RTCs. Another resource would be to check your state's education department site for approved private residential schools - sometimes you can find possible programs in there.

I hear your frustration and exhaustion, and I relate far too well. My son also has had medications tweaked (going on 11 years now), programs revised, consequences employed, and a whole boatload of professionals working on how to find a plan that will help him "get it". He still doesn't. Violence, noncompliance, and now a lot of suicidal ideation because his life is the pits. But *he* won't do anything to change things and persists in blaming everyone else. It's almost a stalemate and we're to the point where the priority of the day is to keep him safe and keep everyone else safe. It's incredibly disheartening.

I send you and your family much empathy. I know you have all been down this road before and have really fought to get him appropriate treatment. I'm just so very sorry that your kiddo is so resistent. I hope you are able to find a placement that will meet his needs.

 

[looking4hope]

I can't add much here except my own experience. My difficult child was the same way until we got his medications straightened out. It took two psychiatric hospital stays within 45 days to get the mix right, but it's been night and day since.

My gut tells me that the Residential Treatment Center (RTC) your son was in didn't want to buy into a mood disorder diagnosis. Given that, before I would shell out more $$$ for a private Residential Treatment Center (RTC), I would spend some of it toward a full evaluation in a pediatric psychiatric facility. Have every test done to make sure that there isn't a medical problem (including hormone imbalance, which would be age appropriate).

If there are no medical issues, then you need to discuss whether this behavior is due to a mood disorder or deliberate. Then you can decide whether you need a mood stabilizer or another Residential Treatment Center (RTC).

I feel your pain. I know that this is frustrating and it's tearing up your family. But don't send your boy away without checking out all possibilities first. Good luck to you and your family.

 

[mstang67chic]

Just to play the devil's advocate here...

My son, while not at the level as yours, is behaving in a similar manner especially now that he's 18. He hasn't been in an Residential Treatment Center (RTC), although I looked into it, but has been hospitalized a couple of times and we've also spent many hours in court. His medications have been tweaked over the years mostly because of growth spurts but also because of manic episodes. He has involved parents, a "support" team consisting of a psychiatrist, counselor, teachers, case manager(s) and social workers. However, everytime we have a meeting it's always the same thing. He wants to be able to do X on his own or get a job/apartment, his goal in school is Y, etc. But yet when it comes time for him to do the work and effort that is required for these goals to be accomplished, he bails. His medications are where they need to be for HIM to do it himself but he doesn't. It's not a matter of can't, he just "doesn't do effort". He wants all of these things but doesn't seem to see the need for him to actually put forth an effort into his own life.

My point is that even with the right medications, counseling, services, etc., if the difficult child doesn't want to do for himself, he's not going to. Granted for your case, this is assuming that all diagnosis's are correct and the medications are also correct. At his age, obviously you can't kick him out and force him to fend for himself. So as expensive as it is, maybe another Residential Treatment Center (RTC) is the right choice. He definately needs the proverbial smack upside the head so something needs to be done.

I'm not saying that the advice you've already received isn't good. Just trying to look at things from a different angle. And just my .02 worth so take it as you will.

Good luck, though, with whatever direction this takes you.

 

[C130family]

Thank you all for the inputs.
We sent our difficult child to my sisters house for Spring break so we can have time to think. We found a wilderness program in our state that is only 85 miles from the home. The program they have seems to be a good strong one with lots of individual attention. The cost is high, but we should be able to get a sallie mae loan for the school to help us out. It's like a year at a private university. The wife refuses to live with him anymore. I'm kinda discouraged, I love our difficult child and worry about the affect on him being removed from the home again but I guess this is our one last ditch effort to rescue him from his ways.

 

[C130family]

Iv'e updated difficult child's medications. Invega 3mg, Wellbutrin 150mg, Luvox 100mg, Concerta 54mg. I will admit that the medications have NEVER really made a noticeable difference. They have been tweaked and changed many times by numerous "experts." I'm sick of family therapy, my wife and I are not the "issue" we have modified changed worked sweated and prayed our guts out. It's time for our difficult child to "work hard" 18 is only 2 1/2 years away.

 

[smallworld]

If you want an opinion on his current medications, he's still not on a combo that treats bipolar disorder. Two antidepressants (Wellbutrin and Luvox) plus an ADHD stimulant (Concerta) can destabilize an adolescent with bipolar disorder. Furthermore, he's not on a first-line mood stabilizer (Depakote, LIthium, Lamictal, Tegretol, Trileptal). The only bipolar medication in the bunch is Invega, and it can't work its magic against the bad side effects of ADs and stimulants.

I agree that you and wife are not the issue, but I think the medications could be. I will reiterate my original position: Before shipping your difficult child off to a wilderness program, get a second opinion with an adolescent psychiatrist well-versed in treating bipolar disorder. And a neuropsychological evaluation wouldn't hurt either. The cost of those two evaluations will be a lot less than the cost of a wilderness program.

 

[C130family]

Okay,
Just got off the phone with a great boarding school in MO. I like their philosophy and their price. Found them on woodbury reports. Anyway I'm sick of Residential Treatment Center (RTC)'s All the medical, medical , medical. Guys, I'm no babe in the woods on this one. He has left many a Counselor, teacher, Pastor, Pediatrician, Friend, Family member, Psychologist, Psychiatrist, Equine therapist,in home family therapist, Neighbor, DFACS, CPC, Firemen, Policemen, Probation officer....etc. baffled at his behavior. So I'm going to take a radical veer away from all that in an attempt to redeem this boy from his destructive patterns.
I appreciate all the advice on medications. By the way most of the medications you all listed have been tried at one time or another to no avail. LET'S FACE IT....THIS KID IS SPECIAL!!!
The only thing that has been lacking in this whole process is a solid Christian focus. Let's give Christ a whack at this one and I'll get back on the board in a few years and let you all know how it turned out!!! I am not Pie in the sky, I am desperate.

 

[slsh]

So glad Woodbury helped you out! I hope it will be a positive placement.

I understand the need to try a different tactic. Honestly, I don't know what the answer is or if there even is one anymore, but I salute you for following your heart. Really hope you come back with a glowing update!

 

[Sara PA]

The issue isn't just that the medications don't seem to have helped your son. There is a very real possibility that the medication he has been taking have made his behavior -- and state of mind -- worse.

There are reasons that antidepressants, for the most part, aren't approved for treating children and adolscents. Among those reasons is that they are known to cause what is convieniently lumped under the heading of "hostility", a category that includes anger, aggression, violence and homicidal ideation. It is a very common negative reaction for children and adolescents. The reality is, your son may be far more normal than you think.

No mood stabilizer will work if the child is having a psychiatric adverse reaction to an antidepressant.

And pretty much all that applies to stimulants, too.

I wouldn't allow a doctor anywhere near my son if that doctor diagnosed my son with bipolar then treated him with antidepressants and stimulants.

Oh yeah, blaming the parents is pretty common when a kid is hostile from antidepressants/stimulants. For some reasons a lot of doctors refuse to believe or are simply ignorant of the psychiatric adverse reactions to the drugs they prescribe. So, refusing to believe they haven't medicated properly, they blame the parents.

 

[C130family]

Okay,
We have found a place. It's 85 miles away and it's a wilderness camp. Strong Christian values. Price $60k a year.
So I contact sallie mae they'll give us 40k. an ok start. Are there Scholarships?? anybody??
Or other ways of creatively financing this thing??

 

[LoneStar14]

C130,

I was thinking about your situation today. Have you checked with your church to see if they can help you financially? Considering the cost of the Residential Treatment Center (RTC), I'm sure they'll want to help and every little bit helps.