6yo step-son with ADHD and ODD..

[adhd.odd.parent]

I'm new to the site, but I am hoping to get some words of encouragement/advice.. I guess I'll start from the beginning.. When my step-son was about 2 1/2 yrs old we noticed he was very defiant, got into a lot of things (baby proofing was useless), destructive, etc. We thought it was just terrible two's and tried to be patient with him.. As he got older, the behaviors worsened. He went from tearing whole books into a pile of confetti to breaking his bed, dresser, knocking the tv off the stand, peeling paint off the walls, breaking his toys, etc. We took him to be evaluated and he was diagnosed at the end of 2009. They put him on Concerta and it seemed to help some, but the impulsivity and aggression were still there full force. He went to stay with his mother while my husband was in ait (we are Army), and his dr. there put him on Adderol, which made the aggression worse. He came back to live with us, he was put back on the Concerta, which again didn't do much for him. We made an appointment for him to see a psychiatrist, and there was a bit of a wait, but a few days after I made the appointment, he tried to choke his brother who was two at the time. The emergency room dr admitted him to the behavioral health place, where he went to therapy daily, they put him on Ritalin for the hyperness and the impulsivity, Risperdal and Trileptal for the mood stabilization. It seemed to work really well, he didn't lie anymore, he was more apt to do what was asked, and the aggression was gone... for a while.. A few months later, we are back to square one. He breaks things when he gets mad, he does things out of spite or just because he can, he aggravates his brother and sister constantly, he gets in trouble almost every day at school, he pouts at therapy and mumbles and whines and will not participate, it is a battle just to get him to clean up his room. His dad is deployed right now, and all of the hospitalization happened while he has been gone, so I am going at this alone at home, they just changed his medication again to Vyvanse, and I am praying that it works. I have tried everything out there to help him behave, from crazy rewards, to sticker charts, color charts, loosing toys, loosing privileges, time-outs, restrictions, you name it, I've tried it, and it's all failed to work. I have started to go to therapy myself, for this on top of other issues I have been dealing with since I was a teen. I just don't know what to do anymore, it seems like I am fighting a loosing battle, but I do not want to be walked all over.. Advice?? Please!!

 

[TeDo]

My first recommendation is to read the books The Explosive Child by Ross Greene and What Your Explosive Child Is Trying To Tell You by Dr. Doug Riley. They will help you think "differently" about the cause of the behavior. Ross Greene says, and most of us agree, "kids do well if they CAN" not the typical kids do well if they want to. This thinking goes against everything most of us are taught and led to believe. It is a whole different way of thinking. I will tell you that reading Greene's book is what got me to trying to figure out what was REALLY going on.

Has he ever had a neuropsychological evaluation? THAT is where I would go. The one we had done was right on the money. What EVERYONE, including me, was interpreting as intentionally defiant actually turned out to be MANY other things instead. ODD is not a helpful diagnosis. It simply describes the behavior but does not tell you WHY they act this way. The only way to fix a problem is to know WHY it's happening in the first place.

It might be some sort of an attachment issue because of the changing households and Dad being gone. It could also be a "thinking" or "processing" issue as it is in our case. It could be that he really lacks the skills to verbalize and deal with his feelings in the "right" way so he acts in a way that releases his frustration. Some medications will also cause these types of behaviors. difficult child 1 has STRONG violence reactions to certain medications. He does well on them for a period of time and then things go downhill fast and furious. Stop the medication and it went away. If he really doesn't have the diagnosis's they are treating, the medications can do more harm than good in some cases.

{{{{(((HUGS)))}}}} to you both. Just try to keep in mind HE is probably as confused and frustrated as you are but doesn't know why or what to do about it.

Welcome to our little corner of the world. If you stick around, you will find amazing support and phenominal advice from parents who have been there done that and then some.

 

[buddy]

Hi there! Sorry you are struggling so... sorry for him too of course. Only six and such big issues. When my son was little three pounds of growth and we had to increase medications...uggg so many reasons that medications can stop working well. I hope this switch helps him.

I agree with all TeDo said and for sure you need to look for more help. He must then have a diagnosis so maybe check with your county and see if there are any programs to get him PCA or respite care ... some time for you to re charge your batteries. Ask for a case manager for a young child with a disability and ask if there are any funding sources for him or any services you can access. Not all are income dependent or insurance dependent.... but dig!

How is school going in terms of support? Is he on an IEP (in special education?)

 

[DaisyFace]

Hello and Welcome--

That seems like a ton of medications for a six year old....not to mention a ton of medication changes in a short period of time!

PLUS that child has gone through some major upheavals in a short period of time:

Step son (so may I assume his parents divorced?), moved in with Mom, then moved in with Dad/StepMom, now Dad is deployed...don't know whether those moves involved changes in schools....hospitalizations, medication-changes Whew! I would EXPECT a bit of out-of-control behavior after all that!

Has he had any kind of *constant" support throughout all these changes? Such as same counselor at school, same therapist, regular visits with grandma, etc?

 

[adhd.odd.parent]

His mom and his dad divorced when he was about 1 1/2, and I came into the picture when he had just turned 2.. We lived in Ga until he was 4, his mom was really never in the picture full time, she pops in and out when having kids suits her, as she still does to this day, then that is when they went to stay with their mom while hubby was in basic training/ait, so about 6 months there, then they moved back in with us in north Ga, then we got orders to move to Tx which is where we are now. The only thing that has really remained a solid constant in his life is his sister, they are always together no matter where they have been. Being in the Army makes it hard to have the same dr, therapist, etc.. As far as school, he did really well in the outpatient program, he went to school there and came home at night, I think mainly because it was more one on one, there was only one other kid there his age, and the rest were teens, so he got more focused attention than he does at his public school where it is one to twenty-two. His grades are really good, he just has trouble behaving at school. Before he was admitted, he got written up because he had his color changed so many times that day that there was no more colors left. The biggest rules he breaks now are not following directions, and not making good choices.. It is really vague, and I wish his teacher would be more specific on her daily behavior charting. At his conference I requested, she told me that his biggest issue is blurting things out, he also does this at home a lot. If he thinks of something, it shoots out like a rocket, wether someone is talking, or on the phone, it doesn't matter. She said it's usually simple things like he needs a tissue, in the middle of her teaching the class he will just blurt it out. He also has trouble with stealing things. He has stolen from the grocery store, his classmates, his teacher, etc. I know that the moving around and his mom being in and out of his life causes a lot of this. When he was in the program, the nurses thought he was stupid, because he wouldn't try to do the work, and he would tell them he didn't know how to do any of the work. He tried to do the same thing to my husband when he came home for R&R, his homework sheet (which is the same every day, just a different letter) he tried to tell his daddy that he didn't know how to do it, and that he didn't know his sight words. He is very manipulating by trying to get others to do things for him that he knows how to do, for instance, making his bed, he knows how, but if he doesn't want to, he tries to get someone else to do it for him. I really think there is something else besides odd/adhd going on with him... The army has a efmp program, which has respite care, I am working on getting him enrolled, I just have to find the time between three kids, two therapy appts. a week, and one with his psychiatric a month.. Today was his first day on the Vyvanse, he didn't get in trouble at school, but we did have some trouble at a friend's house around 5pm, he stole a toy from their house.. His therapist suggested taking 2.5mg of Ritalin about 4pm because the Vyvanse tends to wear off around then.. But of course, I only have one left, and no refills.. So that option is out until his next dr's appointment at the end of the month... Sorry it's so long, I'm trying to fit everything in there!

 

[soapbox]

Hope you don't mind if we ask more questions...

We took him to be evaluated and he was diagnosed at the end of 2009. They put him on Concerta and it seemed to help some, but the impulsivity and aggression were still there full force

Who did the diagnosis? Was an Occupational Therapist (OT) evaluation done? How about Speech Language Pathologist (SLP)?

It's not that the ADHD diagnosis is necessarily wrong... but it could be.
OR... there could be ADHD plus other stuff.
Either way, it doesn't sound like you have the full picture.

The biggest rules he breaks now are not following directions, and not making good choices..

This is school... "not following directions" is a big red flag. Often, that is assumed to be an ADHD trait. However, there are other dxes that would also explain that trait.

If the child has auditory processing problems of ANY sort - from hearing issues, to Central Auditory Processing Disorder (CAPD), to other APDs such as auditory figure ground (cannot "hear" in the presence of background noise), the way this will present in the classroom is often "classical ADHD symptoms". But... medications to NOTHING for APDs or hearing issues. Technology, accommodations and interventions are the only things that help.

Or, if the child were somewhere on the Asperger's/Autism spectrum, the thougth processes are different, and so the child may be processing the instructions differently than the teacher expects. These kids need a totally different approach to parenting and school.

There can be other things as well - these are just two examples.

--
From your posts, it seems like there is much more going on than plain-jane ADHD.
It will likely take more rounds of evaluation to figure out what some of these things are.

 

[adhd.odd.parent]

I don't mind the questions, he got the diagnosis from a psychiatrist a few years ago, and when they admitted him a few months ago, he did group therapy, was evaluated by his psychiatrist that he sees now. He has had hearing tests and they all came back normal. He understands the instructions, he just refuses to do what he is asked to do, like the other night, i got out of the car to talk to a friend, and his brother was asleep, and I told him not to wake him up because he hadn't had a nap all day. He said yes ma'am, and as soon as I closed the door, he kicked the back of his brothers seat until he woke up. He seems to do things intentionally that he is told not to do. I'm not sure what Speech Language Pathologist (SLP) is, or what kinds of evaluations they did at the hospital, they just said they ruled out bipolar disorder. I am going to talk to his therapist Tuesday and see about getting him evaluated again because there has to be something else going on with him. He was taught "coping skills" in therapy, and he can recite them, he just doesn't use them when he needs to, just like he can recite the rules at school and at home, he just doesn't follow them.

 

[TeDo]

I'm sorry to say this but there is a HUGE difference between won't and can't. You're assuming he knows how and is purposely doing these things. In our case, that assumption was 100% wrong and difficult child 1 got punished more than he should have. It wasn't until I changed MY mindset to "he would do well if he COULD" that things started changing. There was a reason difficult child 1 COULDN'T use the coping strategies he'd been taught in social skills class when he was frustrated, anxious, or angry. There's a reason difficult child 1 HAS to wake difficult child 2 up in the morning when he wakes up first even though he's been told a million times not to do that.

Speech Language Pathologist (SLP) is a speech-language pathologist. They evaluate all aspects of language.

Please do you son and you a favor and change your mindset. Something is going on that HE can't help. Try seeing it from a different perspective and please get those books as soon as you can. All the punishment for what my son couldn't control caused him to go into a very deep depression.

 

[adhd.odd.parent]

I am going to talk to his therapist at our appointment Tuesday and see if they can re-evaluate him, the Vyvanse seems to be helping a lot, but the compulsive lying and stealing has come back, and he hasn't done that since before he started the Ritalin. I will get those books before therapy and try to read them while I wait. He woke up this morning around 5am and woke everyone up in the house and he's been told a thousand times not to before.. It's just baffling that he can tell you what he isn't supposed to do by heart, but he cannot follow the rules.. I just hope they can figure out what is wrong so we can get him the help he needs.

 

[cubsgirl]

I just wanted to say welcome. I'm sorry you had to find this place but the collective wisdom is phenomenal!

 

[buddy]

I live with a child who can often tell you the rules and I bet many of us here have that.... the parts of the brain that memorize rules and directions, the parts that can predict consequences, etc... are separate from the part of the brain that controls impulses and puts the "breaks" on thoughts and feelings. Some kids can only hold one strong thought at a time so if they are focused on what they want/need/feel they may have a really hard time accessing all of the brain information they need to do better.

I have been in many meetings where people say "he knew EXACTLY what he was doing" and I say... "SO?" That has not really been a question... (though certainly there are actually things my kid really does not understand, he just has pat answers that he can reply with to fool them into thinking he is not as impaired as he is)..

I again explain that he has a frontal lobe injury.. he has a problem with the filter and the breaks in his brain.....

It really is a hard road for kids like that because they make people angry easily even if they dont mean to. Sometimes they just give up.... can you imagine going day after day having people be so angry and crabby with you all day..?? That is my son's experience and it is really hard to try to overcome that.