About to send difficult child to residential!!!

[muts80]

Ok, so today was absolutely aweful!! difficult child was playing outside with the neighborhood kids when not once, not twice, nope...not even three times....try FOUR meltdowns. I mean kicking, screaming, banging his head against the cement pillar outside, the back door, and his closet door (and broke it). The first one was because his friend said "Randy is better than you at playing Nintendo DS". The second and third was because easy child #2 was asking to play his DS. difficult child lashed out at him too (verbally). And the fourth was because we sent him upstairs to his room until he could calm down. Such little things that sets him off! I called the on-call psychiatrist and told her that I had had it with him. I felt that he was a danger to himself at this point. She said that if I felt it necessary, to take him to the closest ER. She suggested giving him 5 more mg. of his Abilify. I gave him 10. I also gave him 2 mg. of his melatonin to see if he'd maybe fall asleep and give us a break. But nothing worked. He is continuing to be persistent about going outside to play after I told him no. I am about to lose my mind!! I am seriously concidering a residential program for him. He is spiraling out of control.

He finally calmed down about an hour ago...we made banana split sundaes and he was completely fine...and now as I am typing this he's having another meltdown because once again, I said no to playing outside. He's screaming at me "you never trust me"...but I've given him chance after chance (which is probably the reason for this meltdown...he thinks I'll give in). Do you think a residential treatment center would make things worse?? If any of you have experience in this, please help!!

 

[Sara PA]

I don't think you need residental at this point, I think you need a doctor who treats what she diagnosis. If your child has a diagnosis of bipolar, he needs to be on a mood stabilizer. He isn't. If your child has a diagnosis of anxiety, he shouldn't be on a stimulant. He is.

 

[muts80]

I thought the Abilify was for Bipolar. Am I wrong?

 

[Sara PA]

Abilify is a bipolar medication but it is not a mood stabilizer. The antipsychotics treat acute phases of bipolar and can be boosters for mood stabilizers but they are not stand alone mood stabilizers.

The consensus seems to be that they can make things better in the short term but really don't do much good in the long term unless they are with a mood stabilizer. Another name for the antipsychotics is major tranquilizers.

 

[judi]

IF you end up going residential, Tricare DOES pay for it - so in that respect you will be very fortunate.

 

[amazeofgrace]

Sounds like my son although he goes outside even when i say "NO" and then I either have to physically retrieve him or call the police.

I would have difficult child II in residential if I could but in NJ only the CMO agency can decide he needs to be placed there, I can't do it privatley, sigh....

Instead I have an in-home therapist here 1 1/2 a week, a Behavioral assistant here 6 - 8 hours a week and our "family team" meetings once a month and a tutor once a week. My father being a private person is less then thrilled with the daily three ring circus!

 

[muts80]

So I guess I need to talk to his psychiatrist about putting him on a mood stabilizer. I'll try that first...and if he doesn't improve with that, we may have to look further into the residential. My other two boys are suffering because of his behavior...and I don't think it's fair. Not to mention my marriage is suffering. And with my husband being in the Air Force, he's gone a lot. I am trying to keep this family above water all by myself............kudos to all those single moms out there!!! I don't know how you do it!

 

[Sara PA]

Adding a mood stabilizer may not do much good if the stimulant is causing problems. Adding more drugs isn't always the answer. Sometimes you have to take some away.

 

[muts80]

Gosh, I feel like we are never going to get anywhere. How do you know what to add and what to take away?! I know it's up to the dr's...but shouldn't they have figured something out by now. He's seen numerous dr's in his life...and none of them have made much progress with him. It's so frustrating. Thank you Sara for all your help!!

 

[Sara PA]

Because there is no definitive way to diagnose any of these disorders, there's no definitive way to treat them. All the diagnoses are based on subjective reporting and interpretation of observed behaviors. Those behaviors could be caused by any number of things, medical or otherwise. Doctors make what is only their best guess. Then they treat it with their best guess of what will work. These are, of course, educated guesses but still little more than guesses. And unfortunately there is a lot of misinformation circulating about the safety and long term effectiveness of many of these medications. These disorders for which psychtropic medications are prescribed are brain disorders -- the disagnosis implies the brain is malfunctioning. However, we still know very little about exactly how the brain is malfunctioning. Few doctors order what few neurological tests are available which would sometimes pinpoint where and why the brain is malfunctioning. Medicating based on behavior alone without really knowing what's going on in the brain (or exactly what many of these drugs do in the brain) is a roll of the dice.

I have to ask: Have all the doctors he's seen treated him with stimulants? Was ADHD his first diagnosis? Was a stimulant his first drug?

 

[SRL]

For those trying to help Muts80 sort this out, here's her earlier thread. There are signs of possible undiagnosed Autism.
http://www.conductdisorders.com/forum/showthread.php?t=14219

 

[Steely]

I am off the opinion that in a situation like this, the child needs to go to a phosph for a full evaluation. He sounds like he is a danger to himself or others, which are the key words that can get you admitted to a phosph. You can just walk into the ER of a main hospital and have him admitted. Once admitted, they can can reevaluate the situation and tell you what they would recommend.

Just to be clear, because my son is bi-polar and borderline AS, and with kiddos like these sometimes the right medication combo can take awhile. Since the age of 12 my son has been on 2 mood stabilizer, and one anti-psychotic. Mood Stabilizers are medications that keep the mood from swinging around so fast, from vasciallating from manic to depressive - and these medications are things like Depakote, Lithium, Lamictal, Trileptal, & Tegeretol. APs are medications that help take the entire mood down a notch. Kind of like throwing a blanket on a fire. These are medications like Abilify, Seroquel, and Risperdal.

medications that are stims like Concerta or Ritalin, or Anti Depressants like Zoloft or Lexapro, in my opinion, almost always makes kids like this worse until they are stabilized on medications. Sometimes, you can add these medications later, once the child has gained stability, but they are rarely effective as main medications for a bi-polar child.

Hope this helps. To answer your question - before residential - I would suggest getting him admitted to a phosph for a full work up that includes; Sleep deprived EEG, MRI, NeuroPysch testing, and a medication evaluation that includes adding a mood stabilizer.

 

[amazeofgrace]

may I add to Steely's comment because here in NJ it took me 3 emergency psychiatric evaluations in a period of 4 days to finally get difficult child II admittied. PUSH BUTTONS while you're there. Sounds dirty, but they need to see what you're talking about or like me, difficult child II was fine a huggy and happy while there, they did not see him bashing me in the head with the car seats' headrest on the way there.

 

[muts80]

His very first diagnosis at age 3 was ADHD. He was put on every stimulant out there. None of which worked. At age 6 he was diagnosed with bipolar. He was put on depakote and risperdal. Again...stabilized the mood for a little while, but didn't help in the long term. I just think I need to get him evaluated by a neuropsychologist and see what those results are. Then go from there.

Thank you all so much for your wonderful words of wisdom!!

 

[SRL]

If it's looking like Autism Spectrum Disorders (ASD) is a real possibility I wouldn't have him admitted unless he's a serious danger to himself or others. Get your pediatrician to push for an assessment ASAP. Sometimes by making a call they can get appointments earlier than you can yourself.

 

[Allan-Matlem]

Hi,

Good advice I was given is avoid saying ' No' and (treat your kid like your neighbour's 25 yo son). Try to get into a conversation , using open ended questions , how do you feel , what do you think , how would I feel , what is my concern , I hear you , let's try to work this out
We need to think ahead , meaning how will the kid respond or react , not whether we are right or wrong. It often means lowering the rope and giving up ' principles'. Problems are rarely solved in the moment , often can take weeks , so we need patience , get the big picture where we are going , and see the meltdowns as a big wave coming at us , we need to put our heads down , ride it out , find ways to calm the child and get him back on track, the apology and restitution can wait until he is emotionally ready.

Allan

 

[Hound dog]

muts

This is all a learning process. And it takes time, like any other learning process. As you learn it will make more and more sense. I know I felt totally overwhelmed at first, and heck, I grew up with mental illness in the family. (I just didn't have to be involved with the doctor/medication aspect of it all)

But I will give you a valuable tip. When I couldn't get the psychiatrist to listen, I went to the fam/pediatrician doctor. There were times I skipped the referral and made appointments myself. (and got the required referral from a doctor after the fact) Sometimes going with one doctor can be faster than the other, depends on how well they listen to you.

And let me tell you, experience taught me not to stay long with any doctor who wouldn't listen and consider what I had to say. YOU know your child best. YOU are his best advocate. Any doctor only sees him for a short while. YOUR input is valuable to them.

In the meantime, knowledge is power. Read and learn all you can. Ask a million questions.

((hugs))

 

[muts80]

difficult child had his therapy appointment. today, which went very well. She suggested putting him in a social skills therapy group. Obviously, he's struggling greatly with how to deal with friendships...and people in general. So I'm looking forward to getting him into the group.

On the downside of today...he didn't do any of his work at school, and ended up having 14 pages of homework. He got home at 4:30...it is now 8:05....he's done 4 pages. He is sooo distracted, and continues to say "can I take a break now?". I'm gonna lose my mind!!!

 

[smallworld]

You have received excellent advice about medications and treatment.

About schoolwork: Does your son have an IEP? If not, you need to have him evaluated at school immediately for services and accommodations to help him access his education. And you need to make it clear to his teachers NOW that schoolwork stays in school and should not be sent home as homework (if they can't get him to do his schoolwork, why should they expect you to take on this responsibility?). Furthermore, 14 pages of homework is cruel and unusual punishment for any child, let alone a child with a disorder (and his mother!).

Good luck. I hope you are able to make some headway soon.

 

[muts80]

He does have an IEP...in fact, he's in a private Christian school for exceptional students. So they of all people should know that 14 pgs is a little much. This school has what's called "pace books", and the students work at their own pace in each subject in a workbook. So he sets goals for himself everyday, and what he doesn't finish, he brings home. BUT again, 14 pgs is asking the impossible! So I think I'll have a chat with the teacher and ask her if it would be ok if he slows it down a little...because obviously he's not able to get the work done. Seems to me he's overwhelmed. But then again, I also don't want to hold him back on his goals either. I'm glad that he set such high goals for himself, but he gets to a certain point in the work, and he just gives up.

Thank you for the great advice ladies!