Back again

Discussion in 'General Parenting' started by writestuff, Feb 13, 2008.

  1. writestuff

    writestuff New Member

    Hi, folks, I was active here back in 2006 but haven't posted in over a year--dealings with difficult child 1 that first brought me here became manageable, and difficult child 2 got into a steady state of "not doing very well" that I guess we learned to live with. Superbrief history beyond what's in profile: difficult child 1 has always been a "difficult" child, did play therapy at 4-5, and then just tried to cope for a long time until things went downhill very quickly in 2006 with anger and rage outbursts, physical assaults, police called, trips to crisis center, etc. He started Abilify in Fall 2006, and that seemed to cut the peaks off his rage. He is still moody and temperamental, very low frustration tolerance, and also struggling in school (in G&T classes). Saw psychiatrist a couple days ago and we're adding in Strattera to see if that helps there. The thing other than Abilify that seems to have made a big difference is getting over the initial hump of puberty, which happened very early and very fast. It's very clear that the onset of the deterioration coincided with the onset of puberty--his voice changed about the middle of 6th grade, and now midway through 7th grade he's starting to shave! Eek.

    The thing that brings me back here for support/advice is difficult child 1, who was hospitalized first in mid-2006, very briefly and to no productive effect, other lighting a fire under my tail to get her into therapy, a psychiatrist, etc. Both kids have been through psychiatric evaluations now as well, difficult child 2 has been evaluation'd twice through the schools and once by an independent psychologist, paid for by DFS. I would still say that her diagnosis is like the Magic Eight Ball, though there are clear depressive symptoms that have been in place since first grade at least, plus major, major impulse control issues. She first tried Lamictal, had a rash reaction and that was discontinued, then was put on Abilify until very recently (over a year on Abilify, at 15-20 mg). The Abilify did not seem to make a major dent in her issues. Tried adding in Zoloft first time in Dec/Jan of 2006/7, seemed to make things worse. Switched psychiatrists and tried adding in Depakote in spring/summer of 2007, did not seem to make a difference. Tried again with Lamictal as an adjunct to Abilify in fall 2007--no rash this time, but still did not seem to do anything positive for her. At therapist's recommendation, tried adding in Zoloft again, and this time it did not seem to make things worse, but it also did not seem to make things better.

    She got hospitalized for a second time starting last week--both incidents stemmed from meltdown/shutdown incidents at school. She's in a different facility this time. Her behavior at home has been really difficult since November (gradual shift from "pretty difficult" to "really difficult," and did not directly correspond with any medication changes), and across that period from Novemberish to now she was noticeably deteriorating at school.

    The psychiatrist at the hospital wanted to try her with Wellbutrin and Strattera. We've only spoken on the phone, and it took almost a week of delays to get to the point where I could sign consent forms. Part of the problem is that I have real serious questions about that combination of medications as an avenue to pursue. In the end I signed the consent to start Wellbutrin, but I would not consent to starting Strattera at this point. She definitely has impulse-control issues (and appears very energetic esp. when she is not taking Abilify), but she has never met the full diagnostic criteria for ADHD. I also questioned whether it was wise to start two new medications, both of which are completely unlike anything she's ever taken before, at the same time, and both of which in part act upon the same neurotransmitter.

    Part of the problem is that she partially fits the diagnostic criteria for so many things. The label of ODD is the only one that is without a doubt, and of course, there's no specifically "ODD" medication. She is angry and mad half the time, and at home acts out on that physically--assaulting people, destroying property, etc., much more at home than at school. At school she simply refuses to follow directions much of the time. She is energetic and bouncy when not taking Abilify. She has terrible self-esteem, and threatens to kill herself. She has separation issues, has a hard time with transitions, her hygiene and social skills are underdeveloped for her age...just so much stuff.

    *I* read the stuff on childhood bipolar and it seems to make a lot of sense to me, but some of the mental health professionals who are involved with her have said she doesn't "seem" bipolar (because she doesn't have racing thoughts, isn't staying up all night, is not grandiose, etc.) However, her previous psychiatrists must have been considering those possibilities, or else why would they have tried her on so many bipolar medications? However, the psychiatrist at the hospital must not be thinking that, or else I can't see why she would be exploring anti-Ds and ADHD medications (without a mood stabilizer) rather than trying different mood stabilizers/antipsychotics.

    Sorry for the long dump. I'll try to stick around and break up my ongoing thoughts/questions into smaller packages!
  2. tryinghard

    tryinghard New Member

    Good morning and welcome back.

    I know that all children react to medicines differently but both my son and his ffriend had severe mood reactions to Straterra. My son talked about killing himself (he was nine) and his friend tried to (he was also nine). I do not want to scare you, but I wished someone had told me when I put him on it.

    Good luck to you! HUGS
  3. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    Glad you have decided to come back!

    It appears that difficult child 1 has stablized a little - that's good. But it appears you are still working on difficult child 2's diagnosis and treatment. Good for you for sticking to your guns regarding the new medications. I hope some positive results come out of this latest hospitalization.

  4. Star*

    Star* call 911


    Welcome back !!!!!!!!!- it seems like you are on the right path to figuring out things for your son. Sad as it is, sometimes the hospital is the best place for them to be for a medications tweak. My son was on Stratera when he was around 9 and we didnt haev any side effects, we just had no effects, but I blame that on me hanging the moon on a medicine. it was about the last out of 64 medications we tried in 11 years. I hope come back here often to vent - it's such a good place to blow off some steam.

  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Welcome back, although I'm sorry you had to come :)
    Has your child EVER had a private neuropsychologist evaluation? It sounds like nobody really knows what's wrong with her. I, a layperson, of course, think it sounds like a lot more going on than ADHD/ODD. I do think she has bipolar components (having BiPolar (BP) myself) and I can tell you right now that bipolar and ODD go together like soup and sandwich. However, I think she also may have some autistic traits, maybe Aspie traits, and THAT can cause meltdowns and violence as bad as with bipolar/ODD. Also, if that were my kid, I'd be afraid that the stimulating medications were making her worse. All in all, I"m a "better to be safe than sorry" parent, and I'm also a cynic. I truly don't think the school "gets it" and I don't like plain psychologists because they don't do any testing. NeuroPsychs tested my son for twelve hours and were very "on" as far as his issues. I would look further since your son is getting worse rather than better. Obviously, his treatment isn't working. Good luck :)
  6. susiestar

    susiestar Roll With It

    I am glad to see you again, Welcome Back!

    I am very confused. Her medications seem to be rather whimsically prescribed to me. NOT that you didn't think the docs were doing their best, but I have questions.

    What diagnosis or reason did they give you for all of the medication jumping around? Do you feel you had a good rapport with the psychiatrist, and that he had any clue what was going on or any reason for jumping around all over the medicine wheel with-o fully trying any type of medication? Did they give reasons for wanting to keep trying the medications that she had bad reactions/side effect problems with? Instead of trying other similar medications?

    Why not try medications from one of the classes that have helped, fully explore one option before jumping to something else entirely?

    I know the docs don't like to listen to us, and the therapists also have their own ideas. But this just doesn't make any sense, as you probably know.

    I would have refused the Strattera also, and probably asked for something other than an antidepressant. But whether they would agree, or even listen, is questionable. It can be REALLY hard to get them to explain, or to listen.

    I am sorry you are dealing with these problems. I really really think evaluation by a neuropsychologist, or a multidisciplinary team would be helpful. At least you might get more of an idea of what is wrong, rather than just trying whatever medication the pharmaceutical rep suggested that month. (Sorry, I have a real issue with docs who do the medication jumping for what seems like very little reason. Been burned by this with my son and myself.)

    If you didn't do Parent Reports before, it might be useful to set one up now, or to update one if you have it. It seems to me this info might be helpful. (The Parent Report is in the General Archives, if you click on the last page, it is at the bottom. It was the first thing put into the Archives when they were set up.)

    Sending hugs, sounds like life is pretty rough right now.