Marguerite
Active Member
We've been to a Christmas party at difficult child 1's in-laws. We of course took difficult child 3, he's been maybe slightly edgy but it's easy to put this down to the season, shopping and changes in routine. However, several times in the last couple of days he's been particularly resistant to changes in routine.
This afternoon (Saturday) we had a choir rehearsal for Sunday night's community carols program. I wanted difficult child 3 to sing in the choir, he had agreed to, but when I said it was time to go he was resistant. Earlier in the day he was compliant with his daily study routine so I was surprised at this resistance. I reminded him of our plans, he was annoyed that we wouldn't be spending all afternoon and all evening at home where he could play game on the computer.
But he came with me anyway. He did stay for the rehearsal bits where the choir was needed but didn't really try to sing. He also spent every minute he could playing outside with a cap rocket. I tried to engage him more inside, but he was sullen at times. Obstinate.
When it was time to go I had trouble getting him moving, then a friend stopped to chat and difficult child 3, by now in the car, got very impatient and rude, banging loudly on the side of the car and telling me to hurry up.
A little bit of occasional rude behaviour, I will tolerate. A lot of the time it's just difficult child 3 being socially inept, trying to be over-familiar in a joking way. But today it didn't seem like it.
We got home form rehearsal, difficult child 3 wanted to go straight to the Wii but husband was trying to work on a problem with our TV (fairly urgent) so difficult child 3 had to wait (very frustrated). difficult child 3's attitude was very annoying - he was rude, officious, impatient and loudly objecting to our lack of consideration for him. naturally, neither husband nor I will stand for much of this. As I said, occasionally we'll ignore it if it seems to be anxiety-driven, because he generally does stop and self-correct. But not this evening. So we began to chip him about it, to correct hi and tell him to stop being rude to us, it was not getting him anywhere.
difficult child 3 began to get even more belligerent. husband & I tried to handle it by making him change the subject, when the subject was getting nowhere. difficult child 3 kept saying the same arguments over and over, we would answer the arguments ten difficult child 3 would make the same complaint. We finally had to say, "We have spoken, drop the subject."
Again, we only do this under extreme pressure and after our patience has been thoroughly exhausted. Usually it works. Not tonight. Not well, anyway.
Almost at the party. difficult child 3 says loudly, "I'm hungry." Again, tone of voice was insolent, whiny and demanding. husband & I both reacted (not aggressively). I said, "I'm glad you didn't say that at the party. That would have been very impolite."
difficult child 3 said, "I was only trying to be funny."
husband & I both said, "We're not laughing. And jokes like that are definitely not funny in someone else's home; it implies they're bad hosts. And even if you think they are, it's impolite to say so. If you're still hungry after the party, we'll stop and buy you some food."
Again, this is our usual strategy, and usually it's effective.
The gist of all this - the pattern was there (with hindsight) that difficult child 3 was touch in the extreme, belligerent and aggressively loud. Normally we can rein him in, but any attempts to do so were not only not working, they seemed to be making him worse.
At the party difficult child 3 introduced himself to a teenage girl. He was a bit hamfisted about it, but otherwise it came off OK. We left him in that room and were mostly in the next room. In the room with difficult child 3 were difficult child 1, daughter in law and a few of their friends. The party had subdivided into teens/early 20s (one room) and the parents of that group (the next room). The kids watched a movie which happened to be a favourite of difficult child 3's. When I looked in occasionally he seemed to be happily watching it with the others.
This family has a custom at these parties of opening gifts. So as we had brought gifts also (only $3 max value) we participated. It meant that the movie was turned off (I think it had finished) and everybody moved into the room where the kids had been. difficult child 3 at this point was being mildly annoying to difficult child 1 so I intervened and moved difficult child 3. Soon we were all sitting - I was next to difficult child 3, husband was sitting on the floor in front of us.
And now, with a roomful of people, difficult child 3 began to be really annoying. He was tired so he yawned. fair enough, but he vocalised the yawn (a way of attention-seeking and announcing boredom). As the hostess was explaining how we would open presents, difficult child 3 began to say to me, more loudly each time I did nothing, that he thought it was stupid and he didn't like those rules. Then came more loud yawns, then he began to say, "I'm tired."
I hushed him, so he said it louder. I biffed him on the shoulder (like kicking your bridge partner under the table) to try to warn him to shut up, but he got very offended with me. I wasn't doing it hard enough to hurt, just to try to send a message of, "Please pay attention to me, you're doing something wrong."
Then husband rapped him on the leg (the only big husband could reach). difficult child 3 was getting quite loud and objectionable, I had warned him he would have to go outside to sit in the car if he kept this up; so I finally sent him out of the room. I realised too late that I couldn't send him to the car, I didn't have the keys. So we sat in another room with a couch, it was far enough away from the party for it to be a quiet space.
That's when difficult child 3 really lost it. He started punching things (a mattress leaning against the wall), he threw his glasses to the ground (they didn't break), he punched me, he grabbed me by the arm and squeezed hard, he was raging, crying, shouting at me (the party was loud, I doubt they heard much) and at one point difficult child 3 said, "I'm going to kill you and dad." He continued to say he hated us, he wanted us both dead, and so on. He was really angry, his hair was stuck to his forehead and when I touched his forehead he was hot.
At about this point I began to think, "This is NOT normal for difficult child 3 at all. Yes, he is angry because to his mind we've been nitpicking all afternoon and evening, but we've been nitpicking because his behaviour has been uncharacteristically aggressive and rude. And maybe 'uncharacteristic' is relevant here."
Now to put in a possible cause - difficult child 3's medication dosage has been increased a fair bit this year. He takes a sustained release form of dexamphetamine and over this year, the dose has doubled from 20 mg/day to 40. Early in the year we were trying Concerta, and found that not only was it not helping him focus well enough, he also had rebound on it. The doctor increased the Concerta dose and he concentration was better, but the rebound was much worse. Then one weekend we were away and difficult child 3 had forgotten to pack his Concerta, so I had to give him some spare dex tablets I had in my bag. The behaviour improvement was amazing. So after talking to the doctor, Concerta was dropped and we upped his dex to 30 mg/day, with the option of a 5 mg short-acting top-up.
Then later in the year the higher dose wasn't enough for him to be able to complete some especially complex topics. He was having difficulty word-finding, there were other signs that it was attention-related, so the doctor authorised another medication increase.
About tis time difficult child 3 saw the autism psychiatrist for the first time. That doctor expressed concern at the high dex dose coupled with difficult child 3's known history of anxiety. There is another medication the doctor wants to try, but not at such a high dose of dex as well. He wanted difficult child 3 cut back to 20 mg/day at the most. And I know he can't function academically at that level.
So last Tuesday, we saw the prescribing pediatrician. He reluctantly put difficult child 3 on Strattera, with a view to getting him stable on that and then lager on cutting out the dex once the Strattera is on board.
So difficult child 3 has been taking Strattera since Tuesday night. That's 4 doses difficult child 3 has had to date. He's also been taking his daily dose of 30 mg/day of dex (not the extra 10, because he's working on Maths right now and not English, so I took the opportunity to cut back the dose a little). I did use the 5 mg top-up dose on Wednesday and Thursday.
So to tonight's behaviour - when we got home (after a difficult trip home in the car, difficult child 3 still trying to argue and using the same aggressive, belligerent tone) husband looked up Strattera online (he has access to government medical info). And it says in big print, precautions - monitor for any behavioural change and also adverse reactions include hostility eg aggression, oppositional behaviour, anger. Other things mentioned are mood swings and suicidal ideation. The leaflet says to watch for thoughts or talk of self-harm or harm to others (he threatened to kill me and husband; I know it's just talk, but he still said it); feeling very agitated or restless (yep, I'd say so); new or worse irritability; an extreme increase in activity and talking (maybe) and other unusual changes in behaviour.
The advice is to get him seen to ASAP.
We thought about it - the only medical help we can get at this time of night (2.30 am now) is to take him to the hospital. It would take us 40 minutes to get there at this time of night (easier driving this late) but arriving in the middle of the night on a Saturday night,let along one this close to Christmas, they will be too busy dealing with drunks, car accidents and idiots who have been doing stupid things at the beginning of their holidays. difficult child 3 said he's tied and he does function better after sleep.
So I know we took a chance but I think it's the right choice for now, to have him in his own bed getting some much-needed sleep. Maybe in the morning when his dex is back on board, he will behave for us.
I did ring the hospital - the nurse I spoke to had to look Strattera up on the database. She strongly suggested getting him seen, but agreed with the wisdom of letting him sleep vs driving for ages and then sitting for hours in a hospital waiting room to see someone who also was unfamiliar with this medication or this kind of case. The nurse said to contact difficult child 3's doctor ASAP.
The trouble is, the GP started her annual leave on Friday. The pediatrician will be available (I hope) on Monday but not before, and difficult child 3 had his next dose of Strattera due tonight (he's already missed it by a few hours).
So a few questions - has anyone else had an experience like this with Strattera? If so, how did you handle it?
And should I have weaned him off it? I can't cut capsules in half and he was in the first week of treatment, which (for us in Australia, anyway) is a half dose.
Any suggestions?
I'm going to head for bed in a few minutes, but either I or husband will be up in a few hours so we'll be watching for any answers.
Marg
This afternoon (Saturday) we had a choir rehearsal for Sunday night's community carols program. I wanted difficult child 3 to sing in the choir, he had agreed to, but when I said it was time to go he was resistant. Earlier in the day he was compliant with his daily study routine so I was surprised at this resistance. I reminded him of our plans, he was annoyed that we wouldn't be spending all afternoon and all evening at home where he could play game on the computer.
But he came with me anyway. He did stay for the rehearsal bits where the choir was needed but didn't really try to sing. He also spent every minute he could playing outside with a cap rocket. I tried to engage him more inside, but he was sullen at times. Obstinate.
When it was time to go I had trouble getting him moving, then a friend stopped to chat and difficult child 3, by now in the car, got very impatient and rude, banging loudly on the side of the car and telling me to hurry up.
A little bit of occasional rude behaviour, I will tolerate. A lot of the time it's just difficult child 3 being socially inept, trying to be over-familiar in a joking way. But today it didn't seem like it.
We got home form rehearsal, difficult child 3 wanted to go straight to the Wii but husband was trying to work on a problem with our TV (fairly urgent) so difficult child 3 had to wait (very frustrated). difficult child 3's attitude was very annoying - he was rude, officious, impatient and loudly objecting to our lack of consideration for him. naturally, neither husband nor I will stand for much of this. As I said, occasionally we'll ignore it if it seems to be anxiety-driven, because he generally does stop and self-correct. But not this evening. So we began to chip him about it, to correct hi and tell him to stop being rude to us, it was not getting him anywhere.
difficult child 3 began to get even more belligerent. husband & I tried to handle it by making him change the subject, when the subject was getting nowhere. difficult child 3 kept saying the same arguments over and over, we would answer the arguments ten difficult child 3 would make the same complaint. We finally had to say, "We have spoken, drop the subject."
Again, we only do this under extreme pressure and after our patience has been thoroughly exhausted. Usually it works. Not tonight. Not well, anyway.
Almost at the party. difficult child 3 says loudly, "I'm hungry." Again, tone of voice was insolent, whiny and demanding. husband & I both reacted (not aggressively). I said, "I'm glad you didn't say that at the party. That would have been very impolite."
difficult child 3 said, "I was only trying to be funny."
husband & I both said, "We're not laughing. And jokes like that are definitely not funny in someone else's home; it implies they're bad hosts. And even if you think they are, it's impolite to say so. If you're still hungry after the party, we'll stop and buy you some food."
Again, this is our usual strategy, and usually it's effective.
The gist of all this - the pattern was there (with hindsight) that difficult child 3 was touch in the extreme, belligerent and aggressively loud. Normally we can rein him in, but any attempts to do so were not only not working, they seemed to be making him worse.
At the party difficult child 3 introduced himself to a teenage girl. He was a bit hamfisted about it, but otherwise it came off OK. We left him in that room and were mostly in the next room. In the room with difficult child 3 were difficult child 1, daughter in law and a few of their friends. The party had subdivided into teens/early 20s (one room) and the parents of that group (the next room). The kids watched a movie which happened to be a favourite of difficult child 3's. When I looked in occasionally he seemed to be happily watching it with the others.
This family has a custom at these parties of opening gifts. So as we had brought gifts also (only $3 max value) we participated. It meant that the movie was turned off (I think it had finished) and everybody moved into the room where the kids had been. difficult child 3 at this point was being mildly annoying to difficult child 1 so I intervened and moved difficult child 3. Soon we were all sitting - I was next to difficult child 3, husband was sitting on the floor in front of us.
And now, with a roomful of people, difficult child 3 began to be really annoying. He was tired so he yawned. fair enough, but he vocalised the yawn (a way of attention-seeking and announcing boredom). As the hostess was explaining how we would open presents, difficult child 3 began to say to me, more loudly each time I did nothing, that he thought it was stupid and he didn't like those rules. Then came more loud yawns, then he began to say, "I'm tired."
I hushed him, so he said it louder. I biffed him on the shoulder (like kicking your bridge partner under the table) to try to warn him to shut up, but he got very offended with me. I wasn't doing it hard enough to hurt, just to try to send a message of, "Please pay attention to me, you're doing something wrong."
Then husband rapped him on the leg (the only big husband could reach). difficult child 3 was getting quite loud and objectionable, I had warned him he would have to go outside to sit in the car if he kept this up; so I finally sent him out of the room. I realised too late that I couldn't send him to the car, I didn't have the keys. So we sat in another room with a couch, it was far enough away from the party for it to be a quiet space.
That's when difficult child 3 really lost it. He started punching things (a mattress leaning against the wall), he threw his glasses to the ground (they didn't break), he punched me, he grabbed me by the arm and squeezed hard, he was raging, crying, shouting at me (the party was loud, I doubt they heard much) and at one point difficult child 3 said, "I'm going to kill you and dad." He continued to say he hated us, he wanted us both dead, and so on. He was really angry, his hair was stuck to his forehead and when I touched his forehead he was hot.
At about this point I began to think, "This is NOT normal for difficult child 3 at all. Yes, he is angry because to his mind we've been nitpicking all afternoon and evening, but we've been nitpicking because his behaviour has been uncharacteristically aggressive and rude. And maybe 'uncharacteristic' is relevant here."
Now to put in a possible cause - difficult child 3's medication dosage has been increased a fair bit this year. He takes a sustained release form of dexamphetamine and over this year, the dose has doubled from 20 mg/day to 40. Early in the year we were trying Concerta, and found that not only was it not helping him focus well enough, he also had rebound on it. The doctor increased the Concerta dose and he concentration was better, but the rebound was much worse. Then one weekend we were away and difficult child 3 had forgotten to pack his Concerta, so I had to give him some spare dex tablets I had in my bag. The behaviour improvement was amazing. So after talking to the doctor, Concerta was dropped and we upped his dex to 30 mg/day, with the option of a 5 mg short-acting top-up.
Then later in the year the higher dose wasn't enough for him to be able to complete some especially complex topics. He was having difficulty word-finding, there were other signs that it was attention-related, so the doctor authorised another medication increase.
About tis time difficult child 3 saw the autism psychiatrist for the first time. That doctor expressed concern at the high dex dose coupled with difficult child 3's known history of anxiety. There is another medication the doctor wants to try, but not at such a high dose of dex as well. He wanted difficult child 3 cut back to 20 mg/day at the most. And I know he can't function academically at that level.
So last Tuesday, we saw the prescribing pediatrician. He reluctantly put difficult child 3 on Strattera, with a view to getting him stable on that and then lager on cutting out the dex once the Strattera is on board.
So difficult child 3 has been taking Strattera since Tuesday night. That's 4 doses difficult child 3 has had to date. He's also been taking his daily dose of 30 mg/day of dex (not the extra 10, because he's working on Maths right now and not English, so I took the opportunity to cut back the dose a little). I did use the 5 mg top-up dose on Wednesday and Thursday.
So to tonight's behaviour - when we got home (after a difficult trip home in the car, difficult child 3 still trying to argue and using the same aggressive, belligerent tone) husband looked up Strattera online (he has access to government medical info). And it says in big print, precautions - monitor for any behavioural change and also adverse reactions include hostility eg aggression, oppositional behaviour, anger. Other things mentioned are mood swings and suicidal ideation. The leaflet says to watch for thoughts or talk of self-harm or harm to others (he threatened to kill me and husband; I know it's just talk, but he still said it); feeling very agitated or restless (yep, I'd say so); new or worse irritability; an extreme increase in activity and talking (maybe) and other unusual changes in behaviour.
The advice is to get him seen to ASAP.
We thought about it - the only medical help we can get at this time of night (2.30 am now) is to take him to the hospital. It would take us 40 minutes to get there at this time of night (easier driving this late) but arriving in the middle of the night on a Saturday night,let along one this close to Christmas, they will be too busy dealing with drunks, car accidents and idiots who have been doing stupid things at the beginning of their holidays. difficult child 3 said he's tied and he does function better after sleep.
So I know we took a chance but I think it's the right choice for now, to have him in his own bed getting some much-needed sleep. Maybe in the morning when his dex is back on board, he will behave for us.
I did ring the hospital - the nurse I spoke to had to look Strattera up on the database. She strongly suggested getting him seen, but agreed with the wisdom of letting him sleep vs driving for ages and then sitting for hours in a hospital waiting room to see someone who also was unfamiliar with this medication or this kind of case. The nurse said to contact difficult child 3's doctor ASAP.
The trouble is, the GP started her annual leave on Friday. The pediatrician will be available (I hope) on Monday but not before, and difficult child 3 had his next dose of Strattera due tonight (he's already missed it by a few hours).
So a few questions - has anyone else had an experience like this with Strattera? If so, how did you handle it?
And should I have weaned him off it? I can't cut capsules in half and he was in the first week of treatment, which (for us in Australia, anyway) is a half dose.
Any suggestions?
I'm going to head for bed in a few minutes, but either I or husband will be up in a few hours so we'll be watching for any answers.
Marg