difficult child discharge Wed

[TerryJ2]

The psychiatric called this a.m. (I've decided she's either Chinese or Korean from her accent, not Indian as I had first suspected.)

difficult child will be released Wed. at 1 p.m.

She said he has been doing exceedingly well and the ins. company will not cover anything now. (You have to be bleeding through the ears for them to cover you.)

She said he has a tendency to minimize his behavior (NO, really?!), that he is capable of behaving and following rules, and that his behavior is intentional.
That's good news and bad news. It implies bipolar rather than Asperger's, but I'll see what the discharge papers show.

She said he does have a temper and is stubborn (I'm PAYING them for this info?) and that some of his behavior is learned. IOW, he is manipulative.
He likes to blame everyone else for his behavior. (Again, why am I paying for this info? Except to have it validated by a Ph.D/M.D.)

She said to hold him accountable and to call the police if necessary.

And to use a point system at home, using increments of days and one wk, but nothing longer.
IOW, exactly what we were doing. But more so.

He is too young to have a definitive diagnosis. I know, I know.

But he absolutely needs sleep or he will lose it. So he must be on an anti-anxiety/sleeping medication, which at this point is Klonipin.

The blood tests were all part of a basic CBC.

by the way, husband said it's much cheaper to pay foreign nationals to work in the health care system. They're used to crummy conditions and low pay and will work 10X harder than Americans. Did you know that's how Deepak Chopra started out? I think that's when he got smart and realized that publishing books and doing public speaking was far more lucrative than working in the ER.

husband is ecstatic.

 

[smallworld]

Terry, with all due respect to the "professionals," your difficult child is NOT too young to have a diagnosis of AS (if that's what it is) or mood disorder (if that's what it is). Either one points you on the right path toward appropriate interventions. I'd still push for further evaluation outside the hospital so you can get closer to what's really going on.

My older daughter received her diagnosis of mood disorder at age 10; my son his diagnosis at age 12; and my younger daughter her diagnosis at age 8, although we're still refining her diagnosis and medications.

Who gave you the idea that kids with BiPolar (BP) behave intentionally? In my exeprience, kids with mood disorders lose it when their emotions overwhelm them, and they just don't know how to handle their strong feelings in a positive way. When their medications are right, they behave completely differently.

 

[Nomad]

It is interesting that it all depends on what the insurance companies will alow...right? Sad, but a part of our life.

I have mixed feelings about my daughter getting a diagnosis early...mostly positive ones though. It did help...but sometimes I wish we didn't have the label or didn't let her hear the word so early on. by the way, I'm not sure if your child is too young to have a definitive diagnosis. However, better safe than sorry. IT is good that you know what to watch for.

Sometimes I wished she was officially diagnosis'd ADD until age 18 and the doctor told us what it really was on the QT and of course, treated her for what was the reality. (Not sure that made sense...)

It was only with medication and therapy that we saw improvements...we needed to treat early. But the stigma is difficult for everyone.

I still struggle with the idea that kids with BiPolar (BP) behave "intentionally." I believe they strugglle significanly with their emotional liability. However, I also believe that just like others with disabilities, they have to learn how to cope with their difficulties and to seek ways to manage and be accountable for the management. They must also learn to ask for help. Certainly when they are young...they are entitled to some help from parents and teachers. But, this can't be abused. They are smart creatures and can learn how to manipulate those around them and of course, this needs to be avoided. Like with all great difficulties in life, great effort brings about improvement.

Terri...I am so sorry that you've been through so much in the last several months. I know it is really a strain. Sending good thoughts and prayers...extra big time for Wednesday.

 

[Fran]

Terry is this your actual psychiatrist or is it a resident or fellow?
Will there be a team meeting between all the disciplines that evaluated him and you(and husband)?
Ask Dr. where it says the BiPolar (BP) kids behave intentionally and how "calling the police" is one of the only two options given for a treatment plan? She should site her sources. I have never heard of anything so inadequate or dismissive.
Who did the evaluation for Asperger's? What sort of testing was done?

It is in your best interest and your son's to have a list of questions about the studies, the diagnosis and the treatment plan at discharge. Write them down and ask them of the attending physician. The person whose name is on the chart. He/she is ultimately responsible for this hospitalization.

 

[TerryJ2]

It's the same dr he's been seeing all along.
I haven't seen the discharge papers yet, this is just what she talked about on the ph today.
The reason she said to call the police was to help him be held accountable for his own behavior.
She emphasized that we continue with-our family therapy and lots of structure, and that we get a referral for our own psychiatrist so we can be more direct with-the scrips.
I am the one who made the bipolar connection, not she. Don't blame her ... yet! I was picking up on what the soc wkr had told us the other day.
We don't know for sure who will be mtng with-us tomorrow, except that she (the psychiatric) will not be there because she is scheduled to be somewhere else. The problem is, the ins. company will simply not cover difficult child any longer and in a sense, it's out of her hands. I'd love to meet her in person and pick her brain, and indeed, will go in with-a list of questions, but my expectations are low.
Our child psychologist warned us about this in the beginning.
Yes, I will do more testing. But I haven't seen their exact tests yet so I do not wnat duplications.
The ins. just came through for the spectrum testing, so I can still do that any time in the next cpl mo's if it hasn't already been done.

 

[gcvmom]

I have to echo Smallworld's points about BiPolar (BP) kids and their behaviors. When unstable, they absolutely do NOT have control over their behavior and are COMPLETELY overwhelmed by their emotions.

As for being manipulative -- I think all kids are to a certain degree, and it's part of the maturation process. Some are more so than others. Some are better at disguising it. The outward blame is typical for many kids, even "normal" ones. I think it's just the "normal" ones who mature faster emotionally than our difficult child's and catch on sooner with understanding their part in their own circumstances. I think it has to do with being self-aware. That's just my own perception of things. I have no idea how that gets labeled in the psychiatric world!

So he gets to come home a day early, right? I'll bet he's just as ecstatic as your husband! I hope the transition home is smooth and that he's able to get back to school soon without too much difficulty. I imagine the sooner he return to a regular routine, the better.

 

[OpenWindow]

I'm glad he's coming home but wish you had something more conclusive. I never liked the labels but I've learned it's the only way to get the best, most appropriate services.

I have the same problem getting a diagnosis. They tell me he's too young and could fit so many different diagnosis that they can't pin it down. They've told me he is the hardest kid they've ever tried to figure out.

I'm not sure about calling the police, either. He needs to be accountable but I don't think the juvenile system is equipped to handle a kid with a mental disorder. The police have been called on my son 3 times at home and too many times at school to remember (resource officer). He's not afraid of the police and now assumes they will talk to him sternly, tell him not to do it again, and tell him next time he could be arrested. I'm relieved he hasn't been arrested, but I don't like them threatening to arrest him without following through.

Even if they did the aspie testing, I'd do it again if insurance will cover it, especially if they weren't able to rule it out or rule it in.

Linda

 

[klmno]

I have to agree with the others on the BiPolar (BP) and intentional behavior. Maybe that's because it has been these wise people that have helped me so much in accepting and dealing with my son- and they (thank God) have been here to give me those subtle reminders when needed.

When my son was first diagnosis'd with depression, his first individual counselor (a social worker) told me to call police whenever my son left the house or didn't obey me, etc. I think he was treating ODD and had the impression that the prozac was "curing" the depression. I tried this method for months, all the while my son was becoming progressively worse- both behavior wise and in terms of self-destruction physically. I stopped taking my son to that counselor after becoming convinced that I was going to lose my son's life and I started devoting more time with him to just listen to what he had to say so maybe I could at least understand why he was throwing his life away. His behavior starting turning around drasticly then.

So, now, I can assure you that if I thought my son's behavior was intentional, I would kick his rear and/or call police instead of giving him mood stabilizers and working to learn better therapuetic approaches. Also, I spend a great deal of my time trying to convey to people in our lives that mood disorders cannot be "punished" out of a child, or an adult. My son acted the way he did because he didn't know a better way to cope with what was going on with him- it was a balancing act between survival and giving in and giving up. Now, I understand that he needs to be taught better skills to deal with what is going on with him, ways to detect and prevent the negative feelings and self-destructive behavior. This requires teaching, not punishing, and they aren't one in the same. Yes, if he tries to take advantage of having a mood disorder in some way, or he does things wrong when I know he knew how to do better, he still gets punished- he needs to know he can't get by with it.

There is a lot that he needs to learn (so do I) in order for him to live in this world as an adult with the issues he has and be a good citizen, family member, worker, etc. But I can't begin to tell you how I felt when I realized that making sure he's punished for every little thing, no matter what, and giving no other therapuetic treatment was never going to "cure" him. This simply can't be beaten out of a person, no more than diabetes or asthma can. And he didn't chose to have this monkey on his back no more than a diabetic or person with asthma.


OK- I'll get off now! LOL!! Sorry- this is a sore spot for me after so many meetings at school, screening new counselors, testifying to the judge, etc.

 

[Wiped Out]

Terry,
I'm glad he is coming home!

Another echoing that I don't think it is intentional with the bipolar. My son actually received his Bipolar diagnosis at age 7 or 8 (I can't remember right now). I know many feel that is too young to be diagnosis but when I look at my difficult child, even with all of his other dxs, he also so completely seems to fit the BiPolar (BP) diagnosis.

 

[Sara PA]

.....I don't think the juvenile system is equipped to handle a kid with a mental disorder.

But here's the thing.....it sounds like the doctor doesn't think he has a mental disorder. Sounds like the doctor thinks he's just a manipulative, subborn, foul tempered kid who only needs be scared by the police to make him behave.

But back to my earlier post....I would be glad to do a check of his eye medication. I was looking at what classes of drugs were used to treat glaucoma and found a lot of references to anxiety. Maybe I was looking at the wrong class.

 

[ML]

I'm glad he is coming home and I hope that this situation does spur on further testing so that you can have some answers.

 

[TerryJ2]

Thank you all.
Sara, if you could find more info, other than the pfizer page, that would be great.
I'll give you all info after we get home tomorrow.

 

[Jena]

hi,

I"m glad he is being released. yet i'd have to agree on that one. not too young for diagnosis. i'm still working on my difficult child's and getting a bit closer everyday i can feel it, it's been three years now in the making. she is 9, will be ten this feb.

i also suggest reading up on the BiPolar (BP), it is not intentional behavior it's a severe mood disorder with so many varying behaviors. my daughter was diagnosis twice with it, yet i knew there was more and i knew it was incorrect because the medications never worked the way they should have. yet anyhow rules at home and all that are great and needed i'm learning more and more everyday myself, yet i wouldn't give up on a diagnosis.

i'm so sorry to hear the info regarding the insurance company. i've been there it's a horror show what they do not cover.

i wish you luck with this

Jen

 

[Andy]

I would say the combination of difficult child's good behavior in the psychiatric hospital and the doctor's report that difficult child is able to control his behavior is the reason insurance has denied more days.

Did difficult child have sleep problems in the psychiatric hospital? If so, how did the doctor explain those?

When my difficult child was admitted, he was at the point of throwing up when very distressed. A SW told me, "He is doing that intentionally to get your attention." My kid is like me, it is very difficult for us to throw up - we just are unable to make ourselves do that. However, my reply was, "It is because he is looking for help not because he is looking for attention."

psychiatric hospital's purposes is to stabilize kids. Maybe your difficult child stabilized due to the super structure if not due to medications. doctor should have said, "We would like you to continue to follow difficult child through his own psychiatric doctor. He has improved since admission but at this point we are unable to diagnosis anything. Since he is healthy and able to control himself at this point, we need to discharge him. Please bring him back if issues arise again."

I think calling police on an 11 year old is severe. That takes you to another level in disciplining. I hope you can come up with creative ways to not have to call police.

Happy Home Coming tommorrow! My difficult child turns 12 yrs old tomorrow. I hope it is a great day for both our boys.

 

[Nomad]

Re: intentially "bad" behavior from those suffering with mental illness

It is a hard call to make...but I believe I have seen this to a degree.
I have worked in a program at a school for severally mentally ill young children.

I recall not too long ago, they had a child (ChildX) whose behavior was probably WORSE than anything I have read here. I am not suppose to be privy to diagnosis's...but the implication was that he was a child suffering with bipolar illness. Additionally, he had a difficult home life and medication not given to him regularly.

HOWEVER, he was NOT the only child who fit this profile.

Fortunately, these children had two very qualified, energetic teachers. They used a good point system, etc.

One thing I noticed is that ChildX never even attempted to use coping skills that were taught to him or that he observed other students employing.

Other kids would have very bad moments, but then gather themselves in a minute or two. It was obvious that these kids had problems, but with effort or some help from an assistant...they could re-enter "a better place" relatively quickly.

Child X caused great havoc for himself and everyone OFTEN. When I say "great," this would be an understatement.

If he wanted something...he would throw physical fits. The teacher had been consistently removing him from the room every time he had a "fit."

One day, the teacher was preparing cake to give to the students and I was watching them. I saw his little eyes go up...as if thinking about having a fit. He wanted a piece of cake BEFORE the other kids. This type of behavior rarely, if ever PAID OFF...but either he was too immature or too manipulative or too impulsive to project the possible bad outcome on his own.

Instead, I looked at him seconds before the "fit" and said "What do you think would happen if you threw a fit right now?" He got quiet. Then I said "Do you think you will be getting cake anytime soon?" He shook his head no and stayed quiet.

IT was a REAL lesson for me. In fact, he was a little more quiet than many of the other children when cake was being served.

Many teachers had THOUGHT that he had ABSOLUTELY NO CONTROL of himself. Some were beginning to think he was totally hopeless. I agree, this situation was VERY BAD...really awful... This child did NOT have much control and I'm sure when under pressure...might have NONE. HOWEVER, he was CHOOSING to exercise NONE ALL the time. Seems his control, although limited and less than most folks, was on a continnuim, etc.
Some teachers bought into the idea that he had no control and were hoping against hope that he would figure it out one day that he could do better.

in my humble opinion, it is difficult and confusing to talk about personal control when discussing mental illness. Surely we have seen instsances were it seems like it could very well be impossible for the individual to gain control of themselves.AND it's vital that docs don't play the game of assuming those with mental illness are not trying...when in fact they might be doing there very best. The mentally ill are so often victims of bias, etc. It takes observation and understanding...this is not a simple thing.

But the risk of manipulation is there (human nature), esp. with children and we don't do them any good (favors) if we are not well aware of this possibility.

 

[timer lady]

Terry,

I told a psychiatrist in a psychiatric hospital one day that a label belongs on a can in the grocery store ~ these are real, viable diagnosis's. You're not asking for anything more than any other parent on the face of this earth who's child is hurting & struggling.

I've been out of town so I haven't been able to keep up with difficult children entire hospitalization but I take issue with psychiatrist's comments that difficult child is simply being stubborn. I just cannot believe that difficult child wants to live a miserable "Out of Sync" life.

I learned after one or two hospitalizations with the tweedles to demand a proper, well written discharge plan be ready upon discharge; that the discharge meeting be attended my the psychiatrist, SWs & any other staff who worked with kt or wm during that hospitalization. I started the discharge meeting planning almost before the hospital did because I wanted those in charge of treating & "dxing" my children to be a part of that meeting & to be willing to put these things in writing.

Good luck today ~ I'll be thinking of you & yours.

 

[TerryJ2]

Thank you all for your well-thought-out replies. I really appreciate it.

Great intervention, Nomad. If I could catch my difficult child at a moment like that, it would be helpful. I have to pay more attention.

In reg. to picking up difficult child today, husband reminded me to not get into a p*ssing match with-the soc wkr, because s/he will merely be regurgitating the paperwork. :-(
I really, really wish the psychiatrist could be there. I want to spend more time picking her brains. She didn't say anything about a diagnosis over the ph yesterday.

I'll let you all know (I'll start a new thread.)

I'm making a nice big dinner ... black bean soup, home made chili, Mexican rice, and chips. I know difficult child is tired of the food they had in the hospital.

I've also typed up a list of guidelines and house rules and will laminiate it today and post it on his door. We are going to be very strict and regimented from now on. One thing husband pointed out on my original draft was that some of the consequences were too complicated, and that we should streamline it and make most of the consequences identical. For example, swearing at us will earn him 10 min. in his room and a note of apology. Bringing his toys onto our bed and having the dogs up there will earn him the same thing. Same with-refusing to come to the dinner table. But not doing his laundry will earn him the chore of folding everyone else's laundry, too.

with-our easy child, we could be more creative with-discipline. difficult child doesn't "get" creativity. Just routine. At least, for now. This also helps us remember, since when we're stressed and busy, we may forget what we're supposed to do.

Again, thank you all. You're the only ones I can talk to where I can go on and on and you are still there!

 

[amazeofgrace]

and to call the police if necessary

well they will come to your house if you call them, but that's about it. I mean the police who have come to my house have been helpful, don't get me wrong, but difficult child's learn pretty quickly, that not much will happen, unless they use poor judgement and hit one of the officers, which (knock knock) has not happened with us (yet), thankfully. Basically all they will do is try to stabilize the situation, and escort you for an emergency psychiatric evaluation if the situation is bad enough, which gets old real fast.

.....I don't think the juvenile system is equipped to handle a kid with a mental disorder.

I don't think the children's mental health system is equipped to handle a kid with a mental disorder!!!

 

[TerryJ2]

I don't think the children's mental health system is equipped to handle a kid with a mental disorder!!!

I agree, amaze.