Finally got a psychiatric appointment for difficult child (and an update)

[welcometowitsend]

Well, I finally got a psychiatric appointment for difficult child. The problem is the earliest I could get him in was August 13. So he had a paediatrician appointment on the 11th and a psychiatrist appointment on the 13th. So I guess we wait for 6 weeks. Ugh. The other option is to go see a psychologist on July 10th - the only problem is they can't prescribe medications if needed and the psychiatrist that they deal with comes into town (from the USA) once every 6 weeks and I have to pay out of pocket (probably $2500 +) for the assessment. So, I can pay the out of pocket if I have to but it would stretch the budget a lot and I'd rather have it covered under OHIP. The other concern is the psychiatrist and medication changes - what if we run into serious problems and our psychiatrist isn't due back for a month? Do you think I should bite the bullet and pay for the earlier appointment or wait the extra month and see the psychiatrist that is covered under insurance?

In the meantime his mood seems to have lifted and he is behaving more normally again. I just don't know what to think about this boy. Is he just a PITA? Is he depressed? Is he bipolar? Is it the ADHD? Does he have Aspergers? Some answers would be really nice.

He passed all of his courses which I'm relieved about. He went in for exam review yesterday and he said his English teacher was pretty ticked off that difficult child did so well on the final exam. His mid-term was a 78, going into the exam he had a 50 (ie. he did no work the last half of the semester and hardly showed up for classes) and then aced the exam to come out with a 62% average. He couldn't understand why the teacher was ****** - Ummmm.... because he wanted you to learn a lesson from your mistakes and instead you learned that it's ok to screw around and you can still pass the course. He got away with it because he is super intelligent and can memorize very easily.

Anyway, he got up this morning, with some encouragement from me, printed off a bunch of resumes and is in town trying to find a job. Yeah!!! That's a positive.

Yesterday one of his friends on FB told him she was going to commit suicide. He came to me freaking out so I checked out her FB page and it did seem like there were a lot of depressed song lyrics, postings etc.. So, I got him to find someone who knew her home number and he called her. She was acting very weird so he hung up and called back and spoke to her mother. He did the right thing and I was proud of him. Apparently, it was all a big joke - which difficult child did not think was very funny. So, we had a conversation about how serious that kind of thing is and how much it can worry the people that love you. I told him to apply that to our situation - although I don't think he has been joking about his suicidal thoughts - but I thought it would help him think about the pain he would cause the people that love him and about how much he has to live for.

Anyway, I guess we wait and see and hope that he doesn't get out of whack on us again before his next appointment.

And easy child finished school today and got awards for Responsibility, Leadership and Dance. Yeah for her! And her report card was pretty good too (for her)- although she is consistently 10 % points below the class average even with her IEP. Maybe next year will get better. We are off to the paediatrician on July 9 with her psychiatrist assessment and her report card to assess whether medications will help her focus and do better next year.

 

[InsaneCdn]

The other option is to go see a psychologist on July 10th - the only problem is they can't prescribe medications if needed and the psychiatrist that they deal with comes into town (from the USA) once every 6 weeks and I have to pay out of pocket (probably $2500 +) for the assessment. So, I can pay the out of pocket if I have to but it would stretch the budget a lot and I'd rather have it covered under OHIP

Read more: http://www.conductdisorders.com/for...t-difficult-child-update-49327/#ixzz1z6nk5bYY​

OK, background: I'm Canadian, but not from Ontario.

WHY would you have to use the therapist's psychiatrist?
Why can't you use the therapist (psychologist) even if you have to pay for THAT part (usually the less expensive of the two), and still use the OHIP psychiatrist (psychiatrist)?

We have both. Need both.
The therapist is the one that writes the reports that get us... funding therapies, accommodations at school, etc.
The psychiatrist does the medications.

 

[welcometowitsend]

Insane - You have a very valid point there. I've put a call into the psychiatrist to see exactly what the initial (3 hour) appointment will entail and if it would be beneficial to have him tested prior to the appointment. The secretary was kind of ambiguous. The initial consultation involves a family consultation, then 45 minutes alone with difficult child and then we go back into the office for her recap and recommendations.

She said she would check with the psychiatrist to see if she wanted us to get assessments done prior to coming in and seeing her. If I don't hear anything back then the answer is no - but maybe I should go ahead and do it anyway to speed things along and get the ball rolling. If she only sees him once weekly after the initial consult then we'll likely barely have a full assessment by the time he goes back to school and I don't want him heading back down that awful spiral again like he did this past school year. I'd like to have some things in place for him before then - IEP maybe, therapy, medications if necessary. medications scare me because of all the potential side effects and the potential of getting the wrong medications or wrong mix of medications.

Calling therapist again now to see if the full assessment can be finished by Aug 13. I know with easy child it took 3 appointments to do the full assessment and then another few weeks to get the report back.

I am not a patient person. When I see a problem I like to deal with it and move forward - this is a tough thing to be patient about.

 

[InsaneCdn]

medications... well, if it wasn't for medications, I'm not sure my difficult child would even be alive.
When you really need them AND you can find ones that really work... it's an absolute miracle.
If things are bad enough... (our situation definitely was before we got to the "scary" medications), it's worth pursuing.
Like most things, it depends on what you have to gain, and what you have to lose... a tough balancing act, which as slightly easier if you have a medication-compliant difficult child and a psychiatrist who really works with you.

I'm not sure what all the other issues are with your difficult child, but when I see "depression" as a problem, my first thought is "secondary depression" - that is, depression brought on because of other hidden issues.

This is a total stab in the dark - not based on what I know about your difficult child, so take it or leave it, but... has he ever had these evaluations done?
1) Occupational Therapist (OT) for sensory and motor skills. These can be subtle - and can make school horrible - and there are therapies, interventions and accommodations that work. (no medications)
2) Speech Language Pathologist (SLP) evaluation for APDs - especially the lesser-known ones like "auditory figure ground", where the person has trouble picking up language (or other important sounds) in the presence of background noise. Often missed, because it doesn't show up as a language delay. HUGE school impact. Highly successful accommodations and interventions (personal FM, note-taking service, written instruction, etc.) - and again, no medications.

We had to pay for both of these evaluations out of pocket - but not nearly as expensive as a psychiatrist evaluation.

 

[TerryJ2]

Where's the "like" button?

medications... well, if it wasn't for medications, I'm not sure my difficult child would even be alive.

 

[welcometowitsend]

Insane - I will do some research on those assessments to see if it is something that might help difficult child or give us some answers so we can help him. Thank you.

I just want to make sure that you all know that I'm not against medications. If difficult child needs medication then he will get them. What scares me is the trial and error process that can sometimes take quite a while. The more research I do the more I think he could be bipolar (he seems to have had a couple of depressive episodes and a couple of manic episode recently - not manic happy but manic angry and now he seems pretty normal). I could be totally off-base but from what I'm reading that's what it looks like to me. husband and I both took an evaluative assessment online re: difficult child - ADHD or Bipolar or Reactive Attachment Disorder (RAD)? out of 20 questions I scored difficult child bipolar in 16 of them and husband scored him bipolar in 15 of them (independently of one another), the rest were ADHD. This was from the Pennsylvania Child and Welfare Training Program website. Anyway, there is also the possibility of Aspergers and ADHD looking like bipolar because of overlapping symptoms. I guess I'm worried that the wrong medication could send him into a tail-spin and he's already been suicidal so it scares me.

Of course, the alternative is that he goes through this again and becomes suicidal again anyway.

Could someone wave their magic wand for me and sort this out in the next five minutes? The waiting and wondering is torture.

 

[InsaneCdn]

The magic wand? Well, not in 5 minutes.
The only thing that worked for us was... something like a dozen assessements, starting in grade 1.
It wasn't until we had a really solid handle on EVERY SINGLE diagnosis that we began to make progress.
And yes... that includes dxes that were flagged by Occupational Therapist (OT) and flagged by Speech Language Pathologist (SLP)... (which is why I bring them up).

Another thing to research - this one blew me away at first - is "male depression". It isn't always what we think it is... so often, it shows up as "anger". If you're seeing some traits of depression anyway, and then anger on top of it... maybe it's all part of the depression?

We found it helped to do assessments that were long shots - to rule stuff out. And for the most part, it worked. (failed on one because they ruled out when in fact it was there... they didn't have the right test!)

 

[welcometowitsend]

Insane - Wow. It's such a long process sometimes, isn't it? I'm glad that you finally did start making progress.

We are still in the early stages, I'm sure. difficult child has had a diagnosis of Tourette's and ADHD since age 9 but he was home schooled so we were really able to avoid a lot of the stress and triggers that go along with school and the social situation at school. Not to say he didn't socialize because he did, a lot. But it was under more guidance than would happen in a school situation. I'm wondering if we'd have seen some of these problems sooner if he'd been in public school. Guess there's no way to know for sure.

My sister was talking to me about 'male depression' recently as well. She mentioned that it often presents as anger which I didn't know either. I do think he has been suffering from depression, I guess we need to determine if the anger is definitely depression related or manic related or mixed or if it is depression and Asperger's or depression and ADHD (which we know he already has).

I spoke to the therapist today and I think the clinical assessment she would do the same as what the psychiatrist is going to do. What they are offering additionally is cognitive therapy - which is great but I think I'd prefer to send him to that psychotherapist 'Randy' that I spoke to on the phone. I think difficult child would really relate to him - being male, very down to earth and sounds like he really knows how to talk to teens. So, I am going to keep the appointment with the psychiatrist and book him in with Randy as well. I think I can get him in to see Randy in the next 2 - 3 weeks.

So I will cross my fingers that difficult child maintains his good mood until then.

 

[InsaneCdn]

I'm wondering if we'd have seen some of these problems sooner if he'd been in public school. Guess there's no way to know for sure.

Read more: http://www.conductdisorders.com/for...t-difficult-child-update-49327/#ixzz1z95b9qFB​

JMO... no. The only things I've found school to be faster at picking up are things directly related to learning.
A good school system will pick up on kids who are behind in reading, or struggling with letter reversals, etc. Those "classical" learning disabilities, one would expect trained educators to pick up on. But... really, so many things show up at school.

If he's been mostly homeschooled then Auditory Processing Disorders (APD) is one thing you won't have background info about. Classrooms are notoriously noisy (even the "quiet" ones). But at home... it would be more one-on-one, which suits Auditory Processing Disorders (APD) kids far better.

 

[soapbox]

I do think he has been suffering from depression, I guess we need to determine if the anger is definitely depression related or manic related or mixed or if it is depression and Asperger's or depression and ADHD (which we know he already has).



Read more: http://www.conductdisorders.com/for...t-difficult-child-update-49327/#ixzz1z96nAxFB​

IF the ADHD diagnosis is actually accurate (more on that later), then chances of it being just one of the dxes is very high.
- half of all kids with ADHD, also have Developmental Coordination Disorder (DCD) (developmental coordination disorder - a neuromotor problem that affects the planning and/or execution of gross motor skills, fine motor skills or both).
- don't know the percentages, but many kids with ADHD have LDs
- 70% of kids with ADHD plus a Learning Disability (LD)... also have Auditory Processing Disorders (APD)
And that doesn't count the co-morbidity of mood disorders and mental health issues.

by the way - mood disorders are extremely common in kids with multiple dxes... especially anxiety and/or depression. It is the result of their life experiences.

BUT. ADHD may just be "part of" a different diagnosis. One of the common ones is to be given the ADHD diagnosis but actually be Aspergers.

So. You don't really know yet.

 

[TerryJ2]

Oh, boy, does that sound familiar.
Sending hugs.

 

[welcometowitsend]

Soapbox - You're right. It could very well be Asperger's instead of ADHD. They did want to test him for Asperger's after they diagnosed Tourette's and ADHD but I didn't think it fit him so I didn't pursue it. Kicking myself for that now. Of course, that wouldn't necessarily have changed things as they are today but we may have been a step further ahead.

It is my understanding that mood disorders like depression and bipolar are much more common in kids with Asperger's, ADHD, Obsessive Compulsive Disorder (OCD), Tourette's. I am wondering how much of that is biological (genetic and triggered by hormones in teen years) and how much of that is due to experience. A questions I may pose to the psychiatrist.

Time now to just maintain the status quo and wait for his appointments to arrive. Hopefully he continues to be in the 'I want help' frame of mind.

I'm going to start writing down a history for him along with concerns that husband and I have for the psychiatrist. That way I won't forget anything. I'm also going to ask to speak to her privately for a few minutes of the 2.5 hr appointment because there are things about difficult child that I want to tell her that I don't want to say in front of difficult child. I suspect he has been stealing from us but can only prove a couple of instances in which he's actually been caught. And accusing him in front of her would derail the whole appointment. The stuff that I would consider hypersexual I'd like to speak to her about too - but not in front of difficult child - ugh! How do you talk to the doctor about all the odd/not normal behaviours your child exhibits in front of them without making that child feel awful?? Not sure if she will go for it or not because he is 16 but I'm going to try. If she says no then I will give her a written list of things for her to read over instead. Either way she needs to know this stuff.