Help I need help with my 3 year old!!!

[karif]

We adopted my dear son when he was 15 months old. He was drug exposed to meth and crack and severlly abused an negleted. We were his 5th placement in his short life. He has always been aggressive and hard to handle. He was also labled as developmentaly delayed for not walking or talking when he came to live with us. A day after we had him he walked and a week later he started sayinig mama. We adopted another bundle of joy a year ago. Joshua my 3 year old is so violent with him and his two sisters. He has punctured the babies head with a fork, jumped on him mouth so hard it knocked his tooth loose, strangled him, jumped on him. He also screams so much during the day that his voice is hoarse at night time. He never has slept through the night. WE have to give him benedryl to get him to sleep every night. We started taking him to PDR a last week. The doctor diagnosed him with ODD, Intermittent Explosive Disorder (IED), and possible conduct disorder. The PDR stated that in his 20 years of doing this Josh is the most violent youngest patient he has ever treated. WE are going to a neurologist on Monday to possible get him on medication. They want to put him on Respridol maybe. Does anyone know anything about that? I am at the end of my rope. I feel like my kid is getting farther away from me. He can at times be very sweet and loveing. Please help me. Any and all suggestions are welcome.

 

[tiredmommy]

First off {{{Hugs}}} and welcome. What a difficult position to be in. First, I think you need to try to come up with some kind of a safety plan for the other kids. You may even want to consider seeking some in-home care and respite so you won't be so overwhelmed. In addition, you also want to make sure that the doctors are being thorough and not just lumping his problems into fetal drug exposure without investigating other possibilities. As an example, many drug and alcohol abusers suffer from an underlying mood disorder. And mood disorders are highly genetic in nature.

As for the medication, I believe it's an anti-psychotic. Be sure to ask the prescribing physician about potential side effects and what to do if he should experience an adverse reaction.

 

[SRL]

Hi Karif--I'm glad that you found us.

I'm not familiar with the PDR doctor term. Is that a developmental pediatrician?

About the diagnostic labels the doctor mentioned--ODD, Intermittent Explosive Disorder (IED), and CD. All of these are labels which point to behavioral problems for unspecified reasons. It's the medical equivalent of saying "This child has some very serious behavioral problems but I don't have a clue why". I urge you to not stop with these but to seek out doctors and specialists that can get to the bottom of what's going on. This all may be related to the drug exposure in utero, but don't make that assumption or assume that it's the full answer. The more accurate information you can collect on him now, the better equiped you are going to be to help him and help your family.

Since the neurologist is Monday, the kinds of testing that you will want to ask about is the following:
1) Sleep study
2) EEG to check for seizures
3) MRI to check for neurological abnormalities that would be visible

I'd also like to see him have have assessments done in the areas of audiology, speech/language and occupational therapy (for motor skills and sensory integration dysfunction). Don't make the assumption, for instance, that because he's speaking the speech issues are all clear or because he's working puzzles, that motor skills are all fine. Let the experts in the fields take a look at him.

You will want a specialist involved who can do an initial evaluation on the cognitive area and follow up later as he develops. A developmental and behavioral pediatrician or a pediatric neuropsychologist would be the specialists to tap into there.

If he is the most violent 3 year old the doctor has seen, then it is likely that medications will be recommended. We usually like to recommend other options for children this young first but if you're other children are in danger, that seriously changes the picture. I've mentioned before here that if I were considering a beginning medication for a very young child, Risperdal would be one I would consider because parents have reported fewer violent side effects than most of the other medications we hear about. Any medication can have side effects, but weight gain is one of the most common with this medication.

You will want to talk to the specialists about schooling, because early intervention preschool begins at age 3 for kids who qualify. This is through your local public school district and everything--inicluding transportation--would be free to you. Truthfully, it would probably be better if he were stabilized first so the other children are safe. Preschool may also give you some alone time with your little one, and I'm sure you could use that.

There are in home behavioral therapists that can come in and help you do things like devise a safety plan. Ask the PDR doctor or his pediatrician.

Beyond substance abuse, do you know anything about the mental health of the biological parents?

Hang in there--I know this is a lot to throw at you at once but it sounds like you have your hands full. I'd rather see you make the rounds to a lot of specialists over the next few months and get the most answers you can then to take the "after 6 months this person still can't help us so we'll move on."

 

[BusynMember]

Hi. I've adopted a child out of foster care and have fostered. We tried adopting a few others children who were older, but one of them was damaged too much to be in a family.
Let me tell you what I'd do as our drug exposed kids are not like the kids who were born to us and nurtured and loved and given good prenatal care.T
First of all, if his birthparents were drug addicts who didn't care about him before he was born, they are also probably mentally ill and self-medicating. Mental illness is hereditary. But the big kink here, that is different than other people's kids, is that he was likely damaged neurologically by alcohol and drugs. He could be on the fetal alcohol spectrum. A regular psychologist probably would miss this. I strongly recommend a neuropsychologist. I haven't had good luck with Developmental Pediatricians and I did take my adopted son to see a few--they totally missed the boat. So that's MY bias--you may choose to take your child to see one. I prefer NeuroPsychs.
On top of all that, your child has been in five homes in his short life. I am guessing that not only is he damaged in some way by his poor prenatal care, but he likely has serious attachment issues (see Reactive Attachment Disorder (RAD)...Google it up if you have to). It rarely stands alone, but any child who has had five homes in two years is likely going to have attachment problems and they can cause serious behavior problems. A combo of attachment problems and unknown problems from drug exposure/alcohol exposure is way too much for most regular psychiatrists or counselors to diagnose. You really need to take him to a specialist who understands all of these issues and is used to seeing kids who have them AND who knows enough about Neurology to see if the little guy has alcohol effects, which require a whole special type of parenting.
I would quickly dump the professional who gave a diagnosis. of CD to a three year old--that means "I have no idea" as CD is supposed to be reserved for over 18 and usually means years and years of untreated mental illness. He is saying the three year old has psychopathic behavior and he's only three.
Certain locations have very good neuropsychologist centers. Chicago has a wonderful center for kids who were drug exposed.
Your child is more complicated than most children here because of his background. My son was misdiagnosed so many times it made me dizzy. He used to rage and act out, but now he doesn't. Luckily, he is only on the autism spectrum, high functioning. He is not mentally ill (although we were told he was early on) nor is he on the alcohol spectrum even though his birthmother drank (he has no symptoms of the learning problems that fetal alcohol spectrum causes).
You are probably not going to get clearcut answers right away, but I'd definitely want to know if he appears to have been damaged by alcohol (believe it or not, alcohol does worse damage than cocaine--and if they say "yes" to cocaine, they also drink). And you need to address likely attachment issues. For all you know, he was sexually or physically abused in one of those five homes too. We were saddened to find out what some of these foster kids go through while in foster care.
I'd start with a neuropsychologist, and it would help if he sees a lot of kids who are from foster care, as they ARE different than kids who were nurtured even in the womb. Good luck!

 

[SRL]

karif, I want to make it very clear that we are not doctors or diagnosticians. We are only parents, so take any suggestions about potential diagnoses as areas to research and possibly pursue in discussions with specialists.

 

[BusynMember]

I didn't mean to diagnose at all. Kids who are exposed to drugs and alcohol and are moved around are more complicated than kids who are obviously "different" but have always been loved. There are more possible components. Doesn't mean all those components come into play, but in my opinion it's a very good idea to check into them. It is, sadly, VERY common for kids adopted out of foster care, with that sort of background, to be extremely difficult. And since there are extra factors involved it is often very difficult to figure out why. I went through this and I know many who have. It's always good to be proactive and see somebody who is used to dealing with children who may have problems that are not of the norm.
Chances are there will be no clear cut diagnosis now or possibly ever, but there can be lots and lots of help. And to get that help, you need to have the child evaluated by somebody who has seen drug affected children and kids who have been moved around a lot in their first couple years of life. Otherwise, as I found out, you really are fighting an uphill battle to understand your child's behavior or what is wrong...and, trust me, the schools aren't exactly sympathetic either. They just think the kid is "bad" or "slow." Often there is a very bright, very neat kid under the behavior, as in the case of my son. I didn't mean to tell her what he DID have, only what he COULD have. SRL, you are one of my favorite, most intelligent posters, so I wanted to set the record straight. I think you always give wonderful advice. Anyway, have a nice day

 

[Fran]

Welcome, karif. I have to tell you that reading your description of the violence you live with has taken me back a bit. You and your husband are incredibly wonderful to give this child a chance at a life. I can't imagine the amount of sacrifice, patience and determination you both must have.

The fact that he is three allows for a lot of possibilities and probably nothing too concrete. Chances are that behaviors will change with maturity. Some good and some bad. This is pretty much normal with all kids except that most of us have concentrated amount of difficult behavior. You seem to have 3 times what the majority of us deal with.

Getting the best opinions then second opinions is how most of us do our research. You will have to put it all together and with a health care professional helping devise a plan of treatment that probably will be intense behavior modification, medication, therapy and supportive in home services.

In the meantime, your other children and you need a safety plan that can be used to prevent a catostrophe. Your little guy should never be left alone with difficult child. He can't defend himself and needs you to have a plan ready when difficult child is in a state of aggitation or about to become violent.

Since you are still in the early phases, I suggest you start a parent report so that you can keep the info organized and clear. If you search through our archives you will find the examples and direction. It will be a great tool for you.

You have done an amazing job with this little guy thus far. I think SRL's suggestion of additional testing is very valid and would be the direction I would go.

Medication is an issue many of us suffer and struggle with. It was heartbreaking for me but my son would not been able to have any life without it. It's always a possibility that you can wean later as his behaviors are better controlled. If it helps him be less violent, it would be a good thing. Pills aren't a cure. Behavior modification isn't a cure. Therapy isn't a cure but all of those are tools to help our difficult child's get to the next level of functioning and maturity.

 

[Lothlorien]

Welcome.
Risperdal is supposed to help with aggression. We recently put my daughter on it for her aggressive behaviors. It has helped.

I don't know what state you live in, but in NJ we have a state-funded program called Value Options. They send an in-home therapist. You may find that helpful with the other children as well. You might want to check and see if that is an option for you. I've had a very good experience with our in-home therapist. As suggested above, a pediatric neurodevelopmental doctor would be my suggestion.

You can also go the early intervention route and ask for a multi-disciplinary evaluation through Dept of Education. They will do a complete evaluation to determine if he qualifies for aide through the Spec. Ed., which it sounds like he would qualify.

 

[susiestar]

Welcome karif!

You certainly do have a challenge. I am glad you found us. The others have mentioned a lot of helpful things.

One thing to remember is to keep the info from all of hte evaluations and doctors organized. here is a link to a Parent Input Report. It helps you keep things organized and lets you give the docs/experts some info on your family and your child. It isn't something you will finish in one sitting. Break it up into chunks to tackle when you can. http://www.conductdisorders.com/community/threads/parent-input.182/

My oldest, Wiz, was very violent for many years. One thing we had to do after the other kids were born was to NEVER leave him unsupervised with his sister. husband and I would take the same-sex child into the restroom with us because otherwise the younger ones would get hurt. I took my daughter, husband took Wiz. We DID avoid having our children removed when we were investigated by childrens Services because our daughter was being abuse dby Wiz. This was one of the things we did already, and it helped show the investigators we were serious about doing everything we could to keep the kids safe.

I tihnk you will need help for many things. risperdal is a very helpful medication when you have a violent child. I would also be very hesitant to work with a doctor who said my 3yo had CD. Esp if he had not ruled out Reactive Attachment Disorder and Fetal Alcohol Syndrome. You will probably need to find a developmental pediatrician who works with those issues.

 

[karif]

First of all I want to thank all of you from the bottom of my heart for all your wonderful suggestions. I am a seasoned mom with 4 kids but this is beyond me. So I welcome all suggestions. I know that none of you are doctors but as I always say we don't have an md behind our names we have an mom! That is far more powerful than and MD any day. We all know what we have been through and I know God gives us this wisdom not to keep to ourselves but to share with other moms. About the possible diagnosis of CD, the doctor said that he is to young to have an official diagnosis of that but he shows early signs with his extreme violent behavior towards his siblings. He also stated that with therapy and medication it might be prevented from turning into that. Also I have called all around our area, an you would think living in crazy southern California, it would be easier to find psycotherapist. However most do not and will not see patients under 5. I already drive 25 miles to the nearest doctor. I will let everyone know what happens after Monday. I am going to insist on test though. As far as fetal alchol sydrome, as far as we know the mom did not drink. Was she totally honest, probally not. He is very smart, but his constant screaming and volitle behavior is weary. We are looking into putting him in the preschool program through our local school district. It will all just take some time.

 

[karif]

I also wanted to know if anyones child on top of behavioral problems ever ate non food items. JOsh eats or puts everything in his mouth. HIs favorite to eat is aluminum foil, plastic, he loves ice and ice cold things. He also loves to eat ice packs. Yuck! he also drools all the time.

 

[tiredmommy]

I also wanted to know if anyones child on top of behavioral problems ever ate non food items. JOsh eats or puts everything in his mouth. HIs favorite to eat is aluminum foil, plastic, he loves ice and ice cold things. He also loves to eat ice packs. Yuck! he also drools all the time.

It's called pica and can be a very serious problem if he consumes something toxic. My advice is to get him tested for lead poisoning as well. Here's a wiki entry with more info:

http://en.wikipedia.org/wiki/Pica_(disorder)

 

[SRL]

Putting things into his mouth could be sensory related. Check out this article on Sensory Integration Dysfunction.

http://www.tsbvi.edu/seehear/fall97/sensory.htm

If anything here rings a bell, the book The Out of Sync Child by Carol Kranowitz gives more information.

 

[BusynMember]

karif, we don't know for a fact that my son's mom drank either. However, for the most part, if they use drugs, they drink too. Either way, your child was exposed to substances and did not have good prenatal care, and that makes our particular kids harder to diagnose and often far more challenging. I also suggest you look up "Reactive Attachment Disorder" in your search engine. My very best friend (God rest her soul, she has passed) had a foster child from age six months until four years. She had another one too, the same age. The first one was so violent, disruptive, and even dangerous that, in the end, the family tearfully told the social worker that she would have to be moved. All they knew of her background was that t he birthmother used drugs, but she had been in six homes (6!) before they came to her at her young age. She never got better, she got worse. Now, part of that was the foster care worker not allowing her to take the child for the proper evaluations. One night the child tried to choke her foster sister--that cemented their decision. I recommend a total neuropsychologist evaluation because our kids are not the same as those from loving homes--and they can have drug related behaviors and attachment issues that regular therapists can miss. (((Hugs))) I wish you luck in finding your answer.

 

[SRL]

karif, when you say your son is smart, what are you seeing? ie Does he catch on quickly? Shows early interest in academic stuff like the alphabet? Have unusual interests for a child his age?

Does he still have speech issues? Are you hearing any echoing--such as if you ask "Do you want a cookie?" he repeats the question instead of answering?

Outside of the oral stuff, does he show any unusual responses to sensory stimuli? ie loves to spin, very sensitive to clothes textures/tags, etc. bothered by lights or sounds?

One of the reasons that it's very important to have the right specialists do a thorough evaluation is that a number of the disorders we commonly see here (such as Autism and Bipolar) can produce way over the top behaviors when unrecognized and untreated.

 

[karif]

To anser questions about Josh being smart. He has been tested for Autisim. He is not autistic and as far as I know does not show signs. He talks, makes eye contact, and is very loving when he feels like it. It is just his behavior and extreme rage and violence. It really scares me that he could hurt one of my other children. We go tommorow for his neuroligical evaluation. I will let you all know how that goes.

 

[SRL]

Karif, Autistic Spectrum Disorders--especially high functioning or atypical--are so frequently missed by doctors when children are young that we encourage all parents whose kids are dealing with unknown issues to educate themselves. A child with Autism Spectrum Disorders (ASD) may be more loving than expected, more social than expected, or have more eye contact than expected. They also may not show some traits until later (ie school age) when their school situation changes or social demands become greater.

Again, we don't know what you're dealing with but if there were early speech issues, sensory stuff, and extreme beahviors, I would suggest not totally wiping Autism Spectrum Disorders (ASD) off the list of possibilities.

Good luck at the neuro today. Keep us posted.

 

[karif]

Hello everyone! I finally made it back from the land of the doctors. Ha!ha! Our appointment was at 9 a.m. well we have new labels or diagnosis which ever you prefer. Pervasive developmental disorder and we already knew about odd and IET. He is also being tested for fragile x dna and another chromisone disorer. He also has pica (eating and putting everything is his mouth) but we already knew that also. It was good to get a doctors oppion and also very good that Josh showed his true self in the office. Wanting to take off all his clothes pulling stuff off the wall, running around, etc. Oh and throwing his shoes at the doctor that was great also. We had a blood test and An EKG today. He said that right now he doesn't want to do an MRI because the damage done to his brain can't be fixed and may not show up on an MRI. To put him through it with his anxiety at the current levels would be to traumatic for him. He put him on Respridol and Ambify. He had the first dose a little while ago and is sleeping now so I will keep you updated. Hey thanks for listening.

 

[SRL]

Glad you got some help there. A diagnosis of Pervasive Developmental Disorder (PDD) will be much more useful to you in terms of finding help and in terms of getting services.

You don't just want to stop at a diagnosis of pica--look beyond to possible reasons by scheduling an occupational assessment and getting a copy of The Out of Sync Child. Sensory issues were at the root of the clothes issues as my house as well. Changing to a standard super comfy outfit so it felt the same way every day was the biggest help. Cotton t-shirts, no buttons, trim or collars, soft elastic waist shorts (nylon), elastic waisted sweat pants, same style of socks everyday, etc. I had the best luck with Gymboree as their cotton is super soft and Land's End because pants styles tend to be similar from year to year. I became a super sale shopper.

 

[karif]

I gave him Resridol at nap time and he seems to be worse. Is that commen? He seems to be a little more mellow in some areas such as listening but his behaviors such as sucking on hands,eating things seem to be amplified as well as hyperactiity. Does this sound normal? Do I just need to give the medications more time to work?