Help please..do I need a neuropsychiatrist or just psychiatrist??

[sjexpress]

Hi-
I posted once a few weeks ago. I mainly lurk but just that makes me feel a bit better that I am not the only one dealing with a difficult child.
My ds or difficult child is 10. He has a history of being very defiant( at home), occasionally aggressive with husband, brother, and I, very moody (can change in a snap), extremely emotionally immature ( has tantrums the minute it is not his way), and has anger issues! Twice already this year difficult child has been so out of control emotionally, I was afraid and though I had to call for help but then he calmed down.
We have tried 2 psychologists over the past 2 yrs. but difficult child refuses to go or won't participate if he does. Both psychiatric. tried behavior charts, etc...nothing worked. We found a counselor that ran an anger management class for kids his age and after the 5 wk course we also see him privately. difficult child will speak to him but there is no change in his behavior.
We have never been given a diagnosis. difficult child has begun to show his moodiness in school at times I have been told by the teacher. difficult child is extremely smart ( an A student) and athletic and gets along with friends (but really pushes to have things his way or says he won't play).
At this point I feel that things are progressively worse for us and want to do more for difficult child and us as a family as things are not too pleasant here at times and it is not fair to our other ds who is 4. I know this sounds terrible but some days I feel sick when the bus comes home from school because I fear the rest of the day.
I want a diagnosis because at this point, I think we have tried all the basics. Also, the last psychiatric. said medications may help.
My question is, do I just make appointment. with psychiatrist or go straigh to a neurpsychiatrist? I want to just take the straight path now, not go round in circles anymore. Also, will the psychiatrist or neuropsychologist. provide counseling sessions or do I still need to have a psychologist for that?
Thank you for your input. I can't tell you how I cry wondering how to help my difficult child. Some days I feel he is falling apart and I have to find help. Our whole family life is affected as we hate to accept invitations anywhere or have people over since we never know when difficult child will act up! It can be embarresing and I know every eye is on us. It is awful!
Thanks again for the help.

me- over 40, stay at home mom- no family history of mental or emotional issues
husband - over 40, doesn't want to admit something wrong with ds- no family history
difficult child- 10 ds, emotional and behavior issues..no diagnosis
easy child- 4 ds- joy when difficult child not around, otherwise reacts to him

 

[shellyd67]

Welcome ! You just explained my difficult child (10 year boy) to a T ... We live in PA and took him to a neuropysch at the Children's Hospital in our area. He also had one on one counseling for anger management for a year. He was diagnosed with ADHD and ODD.(I am now leaning toward aspergers and am having another evaluation over the summer) My husband did not want to come to terms with difficult child issues for several years. He just kept dismissing it as difficult child being spoiled. My best advice is have an evaluation done with a neuropsychologist and go from there. Having a difficult child is like a rollercoaster. I have felt so many emotions over the years but over time I am learning to deal with him so much better. He is on Concerta and he has improved so much over the last few months. Don't get me wrong he still has tantrums and is very difficult to parent but things are better. I would try and find a neuropsychologist at a children's hospital in your area and have his teacher fill out paperwork and there is so much parental paperwork to fill out but it helps the process move alot smoother. Also, many parents on the board have recommended the book " The Explosive Child" it has been a great read. Good Luck and keep us posted on how things go.

 

[nvts]

Hi! Welcome to the crowd!

I'd head straight to a neuropsychologist. They don't do therapy - they test and test and test! It's done on an outpatient basis and is done over a few appts., but it's very in-depth and will take a lot of the history into consideration.

Don't feel bad about dreading the bus...I've considered hopping the back fence when the busses start coming down the street. It's natural - he's putting you through the mill and you're exhausted.

Did he hit all of his developmental milestones on time? Ever notice sensitivities to certain textures, tastes, smells sounds etc? How is his eye contact with other people (not necessarily you, husband and ds - more like acquaintences or teachers)? Is he an authority on any one particular subject?

More will be around - the weekends are usually pretty slow, but some still swing by for a chat.

We're here for you - just take it slow and steady - come often, ask questions and relax with a group of people who know how you feel!!!

Beth

 

[sjexpress]

Beth-
Thanks for your response. difficult child did reach all milestones on sched. He has no sensitivities to anything specific and is pretty good at all subjects. He has no problems talking to people when spoken to.
I was wondering if I may ask why your 11yr old difficult child was in the hospital? I've read numerous posts about other children being in the hospital too. It sounds scary to me and I have not had the nerve to ask what was so wrong that they had to be hospitalized?
My 10 yr old difficult child can have days where there are no issues and then we can have numerous problems in one day! Again, just wondering and fearful when I hear about hospital stays. Thanks!

Jan

me- over 40, stay at home mom- no family history
husband- over 40, sort of in denial something is wrong with ds. no family history
difficult child- 10 yr ds- emotional and behavior problems- no diagnosis
easy child- 4 yr ds- pleasure when difficult child not around but reacts to him

 

[DDD]

I agree that a neuropsychological evaluation should be the next step. The testing usually is a combination of tests (like word association, for example) as well as psychological conversational
time. The results are quite comprehensive and gives an overview of the patient.

Meanwhile I would start searching for a child/adolescent psychiatrist. in my humble opinion the most important step is find the best available experts. Sometimes, for example, a general psychiatrist has only limited knowledge of child/adolescent behavior patterns and therefore can not accurately interpret what is said or done by the difficult child. Many subtle signals come from our children...especially the A students who "appear" to be terrific kids to outsiders.

Good luck. DDD

 

[nvts]

Hi Jan! No worries about asking about stuff with the difficult child's - I look at it this way: my experience may help the next person avoid what I went through with my kiddos!

He was getting way out of control. While no one (family and therapists alike) believed that he was suicidal/homocidal, he'd make comments about both constantly. "I'm going to kill myself/so and so if I can't get x, y or z." His explosions were getting more and more aggressive, extremely disrespectful AND taking dangerous actions (riding his bike in front of cars and then mouthing off at the driver).

What would normally be frightening turned out to be a great experience. We finally got him on a more appropriate medication and the hospital pointed us in the direnction of more resources. It was a grind, but we're hoping for a light at the end of the tunnel and to be truthful, I don't think I'd have had the nerve to do it if it wasn't for the people on here helping me out.

One of the best things about going the hospital route was that they could titrate the medications a lot faster than outpatient, so we were better able to determine whether or not we were seeing improvements.

Now don't get me wrong - he's still a pita! But we're still not at the therapeutic dose AND they had to release him sooner than they wanted to so therefore none of the other interventions were in place.

Keep your chin up and feel free to ask me anything you need. Honestly, if I'm uncomfortable answering, I'll say so!

Gotta go - the natives are getting restless~!

Beth

 

[TerryJ2]

Welcome, Sjexpress.

some days I feel sick when the bus comes home from school because I fear the rest of the day.

I know the feeling. All too well. But I'm the one who picks up my difficult child and he rails at me the moment he shuts the door.

My son was hospitalized after a series of events ... he broke into a neighbor's house (although, because he's Aspie, he insists he didn't break in because it was a friend's house and the door was unlocked), stole ladies' underwear, got caught, they called the police, police came over and talked to him, he hid in his room for 2 days, then had to go to school and refused to get up and get dressed, husband pushed the issue and difficult child lit off and attacked husband.
The hospital called it ... what did they call it? LOL. Anxiety driven circumstance blah blah blah, but anyway, when a bunch of events lead up to a meltdown.

It was a nice wk off for me, despite the phonecalls. husband was miserable. He missed difficult child and wrote him notes that I intercepted because they were unhealthy. ("I am so sorry you have to go through this but you'll make it." Actually, husband was writing to himself. The therapist agreed that the notes were inappropriate. All husband had to write was "We love you." Period.)

Sounds like your son needs a good diagnosis. It can take wks to get an appointment, then once you have a working diagnosis (emphasis on "working," because nothing is final) you will have more questions than answers.

But it is worth the dr appts. You will get results eventually.

So sorry you have to go through this.

 

[BusynMember]

neuropsychologist all the way. They test for 6-10 hours (or else I'd question if they were a good one). I would expect more from the neuropsychologist than just a counselor...they really don't do much diagnosing and often aren't that good at it. It's not their area of expertise.

 

[flutterby]

A neuropsychologist is different than a neuropsychiatrist. When we use the term "neuropsychologist" on this board, we mean neuropsychologist.

 

[BeyondWeary]

It has been my experience that if your difficult child is a very straightforward easy-to-diagnose case of a major illness supported by Bigpharma, then a psychiatrist can prescribe pills for it. ON THE OTHER HAND, if your difficult child doesn't fit neatly into a category like depression, ADD, etc, and the medication for it doesn't help, THEN you need a neuropsychologist. These folks have studied the neurological disfunctions, abnormalities, et al to the nth degree and they have many tests to examine the behavior/learning/moving/ problems from several angles. The psychiatrists nowdays are very unimpressive to me - we have been to 4 of them - they just seem to keep guessing as they prescribe pills. I think I could do a better job. Just put the pills in dispensers like Jelly Beans at Target with some notes like what they are for, what the side effects are, and I could determine what the difficult child needs instead of all the useless appointments, the repeated questions, the repeated answers, the frustration, etc. etc. etc. HA! HA!