Help with defiant 13-yr-old daughter

[FredGeorge]

My wife and I are trying to figure out how to help our 13-yr-old difficult child, fostered since 2 days old, adopted at 3. Mom drank during pregnancy. No confirmed diagnosis of Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE), but all the signs are there, shared by birth brother, also our difficult child (15 yrs). Other kids in picture: 9-yr-old difficult child boy, also adopted, also from mom who drank and did drugs--no apparent Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE), but sensory issues, and 9-yr-old difficult child girl with DS.

All four are on Vyvanse for ADHD. Won't go into details on other kids in this post. Our daughter was last to go on medications because she was the "normal" one for so long. Realized she was slipping in under the radar because she was compliant--though serious and shy--and her early test scores did not qualify her for an IEP. Then middle school hit. Self-absorption, moodiness, extreme sensitivity to slights, overall sense of entitlement, mean to siblings, disrespectful to parents. On the other hand, shy at school and respectful to all other authority figures. Worries about everything, has to have everything in her order, her way, although doesn't engage in ritualistic Obsessive Compulsive Disorder (OCD) behaviors. Meltdowns at home are regular and over-the-top. While she is not generally aggressive, when she loses control, she will push or shove siblings--mostly in a "get out of my way" fashion. has kicked holes in drywall of bedroom. Got the picture?

So, our quandary. Some of the above symptoms might sound like adolescence (she also just started her periods this summer--with bad PMS--just keeps getting better and better), but it's like adolescence on steroids. She's been on Vyvanse to help with inattentiveness in class (she's the ADHD girl who doesn't look like "ADHD") and we've been trying her on Intuniv to try to help with the impulsive nature of her outbursts, but we're not seeing a lot of improvement, which makes us wonder if the Intuniv is even the right direction to go. We had previously tried Celexa and stopped that because it appeared to make her symptoms worse. To my untrained eye, it appears she's developing symptoms consistent with ODD, and what I've read talks about the need for a multi-pronged approach: therapy, medication. So we will investigate some individual and family therapy options in the area, but we're also going to be asking our child psychiatrist (wonderful) if he thinks we need to be looking at more of a possible anxiety angle we previously have not. Our younger son is on Zoloft, and it has helped him tremendously.

So I am asking for general feedback but also if there are some other medication regimens we could be exploring or asking about.

Thanks.

Me: 53-yr-old adoptive dad
wife: 56-yr-old adoptive mom
difficult child 1: 15, with ADHD and impulse issues, taking Vyvanse and Abilify
difficult child 2: 13, with ADHD, impulse and outburst issues, taking Vyvanse and Intuniv
difficult child 3: 9, with ADHD and sensory integration issues, taking Vyvanse, Zoloft, and Risperdal
difficult child 4: 9, with ADHD and Down Syndrome, taking Vyvanse

 

[InsaneCdn]

Hi, and welcome. Glad you found us, sorry you had to...

YIKES. FOUR of them. You certainly have your hands full.

If, in fact, you are dealing with Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) kids, then your options are limited.
But... lets talk in terms of your daughter, as she is the current topic of discussion.
Has she ever had a comprehensive evaluation? The kind that take 6-8 hours over more than one day of testing?
If not, it's probably warranted. The more you can find out about what you are dealing with, the better off you are.

There's a raft of possible dxes here. And, just to make life more interesting, could be more than one. She is adopted - how much do you know about the medical history of BOTH bio parents, and how current? Some dxes in the parents don't show up until later, especially MI issues. But a lot of challenges have some genetic component.

 

[BusynMember]

I've adopted kids too and done foster care. There is little you can do for Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) other than to carefully watch the child so that she is safe as (you probably know) they do not retain information and don't understand how to do the right thing. It's not t heir faults. It's organic brain damage. Many Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) kids are on ADHD medications, but they rarely do much to solve issues such as defiance. She also likely has other things going on that are genetic or due to other drugs used or attachment issues.

Are you seeing professionals who are familiar with the neurological problems that kids like this face? ODD is a very unhelpful diagnosis used mostly for young kids who are defiant when the doctor has no idea why they are defiant. You can not diagnose drug affected kids the same way you diagnose other kids. I adopted one who had cocaine in his system at birth. He was tricky to diagnose and it took specialists and a few neuropsychologist evaluations. We also adopted one eleven year old boy who was literally a young psychopath and sexual predator and is no longer in our family due to the danger he posed...he was also exposed to drugs in utero. Nobody caught the Severe Reactive Attachment DIsorder he was diagnosed with once he was gone and living in a facility for young sexual predators. All the psychiatrists got him wrong. For eleven years.

in my opinion you need to have her evaluated by a neuropsychologist who is FAMILIAR with the issues of adopted children AND those exposed to substances before they are born. If you don't seek out these sort of specialists, you may well get a wrong diagnosis. They may look ADHD, but that's almost never the big picture when kids have the backgrounds that your kids do...but even professionals often don't get it. Heck, many have no idea what attachment disorder even is. I would seek out a neuropsychologist in a university hospital who has seen and treated many adopted children. They see things other professionals never see.

I'm amazed and awed that you took on such a huge responsibility.

Good luck to you, welcome to the board, and keep us posted! My son who had cocaine in his system has autistic spectrum disorder, but he is almost twenty now and doing very well. It can happen.

 

[FredGeorge]

Thanks so much for the quick replies--I really appreciate your thoughtful answers. I will be making an appointment with our regular child psychiatrist in the next week or two to let him know what's going on, since she's still taking Intuniv on a trial basis, and I will ask him for some referrals for a possible neuropsychologist evaluation. The reason we've never done a full Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) evaluation or tried to get a diagnosis is that the birth mom, who we're still in touch with, denies to this day that she drank while pregnant. She has some mild to moderate MR, as does the birth dad. We know there is some degree of Fetal Alcohol Effects (FAE), simply because of some of the facial features of difficult child 1 and difficult child 2. The other reason we've never worried about getting an official diagnosis is because you're still left dealing with "what is." I learned long ago not to find security in a diagnosis--in the mechanical sense (as in "you're not getting enough gas to the engine? The computer says you need a new fuel pump--problem solved."), which is why I thought your comments about ODD were probably right.

And, it's not that she has no conscience or lacks the ability to empathize--which we're very grateful for. Nor does she show any obvious signs of an attachment disorder. It's just that she is incredibly mercurial in her temperament. She holds it in at school, then lets it out at home. It's almost (almost) comical when you consider the combination of a sensory-seeking younger brother and her ("HE'S POKING ME AGAIN!! AAIIIGHHH!!).

Anyway, thanks for the input. I'll try to keep you posted on what we learn as we continue to pursue this.
_____________________________________________________________________
Me: 53-yr-old adoptive dad
wife: 56-yr-old adoptive mom
difficult child 1: 15, with ADHD and impulse issues, taking Vyvanse and Abilify
difficult child 2: 13, with ADHD, impulse and outburst issues, taking Vyvanse and Intuniv
difficult child 3: 9, with ADHD and sensory integration issues, taking Vyvanse, Zoloft, and Risperdal
difficult child 4: 9, with ADHD and Down Syndrome, taking Vyvanse

Read more: http://www.conductdisorders.com/forum/f6/help-defiant-13-yr-old-daughter-54894/#ixzz2biZmZsvQ
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[FredGeorge]

Thanks for your quick and thoughtful replies--you've given me lots to think about. I will keep you posted on what we find out as we pursue some of these options.