Increased Aggression - new medications?

[ChiefDramatist]

First post! Every forum has its own unwritten rules, so please be patient with me as I learn the ropes!! Thanks!

Help! Hubby was the one who found this forum and suggested I join.

My difficult child has been on Risperidone for a bit over a year. Her serious Obsessive Compulsive Disorder (OCD) is nearly controlled, but she is still very defiant, demanding, never satisfied, mean and periodically aggressive.

Recently, she was diagnosed with anxiety, which was severe enough to land her in our local children's hospital ER TWICE with hives, throat constriction and full body itching. Her psychiatrist took her off of Prozac and put her on Zoloft. The anxiety is gone. Her ODD is still very apparent, and her doctor didn't want her on Risperidone much longer anyway, so she in the process of moving her onto Abilify.

In the past three weeks, she has been increasingly aggressive. She has kicked two children in the neighborhood, and punched me in the arm. (She is really strong!) She has lost the right to play with one girl, and is gaining a reputation as the neighborhood bully. We have taken away privileges, grounded her from TV, etc... She takes the discipline, seems contrite by the end of it, and the day she has regained her "freedom" she immediately does the same thing that got her in trouble in the first place.

We are both at a loss... She just won't listen to us! She won't listen to her therapist! She doesn't respect her psychiatrist. She just does not understand that we want what is best for her, and love her so much. We're tired... And have even thought about sending her away to some sort of intensive inpatient therapy for the summer. My health has tanked in the last year. I'm exhausted, having medical issues all stress related, little sister is feeling marginalized, and our home has been turned upside down in the past year.

I guess this is more of a blind cry for help... Not sure what else to do at this point.

 

[buddy]

Just curious, why the switch?

It's awful when our aggressive kids end up being left out when it is really their medical issues driving it. (understandable but sad)

Is the abilify at the appropriate dose yet? For our family, once aggression starts it's hard to undo so I want it stopped sooner than later. I'm not sure how close in timing these medication changes were made, i never do more than one medication change at a time. That way you know what causes what. Is it the stopping of Risperdal or the starting of abilify or one of the others, or?

If the abilify dose is where they want it then I would be asking for the Risperidal back. Unless there was some medical reason you stopped it.

Two AP's made my son very aggressive. One is working. It has made him very heavy but the pros outweigh the cons. Aggression leaves him out of life. So, quality of life wins over the weight struggle.

Oh, the punishments? She really probably is sorry and wants to do better. She probably can't. You are likely going to have to avoid situations where she could struggle for now. I'd never let her play unsupervised right now. Yes that is hard, I've done it for years and years. The punishments probably won't change things at this point.

Has she ever had a full....six hour or so....neuropsychology evaluation? She has a lot of individual diagnosis. that could fit under a bigger umbrella diagnosis. Many psychiatrists and therapists miss these. (can't see the forest for the trees).
Even if not so, you could get more insight into how she perceives and processes the world. If your discipline can match her thinking and learning it really helps. An evaluation of that depth can really help.

Have you ever read The Explosive Child by Ross Greene? That's another thing that has helped many of us. It is really cheap of you get it used like on Amazon.com.

Nice to meet you. My son had to be locked in our house when medication changes increased his aggression. I really get how hard it is! Hugs.

 

[InsaneCdn]

Ditto to what Buddy said.
Especially the need for a comprehensive evaluation - and "the" book. (we have several around here that we kind of like)

Can you give us more background?
How old is she, what was she like as a baby, who does she live with, was she adopted, family history of challenges (mental health, developmental, etc.)

 

[ChiefDramatist]

Thanks for the reply. I will address your questions individually, so I don't miss any of your great questions.

Just curious, why the switch?

The switch from Prozac to Zoloft was to address the anxiety, which manifested during the time prior to 3rd grade annual testing. The administration and teachers of her school had been harping on the test since the first day of school. They were using scare tactics, threats, rewards...anything to get these kids whipped into a frenzy for the test, which concluded last week. I had meetings with the school counselor, her teacher, and the school principal about my concerns. I felt like I was talking to a smiling brick wall. Luckily, daughter has a 504 in place. She is very bright, and is doing well, so they won't do an IEP for her. (That's a whole different topic.)

Psychiatrist believes the Abilify will address her defiance more squarely. She is also worried about the side effects, now that she is getting older, and will soon be entering puberty.

Is the abilify at the appropriate dose yet? For our family, once aggression starts it's hard to undo so I want it stopped sooner than later. I'm not sure how close in timing these medication changes were made, i never do more than one medication change at a time. That way you know what causes what. Is it the stopping of Risperdal or the starting of abilify or one of the others, or?

She is on full Abilfy, but half Risperdone right now. This coming friday, she will be off of the Risperdone and solely on Abilify. The switch to Zoloft occurred a month ago.

Oh, the punishments? She really probably is sorry and wants to do better. She probably can't. You are likely going to have to avoid situations where she could struggle for now. I'd never let her play unsupervised right now. Yes that is hard, I've done it for years and years. The punishments probably won't change things at this point.

Ugh. You're right... HOW do parents get anything done when they have to supervise play 100% of the time? I KNOW it is the right thing, but it is just exhausting. (I'm just whining. Sorry...)

Has she ever had a full....six hour or so....neuropsychology evaluation? She has a lot of individual diagnosis. that could fit under a bigger umbrella diagnosis. Many psychiatrists and therapists miss these. (can't see the forest for the trees).

Yes, she underwent full psychological testing about six weeks ago. We are still awaiting results. The report is due any day now. Immediate impressions by the lead psychilogist were that she is VERY brilliant. She struggles significantly in math, mainly because she goes into Obsessive Compulsive Disorder (OCD) mode if she doesn't understand something; if she can't do it perfectly, she won't do it at all, and she simply shuts off.

Have you ever read The Explosive Child by Ross Greene? That's another thing that has helped many of us. It is really cheap of you get it used like on Amazon.com.

I have it on my iPad as an eBook. I have started it (along with five other books... Sigh... Not enough time or energy it seems. It was suggested by her therapist. I suppose I should buckle down and read it.

Nice to meet you. My son had to be locked in our house when medication changes increased his aggression. I really get how hard it is! Hugs.

Thank you so much for the robust answer. I really appreciate it.

 

[BusynMember]

Most of us use neuropsychs for full evaluations. Did this psychologist do anything beyond testing her educational skills? Was he looking for any particular disorders or other issues she may have?
Are her current professionals making her better? Do you feel her diagnosis is correct?

 

[ChiefDramatist]

Ditto to what Buddy said.
Especially the need for a comprehensive evaluation - and "the" book. (we have several around here that we kind of like)

Can you give us more background?
How old is she, what was she like as a baby, who does she live with, was she adopted, family history of challenges (mental health, developmental, etc.)

Awaiting the report on the psychiatric evaluation...impatiently waiting!!!

difficult child is 9, and in third grade.

Background: I had a very healthy pregnancy. Although I had some premature labor, she was delivered full term. She had good APGARs. She was breast fed for three months, but I had to speed wean her due to the discovery of a breast tumor (which turned out to be benign). She ate well, had no food allergies, hit all of her developmental milestones on time or early. She slept through the night at three months, napped perfectly until she was three... She was a textbook baby! I could say the same for early toddlerhood.

When little sister came along at 22 months, my difficult child changed personality 180 degrees. If one could label a toddler as resentful, I would. She wasn't just confused by the appearance of her sister, she truly acted like she hated her. They still have a very stormy relationship. difficult child was suddenly very defiant with us, too. Before sister came along, she was cheerful, funny, playful... After, she stopped listening to us, was willfully disobedient, a right terror.

I remember a specific incident when she was 3. It was Easter morning, and we were visiting my parents. It was very cold, and I wanted her to wear tights with her dress. She refused to let me put them on her. Long story short, it was a very difficult day, one of the worst I can remember.

Of course, PPs gave us a ton of advice, as they observed our difficult child... "You aren't disciplining her enough, she is strong willed, you need to get that under control or you will have a problem on your hands..." We read book after book, tried so many discipline methods from the lightest touch to the most strict. Nothing helped her behavior.

Shoe shopping became a dreaded event... She wouldn't wear anything with buttons.... She started washing her hands too much... Socks...tights...leggings, all had to be perfect. Now I know these are all behaviors were the Obsessive Compulsive Disorder (OCD), but NO ONE in our circle of acquaintances ever said anything other than it was a discipline issue.

She was in public for first, homeschooled for second due to what we thought were behavioral issues stemming from very bad influences in her first grade class. Had she not been homeschooled, I don't know that we would have recognized that her difficulties were not simply behavioral...there was something much bigger going on.

February of last year, her cognition simply shut off. She stopped writing, could not add two plus two (or refused to), and stopped reading (she is a voracious reader... Learned to read when she was five, and we had just given her a Kindle for her 8th birthday). She refused to change her clothing, lost interest in activities, in her friends, stopped sleeping, began throwing away, or giving away her toys to her little sister's friends. She started pacing in her room, developing counting rituals, couldn't come down the stairs because "the voice in her head" told her that she wasn't doing it right. There were other rituals too, and she stopped caring about personal hygiene. She had always been very particular about her hair especially. (Had to be perfect...part had to be in a specific spot, no tangles, etc...) She had been very clothing conscious. She is a physically stunning girl, with naturally curly, striking hair of an unusually beautiful color, and she KNOWS it, but refuses to believe it. (That sounds contradictory, I know, but somehow, that is her.)

Last February, we ended up in the ER after she had a complete breakdown the Saturday after her birthday. She was immediatley referred to pediatric psychiatry. After two months of sessions with two psychiatrists, she was diagnosed with Obsessive Compulsive Disorder (OCD) and Mood Disorder. PANDAS was ruled out, even though she had had strep. We began family therapy at a medical center which is world renowned. Our sessions were videotaped, and monitored by a group of psychiatrists because they considered her case to be unusual. They floated the idea of Pre-schizophrenia, but that was eventually ruled out.

She was put on Risperdone and Prozac in April of 2012, and the medications made a big difference rather quickly. She started changing her clothing within a few months, the counting stopped, she began to sleep again, and our lives settled down a bit.

In October, a new psychiatrist added ODD to the diagnosis. She was referred to a new therapist for weekly sessions, which began in January.

School has been a challenge, but not a complete disaster. She does not like her teacher, and TBH, either do we. She is very harsh, says she understands the diagnosis, but certainly doesn't act like it. She has had a tough time making and keeping friends, and is desperate to have people like her. Unfortunately, this means she will do things to try and please people...wrong things. She is very peer-driven.

 

[ChiefDramatist]

Unfortunately, we had to settle for what insurance would cover, and what was available in our area. This practice was our only option. There are four psychologists in the practice, and she was evaluated by two. Evaluation was not simply educational testing.

 

[InsaneCdn]

The problem with the ODD diagnosis is... it is almost always a cover for something else. For us... ODD was the first label that confirmed that we (parents) were not making this up. But... ODD got us nothing. No medications, no interventions/therapies/accomodations... ODD (at least in my world) = bad parenting.

in real life? ODD = missing dxes.
There is a REASON for the behavior. And it isn't likely going to be your parenting.
I just hate it when psychiatrists slap that diagnosis on... and then try to fix it with "therapy".

What is confusing is...
1) the issues coming up with arrival of sibling, and
2) the further regressions

 

[Dixies_fire]

I'm not as savvy as these other ladies but my 8 year old has some of the aggression issues and sibling issues. We are trying a new technique just for that behavior that is working reasonably well.
Sounds like it could be the medications to me and being on the two pills at the same time.
Hopefully it levels out.
Good luck with your evaluations.
It helps a lot to talk about what's going on without being judged.

 

[Liahona]

At age 3 the brain under goes a change where lots of connections that aren't used are gotten rid of. In autism the brain gets rid of the wrong connections.

This could be why difficult child's behavior started at age 3. Or did it start at age 2? Talking to a neurologist to see if there are any physical reasons might be a good idea.

If the testing/sessions are video taped could you send them somewhere else that has better people? If she is an unusual case could you contact a teaching hospital and see if they have a study that could help her or maybe they would reduce the cost of a neuropsychologist? Just trying to think of ways you could find out what is wrong.

You asked how we got things done while supervising. Include difficult child in what ever you are doing. Have some safe places for her to go that the other kids aren't aloud in. Then when you need a break she can go in there. Baby monitors.

welcome

 

[ChiefDramatist]

At age 3 the brain under goes a change where lots of connections that aren't used are gotten rid of. In autism the brain gets rid of the wrong connections.

This could be why difficult child's behavior started at age 3. Or did it start at age 2? Talking to a neurologist to see if there are any physical reasons might be a good idea.

If the testing/sessions are video taped could you send them somewhere else that has better people? If she is an unusual case could you contact a teaching hospital and see if they have a study that could help her or maybe they would reduce the cost of a neuropsychologist? Just trying to think of ways you could find out what is wrong.

You asked how we got things done while supervising. Include difficult child in what ever you are doing. Have some safe places for her to go that the other kids aren't aloud in. Then when you need a break she can go in there. Baby monitors.

welcome

@.@ The girls are less than 22 months apart, so it may as well have been age three, because she turned three when DD7 was only about 8 weeks old . It may be hard to make a case for this, as we had so much crud going on at the time. husband was out of the country for five months, and left when the new baby was two days old, even before the baby came home from the hospital. (Thank you Uncle Sam.) I am sure this didn't help matters, but kids are resilient and recover from things like that...all of our friends' kids did.

Unfortunately, the testing was not videotaped. There is a large university hospital here...thank you for your suggestion. I think it is a good one.

 

[IT1967]

Hi there. My difficult child 1 has A LOT of similarities to your difficult child - the early reading, gifted, shuts down on math, perfectionism. My difficult child 1 doesn't have the Obsessive Compulsive Disorder (OCD) stuff and that kind of aggression, though. But what I wanted to suggest is that it could be the SSRI, and not the AP that is causing the aggression. My difficult child's did NOT do well on Zoloft or Prozac. Both those medications significantly increased their agitation and made them angry. They're both currently on Celexa, and *knock on wood* it's helping a lot with-o the bad SE's that the other 2 caused. I'll be curious to hear what the neuropsychologist testing reveals for you. I hope you get this sorted out quickly.

 

[BusynMember]

Actually, to me this sounds less developmental and more psychiatric. Voices telling her to do something? Is this a common complaint? Does she see things sometimes that are not there or have an immaginary friend that goes way beyond the normal imaginnery friend of childhood, like she really thinks it exists? Any strange quirks? Nightmares? Night terrors? Fear of the dark? Complaints of, say, spiders on her walls or skin? Giving all her toys away, if she were older, is a sign of possible contemplation of suicide...a teen or adult may give all his prized possessions to his friends because he is planning something dire. Does she seem depressed? Does she self-injure? Certain medications can cause worsening depression, even though they aren't supposed to. Some cause hallucinations as well in certain kids. Fact is, certain medications can cause almost every symptom you mentioned.

Do you have any mental illness on either side of her family DNA tree, even if she never sees one side of the family? Any schizophrenia or schizo-affective? Bipolar? Her sudden loss of cognitive skills and hygiene are sort of like what happens to a teen or adult when they develop certain mental health issues. It sounds in my opinion rather extreme for just acquiring a sibling...most kids do that and don't fall apart to this degree.

in my opinion the ODD diagnosis is off the wall. Clearly something has happened inside of her. She is not just being oppositional. She has problems that cause her behaviors. I'm not a fan of ODD anyway, but I don't even see how the psychologist got ODD out of this since she has so many symptoms of very real disorders that she can't help. in my opinion she really can't control her behavior. She knows that you love her and want what is best for her. She just can't do w hat you ask of her right now.

I'm sorry you are going through this with her. Not at all fun.