Major Aggression and Meltdowns Daily

[TiredSoul]

The pediatrician hasn't called us back - I also have a call in to the psychiatrist!

difficult child has been having problems at school during recess everyday and has been super aggressive after school which then leads to him getting in physical fights with his friend. We are to the point where we will not be able to let him leave the house which will result in more meltdowns and more aggression. He is like a ticking time bomb!

He was on the intuniv 1 mg for 15 days, then because he had been in 3 fights and suspended from school, his pediatrician-doctor took him off the intuniv. It's been 6 days off and he still has the aggression just as badly as he did. The intuniv helped him go to bed without a fight (in his own bed), fall asleep much faster, and cooperate better in the morning. But it also caused night time wakening, bad dreams, and early morning awakening.

I don't know what to do and I can't seem to get any help. We saw his pediatrician-doctor last Fri and she was supposed to talk to another doctor in her office and call us back with one of these options:
1. Increase Concerta alone
2. Decrease Concerta and add back Intuniv
3. Switch back to Adderall

I don't think any of those solutions are going to change the AGGRESSION. I mentioned Clonidine and she said she only gives that for sleep problems. We thought she was working in partnership with the psychiatric-doctor we saw one time. She told us Fri she was allowed one call to him and she has used that already.

What the heck do we do? Resources around where we live are extremely limited. It's either pediatrician, this psychiatrist, and/or the psychologist we have an appointment with on Oct. 13. We need help NOW.

I don't know what to do. It seriously feels like we need to cage him when he gets like that. We can't live like this. When he is in a rage like that it is like he is a belligerent drunk!

We need help!

 

[smallworld]

How far do you live to a major city or to a children's hospital?

 

[BusynMember]

I'd have him re-evaluated by a neuropsychologist. Sounds like the diagnosis is wrong to me. I'd want another one.

 

[TiredSoul]

We are fairly close to Tacoma and Seattle. Can I just march him in there and demand they do something? It takes forever to get an appointment for a neuropsychologist evaluation.

I just got an email from the school about him being aggressive in music class! So now it's recess, music, pe, after school. They said it is close to being considered bullying and that will result in automatic conference and possibly suspension. We are in over our heads and I need to do something right now. I just don't know what!

 

[smallworld]

Jules, I sent you a PM.

 

[gcvmom]

I'm not a psychiatrist, nor do I even play one on TV... however I have a difficult child who had problems with aggression at the same age and he was also on stimulants. We now know it wasn't just ADHD going on with him. At the time, our psychiatrist rx'd Risperdal, and it really helped curb the aggressive impulse for him. I have no idea what your difficult child needs, but just want to tell you that there's likely something mood related going on and that there are medications out there that can help, but you've got to get him in to see someone who understands this realm of pediatric mental health. And whatever smallworld says, I'd really take to heart -- she's very knowledgeable

 

[Shari]

Ask about risperdal. It helped with Wee's aggression. might be worth a try.

And FWIW, we had residual effects from some of the things we tried, too. Concerta was really bad, it put Wee in a tailspin that lasted a good long time.

Do you have a regional center in your area (state, for that matter), or a NAMI branch? Dig around and find out. Either of the can help direct you to services in your area. They don't advertise on big neon signs, tho, so you may have to dig.

Beyond that, if you can get him on the books for a neuropsychologist, do it. Don't even try not to cry when you call to schedule...most docs leave a little room in the day to add in an emergency case or 2. And then call a pediatrician there, and give them the same story. Ask to be seen right away, or put on a cancellation list. Tell them you're willing to drop and run if they call with a last minute cancel (that one has gained us a lot of appts).

Wish I had more to offer than just an understanding hug.

 

[TiredSoul]

Thank you everyone. I got an emergency appointment at the psychiatrist's office tomorrow. He agrees to take difficult child on as an active patient if we agree to see an independent counselor in his office. I don't know how I feel about that but I will do it if it gets us help for difficult child. I also left a message with the pediatrician and demanded to be referred to the Children's Hospital for a neuropsychologist evaluation and asked them to call and do whatever they can do to get him seen asap. I can almost bet the psychiatrist will say you don't need to take him to a Children's hospital for a neuropsychologist evaluation. He just needs different medications and counseling. Then about this other appointment with a psychologist at a different office scheduled for Oct 13 - do we cancel it? It's hard having too many players. I don't know why we can't have a one stop doctor for everything.

What would you guys do? See both the psychologist and psychiatrist with- counselor and keep pushing for the referral for neuropsychologist evaluation? Arrgg.

 

[Shari]

I'd keep them all on the books til I find something I like or something that works.

 

[Shari]

Within reason, of course.

 

[TiredSoul]

THANKS! Hopefully the insurance company doesn't give us trouble - but too bad if they do. I would rob a bank if I had to - to get difficult child the help he needs and deserves. Not really but you Know what I mean?.

 

[TeDo]

I agree. Keep both appointments. The more information the better and it always helps to have more than one opinion. Who knows, they might even agree with each other. Keep at it Jules. You're doing the right things.

 

[gcvmom]

Ditto to keeping the appointments at least until you get through this week and get a better idea of what your next step is. Most places just ask for 24hour notice on cancellations anyway. Hang in there... some answers are just around the corner!

 

[TiredSoul]

Thanks. I will keep all scheduled appts for now - and just take it day by day. I am considering not giving difficult child his Concerta in the morning tomorrow before the psychiatrist appointment. Tomorrow is a short school day, so I was thinking I would just keep him home after the appointment. It's been a long time since he missed a dose of Concerta and I am wondering how he would be off of it. What do you think?

 

[gcvmom]

I think you should dose him just as you have been so the psychiatrist can see what you've been seeing.

 

[TiredSoul]

I think you should dose him just as you have been so the psychiatrist can see what you've been seeing.

Ok, thanks. I'm sure you are right.

 

[TiredSoul]

Just got an email from the sped teacher - she said she asked difficult child if he wanted to bring a friend to her room during recess to play a game and he said "sure that sounds like a good idea". She said he played the game and they had a great time. Then he visited her for social skills and brought a different person from class and they played a math game and got along great. So good to hear something positive! She said he seemed CALM. Can you believe that? Maybe it was a relief for him not to have to go to recess and try to get along.

 

[gcvmom]

Some difficult child's do better in smaller groups or one-on-one situations. Recess is a very unstructured and chaotic time for a lot of difficult child's. Too much stimulation. Too many stressors. Too many rules to remember, etc.

Does your school have a mentor program? This is where a younger child or even a struggling older child is partnered with a volunteer student who buddies up with them during recess to help model appropriate social interaction. Sometimes they help them get involved in larger group activities, or they might just engage them in a one-on-one activity like a board game or shooting hoops. It's a way for the struggler to have small social successes and in the long run can help ease anxieties about interacting with other kids. If your school doesn't offer one, suggest it to the school counselor or even the sped teacher.

 

[TiredSoul]

Some difficult child's do better in smaller groups or one-on-one situations. Recess is a very unstructured and chaotic time for a lot of difficult child's. Too much stimulation. Too many stressors. Too many rules to remember, etc.

Does your school have a mentor program? This is where a younger child or even a struggling older child is partnered with a volunteer student who buddies up with them during recess to help model appropriate social interaction. Sometimes they help them get involved in larger group activities, or they might just engage them in a one-on-one activity like a board game or shooting hoops. It's a way for the struggler to have small social successes and in the long run can help ease anxieties about interacting with other kids. If your school doesn't offer one, suggest it to the school counselor or even the sped teacher.

Wow - our school does not have that - but last year I asked for exactly that! I think they thought I was crazy - instead they decided to have him go work on social skills in the sped room with a peer (which is good too). But what you describe is exactly what I wanted. He very much needs as many opportunities for those social successes as possible.

 

[gcvmom]

And I'll bet there are other kids in the school who would benefit from such a program. It's good for the older kid, it's good for the one who struggles. When my difficult child 2 was in 6th grade, they had him mentor a younger non-difficult child and it still benefited both kids.