Medicate behavior for school?

Discussion in 'General Parenting' started by TheBoyHasArrived, Aug 29, 2012.

  1. TheBoyHasArrived

    TheBoyHasArrived New Member

    The Boy, 6, mainly has behavior difficulties (post-institutional, prenatal history unknown). He's not perfect at home or in public, but he's made huge progress and I can usually take him just about anywhere.

    School, however, is a completely different story. He turns into a completely PTSD, raging, screaming, defiant monster. However, I can walk into a room, and he can stop a tantrum on a dime. So, I really believe that these behaviors are manipulative (5.5 years of inconsistent expectations and extreme neglect).

    I do not want him on medication. At all. He was on Risperdal previously (a very high dose, actually, which we tried weaning down slowly to find a 'good' dosage), and it had zero was like giving him water.

    Because I think it is behavioral, I think that the school should be able to manage him. He's having an FBA completely FINALLY, and will have a behavior plan in place asap. On the other hand...I don't want him to be a complete disaster every single day at school. And if medication was a magic fix, I guess I would hop on that band wagon.

    Has anyone chosen medication for their kid just for the sake of alleviating at-school behaviors? I work in his elementary school and it is SO HARD to see him act like such a monster there when he's a pretty good kid at home.
  2. buddy

    buddy New Member

    If this is truly a school only behavior situation, then I would be maybe looking for a better school for him. If this is triggering that much for him he needs a truly loving, calm, placement to help for now. Just my opinion, and it is a hard thing to do, trust me on how much I understand that! It is true, school SHOULD be able to do better, but they likely wont. There may be moments, situations, where they do better, but they now have an opinion and likely use a tone of voice that may not change even with the fba. And beware, an FBA is only as good as those doing them and interpreting them. Many do the basic what is the function of the behavior categories: to seek attention, to escape work, etc. Unfortunately that is highly limited for some kids who have different wiring or mental health conditions. It is often that they do not know replacement behaviors or have the skills to tolerate frustration, to handle the setting, to deal with whatever underlying issues are being triggered. Your kiddo has such a complex history, and just MHO needs a program that focuses on gentle, pro-self esteem methods that prevent the behavior from being triggered in the first place. And since any attention is sometimes as good as anything to our kids, even if he is getting consequences from them it is likely reinforcing the behaviors and they are maybe increasing despite their efforts. He gets a reaction and that is way better than nothing which is maybe what he had to do so long ago. Just thoughts, I could be way off, but it is one perspective. Are there any schools for kids with behavior challenges around you?
  3. Wiped Out

    Wiped Out Well-Known Member Staff Member

    I'm assuming if he was on Respirdone that he has a child psychiatrist? Is he/she a child psychiatrist that you trust? What is her/his opinion?

    I would also want to see if things change once a BIP is in place.
  4. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    If medications didn't work, I think maybe he needs an alternative school setting where he can feel safer and better learn without acting out so much. Some kids can't function in big classrooms.
  5. TheBoyHasArrived

    TheBoyHasArrived New Member

    He was on risperdal in the orphanage, and we continued it during the initial transition. The psychiatric does not feel like we should medicate unless absolutely necessary as he has never had the opportunity to develop emotional regulation due to the massive amounts of medication he was on prior to adoption. She said that if we feel like he NEEDS it, then we'll try again. That's where I'm torn...he doesn't NEED it at home, but maybe at school?

    There's no alternative placements. He is actually much worse in the self-contained classroom than he is when he's pushed into regular education with an aide because the expectations are so low in self-contained. We actually do not want him in an alternative placement--he will have to live in society, so my thought is that giving him a more sheltered placement will just set him up to fail in the long run. He had a lot of time in an institutional setting, and we are trying to move away from that.

    What we've found about the self-contained placements we've looked into (we moved to put him in this school so that he would be semi-included) is that they have almost zero expectations for him other than to not throw a tantrum. They couldn't care less if he learns positive behaviors, learns academic concepts or uses language to communicate--as long as he doesn't throw a tantrum, they are happy.

    And, honestly, it's not overstimulation or crowds, etc., that set off his behavior--it's about 70% testing behavior/control issues and 25% impulse control, in my opinion. And maybe 5% anxiety. The major problem is that he does not self-regulate his emotions so his reactions to minor things are WAY off the charts. My thought was that maybe that's where medication *may* help. I'm really hoping that the behaviorist will be able to help get us on the right track.
  6. buddy

    buddy New Member

    I am sorry the school program options are that limited. Darn. For my son it is a bummer that he has less in terms of typical peers but having staff that understands how to push him to his potential without the added stress of constant punishment and neg. behavior mod. is a blessing. I got a call today saying they wonder if community vocational placement would be better for him which places him more in the real world and back in our home school district.when i wanted.that the Special Education dept refused to consider anything like that for another two years. My sons day in the real world school setting was far more restrictive because what should have happened didn't. I want him to stay in the new school if it keeps going well but most kids are taught skills to get back to their home school programs and average stay is 18 months.

    Something is not right for your son whether its the type of program they use or flashbacks or what? You can only try and if you are doing the fba now my gut would be to go with that unless it becomes unbearable of course. See what they come up with and if they have the ability to help him learn about feelings and how to calm and react appropriately etc. Changing or trying more than one thing (medications plus a behavior program) at a time leads to confusion about what is, is not working or whether the combination of interventions is the ticket. Thats what we try to do though sometimes it isn't possible.

    Anyway aside from that, yes many people just medicate during school times. Depends on the medication. Stimulants to help with impulse control can be used that way. There are of course many options for anxiety support that wouldn't be as risky as risperdal. But you know your child so fight for what they should do. If they don't have a positive, skill development behavior plan or you think the fba is inadequate then ask for an independent fba so an expert from the outside can come. I did that too. Got an excellent person. They can only give guidelines for what credentials and cost and they may have suggestions but you can pick and they pay.

    Good luck. It is not an easy decision. Kids with post institutional issues are not well understood by most people.
  7. whatamess

    whatamess New Member

    With his history, I would say the root of behaviors is 95% anxiety. PTSD anxiety, separaton anxiety,....Maybe the structure of school reminds him of the orphanage he lived in and maybe those reminders are anxiety producing. If you are operating in anxiety mode, then you cannot learn. If you insist on keeping where he is at for school and the medication eases his anxiety then I would medicate in a hearbeat.
  8. InsaneCdn

    InsaneCdn Well-Known Member

    I've been thinking about this one, not sure exactly what my gut reaction was, but as I read the whole thread again now... He hasn't been with you very long, and has come out of a really tough background. Maybe when you send him to school, he feels like you have abandoned him? So, when he has a problem and you show up, YOU are the "medication". He hasn't had enough of you, isn't secure enough in his bond with you? In which case, it's not manipulation, it could be some sort of insecure attachment... which requires a whole different approach.

    medications are tricky. If you know exactly what you are dealing with and what you need to achieve with medication, it's still tricky because each person reacts differently. But if you don't know what you are dealing with - is it really just self-control, how much is really PTSD and/or anxiety and/or insecure attachment - then medication is just a stab in the dark, and the chances of success are lower.

    Risperidone is fairly strong stuff. How long was he on it? If his system is used to that and it was dropped from the picture fairly quickly, that can also be a problem. Not that he shouldn't be taken off of it, but maybe things went too fast? (it's a medication with huge side effects... if you really need it, it might be worth it, but I don't blame people for wanting to switch to less-risky medications if they can)
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Have you ever looked into therapy for attachment disorder? I had a son who spent six years in an orphanage. Spending that much time in an orphanage setting is almost a guarantee the child will suffer from some sort of Reactive Attachment Disorder (RAD) and this will impact his behavior/feeling of belonging in a family, his schooling, and his future. in my opinion before he can succeed in school and indeed in society he will have to be comfortable in his own skin.

    Our first attachment disordered child was very aloof but determined to show the world he was capable. He was always brilliant...that was the first thing we were told before we decided he'd be a good fit into our house (haha...I don't know why we thought that. None of the rest of us are brilliant. But he had so much potential we wanted to get him out of his orphanage in Hong Kong). He is 33 now. We never see him anymore. He never attached, although he appeared to at the time (they are foolers). However, he did show the world he is capable and is brilliant, a millionaire (no exaggeration) and has his own family. THEY are his family to him, not us. Our second attachment disordered child came out of foster care. He was eleven and was such a mess (killed our dogs, molested our kids) he will never function well in society. They are often fairly good at acting as if they are okay, even when they are seething with rage on the inside. They need help.

    Older adopted kids need to have their attachment difficulties addressed even more than learning in school. If he starts to feel better about those early years and starts to think of you as truly his family, the school performance and behavior should improve greatly. Your son is new to this country, this culture and your family, but he is still young. I'd get him help immediately and I'd do it way beyond just medication and nurturing. These kids learn early that they can't depend on anyone except themselves and being in a loving home doesn't automatically change how they feel. They are in survival mode. Often, they are very good at hiding how they really feel about their new country, their new family, everything. They have had to spend their early years taking care of their own emotional needs, being thrown from one orphanage caregiver to another, never able to bond with any.In many orphanages, they cry and cry in their little cribs and nobody picks them up until it is their turn to have their bottle propped or to be picked up for a few minutes. The kids do not get that one-on-one love from a caregiver that every baby needs and it carries over.

    in my opinion you can not attack this just on the school front or with medication. Kids born into unloving and chaotic situations, do not KNOW how to attach to others, even if they can play the game, and it is often, if not usually, the reason why they behave (and are) so disturbed. Has he seen a professional who understands orphanage syndrome, which my first adopted child had? We didn't know about it. I wish we had. That's why I'm telling you about it. I would hate for your precious son to walk out on you completely when he is an adult (we did not fight...he simply never spoke to us again after he married a woman from his country) or the second child we had who was so very abusive and is still a threat to society. Nobody helped us. Nobody warned us. Attachment problems are actually a serious mental illness. The kids act out because they are so disturbed. I wish I had known more about it.

    I think his school behavior is a symtom of deeper problems. (((HUgs))) Been there, done that, have the T-shirt.
  10. JJJ

    JJJ Active Member

    If your presence in the room calms him, can you volunteer at the school? Start out helping out his teacher (cutting out stuff, etc) in the back of the room, then in the hallway, then down the hall, etc. Just be there as he gets used to the staff at school. There are anti-anxiety medications that could help with that short term adjustment as well.

    For Tigger, it often helped if I parked where he could see my car if he looked out the window. I just brought a book and relaxed. The teacher said he'd glance outside every so often to make sure I was still there but it never interfered with his work and he was much calmer. Now, he is very comfortable at school, even though he is at a new school this year.
  11. Allan-Matlem

    Allan-Matlem Active Member

    Medication may be part of a bigger plan, a sort of scaffolding to help him learn skills. in my humble opinion - better than a FBA is to use Ross Greene's guide/check list - assessment of lagging skills and unsolved problems - ALSUP

    Traditionally treatment has focused on medication and treating the symptoms with behavior modification , rewards , punishments, consequences etc

    The book lost at school is a great resource
  12. TheBoyHasArrived

    TheBoyHasArrived New Member

    Thank you for all of the replies- I agree with most. He hasn't been with us very long, and his attachment is absolutely still a work in progress. I don't think he has Reactive Attachment Disorder (RAD), but he does have attachment issues (how could he not with his history). He is more the "loves everyone" sort of kid, which is equally bad, just in a different way. He is too language delayed and institutionalized to participate in any sort of therapy (has an Autism Spectrum Disorders (ASD) diagnosis but no one thinks he is actually autistic), but we try to use attachment promoting parenting, etc.

    My husband and I both teach, so unfortunately we both have to work...the plus side is that I can peek in on him periodically, so he does know that I'm in the building. I think, eventually, that will help him.

    I wish that the risperdone had worked, but we tapered very slowly trying to find a correct dosage, and there was no change in mood or behavior at any dosage. The neuro suggested possibly trying a stimulant to see if the hyperactivity was truly ADHD or if it was a PTSD/hypervigilance/brain damage/etc, but I'm dragging my feet because a) that's the least of his problems and b) he is extremely small and thin and can't stand to lose any more ground in that area and c) I've read that they can increase aggression, which we absolutely do not need. I agree with Insane that medications would basically be a stab in the dark right now.

    I just don't want him to be so miserable at school, and I want him to be able to function well enough to learn from his peers (at home, he learns quickly from his aunt who is 6 also, so I know that he learns from observing "typical" kids when the behavior isn't getting in the way.) I think if the behaviorist isn't able to help, I'm leaning toward an anti-anxiety medication because I think the PTSD/anxiety is what makes him feel like he has to control every-single-situation.

    I'm completely new to medications other than risperdone...are there any anti-anxiety medications that have an added benefit of being used for mood disorders/ADHD? :)
  13. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    The "loves everyone" is a form of attachment disordered behavior. The kids often do not differentiate between those who they should love for a reason and those who are just around to get a hug.

    Has he seen anybody specifically for attachment issues?
  14. TheBoyHasArrived

    TheBoyHasArrived New Member

    Oh, I know it's not a positive attachment behavior. But, he's moving in the right direction...slowly...we have done phone consults, and there's not much more that we can do that we're not doing right now. For him, the problem is that he never had a primary attachment...he doesn't even know what that "is," so it's a slow learning process (not just "re-attaching" to a new caregiver). It's definitely a work in progress!
  15. DDD

    DDD Well-Known Member

    Was your son in an orphanage where English was not the primary language? You and your husband have taken on quite a challenge and I do hope you have the best quality professional support available. Hugs DDD
  16. buddy

    buddy New Member

    I could have written your last post describing the Autism Spectrum Disorders (ASD) but no one thinking so (back then) including me because of the brain damage and adoption /foster care issues. In the end, because so many issues overlapped, the Autism Spectrum Disorders (ASD) classification for school was a much better choice because the teaching methods are much more focused on skill building and accommodations are easier even in the gen ed classes. I figured whatever matched his learning style is what I'd go with. He legitimately qualifies for both the medical and school labels of Autism Spectrum Disorders (ASD) but there are clearly some unique things going on because of the complexity of his history ......socially and medically.

    For us, one day on ritalin made it clear it was a good choice. But for q impulse control was a huge stumbling block. He too learns from others, when behaviors do not get in the way. At your son's age there really is plenty of time to learn to function in the real world after skills are built and all triggers /symptoms are better identified. If choices are limited that may not be easy but if he is truly miserable then he may spiral further down and in the end you may be further away from the goal of dealing with life in a typical setting.

    I agree with Alan ...I hope the fba will help but both professionally and personally I've found people are quite limited in their definition of what that is and have not enough training. Skill deficits, sensory issues, internal states in general, and ptsd types of things are not adequately considered. Then in the positive behavior plan there is often emphasis on not doing the neg behavior or they may even state what he should do but teaching those correct /appropriate behaviors are neglected in many cases. Since you work there (are you a teacher? ) you should be able to see how they plan to teach the coping skills and better choices.

    Also from my experience, being proactive in taking breaks and doing calming things every day on a schedule is not emphasized enough. "Breaks " which should be a good thing they want to do, often end up more like time outs because they wait and are consistently paired with negative behavior ....I hear staff say "go take a break " or " you need a break ",etc, often in a stern tone and in the end kids start to view sensory rooms and break times as punishment.

    Just sharing so you can ask for details about incidents that are often not shared. Behavior reports conveniently leave out what came before the childs behavior (at least in a detailed and helpful way ) so don't be afraid to dig and ask questions. I can't begin to truly share how much I lived this even in very good schools. Usually not on purpose but really limited training.

    You are quite involved so I'm sure you will catch this stuff but thought I'd share.
  17. TheBoyHasArrived

    TheBoyHasArrived New Member

    This is all good information, I'm taking notes for our meeting. I'm an Speech Language Pathologist (SLP) in the schools, so I've not had a ton of experience with behavior plans. I've noticed the sensory equipment being used as a "reward" for tantrums, etc., and have that listed to discuss. The contained classroom staff is absolutely not equipped to teach replacement behaviors; we've observed that already. They very much seem to want to do the right things, but they are just managing behaviors, not teaching new ones. If the school's behaviorist isn't competent, we are going to see a private behavior specialist as well. To be honest, his behavior was so stable all summer, we had put it off thinking the behavior was improving as his language improved. But, we're seeing that's obviously not the case.