Neuropysch normal, family structural therapy recommended

Discussion in 'General Parenting' started by idohope, Oct 8, 2010.

  1. idohope

    idohope Member

    After the 6 month wait list got difficult child to the Neuropysch this month. 6 hours of testing. I have not seen full written report but met with Neuropysch doctor who reported difficult child is definitely not on spectrum; is in high to superior range in all areas with strength in verbal; weak areas for difficult child include holding complex info in memory and working with it. Although this is a weak area for difficult child compared to her abilities in other domains it is still within normal range.

    So the Neuropysch conclusion was that we are dealing with an emotional imbalance ie mood disorder or predominant anxiety. She felt based on difficult children behavior and how hard it was to get difficult child to come to testing that difficult child is not ready for individual therapy, though she stated that difficult child will need to learn coping skills in order to lead a full life and develop relationships etc. She felt that difficult children current "coping skills" tantrums and trying to exert control had really shifted the power balance in the family. She said that difficult child was powerful and at the same time extremely fragile. (By power I think she means that so much of our daily life revolves around managing difficult children behavior and things that parents typically determine such as what car to drive or going on vacation are dictated by her just so that we can get through the days)

    She recommended structural family therapy. Anyone have experience with that? I think it would involve husband and I and maybe siblings and maybe eventually difficult child if we can get her to participate. My understanding is that it would focus on restoring power balance in family.

    I am not sure if this is the route to go. Another would be to identify a therapist who does CBT and just work very slowly to build trust with difficult child and see if we can eventually start to address her extreme anxiety. Another route is medications. She was on abilify for 1 month and now off for 6 weeks. We saw improvement in that rages really diminished but have remained at bay even when off, allowing us to see more of the pure anxiety. psychiatrist would try a differment medication next (SSRI) to directly address anxiety but husband is not supportive of medications at this point.

    I welcome any input from those who have been there done that

  2. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Well, I would take heart that there are no spectrum disorders seen. That is a good thing. Anxiety disorders can be addressed and dealt with in therapy and with medications as can inflexibility. I think family therapy may be a grand idea. Its not so much that what you are doing is wrong but just that it isnt working for this particular kid. If someone can teach you better skills at handling her, well all the better. Maybe she will catch on by osmosis.

    I would think if everyone else in the family is having a perfectly normal happy time, she would eventually want to join in. You cant let her run the show and the therapist can teach you the skills to help do this.
  3. Josie

    Josie Active Member

    I think if difficult child is the one with the mood or anxiety disorder, she is the one that needs therapy. Maybe the whole family can benefit as well, but I thinks saying she is too anxious or not ready to go is not the way to go.

    I would think a good therapist would be experienced with kids that don't want to go to therapy for whatever reason. I have had tdocs come out to the car when my daughter said she couldn't go in. I've had a therapist come to the house when my daughter was too sick to go in. This was a long time therapist who knew her situation. Her Obsessive Compulsive Disorder (OCD) therapist came to the house because her Obsessive Compulsive Disorder (OCD) CBT needed to be done in our house. Not saying you need to find one to come to your house, because that would be difficult, I am sure. Maybe you could go in with her at first.

    CBT for Obsessive Compulsive Disorder (OCD) (Exposure Ritual Prevention) worked very well for my daughter. The two issues that we addressed that way have not come back.

    I saw my own thought processes change for the better when I took Lexapro. I was a worrier and stressed out about nothing. That made me realize the brain chemistry actually does affect our thoughts and actions. Many times, one parent is slower to be ready for medications than the other.

    If your husband doesn't want to do medications, you could consider the girlfriend/CF diet. I don't need my Lexapro any more since I have been on it. My older daughter's ODD issues went away on it. My younger daughter's Obsessive Compulsive Disorder (OCD) is unaffected by it, though.

    Just my thoughts.
  4. smallworld

    smallworld Moderator

    When researchers at NIMH did studies on children with anxiety, they found that the children who fared best were those who had a combination of therapy AND medication. But those who had either therapy or medication at least improved some. So I think doing nothing doesn't bode well for your daughter's future.
  5. Jules71

    Jules71 Warrior Mom since 2007

    I would think the smallest dose of a medication could help get her to therapy so she would be in proper frame of mind for the therapy to help. Would your husband agree to medications if it was short term to get her into therapy and adjusted to that?
  6. Bunny

    Bunny Guest

    My difficult child has anxiety and when we started him in therapy it did help. He was able to control himself and his tantrum a little, but after a while it seemed like we hit a brick wall and were getting no where. We stated him on medications in August and that does seem to be helping. Family counseling is not a bad idea. It will also help you to learn how to deal with her in a way that is firm and compassionate. The therapist I take my son to will talk to both of us first, ask how the week was and if there is anything that I felt needed to be brought to his attention, either good or bad. Then he talks to difficult child to try to find out why he behaved the way he did, again, be it either good behavior to reinforce that he made the right decisions, or in the case of bad behavior to try to find out why he did what he did and how he could correct it. Then the therapist will bring me back in and we will discuss the outcome. It has helped me to learn how to deal with him because how I handle difficult child is totally different than how I deal with easy child.

  7. DaisyFace

    DaisyFace Love me...Love me not


    This is the kind of therapy my family is getting right now. Since difficult child absolutely refuses to participate in therapy (or only participates by sitting there and lying her head off) -our therapist has shifted the focus to the family instead. It is definitely helping us "take our power back" and not be completely driven by difficult child all the time.

    Eventually, the therapist figues that difficult child will come around and want to participate with the rest of us....but even if she doesn't - the therapy will help the family.

    Give it a shot. It may help...
  8. Marguerite

    Marguerite Active Member

    medications may be needed to deal with two issues - the memory thing (which sounds almost identical to what we get in difficult child 1 in our family) needed ADHD medications. And the anxiety has also responded to different medication. Sometimes the doses needed are tiny - you just don't know until you try. But the amazing difference in self-esteem can be marvellous.

    I'm a bit wary of the neuropsychologist finding, though. Girls are difficult to test and it sounds like she was not very cooperative. Or they may not have handled things the right way. Were you able to observe? Did you see any signs of poor management of her? There shouldn't be any air of the schoolroom about this.

    The working hypothesis now needs to match the neuropsychologist report, but I would still keep in mind the possibility that there is more. But the first step is to act on the advice given for now. Test it out. See if you can follow the advice and bring about some improvement. If you really try it all and still it makes minimal difference, then I would revisit the diagnosis in a few years' time.

  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I agree with Marg. While I ws reading it, I wondered if he actually knows what's wrong. The first neuropsychologist testing done on my son was vastly different from later tests because he was extremely reluctant to be himself. We were told he wasn't on spectrum either, but he is. That doesn't mean your child is, but I'd keep an open mind and be careful about holding fast to what you have been told so far..she's very young for anyone to know what's going on 100%. Unfortunately, these disorders are not exact sciences and are hard to diagnose.

    I would work with what you know for sure...and concentrate on that for now. I am not convinced family therapy will help you or her, but it certainly is fine to give it a try. If this were me, I'd seek a second opinion, however, I am very thorough.
    Good luck, whatever you decide to do :)
  10. idohope

    idohope Member

    Thank you all for your thoughtful replies and comments.

    I do not have blind faith but I do have a lot of confidence in the Neurospych. I have a personal connection with a neuropysch who works with adults in a research university. She contacted a colleague at a major Childrens Hospital and her former student and both independently named the doctor we saw as *the* one to see in our area. I was with difficult child for all 6 hours of testing. She refused to go into the room without me. Although she said all along she was not taking the tests she definitely gave her best effort once she got started.

    We had a detailed discussion about difficult child being on the spectrum or not. Her inflexibility matches but other aspects do not. difficult child had the same teacher for two years and she and I both filled out questionnaires addressing spectrum issues. doctor said that teacher seemed to know difficult child very well and that there was good matching between her responses and mine and that they did not support difficult child being on the spectrum. I would remain open to changing or refined diagnosis but for now I will use this info to focus on anxiety as the issue.

    Your responses have been very helpful to me in trying to sort out how to proceed. difficult child had started to build a relationship with a therapist almost a year ago and we had to stop working with therapist because therapist moved practices and was bound by a non-competition agreement. (neuropsychologist was furious about this, knew another person who had dealt with the same situation and said would help us get back with that therapist if we felt that was the way to go). So although it may take 6 months of rapport building before therapeutic work can begin I think it is possible. husband is therapy resistant (although we are in marriage counseling) and if I have to struggle to get someone to participate it would be better to spend the effort on difficult child than husband at this point. difficult child has also been a little better about verbalizing her anxiety lately, so this may be a good time to try therapy for difficult child. I think neuropysch's suggestion was partly responding to division between husband and I. Neuropysch commented on how husband and I see very different aspects of difficult child's issues and she told him that difficult child is not doing her behaviors on purpose and that difficult child needs help. husband is somewhat locked in the "when I was kid you could not get away with this type of behavior".

    So I think the plan will be to identify a good child therapist specializing in anxiety. And to keep our psychiatrist in the loop and see if we can jointly convince husband to go with medications if it seems like it is needed.

    Now this warrior Mom just has to put the plan into action. Thank you all again.
    Last edited: Oct 9, 2010
  11. Marguerite

    Marguerite Active Member

    Fair enough. So it does sound like it was carefully considered. The picture may vary later on, but for now, this still gives a strong direction. The therapy sounds like a good start.

  12. Jules71

    Jules71 Warrior Mom since 2007

    It sounds like you are definitely on the right path! Way to go warrior Mom!!
  13. barneysmom

    barneysmom Member

    Hi idohope,

    What about the weaker area -- holding complex info in memory and working with it. That seems like an important skill, even if it is within normal limits she might be in a very low percentile, and there is a big disparity between that skill and the rest of her skills, which are high to superior. Maybe her brain needs that balance in order to function overall.

    Does the neuropsychologist include the percentiles on a bell curve? Is there any way that skill can be strengthened? How, and how much do you think if affects your difficult child's behavior? I think I might take a closer look at that skill -- as she gets older it will be required of her more and more, and maybe it's affecting her now.

    And maybe I'm all wet -- but I like to hunt down the little clues, they sometimes have made a big difference for my kids.

    Just a thought in addition to all the other good work you are doing.

  14. idohope

    idohope Member

    Thanks. You are right. I will not dismiss those areas. I need to get the full written report to really see what they are how weak they are compared to other areas. difficult child is doing well in school although we have issues with her being late and refusing to go. The school is aware of this and has put into place a plan that I am very happy with. Two teachers have invited her to stay after school with them to be their helper. difficult child is thrilled to be asked. But really they will be helping her with planning for long term assignments and organization.
  15. barneysmom

    barneysmom Member


    Glad to hear the school is putting good plans in place. How kind (and smart) of the teachers to ask your daughter to be their helper after school.

    I went to a Wrightslaw conference in my town last spring, and a fair amount of time was spent on helping us interpret the test scores and the percentiles. It's not for the faint-hearted at first glance, but worth it. So many times I was told one or the other of my kids was within normal limits on testing, but sometimes they were in a very low percentile which meant they were barely squeaking by in that area.

    here's a link @ Wrightslaw that is helpful to interpret test scores

    Good luck with your little girl