New Member - difficult child in Hospital

[WasInDenial]

New here. User name says it all.

45 yo father of two boys. Married 18 years to same woman (47). Bilological parents to both childen.

Oldest 14 yo easy child, couldn't ask for better. No issues.
difficult child 12 yo just hospitalized - diagnosis Psychosis not otherwise specified. Was diagnosis 3 years ago with ADHD. diagnosis progressed to now ADHD, Pervasive Developmental Disorder (PDD)-not otherwise specified, High-Functioning Autism (HFA), ODD and in psychiatric hospital for psychotic behavior and thoughts. Wanted to kill us and our pets. Didn't mention killing brother although said he hates him.

Started out so minor 3 years agp. I thought CST were being overly dramatic. CPS and CST got involved and picked apart entire family life, they placed him in special school for ADHD kids. First year okay then went downhill. Refused to do work in school. 6 seperate IEPs. Was in hospital for stitches after irritating another student enough to hurt him.

Me - Didn't want to accept there was something wrong with my boy. Wanted to believe he'd be okay if I worked hard enough. Left first job after diagnosis to be with him and help. Researched what they said he had, but just enough to wonder if they were right. Now researching this like I'm going for my post-doctorate.

Current psychosis probably revealed by me by pulling him off medications. Previous psychiatrist gave the okay because so far nothing had worked. In retrospect, very bad idea and wont do it again and now questioning previous psychiatrist. hospital psychiatrist says removing medications didn't cause psychosis, just revealed what was there all along. I peeled back the onion.

Now he's in a state bordering on reality and severly depressed.

Don't have signature with details yet, but medications so far. So far condition has been very resistant to drug therapy. Last listed are most recent. Probably missing a few of the older ones tried.

Ritalin -> Metadate -> Strattera -> Strattera, Tenex -> Concerta 34mg, Prozac 40mg -> Concerta 34mg, Prozac 40mg, Abilify 20mg - > Concerta 54mg, Haldol 2mg -> Hospital

Now on Concerta 54mg, Seroquel 25mg, Zoloft 50mg and they will probably change as he's stabilized.

Going to visit him now. Just need to talk to others facimig similar situations. Learning the board code and future post will be less verbose.

 

[DammitJanet]

Im so very sorry you are going through this. Your son has several overlapping diagnoses. The Pervasive Developmental Disorder (PDD)-not otherwise specified and High-Functioning Autism (HFA) overlap. High functioning autism and Pervasive Developmental Disorder (PDD) would confuse me. I would really want a neuropsychologist or someone really experienced in autism to tease that one out. I dont think there are medications to help autism but some autistic kids do have behaviors that medications can help with. I think most times they use Pervasive Developmental Disorder (PDD) therapies to help.

Now the psychosis is probably stemming from the severe depression. I have heard of that happening. Hopefully they can get him stabilized on a good medication regime and he will feel better soon. None of us want to see our kids so unhappy. It breaks our hearts. With the right medications he can feel much better.

Please keep us updated on how he is doing and how you and your family are doing.

 

[Sara PA]

Did you pull him off the medications all at once?

Are you aware that antidepressants can cause homicidal ideation as a side effect?

 

[busywend]

Welcome to the board. Glad you are no longer in denial - that step goes far to helping your child.

Pay attention to the symptoms you want to treat and not so much the actual diagnosis name. Figure out what needs to be addressed first and go from there. They started him on 3 medications at once? I would have made them try one at a time - new ones first by themselves. An AD does not feel right to try just yet either.
One thing I know for sure - make sure he is stabilized for a few weeks before he is released to your home. He said some scary stuff and could be a real danger to you or himself.

 

[Sara PA]

Oh yeah, I forgot to mention that the stimulants -- Concerta in this case -- can cause or worsen psychosis and are not suppose to be given to people who disply or develop psychotic behavior. That's stated clearly in the prescribing information/label/insert required and approved by the FDA and the information published in the PDR for all the stims, IIRC.

 

[SearchingForRainbows]

I just want to welcome you. I'm new here too. There are so many caring and wise people here!!! You really have found a great place for support and information.

Thinking of you and hoping your son starts feeling better soon... WFEN

 

[WasInDenial]

Will attempt to answer all the questions so far in one post.

1. I understand that both Pervasive Developmental Disorder (PDD) not otherwise specified and High-Functioning Autism (HFA) are subsets of the Pervasive Developmental Disorder (PDD) group. He was Pervasive Developmental Disorder (PDD) not otherwise specified for a few years when they didn't have a clear idea I guess. At this point they're kinda thinking High-Functioning Autism (HFA) instead of Pervasive Developmental Disorder (PDD) not otherwise specified. He presents 6 of the 8 criteria for ODD and has for about a year.

2. No, they didn't put him on the 3 different medications all at once. All the ones I listed were added one at a time to see the impact. But after trying all the combinations and things were still getting worse I asked to taper them off 1 by 1. That was in Late Nov 2005. By Christmas he was off all of them. First I removed the Prozac, then the Abilify, then the Concerta. For 2 - weeks he was no different than he was on them. Then it started spiralling out of control. And we contacted the psychiatrist. Thats when he suggested going back on the Concerta and replaced the Abilify with Haldol. That didn't do anything but it was only 10 days before we took him to the hospital. That was last Wednesday.

3. We saw him today and he's doing much better. The boy we remember from a year ago. They upped the Zoloft last night. Not sure that can have an effect this quickly so I don't know if it's medications or something else.

Thanks for all your words of encouragement.

 

[Marguerite]

G'day, mate. Your lad sounds a lot like my difficult child 1 back when he was about 16. Given your son's placements - if he turns out to be High-Functioning Autism (HFA) then that plus those placements would have been at least partly responsible for at least some of the ODD and the deep depression. With the right help these two things can be reversed or at least eased.

I know there are concerns about ADs but Zoloft was brilliant for difficult child 1. It does depend on what the real problem is, deep down, and what works for each kid. And although it's not supposed to work quite that fast, we found it was fairly quick - any changes were noticed within a day or two, at least by difficult child 1.

The other thing we found - he was basically a good kid, cooperative and good-natured - who could quickly lash out violently both verbally and physically when upset or off his dex. Now he's older he has a better sense of his own body and mind and is managing better. But if we lived in the US I'm sure he would have been hospitalised too, at least partly due to his violent attacks. Following an attack he would get extremely depressed and angry with himself for losing control and hurting people he loves - this was even more frightening, because that was when he began cutting himself, or tattooing his hand or arm with a pin or knife. he didn't just cut lines, he would carve patterns in his skin.

It sounds like something is working, at least for now. Can you get him thoroughly evaluated while he is there?

Something I found with our son - although the outward signs were behaviour, the problem wasn't behavioural. The school labelled it as behaviour and shoved him together with other kids who were a behaviour problem (like quarantining them), and then did nothing except fear the boys in this group. Fortunately for difficult child 1, I'm sure that most of the boys in this group are Aspie or severe ADHD, not primarily behaviour. As a result, some deep friendships have formed and they support each other (more than t he school ever did). They are extremely honest with each other, which is NOT what your son would have experienced in a behaviour placement. A school for ADHD kids CAN be good, or it can be swamped with kids who have a wrong diagnosis and who are working the system to their own advantage. The risks of bullying are immense. And if your son has been ostracised or bullied, either by staff or students, it's going to make any apparent ODD seem a lot worse.

Punishments generally don't work. Rewards have to be carefully handled so as to not get out of control or seem insincere. What works best is learning self-control, which in kids like this has to be done extremely carefully and with high involvement.

Some suggestions -

1) get hold of "The Explosive Child" by Ross Greene. Get it out of the library first, if you're fed up with people always recommending books and don't want to buy everything you're told to read. People on this site in general find this book very helpful. It doesn't work for everybody, it won't necessarily make it all better, but it has helped us enormously.

2) If you can, get your wife to post here and read your posts. It works for me and my husband - we thought we were in close communication before. Now we're so in sync it's scary (to other people).

3) Trust your instincts. The way you handled the medication shows you have a good scientific mind and are using it, which is more than can be said for some psychiatrists.

4) Keep notes. Keep your own written record and diary of what is happening. Even the stuff you're sure you will remember - write it down.

5) When dealing with officials, educators, whoever - do it in writing, even if it's just to confirm a conversation you had. Over here we have educators who deliberately avoid putting things in writing, so they can later deny that they said anything. I would write them a letter and get a phone call in reply, even when I asked them to write in repply. So I began minuting the phone calls and conversations, then sending them a follow-up letter - "this is to confirm that when we spoke on xx/xx/xx you told me Y and I agreed to do that as long as you also implemented X. You agreed to do this. If my recollection is not correct please let me know in writing, for my records."
This scares the pants off them because they KNOW you are keeping them honest and their nose to the grindstone. And it's the way THEY should be doing things.

You are doing the absolute best you could be doing for your son. You won't always get it right, but neither do the experts. You and your wife are experts. So is your son. Nobody knows how to be him better than he does, and HE is finding it tough going. You are his best support and his best chance at eventually having a productive, happy, independent life - the ultimate goal of all parents.

Stay with us, we're here for you all.

Marg

 

[Sara PA]

An immediate positive response to an antidepressant is often the activation of hypomania and not a good sign. If that's what's happening, it may last for a few weeks, up to 3 months before it's pretty obvious the behavior is going downhill. Upping the dose will only repeat the initial hypomanic reaction and will not be positive in the long run.

Antidepressants should take 2-4 weeks to show strong results and those results should occur gradually.

There are two types of withdrawal which I call acute and chronic. The initial withdrawal occurs as the drug is discontinued and leaves the body and often lasts about two weeks. The other withdrawal is the part where the brain reverses (as much as it's going to) the changes the drugs made in the brain. That can last months, some say as much as a year, depending on how long the drug had been taken. This can occur with stims (though those drugs leave the body more quickly), antidepressants (all the antidepressant withdrawal sites will discuss this) and, I believe, with antipsychotics (based on what I have read on boards like this and in the newspaper).

 

[timer lady]

Just wanted to pop in & welcome you.

I'm sorry that your difficult child is having such a difficult time of it. Remember to explore all options out there for your difficult child.

Take what you can use here - that applies to your situation & leave the rest.

And don't forget to take time out for yourself. If you don't care for yourself you will be of no use to the rest of your family or your difficult child.

Give yourself a break on the denial issue - you're facing up & finding resources for your difficult child. You are doing all that can be done at the moment.

Be gentle with yourself.

 

[WasInDenial]

Thanks for all the support everyone!

I am a little concerned that he's doing so well after just two days of Zoloft, but not having the experience of 100's of similar cases, can't interpret the effect as plausible or hypomania as Sara notes. I am a little concerned he may suffer from bipolar and they're not diagnosing it and therefore not applying the proper treatment.

What I can say is I know he was profoundly depressed before this whole incident. There could be any number of explanations for that knowing how his last year has been. We just got his report card and he was failing all but one course. :-(

I am concerned that he wanted to hurt us, as my experience is that with profound depression people usually turn those feelings inward and one sees suicidal vs. homicidal ideations. Neither of which is good of course.

Lastly, thanks for such a detailed post Marquerite. I do try to get my wife on the computer, however it's not her first choice of activities. I'm hoping that this incident will help her see the benefits of this forum.

Thanks again all.

 

[Sara PA]

What I can say is I know he was profoundly depressed before this whole incident.

Another side effect issue: Long term chronic use of amphetamine and amphetamine-type drugs (the stimulants) can cause depression. It is extremely common for kids taking stimulants daily for years to develop depression.

I am concerned that he wanted to hurt us, as my experience is that with profound depression people usually turn those feelings inward and one sees suicidal vs. homicidal ideations. Neither of which is good of course.

And, these two ideations are exactly why antidepressant should be prescribed cautiously to people under 25. There are now black box warnings about suicidal ideation in children under 18 on ALL antidepressants. The hositility issue under which the homicidal ideation is covered isn't a black box warning but a regular warning. You may want to google "Zoloft prescribing information". Increased suicidal or homicidal ideation is a big red flag for adverse reactions to the drugs.

 

[WasInDenial]

I agree Sara which was one of the reasons I wanted to see how he was off these drugs. I also question the ADs as well as the powerful neuroleptics they have prescribed in the past. But when I see him better on them (except for the slow downhill slide this last year) it's hard to argue their actually hurting him. I am so torn about trusting them.

 

[BTDT]

Dear WID,

Yours is one of most honest posts I've read in a long time. That of admitting former denial. It's a survival-of-the-tender-heart tactic that we all have at one time or another. We deny what we cannot explain or accept.

I cannot claim to know much about your son's other diagnoses. But ADHD and ODD I know. When your son is medicated and away from the key adults in his life, he will get noticeably better. If he is depressed, medications will make him a new young man. Until he returns home.

Problem is...honesty here...ODD is a reaction to adults and adult rule. Because your child has ADHD, adults in his life have been innocently making the same mistakes all adults make when dealing with difficult ADHD behaviors - mistakes that cause him to distrust adults. What your child perceives as a "mistake worthy of his distrust" does not register as a mistake to his loving parents, who most often parent as their parents did. Don't blames yourself because your child's slant on this defies common sense... until you truly understand ADHD.

There is no cure for ODD. One can only minimize it. (Did you know that 57-64% of all children with ADHD develop ODD? Only the children with the hyperactive or combined types get it, not the inattentive types. Although one can get ODD without having ADHD.) It can be prevented. Medication only eases it a bit. Because the real problem is your child's opposition to adult rule. ODD is the MOST misunderstood of all childhood disorders. Don't even try to find anything useful on the bookshelves. I have read them all. I don't believe it exists, unless something appeared lately.

You are wise to get him stabilized. Trust your doctors. If you don't, find others.

If I may make a suggestion, start looking now for a savvy play therapist with a proven track record of dramatically helping children with ADHD and ODD. No talking therapy. You need a play therapist. This is how to decide they're worth their oats. Ask them how long it will take to complete therapy. On your son, and filial. If they can't tell you 30 sessions or less, then keep looking. Now granted those may be long.........sessions, perhaps three hours. But THAT's what it takes to solve this at your son's age. Fifty minutes a week won't do. And getting a loan now for therapy is a LOT less than paying for residential treatment later. Because I promise you, it WILL get worse without excellent therapy.

And if it were me, I would choose ONLY a therapist that had lived with a child with ADHD/ODD or lots of them. Otherwise, I just don't think anyone can really "get it."

And set up appointments for therapy right away, as soon as your child can attend. The heart of the solution is one- to truly understand ADHD. And two- to repair your parent-child relationship. When you truly understand ADHD, what it means to your child, not what the books say, you will start to get it. The next important step will be filial therapy.

And please don't exhaust and confuse yourself trying to read a bunch of books or websites at this point. Much of what you read is dead wrong. Let your therapist educate you. Because he or she can deal with all the other painful emotions surrounding this heartbreak.

If you must read, find something worthy about how to rebuild the parent-child relationship and keep it strong. Because that's the secret to easing this, no matter his diagnoses.

I am truly sorry for your pain. That's too much for anyone to bear. Remorse only makes it worse. Please forgive yourself first. That's the best way to start helping your son.

When you are able to see him, don't try to talk more than to tell him that you love him dearly, that it hurts to see him in pain, and you only want to help him find his way through this. No need for lots of questions. Just be with him, place your hand on his arm, listen to him, hear him. Don't try to fix him or get him to explain. He doesn't understand it either. Your patient and attentive one-on-one company is the best way to show your love now. And the best way to prove to him that you are ready to turn the tide.

I know these things dear WID because I've...
been there done that

 

[Marguerite]

been there done that, you said, "And please don't exhaust and confuse yourself trying to read a bunch of books or websites at this point. Much of what you read is dead wrong. Let your therapist educate you. Because he or she can deal with all the other painful emotions surrounding this heartbreak.
If you must read, find something worthy about how to rebuild the parent-child relationship and keep it strong. Because that's the secret to easing this, no matter his diagnoses."

That's why I recommended "The Explosive Child". I agree that if we read everything we were recommended we'd never have time for anything else, but so many people here have found it to be extremely helpful. And thinking about it, I believe it DOES work so well because it does a great deal for the parent-child relationship.

With a Pervasive Developmental Disorder (PDD) diagnosis (although this is still being reconsidered) the child often needs a different, almost paradoxic, approach. Often what works with one child will be the absolute worst thing you can do, for another. I think you mentioned this yourself. And I agree with you, I think a vast amount of Pervasive Developmental Disorder (PDD) is caused, in those few kids, by parents doing what always has worked for them before, and what worked for THEIR parents. For 99% of kids, it's the right way to go. But for that one or two here and there - it's a disaster.

With my youngest son especially, I've had to learn to break the rules. They say you have to crawl before you can walk - he had to do it all on the same day as a coordinated exercise. In his case it wasn't walking/crawling, it was language/reading/mathematics, but the same rule - break the rules. He just can't do it like everyone else.

You say you've had success with strictness and consistent discipline - that's great. I agree it's what should work. But not for us. Consistency, yes. But punishment-based - it has led to the ODD-like symptoms we see. Natural consequences work better for him, but he has had so much trouble with impulsivity and distraction - if you're going to try to be strict you need to know whether the behaviours you're trying to correct are even correctable at this point.
Example: When difficult child 1 was 6 his doctor promised him $50 if he could sit perfectly still for five minutes. difficult child 1 just couldn't do it. He knew what to do; he was highly motivated; he was simply incapable. To punish a child for fidgeting, when the child simply can't help it, is to set the child up for failure. When you engage in battle, you need to know that you can win. You never set the child up for failure, you set the child up for graded success. "You sat still for one minute - that was fabulous! Now go and jump on the trampoline." You let the child up BEFORE the fidgets force him up. That takes careful observation and keen knowledge of the child.

That's where "The Explosive Child" helped us the most - it gave me the self-confidence to develop and trust my own observations and to teach my son that I am his facilitator, not his obstacle. He no longer sees me as someone to automatically disobey (if he ever did - it just seems like that when you don't understand the way they're thinking). He knows that if he asks, I will give him a good reason for asking him to do something. I give him respect and in return I get respect. More than most kids, Pervasive Developmental Disorder (PDD) kids need behaviour modelled to them. Failure to treat them with respect is, I feel, the major cause of ODD signs developing in Pervasive Developmental Disorder (PDD) kids. This may not be the reason for other disorders, because every kid and disability has different problems, but it certainly seems to be common in my experience. And when you realise that Pervasive Developmental Disorder (PDD) kids tend to gravitate together and I've seen a lot of them and hear their stories of power struggles with teachers and other hair-raising tales, the pattern seems very strong. None of these kids were ODD with all teachers, but all of the kids were ODD with some teachers. And when I met one particular teacher - I sympathised with the kids and became extremely oppositional to her myself. Flamin' dragon!

Welcome to the site, been there done that. Do let us know more about your own situation.

Marg

 

[BTDT]

Dear Marguerite,

You are absolutely right about punishment (key word) - punitive - leading to ODD. You are also right about children needing good modeling, all children need that.

As far as your saying:
"You say you've had success with strictness and consistent discipline - that's great. I agree it's what should work. But not for us. Consistency, yes. But punishment-based - it has led to the ODD-like symptoms we see."

Did I say that? I thought I had discussed reward and incentive. Besides, "punishment" and "strictness" are not in my parenting vocabulary. No matter who wrote it or read it incorrectly, I agree with you.

been there done that

 

[Hound dog]

I just wanted to add my warm welcome. :grin:

I'm so very glad you found us.

You've already gotten some good advice. I just wanted to say that I think you're doing a wonderful job and I think your difficult child is very lucky to have you. It is obvious that you are doing your very best to help your son.

Hugs

 

[Sara PA]

ODD is a collection of behaviors with no known cause. It is not in any child's best interest for all cases diagnosed as ODD to be treated the same. One case could be the result of a parent-child relationship while the next child could have a serious neurological condition. We as parents must strive to find out the cause of our child's behavior. There is no one explanation for any of these behaviors.

 

[DammitJanet]

been there done that...you paint a rather grim picture of ADHD kids.

 

[Martie]

Hello everyone--

I just had to post when "books and websites" were described as unhelpful. You are ON a website and based on The Parenting Experience Survey, 85% of the 627 respondent have read TEC and many of the remaining 15% are newbies who intend to read the book.

in my opinion TEC builds positive parenting skills and relationships with the child. Greene writes the best explanation of what is going on with ODD children I have ever read. by the way, people DO recover from ODD--one way or the other. It's a pediatric diagnosis, so children either mature out of it, have another diagnosis if other symptoms become clear(er), or are diagnosis'd with ASPD. About 1/3 of ODD kids go on to ASPD, a high %age and scary, but the odds still favor something else emerging in later adolescence. Hopefully something treatable.

As far as WID's son's diagnosis, the early diagnosis of ADHD followed by severe depression would lead me to think of bipolar also. Children with Early Onset Bi-Polar (EOBP) often as misDx'd with ADHD, and then the stimulants make the bipolar worse.

I hope your wife comes here. I will help get on the same page with you which is also very important in my opinion.

Martie