Oh my! I just witnessed a full on RAGE...

[Chaosuncontained]

Carson's younger brother (6) was playing around and went to put an empty box on Carson's head. Carson was watching TV and flew into a RAGE!! He attacked his brother. Then when I sent Carson to his room and Brother to his sister's room (the boys share a room) Carson screamed more. Hit the door over and over with his fists. Screaming that I didn't love him. That he wished he was dead. I went into his room to try and talk to him--he was so angry. After I talked to him for a minute or two I asked him if he understood me (I told him he needed to try and get control of himself. That we all loved him. That he would be staying in his room, in bed for an hour). He said, very angrily, "YES!" I asked again if he understood... He refused to say Yes Ma'm to me (which is what me and husband expect from our kids.

I just left his room. I haven't heard a word from him since. I'm sure he has fallen asleep or is reading a book. But, OMG. I have never witnessed this raging, I mean, not getting just a little mad. Or angry. He does that. But he FREAKED out! He did this last weekend when he was at his Dad's and they were stunned as I am. It was VERY scary. I was able to stop it pretty quickly--but if I hadn't been in the room when it happened... I dunno.

He has been taking the Intuniv for a month. The Celexa for almost 3 weeks. I know some of you have said before that if he has a true "mood disorder" and not just depression that he could have a honeymoon period (and boy, has it been a honeymoon--GREAT days at school...amazing results) on the Celexa and then go waaaaay to the other extreme. He hasn't done this every day. Just twice in a week. But, wow.

Ideas? Advice?

 

[seriously]

Getting really angry like that is scary, especially to the other kids, but the good news is that he was able to stay in control well enough to go to his room, have a brief conversation with you and stay in his room. I'm not sure if it will reassure you, but that is not what I would consider a full on rage. A full on rage involves potentially serious injury to others or self like biting, beating with fists, hitting, scratching, breaking or throwing things, and an obvious inability to control these behaviors. If you ever see one you will instantly recognize it. I am not diminishing the scariness of the incident or suggesting that you should minimize or ignore it. Just giving you a frame of reference.

If he can maintain that much control, then you should feel very positive about his being able to manage his over-the-top reactions with time and help. I would suggest you quietly let him know that you realize it was hard for him to stop and go to his room and you appreciate that. Don't make a big deal of it - just say it once and let it go.

If it were me, I would also react very strongly to someone suddenly putting a box over my head and I would be sure to have a talk with the siblings about avoiding things that might startle difficult child because it's not nice to do that to other people. I think you are going to have to provide close supervision for the foreseeable future when the kids are together even though that is very inconvenient and annoying. You can't trust difficult child's reactions - neither can he so it's not helpful to blame him - and with younger sibs who don't understand it's a recipe for trouble and you would not want anyone to get hurt.

Now, I have to say that depression IS a true mood disorder and should not be dismissed as causing less suffering than bipolar disorder - the other "mood disorder".

What I think you meant about your comment about depression has to do with diagnosing bipolar vs. depression. Many people who have bipolar disorder have depressive episodes or are depressed more than anything else. This can make it hard to diagnose bipolar because the person/child is presenting with symptoms of depression.

One possible indicator of bipolar disorder is that the depressed bipolar patient, when given an antidepressant, may develop hypomanic or manic symptoms. This is not absolute evidence of bipolar disorder. Some people just have weird reactions to a given antidepressant and never show any other sign of bipolar disorder and will do fine on a different antidepressant.

 

[keista]

I agree with Seriously about the "rage". This certainly sounded intense, but not a full on rage. DD1 is very similar in that she has NEVER been in a full on rage. The time she put a knife to her throat can be debated, but to me it still lacked the intensity and lack of control of a real rage.

Continuing, I disagree with Seriously.

you should feel very positive about his being able to manage his over-the-top reactions with time and help.

While this statement is true, and if this were his "normal" state, that would be fine. But if something(medications) are CAUSING this why should he put up with it and try to learn to deal with it. Why should you? Ultimately it becomes a personal decision - are these outbursts worth all the good times? For me and DD1 they were not.

Also, this is the very beginning. You can try to "stick it out" for a while, and it is possible these will go away, but also possible that they will get worse and more frequent. It is a tough decision to make - stop or keep going. Great arguments either way. Only you and the psychiatrist can decide what's best for Carson.

 

[Steely]

I would look for patterns. If this pattern continues, than you know to switch medications. The ideal thing with medications, is to start one at a time so you know which is causing the side effects. Did you start both of these at the same time?

Both of the medications he is on are stimulants, so personally I would be a bit concerned that he is starting to get edgy. But I don't know his full history, and how he acted before these medications.

 

[buddy]

Getting really angry like that is scary, especially to the other kids, but the good news is that he was able to stay in control well enough to go to his room, have a brief conversation with you and stay in his room. I'm not sure if it will reassure you, but that is not what I would consider a full on rage. A full on rage involves potentially serious injury to others or self like biting, beating with fists, hitting, scratching, breaking or throwing things, and an obvious inability to control these behaviors. If you ever see one you will instantly recognize it. I am not diminishing the scariness of the incident or suggesting that you should minimize or ignore it. Just giving you a frame of reference.

I understand what seriously is saying. I would say my difficult child has different levels of "rage"...kind of like defcon 1,2,3...you get the idea. I have been through the kind you described and it is awful. Then like this morning where I was spit on, kicked, hit, had to restrain him and wait a half hour for the medications to kick in. Other days in the past it has been hours and hours or on and off all day. I am so wiped out by the end and so is he. He just can't talk during those times. No way and just when I think he is gonna calm, I think maybe now I can release him, bam, a kick or more screamming etc. when he was younger I could get him wrapped like a "hotdog" and he liked that. One time during a bad medication. reaction, he was only 4 or 5 and it took 4 adults in a private autism therapy setting to hold him and keep him from hurting himself or anyone else. It was just the worst thing I have ever seen in him...he was only 30 lbs or so. That said, I know a kid who bit part of his baby siblings ear off during a rage.
I am thinking your son's rage is what I would like to train my son to get to. But in your son's case, he is obviousy miserable at a time like that and I like the question of whether it is worth that (maybe his body will even out as he gets used to it?). One of my kiddos medications does make him much more crabby. But the alternative is his jumping out a window. So not much of a choice. I feel so grateful that he has some medications that help at all because there are certainly kids who have nothing that works for them.

 

[Liahona]

Sounds like you've gotten great advice. One more thing, just until you get to the bottom of this, you might want the younger brother to share a room with someone else. If I remember right he was the target of the last one as well.

Good luck

 

[BusynMember]

I've had just way too much experience with medication. I would look at the Celexa if this is a new behavior. Heck, my daughter pulled a knife on heself while on Prozac, a cousin SSRI of Celexa. She ended up in the hospital. She had never pulled a knife on herself before or after t he Prozac.
I don't particularly care for SSRIs and children. I know the side effects you can get from then even as adults. I'd be willing to bet it is the new medication. I'm betting it's nothing more than a manicky, irritable, out-of-control reaction to Celexa.
If an anti-drepressant seemt to work right away and too fast, often they means that once there is more build up in the system, it will make the child out of control. It isn't supposed to work right away.
When Zoloft helped me with the FIRST pill, I ended up in the hospital with toxic affects. Unfortunately, it is NOT a good sign for an antidepressant to be a miracle drug right off the bat. I wish it were!
SSRIs cause a higher risk of suicide in the young. They have to be monitored closely

 

[keista]

If an anti-drepressant seemt to work right away and too fast, often they means that once there is more build up in the system, it will make the child out of control. It isn't supposed to work right away.

Interesting. Never thought of it that way and looking back at DD1 they all followed that pattern. Except Zoloft which made her so chronically tired we couldn't tell if it was really working or not.

 

[Malika]

I agree. This doesn't sound like a "full on rage" to me. Children generally have intense emotions and some are naturally more intense than others. This incident, while upsetting, would not be cause for intense concern I wouldn't have thought. Other than the concern about whether it is the medications that are causing it.

 

[Chaosuncontained]

One possible indicator of bipolar disorder is that the depressed bipolar patient, when given an antidepressant, may develop hypomanic or manic symptoms. This is not absolute evidence of bipolar disorder. Some people just have weird reactions to a given antidepressant and never show any other sign of bipolar disorder and will do fine on a different antidepressant.

This is what I worry about. He has taken Abilify and Respridone. And they didn't work for very long at all. And when we took him off those medications and added the antidepressant things were remarkable (within 4 days). He seemed SO much happier, able to do work in class. Making friends. Being more physical (PE, playtime). He even showed an interest in a girl in his class. I hope he isn't hypomanic. My Bipolar is Depression/Hypomania.

Last week he had a very abusive episode. He usually hets angry and yells, calls horrid names and sometimes cries. This time there was hitting, trying to choke his brother, his sister (10) had to hit him with a hairbrush to get him to get off of his 6 year old brother.


Then, this weekend there were two other incidents. All three involved his 6 year old brother.

 

[Chaosuncontained]

I agree. This doesn't sound like a "full on rage" to me. Children generally have intense emotions and some are naturally more intense than others. This incident, while upsetting, would not be cause for intense concern I wouldn't have thought. Other than the concern about whether it is the medications that are causing it.

I am concerned with the medication. And the only reason I am so concerned is that he has NEVER acted to this degree. Sigh. It's always something, isn't it?

 

[Chaosuncontained]

I'm betting it's nothing more than a manicky, irritable, out-of-control reaction to Celexa.
If an anti-drepressant seemt to work right away and too fast, often they means that once there is more build up in the system, it will make the child out of control. It isn't supposed to work right away.

This is what I am thinking. I am just so tired of trying new medications. UGH. I know we have to work until we find the right one but Geez. He's been on Adderall, Ritlin, COncerta, Daytrana, Metadate, Stattera, Abilify, Respirdone, Focalin. And currently on Intuniv (a little over a month) and Celexa (aprox 3 weeks). We are also waiting on the testing they do before IEP. I hate to admit it but I hope they find something else to explain what is going on with Carson. This is all so frustrating.

 

[Chaosuncontained]

Sounds like you've gotten great advice. One more thing, just until you get to the bottom of this, you might want the younger brother to share a room with someone else. If I remember right he was the target of the last one as well.

You are right. There have been 3 incidents and all three involved his younger brother. I will talk to the brother and try (again) to explain why we have to be extra careful to stay out of Carson's personal space. And be extra watchful, which is so hard when we have 7 kids in the house most times.

 

[seriously]

OK. Given what you have said, I would take him off the AD if it were me and call psychiatrist, tell him why I am stopping the medication and get an ASAP appointment if that's possible.

Frankly, you should not be alone in the house with 7 kids if one of them is having these kinds of issues. I think it's obvious to you why. You need help in the form of at least one other competent adult if you are going to be supervising all of them. Or the other kids need to be somewhere else because it is NOT safe. Especially the 6 year old. He is not going to understand the concept of personal space, let alone how to stay out of his brother's. Can he go to stay at a grandparent's or aunts/uncles/close family friend for a week? Can the step-kids stay home temporarily? If your son was seriously physically ill I would think that kind of arrangement could be made. This is the same kind of thing. You could explain it as a medication reaction that is being addressed. If there's a good relationship with ex you could even mention safety but, if there's a chance CPS will be down on your heads if you do then you probably don't want to present it that way.

Are you (in your spare time LOL) doing any mood or behavior charting? If not, I strongly suggest you do that. I suggest each day you rate his mood in 2 dimensions - up/active/agitated and down/sad/fearful/self-critical (whatever signs and symptoms you think match hypomanic/manic and depression for HIM). It's helpful in kids who develop bipolar disorder or severe mood dysregulation to chart both dimensions every day because their mood can change within a single day.

If you are able to also note how long he slept each night, whether he took medications that day, if he was sick - at the minimum those things will give you and psychiatrist a lot of info to help guide his treatment and figure out when something is likely a medication side effect and when it's not. If you can do it for at least a month or as long as there are major medication changes happening it may give you the big picture in a way that shows patterns (or lack of patterns).

Does your psychiatrists office let you book 2 or 3 appts in advance? Is it easy for you to get in quickly on cancellations? You might ask psychiatrist about seeing him in 2 weeks after changing medications given the severity of difficult child's reactions. I have learned to book my once a month appts out 2 or 3 months and leave them on the books even if I have to go in on an urgent basis between appts. That way I almost always have an appointment within 2 weeks if I have serious problems. If I don't need the appointment it's much easier to cancel than to get in at the last minute.

 

[AnnieO]

What you are describing is the kind of behavior that I witnessed when Onyxx started acting up, and when we started not only walking on eggshells but tiptoeing on them later. The explosiveness that could be contained... To a degree... For a while. And heaven help anyone who peeved her off when she was like this - it went over-the-top violent. This is how I ended up getting the snot beat out of me once, and she ended up with a DV charge another time. Of course, Onyxx is bigger than I am - not a lot, but a bit. And dang, she's mean!

I would be really, really concerned about the Celexa. Let me put it this way. I'm not a violent person. I'm actually really laid back, calm... But the wrong medication (bupropion in my case) can turn me into a raving demon. Just a thought... SSRIs work on some people, but not all, and double the "not" for kids. SSRI + hormones (even younger kids have them, just not quite as bad as tweens/teens)... Eeeee.

 

[Chaosuncontained]

****UPDATE****

Today, when I went to pick Carson up from school, one of his teachers approached me and told me that in PE Carson had "gotten upset with a boy, put his hands on the boys neck and 'mauled' him, leaving red scratches on his neck". This makes 4 instances of aggression that Carson has shown, that I would call violent since September 25th. Carson's version of what happened was that the boly was teasing him and "I lost control and choked him".


As soon as we got home I called his doctors office and left a message for the nurse. She called me back within 20 minutes. I gave her detailed info of each incident and who was involved and what set him off. I am waiting to hear from the doctor but I suspect that you all were right. I think the Celexa has caused him to swing over to hypomania. Sigh.

Last year Carson had SEVERAL (I think 4) instances of aggression. When the last one happened I was told by the jacka$$ Principal that if one more thing happened he would have to call the Sheriff. Thankfully we didn't have another incident.

The Principal called me this afternoon to tell me what happened. He was SUPER nice. Amazing what sort of results a Momma Bear can get by throwing a fit after he said "I may not have a place for Carson here" Plus after getting a ton of info about getting IE rolling from you ladies (and sounding like I knew what I was doing)--Mr Principal acts now like we are best buddies. I'm not falling for his ****.

I filled out tons of info in a packet about Carson, my pregancy and all and turned it in by mid-September. Tomorrow I will call the Dignostician and make SURE the school has provided her with that informantion--and to see if they need anything more from me at this time (and get an idea of what happens next and WHEN).

Carson spent half a day in OCS. Guess we will see what tomorrow brings.

 

[Chaosuncontained]

Are you (in your spare time LOL) doing any mood or behavior charting? If not, I strongly suggest you do that. I suggest each day you rate his mood in 2 dimensions - up/active/agitated and down/sad/fearful/self-critical (whatever signs and symptoms you think match hypomanic/manic and depression for HIM). It's helpful in kids who develop bipolar disorder or severe mood dysregulation to chart both dimensions every day because their mood can change within a single day...

If you are able to also note how long he slept each night, whether he took medications that day, if he was sick - at the minimum those things will give you and psychiatrist a lot of info to help guide his treatment and figure out when something is likely a medication side effect and when it's not. If you can do it for at least a month or as long as there are major medication changes happening it may give you the big picture in a way that shows patterns (or lack of patterns).

Does your psychiatrists office let you book 2 or 3 appts in advance? Is it easy for you to get in quickly on cancellations? You might ask psychiatrist about seeing him in 2 weeks after changing medications given the severity of difficult child's reactions. I have learned to book my once a month appts out 2 or 3 months and leave them on the books even if I have to go in on an urgent basis between appts. That way I almost always have an appointment within 2 weeks if I have serious problems. If I don't need the appointment it's much easier to cancel than to get in at the last minute.

I definatley need to be charting moods. I have never done that. His doctor is VERY good about fitting us in if we need extra appointments. I once called and got one the very next day--and I didn't even take Carson in, I went and talked to the doctor without Carson present.

I made a call the the office at 4:00, it's 5:30PM here now. He should be calling me soon--after he finishes with his patients. Wonder what the verdict will be?

 

[InsaneCdn]

<suspense music in the background>...

Now you've got ME wondering, too!
Don't forget to end our suspense at SOME point!
(LOL)

 

[Chaosuncontained]

Carson has an appointment tomorrow at 8:45AM. (Using my best Napoleon Dynamite voice) "Gahhhhh"! I am so frustrated. Why are we having such a hard time figuring this medicine **** out? Oh yeah! Cause we still arent sure what we are trying to medicate.

Makes me think of my husbands ex wife. My 8 year old stepson just came home with lice last week. I asked him "Didn't your Mom treat your hair?" He replied "yeah, but she used dog shampoo" WTH!? Sigh... Gotta find out what's wrong and treat THAT.

 

[keista]

Why are we having such a hard time figuring this medicine **** out? Oh yeah! Cause we still arent sure what we are trying to medicate.

That and it really is so hard to figure out sometimes! Here's hoping that tomorrow brings a good change!