(PMT) Parent Mgmt Training

[TiredSoul]

I am wondering if anyone has any information on PMT programs - what has worked, not worked. I am on the verge of spending a lot of money to fly out to the Yale Child Conduct Clinic (and who knows if that will help) - I just can't live like this anymore. Our home is in constant "oppositional defiant" chaos. It's like a war zone and I am getting resentful and wanting to disengage. I want to be able to help my child and live peacefully.

So, if anyone has any information on a program that has helped them, please please share. We can't do this on our own - we need help. I seriously think we need someone to move in so they can see how things really are and then coach us all intensively.

Thanks in advance.

 

[BusynMember]

This is JMO.
I don't know anything about that program, but if you can't handle your child and the current Psychologist isn't helping (Psychologists are usually NOT good diagnosticians) then I'd get neuropsychologist evaluation before I'd spend that much time and money flying somewhere for a seminar that may not even work. Most of our kids are "different" and have disorders and need up close and personal care. I would be leery of going somewhere to a seminar and expect that to solve my problems.
Are you convinced that the ADHD diagnosis. is a correct one? Do you think maybe more is going on? What are you concerned about, behavior-wise? Anything in your family background on either side. ADHD/ODD often turns out to be a mood disorder. You have one and it is common for kids to inherit them. ADHD medications, like Adderall and even Straterra, will make a child with a mood disorder even worse, more violent, more defiant. Mood disordered kids are VERY defiant, but can also be very sweet at times--like two different kids. When they are unstable, they rage at the drop of a hat and can even hit us and say hateful things. They say them and do them because they are ill.
I would look beyond this Psychologist and get the full evaluation from a neuropsychologist.

 

[jal]

My difficult child has severe ADHD with-a mood component and our house was a lot like yours. My difficult child cannot handle any type of stimulant it makes him more agitated, defiant and off the wall. My child too is a jeckyl and hyde. I went to that clinic when difficult child was around 3.5 yrs of age (this all started at age 2). At that time they said well difficult child is so young, it could be this, that or any multitude of things, but we'll work with you to handle him. Well, we had been working with other people for tips and tactis and NOTHING worked. I never went back there (didn't have anything to do with-the program, I just felt they couldn't help us at his age). I had an in home behaviorists, tried play therapy and nothing until I got connected with-a great psychiatrist. I went the neuropsychologist testing route too. It just agreed with the psychiatrist diagnosis. Our difficult child spent 3 weeks in psychiatric hospital this summer and we washed the medications and started again. He is on an older class of medications they used to treat ADHD with-before all the stims came out - he has responded beautifully. He has been home for 3 plus weeks and has really been a pleasure to be around. Could it be your difficult child can't handle stims?

 

[TiredSoul]

I think the reason I am going down this road of a PMT program is because he is doing fine at school (so far) but not at all at home. This makes me believe either:
We are not managing his behavior at home, and they are at school

-or-

The medications are working but wearing off by the time he comes home from school school

We need a way to manage his terrible behaviors at home. Our home is not a happy place. I suspect maybe a mood disorder. Sweet loving one second, out of control mean mad man the next. Most all of it though stems from being told no, or not doing what he wants us to do when he wants us to do it. He is very demanding.

The behaviors we want to change at home are:
crying
screaming
raging
throwing things
hitting
putting holes in doors
spitting
total disregard for everyone and everything
swearing
being mean to little brother and dog
raising his hands at us like he is going to hit us
telling us what to do
not doing what we tell him to do
not giving up when he wants something - no matter how many times he is told no
won't sleep in his room by himself
won't do ANYTHING he is told

I go to Chadd meetings but mostly they don't help because it is all about getting information. I already have enough information. I need to know what to DO.

We are not seeing the psychiatric anymore. Absolutely no help.

I have read book after book after book. Nothing seems to work.

I want to run away from my family, which is terrible!!

He is 6!! I dread what he will be like as a teenager.

Sometimes I think we get so hung up on diagnosis's and what to call it - when the real issue for us is -- what do we do about it and how do we handle it? We cannot live like this anymore. Should I try a new medication when things are working at school? Everyday I hear "you are the worst mom ever", but I also hear "you are the best mom ever". Yesterday he told us he was going to find a new family to live with. It's exhausting.

Thanks for the responses!

 

[jal]

Jules 71- I really do sympathize because everything you wrote there is everything that has been going on in our home for years. Unfortunately, my difficult child can't even control it at school. He has been through 4 daycares and I lost a job of 9.5 years because of him. His behavior was this way anywhere he went and at anytime. So I can understand your frustration of why can difficult child do it there and not in his own home? A lot of times difficult child's with a mood component can hold it together at school and then unleash when they get home. I know my difficult child would hold it together for daycare (not always) but as soon as he got in the car he would verbally vomit all over me and then scream and fuss and yell.

Unfortunately, I don't have an answer for you as I am still searching for my own, but I know that the number of books I've read, the strategies didn't help, the out of pocket in home behaviorist, didn't help, nothing has worked until this new medication and psychiatric hospital stay. We have gotten him to a point where maybe 1 meltdown a day if that happens and he's much easier to handle when told No, he is not throwing things, kicking the walls, etc. Now I can talk to him and employ all of the strategies I have learned and been taught. I had to get him to a place where he was calm and open to begin working with him rather than him being so wound he couldn't hear me at all. He had no control over himself at all. Everyone luckily could see that, the doctors, the school, daycare...but we have finally found some peace in our home. Best of luck to you.

 

[TiredSoul]

jal,
Didn't it scare you to death to put him in the psychiatric hospital? I have thought about it but can't imagine. What led you to that? Our difficult child didn't use to be able to hold it together in school - he has had problems at daycare, etc since he was 2. Never kicked out of one, but close. I think a combination of his medications, getting older (maturing a little bit), and the controls in place at school have helped. Seems to be getting worse at home.

We really have no support. My mother lives an hour and a half away and works full time. She takes him overnight on an occasional weekend. No other family/friends in the area. husband and I can't even have a conversation, let alone come up with any kind of plan. This area doesn't seem to have a lot of resources available either.

I don't have experience with either of the medications your difficult child is taking. I will look them up. I can't even find a psychiatrist in our area to work with on the medications - the only one is his pediatrician. She was reluctant to refer him for a neuroeval. Maybe I need to keep pushing down that path - but again, even if he does have bi-polar, or a mood disorder, or Pervasive Developmental Disorder (PDD), or Aspergers - what do we do to live with it? Is the only hope really just finding the right medication?

 

[Allan-Matlem]

Hi,
PMT is basically behavior modification using incentives, consequences etc to manipulate behavior , help parents regain control , be more effective in getting compliance. in my humble opinion , not only does it not promote life skills, the lacking cognitive functions which our kids lack , the structures of control , our ability to control others is limited

There are different approaches and understandings of ODD. I prefer to see behavior in terms of a learning disability and the intervention is a learning , thinking and problem solving ' working with ' rather than a dong to behaviorist , motivational approach

I hope this helps
Allan

 

[jal]

anonymous - It was awful to place him in the psychiatric hospital. What led to it was that we were taking him off of medications he had been on for over a year under the direction of his psychiatrist. This was over a 4 week period and he began to spirial in daycare and at home. His psychiatrist was overseas and difficult child was running out of daycare into the street (he has always been a flight risk). He just began to become unmanageable. His psychiatrist (even though overseas always in contact) highly recommended we take difficult child to the ER. I have a 3 ring binder that I carry documenting all we have been through and I showed this to the on call psychiatrist. The on call psychiatrist said he wanted to get him in there (even though he wasn't presenting at that time)and that it is very rare that kids who come to the ER are almost medication free. It broke our hearts to do it, but I have to selfishly say my husband and I has 3 weeks of respite (much needed). We visited difficult child every other day and for several hours on weekends, but there they were able to see him off medications, trial a stimulant and see that that wouldn't work for him either.

We thought difficult child would be tramatized by a 3 week seperation. This is a kid with-high anxiety separation. Even though I used to travel a lot for work after he was born (so it wasn't anything new and he went to daycare from the age of 4 months). Surprisingly, he did very well and he was able to be observed 24/7.

Our difficult child also had an IEP in kindergarten and a one on one para. He continues to have a para in first grade too, but he had a frightening meltdown and is now separated from his class. We are currently in the process of getting out of district placement for him for first grade. Which is also very heartbreaking considering how well he is doing at home. difficult child cannot handle any type of stimulaion he goes batty. He has even FINALLy after all the years of trying to understand what was wrong has been able to tell us the class room is too noisy he can't understand what is being said.

Finding support IS hard. We have the psychiatrist and a family therapist. I have been encouraged by our therapist and the hospital where he stayed to contact DCF voluntary services, because they can open a bunch of doors to programs to help us and difficult child. We have the support of family in terms of talking things out, but we don't have grandparents take difficult child very often because he is so much work. I have never left him with-a babysitter!

I would push for the neuropsychologist evaluation. They can pick up on things that others miss. In our case she agreed with the ADHD and the mood disorder and ruled out learning disabilities. difficult child is a smart one. The medication he is on (Pamelor aka nortriptilyne) is an antidepressant that used to be used for ADHD before stimulants came along. The Seroquel is a mood stablizer. My difficult child went from not focusing on anything to actually playing with toys for 30 min plus (he had never in his life been able to do that). He is holding together at daycare after school and has always been pretty polite, but now even more so. He may still have small bouts of tears and fussing when not getting his way, but I am able to talk him out of it instead of him going into rages.

For children that have a mood disorder it is about finding the right medication or combination of medication. I cannot say for certaing that my child is bipolar although he has that diagnosis, but he definatley has a mood disorder. My mother in law and her sister are both bipolar and my husband is Obsessive Compulsive Disorder (OCD).

 

[TiredSoul]

Allan,
Thanks for your reply. The first link you provided did not work. Are you referring to The Explosive Child and the CPS model? I have read it, and have tried it. I think to be really honest with myself - I felt too exhausted to keep it up. Everything felt like a negotiation. Sometimes I would just like to say "No we can't drop everything and go to the store right now to get what you want - and I don't know when we will". My difficult child is a classic example of someone who gets stuck on something and cannot let it go. Last night it was about going to the store and getting some glow in the dark paint. He absolutely freaked out when I said we could not go (I was cooking dinner). I kept trying to explain, etc, but it just kept getting worse.

So although the book helped me understand my son better and that he does not choose to be this way - I don't know how I can possibly use this model for every single thing that doesn't go his way. I feel like my entire existance revolves around my difficult child and it is sucking the life out of me. I don't feel like I have anything left to give to my husband or my other child or myself.

 

[TiredSoul]

jal,
Thanks for sharing your story. I too would feel difficult child would be traumatized by a separation of that length. He won't even sleep without me in the same room. I am so glad it turned out so well for you and your family.

I have only used a babysitter once. Actually it was one of my friends and it was awful. She will not do it again (she didn't come right out and tell me that, but I have asked on other occasions and she c/would not do it).

I never realized my difficult child was sensitive to noises - because lord knows he makes tons of noise (between talking incessantly and loudly and just plain screaming and yelling all the time), but just probably the past 6 mos. I have noticed he cannot do things that require his concentration with other noises going on. He also has to have things repeated to him several times to "get it". His hearing is fine, but it's like he doesn't know what was said to him. (Come to think of it, I think husband is like that too - he can never give me the play by play of what was said in a conversation.) My difficult child, like yours, is extremely SMART. Probably too smart (high IQ, etc). But for instance at swimming lessons, I tell him to go join his class, and he says where is my class, and I point and show him the same place it always is, and he asks again over there, and I say yes over there - and he still seems unsure. He was the only kid in summer camp who didn't come up and get his certificate on the last day when the director announced his name (several times). He said he didn't hear her. So is that the ADHD (inattention) or something else?

The psychiatric who diagnosis'd him also indicated (in addition to ADHD and ODD) he scored in the clinical significant range on the pervasive developmental problem scale. He also had a % rank of 97 on the affective problems scale and a 96th % rank on the anxiety scale. He goes on to indicate he is concerned that he has problems with affective instability and that he may have a mood disorder. Then he recommends stims for the ADHD. I don't get that. I thought stims make mood disorders worse.

Do you know how long they need to be off medications before they can start a new medication? His prescription is just about up, but I wonder if I should plan for a break from school to try something different.

I am so confused.

 

[jal]

Are you sure you don't have my kid?

My difficult child gets stuck on things, just like you posted to Allen. As you describe in your last post my son does the same.

Being that your difficult child is on Adderrall - that is a stimulant that goes in and out of the system in the same day. So trialing another medication should not be an issue. For a mood disorder you want to stablize them first on a medication and then add the stimulant. My difficult child's previous regime was Depakote (for mood), Abilify (mood and agression), Tenex and Staterra to combat anxiety (they are not stims).

The vaccuum used to get my son stirred up. I could vaccuum under his crib as a baby, but as a toddler up until just a bit ago, I would start and he'd bounce off of walls and furniture. My difficult child has always been loud too. Talks louds, yells, screams loud, and bangs loud. That is in his world, when the world intrudes upon him he gets set off.

 

[BusynMember]

The diagnosis is very important. Why? Because the wrong medications or not getting interventions for certain problems make our kids worse. Adderall is going to make ANYBODY focus. Kids take stims in college for long nights of studying. If he is still raging and violent at home, I would be thinking he probably has a mood disorder, with your history.
Pamelar is an antidepressant. I took it for many years, it has nothing to do with ADHD. I took it for depression. It didn't work that great, about 50%, but I was sensitive to all the old antidepressants before they came out with SSRIs (and I'm sensitive to some of them too). Seroquel is an antipsychotic, agian not a medication for ADHD. Jal, in spite of the diagnosis. I think your doctor is treating your child for a mood disorder. Maybe he thinks you'll be upset if you hear this, but those medications are for mood and rage.
First poster, sounds like some rebound effect. Frankly, I'd want a new diagnosis. Lots of mood disordered kids can hold together in school, BUT it is hard so they come home and give it all to us, the ones they trust and know love them. Your child should be doing better than he is. I recommend another opinion and we had great luck with NeuroPsychs. Our neuropsychologist totally disagreed with our psychiatrist, and my son got better after that. Instead of just listening to us and looking at our son for an hour or two, the neuropsychologist did all sorts of evaluations/testing. It was ten hours in all and well worth it. Pinpointed every problem.
Good luck!

 

[TiredSoul]

MWM,
Thanks for your posts. I agree it sounds like jal's difficult child is being treated for a mood disorder (the Early Onset Bi-Polar (EOBP)). So my question for jal would be - are you seeing improvements in just behavior but the ADHD symptoms are still there? Maybe the ADHD is a misdiagnosis - in her case as well as in mine. I never suspected ADHD for my son - until we went to the psychiatric. He seems to fit the criteria - but I have always felt there is more to it - the ODD for sure.

jal,
I was thinking the same thing - 'do you have my kid'! My son used to love the vacuum - now he gets irritated when I vacuum and turns it off. He does this mostly when he is watching tv or on the computer. I think I have also noticed since it is loud at swimming lessons and it echos in there - he doesn't hear what they want him to do - and then he also doesn't ask for clarification.

So maybe I need to make an appointment. with his doctor, ask to trial a mood stablizer, and hold off on the adderall for awhile? Should I see if this works first, or try for the neuropsychologist evaluation first?

Thanks again everyone!

 

[smallworld]

Actually, MWM, Pamelor (brand name for Nortriptyline) is an old-time medication used off-label to treat ADHD sx when stimulants didn't work well. My younger daughter M's psychiatrist just mentioned it as a possibility because M has both anxiety and inattention.

 

[BusynMember]

I don't know that smallmom. I used it for depression. It is an antidepressant, but not as strong as, say, Tofrinil or Amitriptylene, which I couldn't take. Nortriptylene was new and they put me on it. It kept me marginally functioning. I didn't notice any change in my attention span, but then, I was depressed and you don't really focus well when you're depressed. Interesting that they now use this for ADHD.

 

[katya02]

Hi, I'm late joining but I have to say, jal and jules, your kids sound like clones of my difficult child 2 at that age! He had diagnoses of Asperger's, Early Onset Bi-Polar (EOBP), ODD, Obsessive Compulsive Disorder (OCD), Pervasive Developmental Disorder (PDD) not otherwise specified, you name it. He was tried on just about every medication out there, including stims (VERY bad idea). I never came up with a perfect plan but the most helpful book I ever read was When Love is Not Enough by Nancy Thomas. I know she's had some bad press for her second book but the first one is great, in my opinion. She's a therapeutic foster parent for kids with Reactive Attachment Disorder (RAD) and has had a huge success rate. There's been criticism of the 'holding' technique for Reactive Attachment Disorder (RAD) but this book doesn't advocate that. Some of the detailed suggestions or stories go farther than your difficult child may need, but you can take what's helpful and leave the rest. The big thing, to me, was her advocacy of powerful parenting, meaning you don't discuss, argue, plead, negotiate, or put up reward charts. (Reward charts never, ever worked for us.) You say something once and then you follow up with action, not words. That sounds too simple but it's best to read the book. The techniques threw my difficult child completely off when he was in control, and when he wasn't in control they worked better than anything else I tried too. We still needed an in-home TTS person many hours/week and school was still h*** to get him to (he behaved there, but went wild at home). But we could cope.

 

[susiestar]

As a child myself, neighbors went the whole PMT routine. their kids were pcs, not difficult children, and what I saw was that the kid got into the mode of refusing to do thing unless the reward was big enough to motivate them. the parents changed from that method simply because the cost of the rewards was breaking their budget - the mom actually went and got a job (she was a stay at home mom) to pay for the rewards. Her pay ONLY covered the rewards. so think carefully before you try this.

again, I was eleven when this went on, so take it with a grain of salt.

 

[howlongto18]

Jules, your kid sounds just like my son before we got him stabilized on seroquel. Our son's rages would last hours sometimes and I had to physically restrain him to keep him from being violent, is that happening in your case? My son is 6 and we've been dealing with this since we adopted him at almost 2 1/2. I was so reluctant to medicate him, everyone around me made me feel like garbage for doing it. The medications have helped him to be himself, they've helped us to bond, they've stopped the violent outbursts and hours long rages. I don't find myself resenting my own child anymore! That alone was the most priceless gift of getting treatment.

The bottom line is that if your child has a mental disorder, no amount of love can push away the monsters. Don't beat yourself up for being human.

 

[TiredSoul]

Katya,
Thanks for the book recommendation. I read the first few pages online and it looks good. It says it can help with kids who have ADD, Borderline (BPD), etc - but is that only from a Reactive Attachment Disorder (RAD) perspective (a child with Reactive Attachment Disorder (RAD) who also has ADD)?

I would love to not have to "discuss, argue, plead, negotiate, or put up reward charts".

Susie,
I can totally see that happening to us like it did to your neighbor (having to go back to work just to afford the rewards!). I don't want him to do the right thing just to get the reward. To me that's the same problem as kids who want something so bad they think the consequences are worth it (sneaking out to go to the party when the consequence is being grounded for the next month - they got to go to the party so, so what).

Has anyone had an success with any of Barkley's books?

 

[jal]

MWM, Yes, I know my son is being treated for a mood disorder. He was originally diagnosis'd with-adhd and when the stimulant didn't work it was changed to EOBD under his first dr. Our current dr also diagnosis'd bipolar with-severe ADHD. We have been treating the bipolar but the ADHD was definately was still present. He was theraputic level on Depakote and taking Abilify, Tenex and Stratterra. The recent change was the psychiatrist wanted to wean him off those medications and address the ADHD, that is what led to the psychiatric hospital stay. I was told at the psychiatric hospital since he does not respond to stims that they will try Pamelor (nortriptyline). I was told upfront that it is an antidepressant but they also use it to treat ADHD symptoms and it is an older class of drugs. We have found great success with-it so far. This is a child that could not play with a toy for more than 30 seconds EVER in his life. He now can play for 30 min to an hour with a toy. Truthfully at this point I am so grateful for this medication as I now can enjoy my child. He engages with-us, sits with-us, I don't have to peel him off the ceiling anymore, he is not acting like a wild animal. He is managing at school (while we wait for out of district placement), he is managing at daycare. He finally can tell me what's going on that distracts him in the classroom and our stress level in the home has gone down to zero concerning him. I actually now look forward to coming home and spending time with him. So, for us this new trial so far has been a godsend.