Problems with difficult child trying to avoid taking medications

Discussion in 'General Parenting' started by LadyM, Jan 29, 2010.

  1. LadyM

    LadyM Guest

    Things have been going very well with difficult child and I. We're not arguing anywhere NEAR what we were this time a week ago. That said, a new problem has come up.

    Yesterday morning, I barely saw difficult child as I was leaving the house (he said goodbye to me as he was coming down the stairs from a shower and I was on my way out the door to work). When husband went to give him his morning medications that same morning, he told him that I had already given them to him. This was obviously not the truth. husband has told me before that difficult child has tried to get out of taking medications (i.e. pushing them under the placemat or other things to make it look like he'd taken them). husband's cell phone was not charged so he had no way to contact me to verify, so he didn't give them to difficult child. difficult child then had a TERRIBLE day at school and was acting up really badly with his teachers (aka, no medications).

    difficult child has been doing VERY well in his new school (been there since october) and there has been some talk about moving him to a regular high school (special classes). I have very mixed feelings about this.

    He's been talking about some of his friends at school, makes me wonder if he doesn't want to take his medications so he will act up and avoid going to a new school (I'm not even sure if he knows) but that all seems rather calculating and a bit above something he would think of.

    I was proud of myself when I approached him about it this morning. Instead of arguing, I said "honey, I heard you told dad that I gave you your medications yesterday morning. Now you know that's not true. Remember how we talked about you acting like a young man? Do you think lying about your medications is something a young man would do? Do you want to risk having a seizure because you're not taking your Depakote, etc etc). He didn't really want to respond and I had to go to work.

    No idea how I should handle this...

    p.s. Before anyone asks, I usually give medications at night, husband does it in the morning because he sees him off to school.
  2. gcvmom

    gcvmom Here we go again!

    So is his dosing split up into a.m. and p.m.?

    One way to help eachother know if medications have or have not been given is to use a pill box. There are some set up for twice a day dosing schedules. You fill it up for the week and it makes it very easy to see if a dose has been missed or not.

    If he's really resisting his medications, perhaps you could offer some kind of reward or incentive for his compliance. Give him some kind of goal for the week and then a reward on the weekend if he's diligent and cooperative.

    That's very good news that he's doing so well in school!
  3. Marguerite

    Marguerite Active Member

    He's been talking to friends. They may be advising him on how to behave to get what he wants. I remember a kid at school who was angry that her mother had a new boyfriend, got us all to gang up on the boyfriend and be mean to him. He finally came over to us and said, "What is it I have done to you? Why are you choosing to be mean to me? I have no quarrel with you," and we realised then we should have stayed out of someone else's immature problems. But kids will be kids.

    Even if the medications are not that critical whether they're taken late pm or early am, I think this is causing problems. First, it sends a message to him that if you can have that much leeway, then maybe the medications aren't that important.
    Second, it does make it easier for him to fool you and/or husband about who dosed him when.
    Third - we found with our kids in their teens, they got to a point where they wanted to challenge their medications, to test for themselves how they could function without them. Also with our boys, cola (or other caffeine source) was having the effect of switching off their medications and making them aggressive and hyperactive; difficult child 1 would deliberately buy caffeine-laden drinks or snacks just to "prove" that he didn't have a problem. It only proved that he did, the trouble was he was the one who couldn't see it for himself. Even now if my kids skip their medications, they aren't aware of how horrible they're being.

    It's an independence thing, a self-determination thing. He probably really needs to know (and not simply be told, although that may be enough if his doctor tells him) exactly what will happen, if anything, if he skips his medications.

    A weekly pill container has always been helpful for us. And it needn't be from a medication-nanny point of view either, sometimes a weekly pill container is easier to grab if you're staying overnight with a friend.

    Our current problem is that difficult child 3 doesn't want to refill his pill container. He's got in the habit of dosing himself from his main supply, which means we can't check independently if he's taken them. Luckily we can trust difficult child 3 to be truthful about this, but he often can't remember if he took his pills or not. At least in our case, skipping his pills doesn't cause seizures. Where that is a possibility, you need a back-up.

    How's this for a suggestion? Talk to the doctor, ask the doctor to explain to him exactly what is likely to happen if he misses his medications (not "deliberately skips his medications" because you can miss your medications for all sorts of no-fault reasons, such as a tummy bug). He needs the truth and the whole truth. It's also the opportunity for difficult child to tell the truth and the whole truth, at least to the doctor. If difficult child doesn't want you in the room for this, you need to respect this. The most important thing here is difficult child's increasing responsibility for his own health care and that includes him becoming more responsible about taking medications where needed. Independently responsible. Again, this is where you need to be on his team, rather than team leader. So you can SUGGEST he use a weekly pill container, you could even buy one for him and say, "I saw this while I was out, I thought you might find it useful." But he has to choose to use it.

    Next, talk to him about how his day went when he missed his medications. Ask for his perceptions. Then tell him of what you were told by other people. Ask for his feedback - why would people say this, if they didn't know he had missed his medications? That is a point you may need to keep reminding him - other people did not know he hadn't taken his medications. He will realise this intellectually when you point it out, but until you do, part of him could be thinking without theory of mind - ie that what he knows about himself is an open book to everyone else as if they were there and knew he missed his medications. So remind him that nobody was being mean when they said he had a terrible day at school that day. As far as the staff knew, he was the same, medicated, difficult child they usually see. So why would they choose THAT day to say, "He was horrible today."?

    Also, he needs his medications to ALWAYS be at the same time of day. Even if the doctor says it doesn't really matter, use the "oops, we forgot earlier; take them now" only as an emergency back-up. The issue here isn't just difficult child's body and when the medications need to be on board, it's also difficult child's mind and how it works; he needs a strict routine in order for him to realise its importance as well as to get into the habit.

    Talk to difficult child. Ask him why he seems to be taking steps to avoid taking his medications. Find out if there is anything else concerning him, too; something like a move to a mainstream high school. You seem to think difficult child doesn't know about this - how sure are you that a teacher or someone hasn't spilled the beans or been overheard? If difficult child hasn't been consulted about this, he could very well be trying to sabotage it. That is well within the bounds of someone with High-Functioning Autism (HFA), especially in his teens. He needs to know that anti-seizure medications are not to be trifled with. He also needs to be given a voice, if he has not been consulted. You have your concerns - so you must have your reasons. It sounds like you're not really being given a say, either. Interesting. Transfer how you feel about this to difficult child, then multiply it about a hundred-fold for how powerless and scared he might be feeling about this, especially if he's still waiting to be officially told about it. It would be very hard for him to trust people who aren't keeping him in the loop about what's planned for him.

    You did well when you spoke to him. It sounds like it's really bearing fruit. You're asking him questions rather than giving him statements. One minor criticism - you need to be careful to not ask loaded questions. Such as, "Why did you go so close to the cliff? Do you want to fall and be killed? Are you trying to kill you poor old mother with worry?" are loaded questions, almost rhetorical. The presence of the question mark there does not indicate a real question; rather, it indicates passive-aggressive behaviour designed to induce guilt and an automatic response of "Of course not." You also need to avoid asking any question, even an apparently innocent one, with an expected answer, because these kids have by now become VERY skilled at giving you the answer YOU want, and not the answer THEY want (ie the answer they really should give, if they're being honest). For example, "We have vanilla ice cream, or chocolate. You'd prefer vanilla, wouldn't you?" is a loaded question and greatly increases the chances with a kid with High-Functioning Autism (HFA), that he will reply, Yes, of course, I will have vanilla," because YOU expect him to. He may have a slight preference for chocolate, but you indicated you expected (therefore in his mind, he should) have vanilla. They are more likely to do with with people they don't know so well or don't feel quite so sure of.

    So "do you want to risk having a seizure because you didn't take your Depakote?" is actually loading the question with an expected answer. The biggest problem with this - it put up a barrier to him being honest with you. He may answer, "No, of course not," because your tone of voice, your clear concern for him, tells him to answer that way (from what he has learned in the past with similar questions). So he loses the opportunity to say to you, "I'm scared, I don't want to go to the new high school, I'm just settling in here. I thought if I had a few bad days then the teachers wouldn't be looking to make me change yet again. I didn't realise about the seizure risk; or I thought the risk of seizure would be worth it, to not have to move."

    I don't know how he would have answered, but I suspect that if he's talking to kids at school, you need to be in this loop as well.

    Another suggestion - don't know if it will work for you - cultivate his friends. Especially if they're 'normal' - get them to talk to you about their concerns for him. Keep "open milk and cookies" at your house when you can, in order to welcome his friends to your home and make it a friendly place to chat. This can have so many good fringe benefits - it make the other kids see you as "cool". Other kids feel comfortable talking to you or around you. You quietly gather intelligence on what your son thinks and feels, as well as what his friends think and feel. It keeps you young at heart. And most important - it means you know where your son is and who he is with, far more readily.

    I think you are doing great. And I think you're already seeing - it doesn't fix things. It just makes them easier; makes it possible to see your way clear at last.