Teen daughter with ODD

[louissa]

I'm at my wits end. My daughter is 14, she's had behaviour problems since she was small but they've gotten so severe and she's recently become violent to her older sister, threatening her life and threatening suicide. The screaming fits and temper have become a daily occurence, with our two other daughters aged 16 and 7, the stress on the whole family is tearing everyone up.

Our family pediatrician told us last Friday to take her to emergency for an immediate evaluation, and she was admitted to an adolescent psychiatric hospital that night. She has been diagnosed with depression and ODD. They started her three days ago on zoloft, doubling her dose to 50mg yesterday.

We had a family meeting today with the social worker at the hospital, all of us but our youngest was there and they are saying they are probably discharging her tomorrow, despite her having an outburst during the meeting where she stormed out of the room.

No one in the family feels comfortable with her returning home, we see no change in the anger, particularly that aimed at her older sister and feel she is still a danger to her. The hospital social worker told us to go to the police and file a CHINS petition and take her for an outpatient appointment next week, but there's just this horrible feeling of dread in the whole family.

Of course at the hospital she's relatively calm, but both times her sister has visited she's turned hostile, I don't understand how they can honestly feel she's ready to be home? On top of that, our family doctor warned us that she could become more aggressive on her medication and that is usually apparent within the first week to ten days, she's only been on it for three days.

Has anyone else dealt with a child with ODD and depression, a child that makes death threats against a family member and/or suicide threats, that displays physical violence, has daily temper outbursts with foul language, problems with school, messing with alcohol, cigarettes and fire? I could really use some insight as to how you cope, how you handle the rages, how you keep the house safe.

Thankyou
Louissa

 

[oceans]

I don't understand why they would release her so soon. It certainly does not sound like she is ready. Did they do an evaluation on her? Did they involve her in some therapy sessions? Did the social worker talk to you about other options besides returning home, like Residential Treatment Center (RTC)'s? Did you talk to the psychiatrist who examined her? Based on the experience I have been having, it does not sound like they are doing what needs to be done.

Have you looked into your community to see what supports for mental health are available? Have you checked into NAMI and other means of support? There should be some services available for you in the community.

Does your difficult child have a psychiatrist and psychologist she has routinely been seeing?

 

[louissa]

I have to apologise but I'm not sure what difficult child means, but I think you mean my daughter.

She went to anger management counselling last year, it didn't help. She's had counselling in the past and hated it and refused to go back, the behaviours were manageable then, now however they are not.

When we voiced our concerns to the social worker today, she said it was up to the doctor and that if he felt still that she was ready to go home, our insurance would not cover her remaining in the hospital. How he can spend minutes with her and not meet with the family so he can see her interactions and behaviour as we do puzzles me. She's telling him what he needs to hear and all we've had is a 5 minute phone call from him where he asked my permission to try her on zoloft.

She was admitted last Friday night about midnight, they didn't do therapy over the weekend, just a couple of chats with her and then therapy sessions started on Monday as did the medication. They are a short term facility and have said that their job is to make her stable but not cure her. If she can't be around her sister without getting angry and agitated in a controlled situation with a social worker, I just don't understand how they can feel she's stable enough to be safe around her at home.

She has an intake appointment next week and the social worker has said she is going to contact them and stress to them that the family needs as much support and assistance as they have available. Until then we really have no idea what is available, we are in southern nh.

The school have been very helpful, they understand what is going on and are working with us. Her behaviour at school is less disruptive but she refuses to do homework and skips detentions and forges signatures. Last semester her math teacher said she missed at least 24 homeworks and had 8 detentions. When she's asked she says she didn't want to do it or couldn't be bothered. Also she recently changed friends and is around kids taking drugs and bringing in alcohol which she admitted to drinking last Thursday in school.

The pediatrician is also a good support, but they really don't have the expertise to treat her.

 

[smallworld]

You might want to ask about a day treatment facility (possibly associated with a university or children's hospital) that she could go to following discharge from the hospital. That way she would be monitored daily for medication reactions, as well as have access to individual, group and family therapy. My easy child was in day treatment last summer for 5 weeks following the development of a choking phobia that led to an eating disorder. Day treatment was a godsend in our case.

by the way, difficult child is Gift from God (the child who brought you here) and easy child is Perfect Child. Even PCs can have issues, however.

 

[louissa]

For us the concern isn't so much during the day and she is already flipping out about missing school, the rages happen most evenings and/or when she is near her older sister and we have concerns she will harm herself or her sister during the night or early hours.

We have switched around bedrooms so our eldest easy child is now upstairs and difficult child is in the downstairs room, this gives her no reason to be upstairs and gives the other two children a little more safety and feeling of security. The doctor suggested putting a motion sensor outside eldest easy child's room but with three cats this isn't going to work.

The social worker did say she was going to make calls to try and get some in home therapist, but again the intake appointment isn't until next Wednesday, I am concerned about what will happen between now and then.

 

[Sara PA]

Were you warned about what psychiatric side effects to watch for when he started her on Zoloft? Are you aware of the black box warning for chidren and adolescents taking antidepressants?

 

[louissa]

Sara,
The psychiatrist at the hospital literally called Monday late morning and introduced himself as difficult child's doctor and said he wanted to start her on trial medication I believe he worded it as. I asked what medication and he told me zoloft and didn't elaborate much more than that.

I was the one that asked him if there was any risks and he fed me a line about Paxil I believe, saying they don't prescribe it because of negative effects in adolescents, but Zoloft didn't have those problems.

I took him at his word and gave permission, I was literally only on the phone for a matter of minutes and most of the information I had to drag out of him, he wasn't really offering up much at all.

I asked my family doctor about zoloft and did some online research and it was then I became concerned because there were risks that were not explained and as much as I believe medication may help her, I don't feel the psychiatrist was up front with me on the phone and now I feel he is sending her home prematurely and in fact with a possible increased risk of harming her sister or self harm.

It's like I have this sickening knot in my stomach that I just can't shake, but they are the professionals and it's their call. I feel completely helpless.

 

[Sara PA]

Originally Posted By: louissa
It's like I have this sickening knot in my stomach that I just can't shake, but they are the professionals and it's their call. I feel completely helpless.
No, it's not their call. Just like you can refuse to take a medication, you can refuse to allow your child to take a medication. Or, depending on your child's age and the state in which you live, your child can refuse to take a medication.

Most people have incorrectly decided that I am against all antidepressants and the use of them. It is true that I have little good to say about them -- I don't have to say the good, the pharmaceutical industry has that pretty well covered -- the part that I am most upset about is that too many people in the medical profession blow off the side effects that the FDA has said they are suppose to be informing the patient -- or the patient's parents -- about. Only with the proper information can a patient -- or the patient's parents -- make an informed decision about his/her medical care. If the patient -- or the patient's parents -- decides to try the medication, only with the proper information about what adverse reactions can occur can the patient -- or the patient's parents -- recognize the behaviors that may be an adverse reaction.

Give the Zoloft a try. But be aware of the possible side effects and that they can occur when your child starts taking them or after a few months. But don't think that you have to do it. And know that either this doctor lied about there not being problems with Zoloft or he is woefully misinformed.

 

[oceans]

http://www.naminh.org/

Here is the web site for NAMI of NH. You should be able to find support groups and help near you.

My difficult child has been on many antidepressants, and though everyone is different, he did not experience any adverse effects on Zoloft. He has had a difficult time finding a medication that will help him, but until she tries you do not know if the Zoloft will help or not. You need to watch her carefully to see if there are any adverse reactions. It can take several weeks to actually have a positive effect.

 

[flutterbee]

First, hello and welcome to the board. I'm glad you found us.

When my easy child (former-difficult child) was 10 he was diagnosis'd with severe depression and his behavior was exactly what you describe with your daughter minus the drugs and alcohol. He was extremely violent with his sister and me - if he had been the age/size he is now I would have been afraid for my own safety with him. I couldn't leave him alone with his sister for a minute.

He was prescribed Paxil (before they stopped giving it to kids) and he refused to take it. He was non-compliant with therapy - even running away from the pscyhologists office on one occassion and almost right into oncoming traffic in doing so. He was extremely angry, hostile, hateful...toxic.

My advice til Wednesday - don't leave your other children alone with your difficult child at all. If you are truly afraid for their safety, maybe you and your easy child's can all sleep in the same room. If difficult child becomes violent and uncontrollable, call the police. Just because you call the police doesn't mean difficult child will be arrested. Once you explain the situation, they will probably try to talk to difficult child and if that doesn't work will probably take her to the hospital. I recommend calling the juvenile dept of your police department and giving them a heads up. They do this A LOT. It won't be anything new to them and there won't be as much confusion in the heat of the moment if the need to involve them should arise. NO ONE likes the idea of calling the police on their child. I know. But you have to able to protect your other children as well as yourself.

Yes, there is a possibilty of adverse reactions with any of these medications. The doctors are responsible for informing you of these and failure to do so is completely unprofessional in my opinion. However, if adverse reactions were extremely common, they wouldn't be prescribing them so readily. Keep your eyes open for them, but don't obsess over it.

Hang in there and keep us posted.

 

[Sara PA]

Originally Posted By: wyntersgrace2
Yes, there is a possibilty of adverse reactions with any of these medications. The doctors are responsible for informing you of these and failure to do so is completely unprofessional in my opinion. However, if adverse reactions were extremely common, they wouldn't be prescribing them so readily. Keep your eyes open for them, but don't obsess over it.
The reason only Prozac is approved for use by children with major depressive disorder is because none of the other antidepressants were found to be effective and safe for use by children. And there are researchers who have read the studies who believe Prozac would not be approved for use by children if the studies were being evaluated today.

Do not for a moment believe that these adverse reactions are not common. They are common enough to block the drugs from being approved for use by children. Most prescriptions for antidepressants being taken by children and adolescents are being written off-label and there are many, many doctors who fail to or refuse to acknowledge the psychiatric side effects of these drugs.

 

[louissa]

Thankyou to everyone for their support, sometimes it feels like you're totally alone and it's good to know there are others dealing with similar issues.

My feelings of being helpless are more regarding her stay at the hospital, I knew I could refuse the zoloft for her but I believe she does need medication, I just wish the doctor had met with us and been more upfront and given all the facts.

If they do send her home tomorrow as they have indicated, we are going to have to keep a very close eye on her until we can be sure she will be safe and we have a better support system in place.

 

[flutterbee]

I'm about people being informed and making a decision based on that information and what they feel is right for their child. Period.

Edited cause I'm having a bad night and let a knee jerk reaction get the best of me.

 

[BusynMember]

I'm wondering if this child actually has early onset bipolar. I'd look into it. In that case, antidepressants can be very dangerous. There ARE black box warnings on higher suicide rates for children under 18--this is not made up, and my experience with ad's for kids is very bad. Unfortunately not all experts call it right either, which can be very maddening. Both of my younger kids who had problems were tried on Prozac, which is supposed to be safe for kids under 18. Maybe it is for some kids. My son became psychotic (he is on the autism spectrum) and we removed it. My daughter who was a teen, told me Prozac made her feel weird, then, shortly after, pulled a knife on herself. I have bipolar and have taken Zoloft and take Paxil. Although I personally wouldn't give either one to a child under 18 (knowing what I know now), Zoloft made me nuts and Paxil helped me. Both have serious withdrawals if the child quits taking it, and they can last for months. I'd want, if this were my child, to have her tried on a mood stabilizer, maybe Lamictal because that's good for depression. My daughter was in a hospital and they totally misdiagnosed her. They didn't even figure out she was using recreational drugs. None of us, not one, has to accept what a doctor tells us. Depression is often the first diagnosis. before BiPolar (BP) is diagnosed (it was for me). No mental illness has as high a rate of suicide as bipolar and antidepressants do make it worse. She should be watched like a hawk if she is going to continue to take it. My daughter's suicide attempt came out of the blue. Later, we found two knives under her bed. I'm not using a scare tactic. The fact is, these medications do cause certain disorders to become worse. Even as an adult, who was tried on most ad's, the only one that helped me was Paxil and many others had scary side effects. I agree that antidepressants CAN save your life, IF it's the right diagnosis. Without Paxil, I'd be dead, but I'm an adult, I have bipolar II (which is different from bipolar I), and the fact is getting the right diagnosis. and right medications can take (I've read) up to ten years. It did for me. I'm going to post a site about early onset bipolar. All kids with bipolar have ODD behaviors. That's just part of the disorder. I believe I had bipolar very young, and the defiance level is through the roof mostly because you can't control your swinging moods and you get into "mixed" states where the rage is not even within your control. To me, I'd want to try a mood stabilizer before an antidepressant. Mood stabilizers are Lamcital, Lithium, Trileptal, Tegretal and Depakote. Like all medications, one may not work, another may. And, like antidepressants, they can take up to eight weeks to kick in. But they don't have withdrawal side effects and don't cause suicidal thinking. You can always switch to ad's later on. This is just what *I'd* do based on my own illness and experience with my kids. It can be darn hard to find a professional who diagnoses right!!! And any child who is started on a new medication should be watched VERY closely. If the behavior is worse, not better, after a month or so (it takes that long to kick in) then question, question, question if it's the right medication. Zoloft put me in the hospital after a month of taking it. I'm sure it helps others. These are powerful medications and we have to be cautious and make sure the child is diagnosed correctly. Since there's no blood test, it's always a crapshoot. Hugs.

 

[kris]

welcome.

for what it's worth both of my kids...a boy & a girl....suffered from depression. both took zoloft successfully. jarrod's depression was major ~~~ suicidal ideation & major ODD symtoms. sarah's was not as profound....more in the moderate spectrum. both were prescribed zoloft (jarrod had trialed a couple of others with-no success). both found relief at 100mgs/daily. both are in remission & off medications. by the way, it may be four to six weeks before you see positive effects.

i would strongly recommend that you push for a neuropsychologist evaluation to be done by a qualified professional. you can discuss that with-her psychiatrist (psychiatrist).

there are some very good books out there on teenage depression. check out our book list (you can link to it on the homepage) or check out your favorite book site...mine is barnes & noble. you don't have to buy them....that's what the library is for. if you find one that is particularly helpful then you can buy it.

due to insurance concerns psychiatric hospitals are usually only given a few days approval. enough to do some observation & then give/change medications. they never allow enough time for staff to see if the medications actually work. psychiatrist doesn't just base his diagnosis on what he sees....he depends highly on staff to provide the appropriate info. he's not flying as blindly as he seems.

hang in. hopefully they will get you set up with-the proper supports.

kris

 

[rejectedmom]

I'm going to address some thing that I don't see addressed in previous posts.

"Also she recently changed friends and is around kids taking drugs and bringing in alcohol which she admitted to drinking last Thursday in school."

The violent outburst anger and rages could be caused by drug use.
There is no way your difficult child would admit this. My difficult child was always difficult but he never was violent until he started using Pot.
The Pot of today is not anything like that of the 60s-70s. Some of it is soaked in embalming fluid to give a quicker and longer lasting high. The embalming fluid aside from the obvious health risks can cause violent rages and severe and unreasonable anger.
He was 14 when he started and he had no job no money so we never suspected it. But they can get it pretty easy. And there are ways that they can pay for it that you would not even suspect.
I suggest you do a little reading on our Substance Abuse board.
You will see then that it is not out of the realm of possibilities.


"The doctor suggested putting a motion sensor outside eldest easy child's room but with three cats this isn't going to work."

You can put the motion sensor a little bit higher than the cats height and they won't trip it when they walk through. I would also suggest a nannycam that is placed in the area where most of the confrontations take place. This way you will have a very accurate picture of your difficult child's behaviors and what triggers the aggression for her psychiatrist. -RM

 

[dreamer]

I tried unsuccessfully to post a reply last nite.
If my reply posts in duplicate or triplicate, my advance apologies....(a WebTV-new site complication)

Mostly I wanted to say medications are like fire. Both can be very helpful and useful, can even save lives. BUT both can also be quite dangerous.....Yes, you do need to be informed and know what the possible risks are and what the signs and symptoms are that you should watch for. And you need to be aware docs and pharmacists are human and even the best can make mistakes miss signs or whatever....AND you need to realize the risks one person may be willing to gamble with might not be risks someone else is willing to gamble with. For example, I did risk certain side effects for my dtr on some medications she was given, such as weight gain at the time becuz in my opinion the risk of suicide was a greater immediate concern than whatever problems severe weight gain might hold. Sadly, suicidality got worse with those medications.
I am on some medications currently that are full of possible life threatening risks. I am not sure I would permit my children to take the medications I currently use.....BUT the option for me is to remain helpless and totally dependant without these medications....so- I chose to take the associated risks for myself, even if I am borrowing time from the end of my life to raise my kids.

The main point does seem to be INFORMED consent.
As a nurse I personaly know MANY docs and many pharmacists who feel they do not want to take the time to fully inform a patient of ALL the POSSIBLE adverse reactions to medications. Not verbally, anyway. SOme will say they do not have time. SOme will say it would scare patients away from possible help, - some will say hey, the insert comes in the drug packageing. IF your Rx comes with the drug insert, READ IT. If you do not understand the terminology on the drug insert, LOOK IT UP. Becuz the drug insert is usually included with a medication, many docs and pharamcists will fall back on saying THAT is your informed consent.....you were provided that info- it was your responsibility to read it. ANd if you had concerns or questions, you shoulda brought those concerns/questions up with the doctor.

Please understand, I am NOT saying I agree with this stand but I am saying this is what a LOT of docs feel.
Also please understand I am not saying ALL docs feel that way.....but many docs.
It is prudent and wise to research any medication you take or give your loved ones. People DO make mistakes, errors happen and adverse side effects DO occur. Some are simply an inconvenience, some are uncomfortable, and on occasion some can be life threatening, and some can be irreversible.
Do you research so YOU can make the decisions based on which gambles YOU are willing to accept. What do YOU personally feel is an acceptable risk? and research it so YOU can identify the warning signs of an impending problem ASAP-----becuz it is YOU there with your child much more than the Rxing doctor. It is YOU who will notice signs first, so you do need to know what to watch for.

Also keep in mind- a "low risk" is still a possibility. a 1% risk is still a risk. ANd sometimes one of us just might be that 1% of the people who do develop that adverse effect. Know how to recognize it should it happen.

Everyone here must have access to internet. Look up your medications by their manufacturer. READ the info the manufacturer provides. Whether your doctor informs you or not-----it is your loved one at risk----take that step.
All of us have different levels of risk we are willing to take.
And when you read the info ASK your doctor any questions you have. Ask him point blank.

 

[louissa]

The social worker called from the hospital at 10am to say they were discharging difficult child, we said we'd be there before 12 and then 5 minutes later she calls back to say they changed their mind and the psychiatrist is calling the insurance company to try and get her stay extended to Monday but they don't know if they will so we still might have to take her home today.

We're sitting here waiting for the call and our difficult child calls us, she says they told her they were going to discharge her and then said maybe not and she doesn't feel ready to come home, that she still feels after the family meeting yesterday that she could harm herself or her sister because she doesn't feel she can control her rage if she comes home. She says she's feeling no different on the zoloft, I explained it can take time, but she's saying she has not told them all of what she is telling me, because she finds me easy to talk to and that everyone at the hospital always seems busy and unavailable and she has trouble understanding the psychiatrist as he's Egyptian and has an accent.

I don't understand why they are not talking to her properly, why they are not hearing and seeing how she's feeling. She says she's good at hiding her feelings, but aren't they trained to know this kind of thing and work around it so she will open up to them with her concerns?

 

[Sunlight]

Hi there, and hugs to you for all you are going thru. my son was admitted to a psychiatric ward against his will at about age 15. in PA if they are over 14 I think...they can tell the doctor not to release info to you. he was kept only overnight and signed himself out. the doctor prescribed day treatment/partial hospitalization. my son refused to go.

it turned out my son was deep into drugs and that was causing his extreme anger and behavior swings. he broke lots of stuff and hit walls and door til they had holes in them. he raged, ran away and was angry and mean.

the psychiatric hospital will hopefully give you some answers. they were right about my son. (he is now drug free and behaving right)

once you know what you are dealing with, you can educate yourself in how to cope. God bless.

 

[ellenr1]

Louissa:

My two oldest kids have 7 inpatient hospitalizations between them. It goes like this: they threaten or do something dangerous, they get admitted for observation, which lasts exactly one week, then they get discharged, because that is what the managed care insurance industry dictates. Sometimes the doctors can buy additional time but not always, and then it's a choice as to whether you want to pay upwards of $1,000 per day for continued hospitalization.

My advice is, if you feel that your child is a threat to the safety of your other children, to you, or to herself, you must bring her back to the emergency room. I know, it's hard when you know you're going to sit there for hours and hours before they even make a decision if she meets the criteria, but believe me, no hospital wants to be stuck with a lawsuit from parents whose child did something dreadful after a doctor discharged them.

My son was 9 the first time he was hospitalized for anxiety and ODD (he tried to poison me and kept slapping and punching me, trashed the house, threatened his little sister with a knife). He was hospitalized for seven days. Took him home on a Friday afternoon, he was back in the hospital by Sunday night and stayed two more weeks. He went bonkers and tried to jump out a second floor window (they had upped his Zoloft but never told us about the side effects) after he hit me again. He actually slapped me in the car on the ride home from the hospital (I was alone with him) but I was so guilt-ridden over the hospital stay I didn't even tell my husband about it. I should have turned the frikkin' car around and gone right back to the facility.

You need a safety plan in place before she is discharged. Insist that the hospital social worker draw one up with you.

And good luck. It's awful, what you are going through right now, but so many of us have lived through it and survived and learned from it. You will get support here. The suggestion to contact NAMI is excellent, and I highly recommend getting yourself to a local support group meeting . They will listen and help you.