Update/Consequences?

[MyHrt31]

Today my son's school called me because he threw a desk at a student and cursed at everyone. When they put him on the phone with me I told him to apologize but he kept saying no. He finally apologized but in a really mean way. I spoke with the assistant principal and told her that he would only be rewarded for his behavior if she would send him home today and she agreed. The only downside is that they gave him an out of school suspension for tomorrow. My question to you guys is what kind of consequences should I use and for how long? I never know how severe the punishment should be. This is something pretty big so I would assume that everything should be taken away until Monday but he will seriously drive me nuts all weekend long because then he will have nothing to do. Any suggestions?

 

[BusynMember]

Besides making it a very boring day (maybe get his school work, no television, no electronics, maybe extra reading)...I'd get him to his psychiatrist right away. He is clearly unstable and probably isn't 100% in control of himself. While I would definitely give him consequences, I would be more interested in helping him. This kid needs help for his Aspergers. I have an Aspie site to send you to that may help you see how different even the grown adult Aspies think. Maybe they can help you too. I think in my opinion that a lot of his strange and seemingly cold behavior is actually Aspie behavior. These kids (and adults) don't "get" people or how they make them feel unless they are taught in a text book way. My son has learned. It is very possible. Unless the Aspergers is addressed, things will be grim in my opinion. You are not going to get this differently wired child to understand things by applying "typical" methods and explanations to him. You need more help than that and your professionals are failing you and your son. I'd call the nearest Autism Society to see where you can get him help for his Aspergers. You need help in school too--in fact most of my son's interventions were in school and they changed his life.

 

[MyHrt31]

Thanks! He started cursing me and throwing things around when I told him he lost his privileges today. I explained I would have to call an ambulance if he tried to harm either me or himself. This calmed him down some. He's begging me for some extra chores so he can get his privileges back (He heard the psychologist mention giving him extra chores when he wants to earn his privileges back). Right now, I have him just sitting quietly on the couch. He seems pretty tired. He hasn't been sleeping well at all. I did explain this to the psychiatrist and psychologist so I am just waiting to see what they want me to do.

Thanks for the link! I will definitely check it out Both his psychologist and psychiatrist seem to think his behavior is manipulation and apart of conduct disorder. They want me to be more assertive in my parenting. I admit, I do need to step up to the plate even more but its so hard because with his increased irritability and aggression at school, I'm afraid I'll make things even worse.

The school wants to send him back to the "alternative school" for children with behavior problems. We have a meeting on Monday. I guess I'll have to see how that goes.

So do I take away his privileges for the entire weekend? I know that some of this is because of his disorder but I want him to know he made the wrong choices by cursing and throwing things at people. Someone seriously could have been hurt

 

[BusynMember]

If that's where your professionals are going with this, I'd dump both and see a neuropsychologist now. I'm just a mom, but my mom gut (and 30 years in the mental health world myself) tell me that you have a few bad eggs. They exist in droves in the mental health profession. I'd have him evaluated and I'll bet you stop hearing about how it's your parenting. And this time maybe a couple males would be better. Truly, if these two were treating my kid, I'd fire them. You need people who will dig deeply to see what is wrong, not this--as you can see, it's not working. If this were me, I'd take the focus off of being "hard" on him because in my opinion it's not completely his fault and your being "soft" on his isn't the issue. One day is an eternity to our kids. Maybe others will disagree, but I would keep it to that and focus on finding that neuropsychologist, and finding out what is really going on. It will be a terrible weekend for you if you try to restrict him for three days and he probabaly isn't going to change his behavior because of it. in my opinion I doubt he CAN change his behavior yet. He needs a different sort of help than what he is getting. JMO, but I've had a lot of experience both with myself and my kid. Not that this makes me a pro...lol. Until the neuropsychologist evaluation. was completed, I would hold off on the alternative school. How can they help him if they don't even know what they are dealing with? I'd push for a small class in THIS school. JMO again. Good luck again

 

[MyHrt31]

Thanks I've been looking into neuropsychologist? in this area and also into doing a sleep study on him. Also, my son's social worker helped me to see about putting him inpatient for a little while for a medication wash because she feels like the medication is only making things worse. My thing is, if he's going to be on three kinds of medications, he'd better be jumping on command, you know what i mean? So if all of these medications are in him and he's still defiant, angry, irritable, and impulsive... why am I giving it to him again? Its kind of getting me mad! Maybe thats what I should be instead of feeling guilty all the time about not being the world's best mommy. Thanks again!

 

[Andy]

I think I would recommend "The Manipulative Child" to you also if you are feeling some of his behaviors are manipulation. As with everything else, it will not be the cure all but may help in a small way in this situation?

Maybe to earn extra privileges he can do some writing? Have him write positive things such as, "Some day I would like to take a vacation to......" and describe why he chose that location, or serious things such as,"Good friends should........" or "When I grow up, I would like to get a job as........." or hard things such as,"When I threw the chair, the other kids........" You can learn a lot about your kids by what they write. You can set a word limit. Give him a note book just for these assignments.

You can also ask his teacher for extra work in various subjects.

He might as well be learning or practicing math or writing while earning privileges.

You are a great mommy. Never put yourself down. Just being here shows you do love your son and want to find an easier way for him. That is what the World's Best Mommies do. You are one of those World's Best Mommy! It just takes our difficult child's a little longer to see that. When their behaviors try to make you guilty, just stand strong and don't listen.

 

[BusynMember]

Because I've spent so much time myself in the mental health system as a patient, I am so leery of getting medications thrown at you. Yes, you need a mood stabilizer and maybe an antipsychotic too if you have bipolar. But the new thing is to medicate EVERY symptom. Being a patient myself I know how CRUMMY you feel all doped up on psychiatric medications. Sure, you may be more compliant. Who wouldn't be when you are half full of drugs? When I see stims for ADHD mixed with mood stabilizers, antipsychotics and antidepressents in ONE CHILD I really wonder about the doctor. I have bipolar. It is NOT all about the right medications. I still have bad anxiety at times, but I'd rather have learned how to manage it (as I have as I got older and got some good therapy) than be put on ten medications so that I can't think. I still have slight moodswings (not so bad, but they happen), but I'd rather learn how to manage the smaller swings than to take heavy duty drugs. Our poor kids don't know what's wrong. I know my 15 year old was offered medications for Obsessive Compulsive Disorder (OCD). He is on the autism spectrum and ALL Autism Spectrum Disorders (ASD) kids are bothered with Obsessive Compulsive Disorder (OCD) thoughts that can get in the way. He is usually passive, but he said, "No!" That surprised me. He said, "I don't need them. It's ok." I asked why and he said, "I don't like how they make me feel." And that's that.
Get your son a neuropsychologist evaluation. If it turns out that he even needs medication (it turned out that my son didn't) then find a Psychiatrist and ask him about his medications policy--does he try to medicate every symptom or does he take a far-reaching look at the disorder--a combo of one or two medications, therapy, and maybe good nutrition, exercise, routine, sleep. I can't tell you how HORRIBLE so many of those medications made me feel. The medications alone made me want to jump off a cliff. Then, again, when I found the right combination, I felt like I was born as a new person. But getting there was hard, and I still won't overmedicate myself. I don't like the feeling of being drugged. And if you're on five medications, you have got to feel abnormally drugged. JMO--I'll get off my soap box. One more thing--some therapists do more harm than good too. My favs are CBT therapists. They rock

 

[MyHrt31]

Because I've spent so much time myself in the mental health system as a patient, I am so leery of getting medications thrown at you. Yes, you need a mood stabilizer and maybe an antipsychotic too if you have bipolar. But the new thing is to medicate EVERY symptom. Being a patient myself I know how CRUMMY you feel all doped up on psychiatric medications. Sure, you may be more compliant. Who wouldn't be when you are half full of drugs? When I see stims for ADHD mixed with mood stabilizers, antipsychotics and antidepressents in ONE CHILD I really wonder about the doctor. I have bipolar. It is NOT all about the right medications. I still have bad anxiety at times, but I'd rather have learned how to manage it (as I have as I got older and got some good therapy) than be put on ten medications so that I can't think. I still have slight moodswings (not so bad, but they happen), but I'd rather learn how to manage the smaller swings than to take heavy duty drugs. Our poor kids don't know what's wrong. I know my 15 year old was offered medications for Obsessive Compulsive Disorder (OCD). He is on the autism spectrum and ALL Autism Spectrum Disorders (ASD) kids are bothered with Obsessive Compulsive Disorder (OCD) thoughts that can get in the way. He is usually passive, but he said, "No!" That surprised me. He said, "I don't need them. It's ok." I asked why and he said, "I don't like how they make me feel." And that's that.
Get your son a neuropsychologist evaluation. If it turns out that he even needs medication (it turned out that my son didn't) then find a Psychiatrist and ask him about his medications policy--does he try to medicate every symptom or does he take a far-reaching look at the disorder--a combo of one or two medications, therapy, and maybe good nutrition, exercise, routine, sleep. I can't tell you how HORRIBLE so many of those medications made me feel. The medications alone made me want to jump off a cliff. Then, again, when I found the right combination, I felt like I was born as a new person. But getting there was hard, and I still won't overmedicate myself. I don't like the feeling of being drugged. And if you're on five medications, you have got to feel abnormally drugged. JMO--I'll get off my soap box. One more thing--some therapists do more harm than good too. My favs are CBT therapists. They rock

Thanks! It really helps to have insight to someone who knows what is like to actually take the medication and how it can make you feel. I take Welbutrin/Topamax but they make me feel great. I couldn't imagine taking anything more (actually I won't be able to afford those anymore because I have no insurance, lol). I hate having him on medications but sometimes I feel its necessary to manage his anger. If I can help him to manage his anger without the medications,than great! Whats a CBT therapist?

 

[MyHrt31]

I think I would recommend "The Manipulative Child" to you also if you are feeling some of his behaviors are manipulation. As with everything else, it will not be the cure all but may help in a small way in this situation?

Maybe to earn extra privileges he can do some writing? Have him write positive things such as, "Some day I would like to take a vacation to......" and describe why he chose that location, or serious things such as,"Good friends should........" or "When I grow up, I would like to get a job as........." or hard things such as,"When I threw the chair, the other kids........" You can learn a lot about your kids by what they write. You can set a word limit. Give him a note book just for these assignments.

You can also ask his teacher for extra work in various subjects.

He might as well be learning or practicing math or writing while earning privileges.

You are a great mommy. Never put yourself down. Just being here shows you do love your son and want to find an easier way for him. That is what the World's Best Mommies do. You are one of those World's Best Mommy! It just takes our difficult child's a little longer to see that. When their behaviors try to make you guilty, just stand strong and don't listen.

I will definitely see if I can find that book. I love to read! I am reading The Explosive Child right now and its pretty interesting. I will definitely try giving him those positive thinking "chores" during the day to earn back a privilege or two. It may help him to open up a little bit. Sometimes its hard to get him to talk about how he's feeling. He can't explain why he's mad, he just is. I love him so much and I want others to see the sweet little boy that I see. He has a good heart, he just has a different way of showing it. His hugs don't come often at all, but when they do, I cherish them .

Thanks for the encouragement

 

[BusynMember]

I feel good on my medications too. But that hasn't always been the case, and if they added any more, and I started feeling that vague "I'm in a dream" state again...that freaks me out. I hate it. Lithium made me feel like I was out of my body and it made me suicidal, but when I said I thought it was the Lithium, the psychiatrist (who was an idiot) just upped the dose and put me on more medications until I took a whole bottle of Valium so I could sleep and not think about feeling like I was outside of my body. I didn't mean to kill myself, but I didn't want to be awake either.

Three days later I woke up and I found a new psychiatrist and he took my Lithium level, he was livid. I was WAY toxic. The other doctor hadn't checked. He just kept shoving MORE medications at me, never once thinking that maybe the problem was too many medications or the wrong medication for me. Even if he had checked, my level was 1.6. THat is normal for some people. But I'm sensitive to medications. Oh, this is but one of many "medication" experiences...lol. I trust myself now more than the doctors.

Some kids need medications. in my opinion no kid should get a medication for every symptom. Some things we have to learn to do without medication. That may include paying attention. My son has trouble with that, but he doesn't want to be on stims and I don't want him on any and half the time they make things worse rather than better. I do think they push the medications as a fix way too much and, in the process, often make things confusing and worse...what's the problem...the patient? The medications he's taking? It's ridiculous. We medicate more than any country in the world. I do think we NEED to medicate things like bipolar and schizophrenia. But with five or six medications? My son used to walk around in a stupor and he couldn't do well in school from just two heavy medications. I can only imagine if they'd have put him on four. I'm just talking as a patient more than anything. I don't pretend to be an expert nor do I expect anyone else to agree with me. I"m just venting and it's JMO I totally hate when a doctor says "bipolar!" and pulls out the prescription pad before having a neuropsychologist screening to make sure that hmmmmmm maybe the behaviors are NOT all because of bipolar...but too often the psychiatrist doesn't ask for any help. I've seen enough very arrogant psychiatrists in my life. Some had a nice mannerism and bedside style, but they still felt THEY were 100% right. It is hard to find a good doctor. To me, a good psychiatrist is one who asks for other opinions before deciding on a diagnosis and medication. They DO exist out there...lol. I've learned to never trust just one opinion

 

[MyHrt31]

I feel good on my medications too. But that hasn't always been the case, and if they added any more, and I started feeling that vague "I'm in a dream" state again...that freaks me out. I hate it. Lithium made me feel like I was out of my body and it made me suicidal, but when I said I thought it was the Lithium, the psychiatrist (who was an idiot) just upped the dose and put me on more medications until I took a whole bottle of Valium. And when I found a new psychiatrist and he took my Lithium level, he was livid. I was WAY toxic. This doctor didn't check. He just kept shoving MORE medications at me, never once thinking that maybe the problem was too many medications or the wrong medication for me. Even if he had checked, my level was 1.6. THat is normal for some people. But I'm sensitive to medications. Oh, this is but one of many "medication" experiences...lol. I trust myself now more than the doctors.

Some kids need medications. in my opinion no kid should get a medication for every symptom. Some things we have to learn to do without medication. That may include paying attention. My son has trouble with that, but he doesn't want to be on stims and I don't want him on any and half the time they make things worse rather than better. I do think they push the medications as a fix way too much and, in the process, often make things confusing and worse...what's the problem...the patient? The medications he's taking? It's ridiculous. We medicate more than any country in the world. I do think we NEED to medicate things like bipolar and schizophrenia. But with five or six medications? My son used to walk around in a stupor and he couldn't do well in school from just two heavy medications. I can only imagine if they'd have put him on four. I'm just talking as a patient more than anything. I don't pretend to be an expert nor do I expect anyone else to agree with me. I"m just venting and it's JMO I totally hate when a doctor says "bipolar!" and pulls out the prescription pad before having a neuropsychologist screening to make sure that hmmmmmm maybe the behaviors are NOT all because of bipolar...but too often the psychiatrist doesn't ask for any help. I've seen enough very arrogant psychiatrists in my life. Some had a nice mannerism and bedside style, but they still felt THEY were 100% right. It is hard to find a good doctor. To me, a good psychiatrist is one who asks for other opinions before deciding on a diagnosis and medication. They DO exist out there...lol. I've learned to never trust just one opinion

Well I sure am glad I found this place. My son's psychiatrist is amazing, don't get me wrong. She's very thorough. She did a complete history on him before even trying to prescribe anything for him. She interviewed the both of us and got myself and his teachers to fill out these forms to help her pinpoint a diagnosis. In the past, my son's psychiatrists have pulled out a prescription pad within the first five minutes we are in the office. My problem is, they ask me "What are YOU doing to do about it" "This behavior disturbs me" "He is being manipulative" "You need to do something about this before he gets older". I hear this a lot and I am trying the best I can. Its so frustrating! He's never had an EEG before. Do you think that maybe this could show us something that has never been brought up before? I understand that a lot of it is behavior modification but his temper is so bad for a 9 year old. He's had to be restrained numerous times because he's tried to hit and kick teachers. I don't feel this is normal and I don't think any amount of behavior modification is going to help him. Is it wrong of me to rely on medications for these issues or do you think that behavior modification can actually help these problems? (Sorry for all the questions) Thanks for the advice and your opinion. I welcome any and all comments

 

[BusynMember]

In a word, I recommend dumping anyone who thinks you can stop his over-the-top behavior with behavior modification. in my opinion, that works for "normal kids", not ours. I would see a neuropsychologist. Teachers comments don't tell the doctor what's wrong. They are educators, not professionals. And her "What are YOU going to do about it?" sounds like a waste of time. He is sick. What is SHE going to do about diagnosing him? I so head for the hills when a therapist tries to act like really strange behavior in a child is because the child is a "brat" or "spoiled." If t his were my kid I'd be on the phone with the neuropsychologist and also want a new Psychiatrist. She didn't do the sort of testing neuropsychologist's do and she is insinuating that you can "cure" him by being tougher on him. In fact, in my opinion that's bad advice. He isn't "bad", he is in some way wired differently than other kids. in my opinion this isn't a keeper. The doctor should be telling you to get a neuropsychologist evaluation since she really isn't sure what is going on. A laundry list of diagnosis usually means, "I have no idea so I'm not going to leave anything out, and, on top of it, I'll tell you that part of it is YOUR fault. It can't be ME. It can't be that I don't know the real answer because, well, because *I* went to medication school." This not only happens in psychiatry, but in regular medicine too. You have to go with who you trust. My own personal opinion is that I would not trust this one or the therapist if she is of the same ilk. And I would not want my kid on any medications before a neuropsychologist agrees that this child really is bipolar and that there is no other option. And it may be that there is none, but she really didn't do all that much to come to her conclusion. There are "diagnoses of the day." First is was ADHD and now it is bipolar. Certainly many kids DO have bipolar, but when a diagnosis gets trendy you have to make sure that the child really has it because of the heavy medication that the disorder requires. Some of us were told our kids had bipolar and were blindsided when it turned out to be a high form of autism. The treatment for the two disorders are entirely different, even if the symptoms SOMETIMES can confuse a Psychiatrist (part of the problem is that too many Psychiatrists know nothing about neurological differences). Ok, so I've rambled on and on...lol. It's interesting to be a patient as well as a mom. I had a very serious mood/anxiety disorder that my mother says goes back to infancy. I was a very atypical child and have had many differences all of my life. Since my new medication combo, my life has been good. Until then, it was, at best, challening for myself and others. Along the way, I learend A LOT--like I trust self-help groups and their members a lot more than many therapists. I got more help from self-help groups than most therapists I've seen. They come with their own baggage. I worked for a group of Psychologists once and we knew their stories. A more screwed up bunch of people I never met...lol. One was a cocaine addict and he still saw patients...lol. Ok, take care

 

[MyHrt31]

Well thanks for being so upfront with me. While I do "get" that I need to work on assertive parenting, I know that this explosive behavior is not my fault and therefore there is nothing I can do about it. Its nice to hear it from someone else. Thanks for listening and for helping me to feel like this is not just my fault That may not be what they are saying but it sure as heck feels that way. And after 7 years of heaven knows how many different types of medications he's been on, I just don't know what my options are at this point. So, in order to get an appointment with a neuropsychiatrist, do I just have to call or do I have to have a consult? My son has Medicaid (now that I am unemployed because I can't work with my son getting in trouble all the time) so I'm pretty sure they will pay for it all. I have enough money in savings to live off of for the next month or so and then I'll have to start working again. I can also use my income tax return to live off of for a little while to get all of this taken care of until we get things figured out. I'll start looking into getting him an appointment tomorrow (I'm sure there will be a few weeks wait) Thanks again for helping me to feel better about the situation

 

[BusynMember]

I was just able to call. But you may need to ask your Pediatrician. I would ask HIM, not the Psychiatrist. She probably will say "He doesn't need one." She probably thinks she has it all figured out...lol. I'm pretty cynical.

 

[susiestar]

You say he has NEVER had an EEG? I would STRONGLY push for a SLEEP DEPRIVED EEG, not just a regular EEG. If the patient is sleep deprived it helps make certain things show up on the EEG. It used to be that before a person was put on medications for ADHD they HAD to have the EEG done.

In my case I pushed for the EEG for my son. Then a teacher tried to insist my daughter was ADHD inattentive type. But in my mommy gut I knew there was more going on than ADHD. so I took her to the same pediatrician neuro and got the same test run on her. And then they asked us to come in to get the results.

A phrase that strikes terror in the heart of any parent!

Turns out Jessie WAS missing the instructions and WAS not paying attention. But it was because she was having Absence seizures. No one else can see these seizures, but her mind just "goes blank" or as she says, she "blanks out" and it can happen very frequently and not be caught by anyone. So she ended up on seizure medications and has no NEED for ADHD medications.

When you describe your son throwing chairs, cursing at people, etc... has anyone suggested Tourette's as a possible problem? A good pediatrician neuro would check for that also, esp when a child behaves the way your son does.

I hope you can get out of the "blame Mom for everything" game so many "experts" play. And if the doctor thinks your child is bipolar or has a mood disorder, then WHY does she have him on a stimulant? Stims can keep a child cycling, or even make their cycling worse. There actually is a protocol docs are supposed to follow with a patient with a mood disorder. First is to start one mood stabilizer. IF that does not work, you may need a change or to add a 2nd mood stabilizer. Once these medications have been at therapeautic levels for 6 weeks or so then you evaluate the behaviors you see. If there are still problems, then you add treatment for those, including stims or anti-depressants very very slowly. You keep a close eye on your child, and a mood journal through all of this. Many people with bipolar cannot take stims or anti-depressants because it makes them cycle.

This is not a protocol I made up. it is on the website for the Amer Academy of Child and Adolescent psychiatrists, AND is the same protocol for the adults. I don't know the exact name of the group, but it is something like that.

If you read The Bipolar Child it will give a LOT of info. It also has this medication protocol in it.

I would push for new evaluations, and for a trial with-o the Vyvanse. Stims can REALLY make a person edgy and angry feeling. esp when combined with other medications.

Hang in there. Know that WE know it is not your fault. We know your son is mentally ill and often meltsdown because that illness. Yes, your son has to work on some things toget better. But he should get some breaks because he may not really understand why things are right in one situation and wrong in another.

Gentle hugs!

 

[Wiped Out]

Sorry if I peat anything but I didn't get to read all of the read all of the responses. Whenever my son has been suspended out of school, I made him do either school work or housework the entire day and he could only have a boring lunch.

It didn't really stop the behaviors in school but he didn't enjoy the days. I never extended it past the day of suspension and only during school hours. Don't think there would be any way to live through that!

 

[smallworld]

My son J's psychiatrist doesn't like to classify behavior as "manipulative" or "ODD/CD" because he says it's impossible to tell if the child can or can't control it. He does say that this type of behavior is a maladaptive coping mechanism that needs interventions (in the form of medications, therapy, school accommodations/services, etc).

But first you have to know what is fueling the behavior. If it's bipolar disorder, it most certainly needs the right combo of medications to stabilize the mood and then therapy can be helpful. If it's an autistic spectrum disorder, that might need medications (50 percent of kids with autism do take medications), but interventions at school and in the community most assuredly are also needed. Straight behavior modification doesn't always work with these kids because they have cognitive deficits that take them from 0 to 100 in about 2 seconds flat. They first need to learn (as in be taught) not to meltdown at the slightest hint of frustration.

I went back to your first post and saw that your son is taking Lithium, Abilify and Vyvanse. There have been anecdotal reports about Abilify causing irritability and aggression. In addition, Vyvanse can rev kids up instead of calming them down, particularly if they have a mood component to their symptom complex. I really wonder if your difficult child's medications are causing the behavior instead of treating it. If he seems worse than before he started the medications, I'd recommend asking the psychiatrist to switch medications. If she refuses to revisit the medications, then I definitely think it's time for a second opinion.

 

[MyHrt31]

Thank you all sooooo much, from the bottom of my heart I really do feel that since he's started the Lithium and Abilify, his irritability and aggression has gotten worse. Its hard to figure out which one because she started him on both at the same time. The reason she had him on Vyvanse is because he was already on it for a year and he seemed to respond better to it than the other stimulants. I do see what you are saying though about how stimulants can make bipolar children irritable. I did read the Bipolar Child a looooong time ago. It was probably about 4 years ago? I have a lot of reading to do, lol. I have a list of things I am writing down from the advice you guys are giving me. I think the first thing I'm going to do is to try and get an appointment with a neuropsychologist (I wonder if my son's social worker can call in a consult?) She's really on board with getting him more testing. I'll get him working on lessons tomorrow and add in some extra chores (I could always use extra help around the house).

He took a long nap when he got home from school and now he's sleepy again. I'm tempted to give him some Benadryl (the pharmacist gave me the okay to give this to him when he is having trouble sleeping occasionally) so he can get a really good nights rest. He's very calm right now but he doesn't want to talk about what happened. I asked him what he could have done to change things and he says he really can't think of anything. I'm just going to let it slide tonight and not make him talk about it until later.

Thanks so much to each of you for all your help

 

[Allan-Matlem]

Hi,

in my humble opinion forget about the consequences , forget about trying to motivate him using consequences , reward and punishment . Medication may help a kid to be more responsive to ' teaching ' , but medication does not teach skills that are needed to navigate the world.
Ross Greene has a new book - Lost at school ' - until your child feels that he is understood , his concerns are being met and that caregivers are working with him to come up with a better plan , improve his coping skills I doubt that his needs will be met. Using behavior modification to try and manipulate his behaviors and medication to treat the symptons in my humble opinion is not the way to go.
Check http://thinkkids.org . Doing to your kid will just make him resist even more and damage relationships . When a kid is able to trust his caregivers there is progress

Allan