Wisdom of the GAL

[klmno]

Hello, everyone! Just dropping in for a short (ok I promise to try to keep it short) vent.

I had called and left a message for the GAL to ask if there would be any problem with the court to change difficult child's psychiatrist and therapist. We played phone tag for a couple of days. I said psychiatrist wasn't being responsive, tdocs say they can't do anything while difficult child is unstable, I think I might have located a great therapist, and difficult child is hypomanic so something has to be done. Then, I get this message from her - she needs specifics and would I please explain to her what hypomanic is because she has never heard the term and has no idea and doesn't understand it.

Now, I could understand that except- she is making legal recommendations to the court regarding my son and has done so for the past year. These recommendations include punishment, therapy, placement, etc. She has been kept informed of diagnosis, medications, the prozac trigger last year, etc. And she doesn't HAVE ONE CLUE what symptoms or characteristics of the diagnosis are? Couldn't she have looked this up or asked me before- like last year? Her recommendations come #1 with the judge's decisions. I couldn't believe it. I guess I should be glad that she asked now. She had said she represented kids on IEP teams sometimes and might go to an IEP meeting for difficult child and me. How could she help with that if she didn't even have a clue?

Well, I faxed her about 15 pages of info. that I printed out from 3 different websites. If she doesn't read it, I can't help it. I'll make sure difficult child's defense attny is informed of this.

On a side note- the wonderful therapist called and left a message that he will NOT do after-hour appts. He could do 10:30 am tomorrow. difficult child's sd is doing their big testing this week- that would never work. I'll call that receptionist again tomorrow and see if there are any others in their office who do appts. after hours.

We did see psychiatrist today- he finally filled form out for bloodwork. He switched difficult child from seroquel to risperdal (sp). Any advice or signs I need to know about for this one?

SIGH.... Just another day I guess. Thanks for reading and helping me through. You guys are my strength!!

 

[Steely]

Seriously...........who are these people that are supposed advocates for our kids??? Never heard of hypomanic???? Sigh!
Of course, as I am typing the word hypomanic, my Websters Dictionary browser feature is telling me that this is not, in fact a word. So perhaps, mental illness is just all too new for the world to keep up with.

As far as Risperdal, whatever happened to the dosing on Seroquel? As I remember he was on a really small dose? You have switched through the APs pretty fast, Zyprexa, Seroquel, and now Risperdal - I might give the Seroquel a chance with the right dosage.

 

[klmno]

difficult child is still cycling- having some problems with the seroquel zonking him out. teachers are saying difficult child is lethargic, sedated and unmotivated at school. difficult child went to appointment today with hair uncombed and looking like it hadn't been washed in 3 weeks and saying he felt sick and numb. psychiatrist explained (which others here had already explained to me- thank you!) that seroquel in small dosages works as a sedative. If he increases it to get to a dose that would help with mania, then there would be days of difficult child being severely worse with the "sedated" effect. Maybe it is just that our sd is doing their testing right now- maybe psychiatrist isn't crazy about seroquel (he did mention that getting the dosage right with this one is very tricky)- anyway- he says risperdal can be raised to a therapeutic level quicker and with less sedating effects, yet still should help him sleep at night.

Regarding the advocates- I really don't think we've seen a therapist yet who really has experinece with this. I'm sorry- I think they are misrepresenting themselves. You know- like the car mechanic who swears he can work on any car- but then directly ask him if he has actual experience working on a foreign car. That is how I feel right now. I should clarify- it is court ordered that difficult child sees his psychiatrist and therapist and is compliant- I am providing it and paying for it and I am the one who went in there showing the treatment I was providing for him, so the judge wrote it in his order. My question to GAL was only if there would be a problem changing the actual provider. Mainly because since difficult child has been seeing his psychiatrist for over 2 years, the judge listed the psychiatrist by name in the court order "difficult child must meet with and comply with Dr. XXX". Now, I am asking , can I change Dr. XXX to another child psychiatrist. I didn't think it would stir up a major chaotic event.

Oh- then, by the time we got to psychiatrist appointment today (before I faxed papers to GAL) psychiatrist says GAL has called and left him a message for him to call her. So, she STILL is out making rash decisions and stirring up more before even finding out what is going on. This kind of cr** from her last year almost had my son in ss custody- which opened the door for my bro to file custody. I had thought GAL's would look into facts and then make a decision- she is as prone to impulsive dedcisions as my family.

PS- I take it Webster didn't have a BiPolar (BP) kid.

 

[Christy]

I may be a little confused about the order of events but I am wondering if the GAL contacted psychiatrist for informatioin aout the hypomania? I understand your frustration, but at least she asked for information instead of just assuming that she understood the diagnosis.

As for the therapist and the school testing, in my humble opinion you have to ask yourself which does my child need more the appointment or the testing. I would keep the 10:00 appointment and let the school deal with a make-up. As a teacher, I know all about what a big deal state testing is and I also know that we had kids that were absent, arrived late, got ill while taking the exam, even a family at disneyland during testing week. There are provisions for make-up testing. Unless the court would have a problem with it, keep the appointment.

Best of luck as you continue to navigate through this situation!
Christy

 

[jal]

klmno,

As for the risperdal, it can cause weight gain. One side effect my difficult child experienced was his chest devloped what I can best describe as little "man boobs". There is a scientific name for this condition. We took him off of it for that reason and that condition went away.

 

[klmno]

Thanks, jal! I'll keep an eye out for that. Weight gain is already an issue- I wish there was a solution. psychiatrist did tell difficult child yesterday not to panic if something starting changing on his chest- and to tell psychiatrist so he could change medications if this happened.

I'm still weighing the therapist issue. One appointment., one time or occassionally, would be one thing. Having 10:30 am appts. means dropping difficult child off, going to work until about 9:40am, leaving to pick difficult child up and go to appointment., then dropping difficult child and getting back to work around 12:15 (lunch time)- assuming the appointment. is right on time. Do you see where I am going with this, being a single working Mom who needs to be putting more hours in at work, not less? Less hours means no money for medication insurance, which means I can't afford therapist anyway. Then, if I find a way to make this work for the 3 mos of summer, how much school is missed in the fall doing this weekly or every 2 weeks? Or, do we change counselors again in 3 mos.?

 

[susiestar]

I am sorry the GAL still has her head buried where it shouldn't be. I am appalled at the fact that she hasn't educated herself on difficult child's condition. in my opinion this should be criminal as SHE makes so many recommendations and decisions regarding your child.

You may need to go to the judge to get the psychiatrist changed.

Why, if it is court ordered, is the court not paying for it? I have been wondering this for a while. Here, if the judge says person needs treatment, docs, Residential Treatment Center (RTC), whatever, the county is required to fund it. You may want to look into the requirements for this, as they may have to reimburse you for a lot of expenses. Just a thought.

I hope GAL and psychiatrist and therapist get their acts together.

My difficult child was on risperdal for over 5 years and did gain weight, but never got man-boobs. It IS a side effect that happens, but not everyone gets it.

 

[jal]

That is a tough call with work and appts. We have been fortunate that difficult child's psychiatrist has after hours and the therapist we had also did after hours. psychiatrist wants us to use his therapist friend who would come to our house and do it, but I am hesitant as I do not know how much it will cost as neither takes insurance. I pay straight out of pocket and then have a h*ll of a time getting reimbursed.

 

[klmno]

It's a long story Susie, but in short, I got my son out of detention by proving that he needed treatment and by having it lined up for him. So, since the judge couldn't just let him go free, she wrote in his order that he had to follow this treatment. They would pay for A treatment- but I already know he would be sent to the county agency, whish is the LAST place I would want him to go (you would have to know what they are like here- I tried it 2 years ago- I think they are incompetent in EVERY way here.) And, at one point they were sending MST over here to do a behavior contract. I took that before the judge to get that requirement removed. So, more time, energy, and attny fees for me to prove that a behavior contract will never cure BiPolar (BP) or mood cycling and that this guy's 2+ required meetingss each week and desire to be involved in writing IEP and accompanying us to any other therapist appointment (which he really didn't want us to have to begin with) was interfering with the appropriate treatment that my difficult child should be getting. The judge ruled in my favor. I am more than happy to provide it -

Oh, I am glad the the GAL asked what hyppomania was. I just think she should have asked last year, once we had the diagnosis and I presented it to the courts. She has since appeared in court four times to make recommendations to the judge about what would be best for my difficult child. Shouldn't she have found out what his diagnosis really means and what the characteristics are and what is the recommended treatment first? The judge puts most weight on what the GAL requests- it was the GAL who requested MST. She didn't have a clue what treatment my son should be getting. She recommended the "county standard" and what the county had available. I'll move if I ever need assistance from my local agencies. This may be what I have to do soon.

 

[janebrain]

where we live you still have to pay for treatment even if it is court ordered. My difficult child 1 was court ordered to rehab but we had to foot the bill. Also, she could not be kept there against her will so once she got her GED at the rehab she decided she was done (she was supposed to stay there til she was 18 but wanted to leave 2 months early). She refused to cooperate at the rehab so they called and made us come get her. Since it was a violation of her probation we could have gone back to court but since she was nearly 18 and seemed to want to improve her life we let her come home (mistake!!!)
Jane

 

[susiestar]

thanks for explaining. I know our old therapist here used to have to be in court for a few patients, and the courts paid the fees for many many different things. some were incompetent, but some were really good.

It sounds like you are as on top of things as any of us can get - why can't the judge rule that difficult child has to attentd treatment/therapy/whatever as recommended by the expert on your difficult child - YOU? Yes, I know. Pie in the sky. But it would be nice to see a sensible and logical outcome after all you have done and fought for to help your difficult child.

It infuriates me that this GAL woman has been making recommendations for your son when she had NO idea what was going on!

Susie

 

[klmno]

Thanks, Susie! I don't think the GAL means harm- it's the county paying her fee and she is swamped with cases so I guess she is spending minimal time on each one (you know these people- the ones who know better than the parents LOL!) Anyway, I am educating her as fast as I can. She can make rash decisions, though and that scares me.
I wouldn't have even called her over this if the judge had written up as "difficult child must comply with psychiatrist's recommendations" but, since she listed psychiatrist by name, then I felt I should call if I was thinking about changing psychiatrists.

The thing I really wish they all could see- the problem isn;t that I won't comply with treatment and difficult child does, except for a few bumps periodically, the problem is that adequate mental health treatment is not there. At least, I haven't been able to find anything that I can provide in between the 15 min psychiatrist appts. every 3 weeks (at best) and acute hospitalization. I am worried that gal will say, then just send difficult child to state psychiatric hospital. That is 3 hours away and the kids are up there in bad conditions and treatment is delayed due to beauracracy and really, I think he just needs an adequate (experienced in BiPolar (BP)) therapist and maybe partial hospitilazation for a few weeks or 2-3 mos at most. The gal tends to look at what the county can provide, then pick something. Not looking at what difficult child needs and asks if it is available and advocate for it if it isn't ready available- like I think she should be doing. The big pressure is coming from difficult child's court dates in 3 weeks for the judge to determine his sentence and if he can remain at home, if he needs to stay on probation, should she turn him over to state dept. of corrections (who can put him in state psychiatric hospital), etc. i already know, ss and psychiatrists and tdocs have confirmed- the state cannot provide more for him than I can. My concern is that the GAL isn't well enough informed to know that- so she could recommend it anyway- and the judge will listen to her.

 

[DammitJanet]

KLMNO....please dont take my question the wrong way because my mood isnt very good right now so I probably shouldnt even be posting but....I am a bit confused exactly what you expect out of everyone involved in your sons care...psychiatrist, therapist, GAL, laywers, school personnel...everyone.

Are you expecting that because he has a mood disorder diagnosis that there will be some sort of magic pill or therapy or doctor or situation that will make this all work out smoothly? I dont think any of those things exist. You can try for the best medication combo you can find with the least amount of side effects but a bipolar person will never be completely stable...not all the time. No psychiatrist is going to be perfect. No therapist is going to do therapy exactly the way you may wish that it would be done. Therapy is long hard work that can take years to see the results. School systems can put in plans to help try to assimilate these kids but in many cases it just doesnt work well. The kid has to want to try too. If both arent invested in the end result...it wont work.

I think maybe its time to lay some of the ball into your sons lap and help him learn to advocate for himself. He needs to learn about his illness and his medications and how to get help for himself. He needs to learn that he isnt a victim to his disorder but how to use tools to rise above it and not to use it as an excuse to behave badly.

Please dont take this wrong. I am just trying to give you advice from the other side of the bridge. I tried desperately to get mine all the help under the sun and run in front of him with a neon sign saying...danger danger dont do that...but he did it anyway and look where we are today. 21, 9th grade drop out, convicted of 4 felonies and a 2 year old. Nice huh?

 

[klmno]

No offense is taken, Janet- I appreciate your input. I do tend to question everyone and everything when difficult child isn't as stable as I think he should be and I'm sure I expect more than I should of others during these times. I think the gal is expecting that difficult child should be stable now and forever- maybe I am wrong- that is just my interpretation. That makes me feel more pressure.

Yes, my son does need to learn about his illness and start learning how to maintain himself and function with it. This is the therapist issue- partly. It might be our fault, too, but I'm not sure we know what more to do without a therapist helping out.

Anyway, thanks for trying to keep me firmly planted on the ground and reminding me to have realistic expectations!!