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And the therapist said...

Ninji's picture

https://www.steptalk.org/node/242165

Last Wednesday was SS's therapy appointment. I hesitate to call it his first because she mostly asked me questions about his history. I think this week's appointment will be more her and him. I think.

Anyway, after asking questions about when and where he is having his tantrums and asking about his grades, she told me that she is not prescribing him any medication at this point.

She said that because he is bringing home all A's and B's that ADHD medication will do nothing for him. Also, since his tantrums are only at school and he is well behaved at home, that she feels he is choosing when and where to have these meltdowns. Also because it's primarily when he isn't getting his own way, she doesn’t think medication will do anything to fix the problem.

I was (and still am) pretty disappointed. I have no idea what she is going to do to "fix" his behavior. After the three of us spoke, she asked for time alone with SS. She spoke with him for about 5 minutes. He said she gave him calming strategy's. That also disappointments me. He has been given dozens of ways to calm himself. Including his own time out space in the school. Every teacher since 2nd grade has had him sign a contract that states ways he will calm himself and other strategy's. He CHOOSES not to use these techniques.

I just have to try and have faith that she knows what she is doing and she maybe can have some positive effect on him. If not, I am putting SS on my insurance next month and will look for someone else.

Comments

WalkOnBy's picture

Give it time. Medication is not the one size fits all that parents so desperately want it to be.

You also may consider looking for someone who specializes in cognitive behavioral therapy. Worked wonders for Thing2 when he was younger.

Ninji's picture

You're right. I need to give the process time. I'm just feeling desperate.

Honestly, I have always said that he is choosing to behave this way. He will behave fine for me when we go out in public but if DH is with us, he starts to act like a baby and will pull on DH the whole time and whine about being hungry or thirsty. SS knows I will not tolerate that behavior and will we will leave immediately and he will be lucky to go anywhere with me for a few weeks.

So, part of me thinks that he is doing this purposely and other part of me thinks something has got to be wrong with him. I would never have wanted to be seen in school at 11 years old crying my eyes out with snot running down my face because I didn't get to play the game I wanted at recess or didn't get to check out two books at the school library. I would have felt humiliated.

I looked up ODD and it kinda fit. Except it said that behavior is primarily at home. His is at school. Again, I'm just lost and mainly I'm afraid for him. His has already ruined most of his childhood. He has never had friends, no birthday parties, no sleepovers. It really makes me sad for him.

Indigo's picture

Shoot. I just responded to your last post. Multi-tasking fail. I'll let the posts stay there for now.

Something IS wrong with SS -- he isn't acting this way merely because he can. Manipulation and lying are learned behaviors that get results and take the pressure off of him. This youngster is in pain. I'll bet that he'd love for some peace in his life.

Keep on doing your best to help. {{Hugs}}

Ninji's picture

He whines with DH but has never had a full on tantrum like he does at school with the screaming, crying, cursing and threatening violence.

At this point, he is grounded from everything except skipping around the back yard and reading books in his room. When he has a really bad day, he doesn't even got to do those two things. He has to sit on his bed and be bored until lights out. Does not matter to him. We have tried every punishment I can think of and tried so many different kinds of rewards. Nothing works.

strugglingSM's picture

ADHD medication typically helps mostly with focus, so if he's able to focus enough to get his work done, then it is likely that common ADHD medications will not help him.

My SS takes ADHD medication to help him focus at school and it has not stopped his meltdowns when he doesn't get his way.

MoominMama's picture

Sounds like she thinks this is purely a behavioural problem. SS here used to be on Ritalin. It didn't help and he was on it for a few years. DH stopped giving it to him and he wasnt any worse so we just worked on the behavioural side and him learning to handle his anger. SS was never diagnosed with ADD, his diagnosis was a bit sketchy, PDD NOS. Then they just said he was high functioning auti. A lot of the time I don't think they
really know.

nengooseus's picture

Has anyone (including the school!) done full psych testing on this kid? That would be the logical first step to me. Sure, there's still subjectivity, but it's a bit more structured than just handing the kid some coping strategies.

I'll be honest, my bioDD is nearly 12 and struggling with her behavior at school this year. There was an incident at the beginning of the year that the school handled poorly and DD is really struggling to get passed. And instead of acknowledging how poorly they handled the issue, the school is pointing at DD as the problem.

I've had DD psych tested *several* times. She's highly gifted and struggles with anxiety, and has since she was a pre-schooler. She doesn't throw chairs (anymore), but she's been accused of "menacing" people by looking at them creepily (I've seen what they're talking about, it just doesn't bother me. She's weird.), and being "disrespectful" because she questions EVERYTHING and not always in the "right" way because she's not quite 12. Frankly, she expects to be treated more like an adult rather than a child (which is fully my fault), and they don't know what to do with that.

All that to say that if he's misbehaving at school but not at home, there may be something else going on that's causing him to act out. It's not necessarily a bad thing that the therapist wants to take a minute to figure it all out. Don't get me wrong, that doesn't solve your problem, but it might be a better approach than it seems.

beebeel's picture

No conscientious therapist will prescribe any meds to a preteen at the very first appointment. She will do a full evaluation before meds are even discussed.

just-a-lurker's picture

I would suggest you do some research on toxic stress for kids and it's effects on their developing brains. Just because he can control his behavior at home, doesn't necessarily mean he is simply chosing to throw tantrums at school, his mom's or wherever. It's not likely an attention disorder, but a stress disorder. If those environments are stressful for him, or if he feels on edge, it can have a major effect on his reasoning and decision making abilities in those environments. If this is something that has been going on for years, with no changes, it seems that it is beyond just being a choice for him. As I have said before, your SS and my SS sound identical in their behaivors in various environments. My SS has a stress disorder diagnosis. I at first thought it was a load of bull, but after hours of research and just witnessing his behvior amd reactions to things over the years, I wholeheartedly agree that chemically, his brain is off when it comes to reactions to stressful situations/environments.

This link has some good information about maltreatment and toxic stress' effect on the brain.
https://www.childwelfare.gov/pubPDFs/brain_development.pdf

Ninji's picture

Thank you. I will look into that. SS does sound a lot like your SS. He also hasn't formed any relationships outside DH, his sibling and I. I don't really think he has a bond with his mother. She has never really been around and all he has gone many weeks without seeing or speaking to her and never asked about her once.

Dontfeedthetrolls's picture

You have a good therapist here if she's not jumping to give him medication. You've stated that he can and does behave in one place and not another? That is a big deal. This is behavior and giving him a pill wont fix it. He has to learn how to behave in all locations and those dealing with him have to learn how to make it better.

For instance SO's son is a "normal" child in our home. Yeah we've dealt with crap but he knows our rules. When he's at mom's he acts up. Is that his fault? Yes technically but lets also consider her role as the parent. She is failing to make him behave where evidence show's he is clearly able to.

Its the same way with school. Yes it's hard but the child can listen under your care. There is something about school that isn't working and that needs to change. Putting him on medication when he doesn't need it can be a HUGE problem.

If you want to help the school your best approach is to ensure you are supporting them. That his behavior has consequences at home and that you are working with them to help him.

A good book for this is "The Collapse of Parenting." It actually looks at the over use of medication for children. That YES ADHD is real and should get treatment BUT there are times where simple parenting changes can help.

Please don't think I'm saying your doing anything wrong because I don't know what's going on but if the problem is at school then that's what it is. It's not a neurological disorder.

just-a-lurker's picture

SS is a normal child in our home as well. We have never had problems with out of control behavior with him, but he could be a terror at school and at his mom's. Absolutely no amount of consequences or positive reinforcement could change his behavior in either of those situations. And believe me, we've tried for years. I would say it was in part due to the inability of his mom to effectively parent him at her house (where she is extremly verablly demeaning), but it doesn't account for his behavior at school where they have been nothing but supportive and respectful to him, and give him all kinds of options and outs instead of freaking out. When he enters what he perceives to be a stressful envionment (which school has been from the get go), his logical brain goes right out the window, and he is unlikely to be able to effectively regulate his emotions and behaviors due to a heightened state of arousal (stress). The wrong look, touch, noise from another child sets him off. It's all about fight or flight for him and it goes beyond "chosing" to act that way.

I do agree with you that some meds, particulary ADD/ADHD meds, will never help regulate behavior related to stress and shouldn't be used. But other types can help if that is truly the problem. It is a proven fact that toxic stress and maltreatment alters the way children's brains grow. While the usual case studies involve significant maltreatment, there can also be a middle of the road sitation that can cause damage as well.

Dontfeedthetrolls's picture

School is in directly realtionship to his behaviors at mom's. He sees it as "unsafe" for some reason same as her home. Your home is "safe" and consistent.

Who has primary in this situation?

just-a-lurker's picture

BM had primary up untill SS was 3, then it went to 50/50 and has been since then, he is now 11, with the exception of a few stretches where SS lived with us full time because she "couldn't handle him". Dad is SS's rock, and he has always responded well to the both of us.

We know he sees school as unsafe, even though there is no logical reason to. In all the time he's been there (a separate school for EBD kiddos) he hasn't formed a trusting relationship with anyone, even thought it has mostly been the same staff year after year. He gets along with the staff, doesn't complain about them, but isn't as close to them as he is to us. Everything we do at home, they do there. It never mattered. 5 years worth of interventions, therapies, planning etc. didn't make a darn bit of difference. The medication he started about a month ago DRASTICALLY changed that. His weekly percentages have gone from low 30's to 80 and above. Meds were used as an absolute last resort, but have made a huge difference. Not out of the woods yet, but at least he now has a chance to process information and think about things before reacting.

mommadukes2015's picture

If the child is choosing to act out in a specific environment then it might be a good idea to meet with the school and negotiate the rules.

I worked at a children's psych hospital that was very structured-if a situation escalated to a certain point then certain things would happen. The children always knew what would happen if they did ABC and if that didn't work then the next time ABC happened a more strict consequence would be care d out. For example they earned points each day, if they earned above a certain number they got special rewards if they earned below they didn't. If they acted pout because they didn't earn the points they wanted they were sent to a comfort room and when they were calm someone would plan out what went wrong and what they need to do better tomorrow. Of course if they were unsafe to themselves or others they were removed from the unit altogether. We saw some kids with some pretty outrageous behavior but over time with consistency and predictability, ry all got with the program eventually.

If the school is having the problem, I would be curious to know what would happen of they were to adopt a predictable structured set of rewards and consequences and stick to their guns. So when he chooses the behavior he chooses the consequence.

Myss.Tique D'Off's picture

Is SS seeing a psychiatrist? Because if he isn't I would recommend that you take him to one. Dismissing medication for ADHD becuase he is doing well at school does not take into account that he is having aggressive outbursts which could be violent. Sounds like he needs an anti-psychotic more than medication to focus.

He needs to have a complete physical and neurological work up to see if there is any underlying pathology for his behavior - this is something a psychiatrist can look at rather than a behavioral therapist. There IS a problem with your SS's behaviour and your are trying to help him. If this person treating him is not a psychiatrist move on to one. If this person IS a psychiatrist, find a different one: bring home A & B's mean medication will do nothing for him? That's my cue to dump this person. This isnt limited to a school environment. He has had an outburst at church. There is a problem and I really doubt the person you are seeing is the person to solve it. Hopefully it IS behavioral but first rule out any underlying pathology.

advice.only2's picture

I would still look into if he's got Tourette’s, they can be over the top emotional about stuff.

My BS has it and pre-teen years were awful. He would have total meltdowns like you are saying, even going to far as to start hitting himself. DH and I have learned over the years how to handle him, and he still has outbursts on occasion, but he's gotten much better control over himself. His pediatric neurologist advised us against medications since they have far worse side effects than the Tourette’s.