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Author Topic: residential education facility  (Read 1514 times)
ProfDaddy
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« on: April 11, 2013, 02:41:54 PM »

I'm looking for a residential education facility for my S8, who has experienced explosive moods since age 4, multiple psych hospitalizations, behavior schools, etc.  He is showing early signs of full-blown BPD, using destructive rage, harm to self, etc. any time attention is on someone other than him.  He doesn't care if he destroys the family to gain all the attention.  His mom, my ex, is dBPD. 

Right now, S8 is in psych hospital to be stabilized, will probably transfer to longer-term psych facility, then we think he needs to be in a residential education facility for a year or so.  One of y'all recommended a longer-term residential psych hospital facility.  Now, does anyone know of a residential SCHOOL that has experience dealing with what will be a 9 year old with behavioral outbursts and early BPD tendencies?  Southeastern US would be good, if not anywhere in the US might work.    I'll post all the gory details of the case in a second message. 

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« Reply #1 on: April 11, 2013, 02:46:47 PM »

Here's a text of a letter I sent to the case manager at my insurance company, it details the current situation.

The situation with S8 has deteriorated.  Things have gotten progressively worse since October, 2012.  S8 is unable to function at school and at home.  His lack of emotional regulation and violent outbursts have recently resulted in suspension from school (11/2012), felony assault charges (11/2012), hospitalization (11/2012), placement in a public behavioral school program (3/2013). 

Monday this week (3/8/2013) S8 refused to get out of the car for school and was carried into the building and containment room by the Principal, an educational aide, and the school police officer.  Incidents of violent rages last week and this week, on a daily basis, have resulted in the need for containment.  Yesterday (3/10/2013) at the behavioral school he lost control over wanting a piece of tape during library time.  At home, he was in a violent destructive rage over having to sit in his room quietly for 30 minutes.  He threatened to destroy the house and started throwing and breaking things; he was not calming down even after 30 minutes.  The last time S8 threatened to destroy things (3/2013), he smashed holes in drywall in two walls of the house, with his feet and bare fists.  Because of his history of threatening to harm himself and others when this intensely out of control, and his history of destroying things, I called 911, the police and an ambulance crew helped get S8 slightly under enough control that I was able to take him to the Psychiatric hospital in NEAREST MAJOR CITY. 

It is unsafe to have S8 at home, unsafe for him and his sister and I am concerned that it is unsafe for him to be at school, since the behavioral measures even in the behavior classroom have not reduced the frequency, intensity, and duration of his rages.  In fact, they have increased.  S8 himself, the entire family, S8’s classmates, his teachers, and his caregivers are at risk when S8 loses control in his rages. 

Another important consideration the certainty of the psychological harm to S8’s 11 year old sister, D11, who is severely traumatized by living with S8’s violent mental illness.  S8 displays intense rages an average of three times a day, over normal daily activities, such as showering, washing clothes, taking turns, etc.  His sister is showing signs of depression, her grades at school have fallen, she cannot perform basic daily functions in the home (take turns, get help with homework, have quiet time to do homework and read, play a board game, etc.) because of her brother’s illness. 

S8's medications are not working and his current Psychiatrist is ignoring the clinical assessments administered by his Psychologist, who diagnosed OCD and anxiety with standardized tests.  PDOC (seen 2 days ago) only wants to switch from Risperidone to Abilify, because of lower incidence of weight gain -- the problem is that class of medication isn't working, S8 has not experienced any weight gain. 

Intensive in-home behavioral interventions have also been tried, 4 years ago, AGENCY sent a pair of workers who helped S8 and the family multiple times a week over a long period of time.  I have followed the behavioral plan they put in place, with adjustments over the years from THERAPIST.  I have a PhD in Psychology and so does my fiancée.  S8’s behavioral problems are not responsive to correctly implemented interventions, delivered consistently across many years, consistent across school and home. 

The behavior programs in the public schools have also not been effective.  S8 was in a behavior program in preschool and kindergarten.  He re-entered the behavior program in March of 2013. 

So I am trying to figure out where we stand.  MAJOR CITY PSYCH HOSPITAL is a short-term emergency measure -- they might be able to try a different medication and get his moods a bit more stable.  However, the last two admissions to HOSPITAL really didn't accomplish much for S8 but there are no other options for an 8 year old.  S8 had similar problems last November, HOSPITAL did not change his medication then and only recommended that I read Ross Greene's "Lost at School."  During the visit to HOSPITAL 4 years ago, a floor nurse suggested "supernanny." 

S8's medication isn't working, the behavioral measures at school aren't working, he continues to be a risk to himself and others, and there are no resources here that make a difference.  Here is the treatment plan I have in mind.

1)   Stabilize S8 at HOSPITAL.

2)   I would like for S8 to be admitted for longer term residential treatment.  Hillside hospital outside Atlanta is the closest facility that works with these sorts of cases in 8 year olds, taking a different approach than our current providers in the CURRENT area.   I have completed application paperwork at Hillside. 

3)   Longer-term, S8 needs to be placed in residential education for at least one year.  You indicated that this is not covered by INSURANCE COMPANY. 

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« Reply #2 on: April 11, 2013, 03:50:49 PM »

Hi Prof Daddy,

I'm sorry to hear how things have progressed. I really hope that you get the attention you need from your case manager at your insurance company.

I have a couple questions if you don't mind answering them:

1. It sounds like you are looking for residential treatment in a hospital setting (Hillside) followed by residential education. What do you mean by residential education? Typically, I think of residential treatment to be outside of a hospital setting that includes treatment and providing for his education.

2. Your school district via an IEP might be a form of financial support for a residential treatment center. It was for us. Have you checked into that?

3. Your county or state may also be a source of funding for residential treatment. Have you checked into that?

Being Mindful
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« Reply #3 on: April 11, 2013, 06:32:52 PM »

Prof Daddy it must be hurtful for you to be making these sort of decisions. And your poor son must be feeling so much pain to behave the way he does.

I just want you to know that I am thinking of you and your family,

Vivek    
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« Reply #4 on: April 11, 2013, 07:05:49 PM »

profdaddy

My heart goes out to you... .   what a battle you have been fighting. Your s is so young and to be so troubled I have to agree he needs some long term care. I am in the south but have you looked at the McLeans program? 115 Mill Street, Belmont, MA 02478, 800.333.0338... .   I am not sure where you are located but they have very good program there lead by the top doctors in BPD.

Has he had any success at the p hospital? Has he stayed there long term? Is there ever a time when he is happy? Sorry for all the questions but I wonder why he is so angry all the time.

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ProfDaddy
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« Reply #5 on: April 11, 2013, 10:08:31 PM »



I have a couple questions if you don't mind answering them:

1. It sounds like you are looking for residential treatment in a hospital setting (Hillside) followed by residential education. What do you mean by residential education? Typically, I think of residential treatment to be outside of a hospital setting that includes treatment and providing for his education.

I'm thinking a residential school for a year once he is stable.  He needs to unlearn all the manipulation of his teachers, caregivers, and family mmebers.

2. Your school district via an IEP might be a form of financial support for a residential treatment center. It was for us. Have you checked into that?

Working on that.  For that to happen, the school must have exhausted all options and declare that they can't handle him.  The school isn't likely to do that.  They will keep him in the behavior program, even if he is doing worse.  How did you make this happen?

3. Your county or state may also be a source of funding for residential treatment. Have you checked into that?

I don't even know where to start with getting county or state funding.  Any ideas?
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« Reply #6 on: April 12, 2013, 07:17:23 AM »

It sounds like you are looking for a therapuetic boarding school for your son once he is stabilized.

Getting a school district to fund an rtc/tbs can be a struggle.  There are educational attorneys that can help.  Also having the written recommendation for rtc/tbs from a pdoc, general physician, psychologist. Consulting with an independant educational consultant and having them appear at an IEP meeting with you may help.  Sometimes the school district will pay the educational portion (and also the residence portion) and the other 1/2 or so the insurance co will pay for depending on the certification of the rtc/tbs (jacho).

Getting the county/state to fund placement is a whole different route.  When I was first inquiring into tbs/rtc placement for my then d12 I was told I would have to relinquish my parental rights for them to step in and would have no say in her care or placement, that she would most likely go into therapuetic foster care rather than an rtc.  Perhaps your situation would be different.  It is something you can explore.  Maybe contacting your local MHMR and get educated on the options available for your son.

Hang in there, this is a tough row to hoe and you are a good father doing the best you can to take care of your family and get your son the help he needs.

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« Reply #7 on: April 12, 2013, 11:14:53 AM »

Hi Prof Daddy,

My d. for years had a 504, then an IEP. We did not have to exhaust all options within our school district before the placement in the RTC. We had recommendations from her therapuetic team, plus we had been working with the school district too. By the time, we were working on finding an RTC, the school psychologist was calling us to schedule a meeting because they could no longer provide an education within their means AND this was based on safety issues. No matter what interventions were tried, they couldn't keep her safe (neither could we at home) and all interventions for doing school work and being in school failed... .   regular classes to a structured setting. Luckily, we had an excellent school psychologist that was an enormous advocate for the RTC.

For county/state support, our RTC helped and suggested we begin that process immediately knowing that insurance companies push to get kids released before they are ready. Their idea was to have them on board to provide some financial support and full support if the insurance company eventually denied us. When we placed, we were only using insurance and some from our district. By the time of discharge, we had county and state services too. To lbjnltx, she has a good point about relinquishing parental rights. In my state, a number of years ago a law was past that did not require relinquishing and in fact, much policy was rewritten with the idea that the best support for these kids was to have parent involvement. Thus, you do want to be careful of that and really check well within your state.

Upon discharge, our d. qualified and received a ton of resources... .   some good and some really, really bad. The really bad part was a therapuetic DBT foster home that fell extremely short. Working with the state and county was a lot of work and dealing with people that just didn't get it. It was almost a full time job for me managing the services and being an advocate for our d. By the time she was fully qualified, she was entitled to $39,000.00 per year of services. We were able to direct those funds to where we needed them, where we thought it would best serve our d.

All of these processes are hard work and sometimes extremely frustrating but it can be done. I hope that helps some. Let me know.

Being Mindful
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« Reply #8 on: April 12, 2013, 11:36:47 AM »



I know one of the clinical psychologists associated with this facility:


www.youthvillages.org/

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« Reply #9 on: April 14, 2013, 11:36:09 AM »

Even more complicated.  Been engaged to a wonderful woman since February, we have known each other 14 years and dated the last 2.  We are at the point this month of selling both our houses and moving into one home.  She is aware of S8's difficulties and has been compassionate, supportive, and understanding.  However, the last few months have been intense and nobody in the family is functioning well.  We have signed a purchase contract on a new home and she has signed a sales contract on her home.  My home is up for sale and showing today.  The problem is that she is not sure she can live with the chaos of my son.  Even if he is placed in residential treatment, even with changes to medication, the future certainly holds more of these challenges for my family.  We are now contacting real estate attorneys about breaking the contracts and are not sure if our relationship can continue.  Really sad, I love her, my D11 regards her as a second mother.  I don't blame her for not wanting to live with this turmoil, D11 and I must do so, but will get occasional breaks when he is in treatment.  Not much of a life for my fiancee. 
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« Reply #10 on: April 14, 2013, 03:20:53 PM »

ProfDaddy - so much sadness for you today. We each face really hard choices in balancing the needs of our families. Maybe this is just not the right time to make the move. Keeping you in my thoughts.

qcr
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« Reply #11 on: April 14, 2013, 05:30:01 PM »

You would be feeling torn between what you have, what could be and what you want... .   it seems that whatever happens, your life will continue to be complex. Real estate decisions are also highly stressful situations and would affect all of you.

I am thinking of you in these hard times, 

Vivek    
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« Reply #12 on: April 14, 2013, 06:49:05 PM »

Ahhhh ProfDaddy,

I am so sorry for all this uncertainty that you are facing.

Being Mindful
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« Reply #13 on: April 14, 2013, 08:58:45 PM »

Profdaddy

My heart is hurting for you tonight... .   surely there must be a way to make this work? I don't know if I understand but have you broken off the engagement then? Are you not seeing each other anymore?

Your future is going to be hard but I am hopeful your s will have a good life. I am sure the next few years will be challenging but in time I hope you all get to a better place. I hope your gf can see that... .   you are a good daddy and you are doing the best for your son and that is the most important thing right now. I hope your gf can see that and respect the man you are.
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« Reply #14 on: April 14, 2013, 09:38:26 PM »

Hi Profdaddy,

I've been following your story and have been so concerned for you.

I am a Smom to 2 SS now 10 and 15, who have serious psychiatric issues ... .   who have a BPD bio mom. It's a very very difficult thing to be at times.

My DH is in your position of having a low functioning ex and no support from her as well as being the residential parent. We have all 6 of our kiddos almost all the time.

I do hope your GF can see what a good thing she has with you.

Marriage is not right for everyone, neither is being a Stepmom. Also, buying houses and selling houses is really stressful for everyone.

I hope, at the least, your GF continues to have a relationship with your D11. I think she needs all the strong, loving, stable women she can get in her life right now.

Yours,

mamachelle
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« Reply #15 on: April 15, 2013, 11:52:00 AM »

Things are ok with the GF, just scared all around in my family right now.  We're going ahead with the new house -- the rest of the family needs to live our lives and be happy. 

The insurance company recommends long-term psychiatric treatment at Laurel Heights, outside of Atlanta.  Does anyone have experience or information about that facility?
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« Reply #16 on: April 15, 2013, 12:24:47 PM »

profdaddy

That is good news and good advise... .   live your life and be happy... .   that is the best thing you can do for your family!
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« Reply #17 on: April 20, 2013, 07:20:48 AM »

Update.  S8 is now at an RTC for at least 2 months.  His dBPD mom insisted on going with for the trip to admit him.  I really wanted to do this without her drama and needed a break, so I gave her the contact information and said "fine, you take him there."  Surprisingly, the world's most disengaged parent did it. 

S8 is adjusting ok, pdoc from facility called and will try an SSRI and abilify for his rages.  S8 is sad, wants to know "why I sent him to this madhouse."  Life was unmanageable, nothing except caring for him could happen, the rest of the family was disintegrating.

Now that S8 is away, D11 and I can spend time together, fiancee feels more secure (knows he will be back, but also knows when things get bad I will get help for S8). 

Long-term, I ain't feelin' much hope after reading all of your continued struggles on this board.  Seems like the first of many visits S8 will have to RTCs.  He has been to the local psych hospital 3x... .  

Ok, D8 up now, time for breakfast and to finish our movie from last night.

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« Reply #18 on: April 20, 2013, 07:51:37 AM »

Hello ProfDaddy,

Glad to hear that s8 is in care and that the rest of the family has found a peaceful space.

I don't know about the rtc that your son is in. Is this clinical rtc a long term treatment facility?  Meaning 6+ months or longer?  Is the eduational aspect covered?  Once a patient is stabilized is the norm to move to long term care?

I too was very disheartened from reading about the struggles other members continued to have with the children/adult children.  Because I am a stubborn and determined person I chose to find a way for our situation to turn out differently or at least make every effort for that possibility.  My d went to a Therapuetic Boarding School (Long term RTC) for a total of 10 months give or take a week... .   today... .   we are living a life of normalcy and in some ways better than normal.

We are 2 years out of RTC graduation... .   can't guarantee what the future holds for my daughter.  I can guarantee that she has the tools and skills to deal with whatever lies ahead for her.  I attribute her success to the fact that she got treatment very early on, she got treatment in an excellent facility chosen specifically for her needs, her dad and I did 100% of our part to be the best support/advocates for her and most importantly the rtc motivated her to work hard on herself.

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« Reply #19 on: April 20, 2013, 08:59:59 AM »

Thanks for the reply lbjntlx.  S8 is in a psychiatric hosptial that has a school.  I did not find many that could help an 8 year old.  Their goal is to work with medication and behavioral treatments then plan a transition back to home and school.  I don't hold out much hope for a successful return to home and school, since his past pattern has been to use rage to control every environment and get the people around him to comply out of fear.  

I need to find names of therapeutic boarding schools and check out the facilities to have as backup in case return to home and public school either can't happen or doesn't go well.  I also have an attorney working on having the public schools pay part of this treatment, since their interventions to date have failed.  So, what are resources for finding therapeutic boarding schools?
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« Reply #20 on: April 20, 2013, 09:24:41 AM »

When I began the search for TBS/RTC is searched the NATSAP website.  This assured me that the resources were accredited schools for the educational component of her treatment.

It will take a great deal of time to vet them as you will find most won't accept such a young student.  This will also narrow your search as to where to invest your time... .   so it is both good and bad in that sense.

Have you considered an Educational Consultant to vet and present options to you?  They can help also in getting the school to fund placement.  Do not let the school tell you where to send your son!  This is for you to decide with guidance from peers, professionals and your own assessments of the facilities.

lbjnltx
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« Reply #21 on: April 21, 2013, 12:33:16 AM »

Hi Profdad,

I completely understand how disheartening it can be. I want to let you know that I never dreamed things could be as good as they are with my d. While she has improved, she has a long way to go. One of the largest changes came within my dh and myself. This was a huge factor in our lives to make the effects of the borderline more tolerable. It took a tremendous effort on our part.

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« Reply #22 on: April 22, 2013, 11:16:13 PM »

I considered an educational consultant.  They charge $4000 for the consultation.  The schools themselves are horribly expensive as well.  We're stuck, because the last year in public school has been a disaster and living at home has been traumatic for everyone.  He is only 8, far from everyone who loves him, and I miss my little boy.  This is really difficult.
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« Reply #23 on: April 22, 2013, 11:41:44 PM »

Profdaddy - can't even imagine how much you miss him, even though your home is more peaceful and you have a respite with your D. Whast kind of contact is planned for you with him?

What does the attorney say about the school district's contribution to the rtc? Hope this can be resolved quickly.

Keeping you and your kids in my thoughts and prayers.

qcr
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« Reply #24 on: April 23, 2013, 09:32:21 AM »

profdaddy

I am in the same boat as you. My daughter has been at her RTC now for one month. The distance from her has allowed me to look at her actions with less emotions and really see her illness. I feel that has helped. It also has given me a much needed break. Try not to feel bad about that. The first few weeks I could not walk past her room without crying. I miss her a lot but I know she is getting help where she is and that is more important than how I feel. Your son is young so I feel very hopeful for you that he can get some help early.

Now is a time for you to really take advantage of reading and taking classes if available. There are many videos too to watch. Also take some time just to relax and take a deep breathe. I am going to start going to a therapist too and I hope that will help me cope with everything that is going on. Take care of yourself... .   sending a hug your way... .   stay strong... .    
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« Reply #25 on: May 10, 2013, 02:44:13 PM »

Look into Midwest Center for youth and family in Indiana. They take as young at 6 years old at their Kouts location. They are used to dealing with aggressive boys. the staff are AMAZING and so caring. School is onsight. Its more of long term place 6months-a year. It can be longer depending on your childs needs. I am in their South Shore Academy Valpoariso Indiana location for girls. I have been here for 5 months already(im 19) and i have another 2-3 months to go. MCYF is a DBT residential center. Its amazing and has helped so much
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« Reply #26 on: May 10, 2013, 08:28:08 PM »

Profdaddy,

My heart goes out to  you and your little one.

1) Dealing with your insurance company:  Try writing a letter to the President or CEO of the insurance company.

Try to enlist the help of a local TV channel

2)Look into getting Medicaid from your state. Lot of RTC's take medicaid.

3) Enlist the help of your local Senator.

My thoughts and prayers to you and your family.

peaceandhope
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« Reply #27 on: June 07, 2013, 07:09:18 PM »

Thanks so much Smith.  That looks like exactly the type of program S8 needs.  The educational consultant found four placements, none of which seem quite right: Sandhill Child Development Center in New Mexico; Forest Heights Lodge in Evergreen, CO; Intermountain in Helena, MT; and Woodland Springs in St. James, MO.  Does anyone know much about these four? 


Look into Midwest Center for youth and family in Indiana. They take as young at 6 years old at their Kouts location. They are used to dealing with aggressive boys. the staff are AMAZING and so caring. School is onsight. Its more of long term place 6months-a year. It can be longer depending on your childs needs. I am in their South Shore Academy Valpoariso Indiana location for girls. I have been here for 5 months already(im 19) and i have another 2-3 months to go. MCYF is a DBT residential center. Its amazing and has helped so much

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formerly Dad6145


« Reply #28 on: June 07, 2013, 07:19:12 PM »

Update.  S8 has been in the longer term psych hospital, I think y'all are calling them RTCs, for 8 weeks now.  They have entertained many diagnoses.  They're keeping mood disorder NOS, adding Generalized Anxiety Disorder, ADHD due to impulsivity and distractability, and throwing in Aspberger's due to social awkwardness.

As for meds, the pdoc added Celexa for the anxiety -- I'm not sure if that is doing ANYTHING at all.  They added Strattera for the ADHD, again not sure if that does anything.  They continued Tenex for the aggression.  They switched from Risperidone to Abilify for the mood disorder.  I wasn't happy with the Abilify, since that class of medicines eventually causes permanent physical harm -- so I had them discontinue the abilify a bit over a week ago.  S8 has lost control on a daily basis since then.  Can't accept limits and consequences.  Was so mad about not earning enough point to go on an outing off the unit that he stripped and peed on the floor out of anger.  Totally out of control... . unless he gets his way... . which he can't there.  Pdoc ready to call it bipolar and put him on antipsychotics for life. 

Prior to stopping the abilify, the insurance company was saying "yep, he's stable enough, send him home and back to public school."  My fear is that the abilify is a bad idea for two reasons.  First of which is the permanent tardive dyskenesia, diabetes, and weight gain associated with long-term use of the med.  The second reason is that by preventing S8 from feeling any intense emotions, we get partial control over the rages, but long-term he is not learning to cope with these emotions in any sort of functional way.  This will create a larger problem once he matures and adolescence hits, he will experience even more troubling emotions, after having spent his childhood not learning to deal with them.  He will have no working coping strategies, no tools, no experience, stronger emotions, damage from the medications, etc. 

Aargh! what to do?
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qcarolr
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Gender: Female
What is your sexual orientation: Straight
Who in your life has "personality" issues: Child
Relationship status: Married to DH since 1976
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« Reply #29 on: June 07, 2013, 09:59:38 PM »

ProfDaddy

It is so hard to balance the benefits/side effects of meds, esp. with kids so young. My gd7 is switched from Tenex to Intuniv - a time release version of Tenex - and it works for both her anxiety and hyperactivity. I can tell when she miss the meds at breakfast by about 3pm and by bedtime she is bouncing off the walls. She is overall so much less aggressive than her mom was at that age (dh and i have custody, BPDDD27 is out of home now) so I maybe don't label it that way with her. Just much more defiant when off her meds. Sure can see the improvement for her.

The second reason is that by preventing S8 from feeling any intense emotions, we get partial control over the rages, but long-term he is not learning to cope with these emotions in any sort of functional way.  This will create a larger problem once he matures and adolescence hits, he will experience even more troubling emotions, after having spent his childhood not learning to deal with them.  He will have no working coping strategies, no tools, no experience, stronger emotions, damage from the medications, etc.  

Aargh! what to do?

There is a delicate balance between meds. needed to make the brain available to think - the side effects - and being so out of control that thinking is just not available to learn any of the coping skills. The other interpersonal piece is how to build a safe container for your S8 to be in while the meds. work. From a neurological functioning point of view - he has to believe at an unconsicous level that he is safe and loved before the mental connections can be made to think and learn. This is hard when a young child is so defiant -- he is in so much emotional turmoil and pain. I do not have a picture in my mind of how to find this - what do you think the rtc has to comfort him. Who sits with him - in a safe way - to tell him things will get better - he is trying hard and doing his best -- he will not be alone. My heart cries with you and him. This is so hard.

Keeping you both in my thoughts and prayers... .

qcr
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