6 yr. old w/ neuro and behavior issues

[Dee]

My son has epilepsy and Tourettes and at the moment the Tourettes is fairly severe.  By that I mean a vocal tic (gasping) that leaves him hoarse and several motor tics - head nodding, head jerking to the side and jumping.  He also repeats certain phrases, "right now," as well as mumbles to himself, but not conversationally.  During the course of these conditions he's been tried, without success, on several medications.  At the present he is on a very low dose of Lamictal.  The problem we have encountered since his symptoms began suddenly last year is the extreme change in behavior.  He cannot handle his anger and becomes physically aggressive.  Last night I asked him not to eat his chips in the living room.  He refused to give me the bag and when I went to grab it he tore it up and pieces flung everywhere.  He looked at me and smiled.  I said he had to go to his room and sit quietly on his bed.  He refused, as usual.  When I grabbed him he went down on the floor and started kicking.  I grabbed his legs and drug him to his room and then did the tug-of-war with the door holding it closed.  At that point I will not converse with him through the door other than to say he has to sit quietly for 15 minutes and then he can come out.  As usual he will grab anything in sight and beat the door with it all the while saying he'll, "Kick my ___ and send me back to h__."  Well, we're not a cussing family, but I won't even try to figure out where that came from.  He got quiet and then after 15 minutes he came out.  He came up to me and said he was going to hit me (I was cooking supper at the time).  I told him he knows he is not permitted to hit anyone (and we don't spank).  He then hauled off and punched me in the stomach and ran away laughing.  He we go again with the physical struggle getting him in the room and holding the door closed while he beats it.  I don't know how much more of this I can take.  Part of me can't blame all of this behavior on his neuro conditions, but part of me knows it has something to do with it.  With these things in mind, how do I handle a child that refuses to go to his room to settle down and actually ENJOYS me having to drag him?  For the record, when I try to pick up this 65 pound child, he goes after me with fists and legs and spits on me.  Yes, later on after it's all over, he says he's sorry and I say I accept his apology, but then I ask him how he could have handled the problem in a better way.  He'll always tell me a good answer, but says that he just "got so angry."  Yesterday's episode lasted for about 3 hours.  He later said his head hurt (mine did too), but then immediately went to sleep.  In your experience, do children with epilepsy (first complex partial and now primary generalized) and Tourettes exhibit these kinds of outbursts, or is this a totally separate issue?  I really do appreciate your input.

Dee

[Kevin Kennedy, Ph.D.]

Dear Dee,

It is not unusual for children who display seizure or tic disorders to also display aggessive behavior and generalized disinhibition. While such behaviors are not, in and of themselves symptomatic of neurological disorders such as those listed above, and should not be considered (partcularly with Tourette Disorder) part of the condition, they are often seen side-by-side in epileptic or Tourette patients.

Such a composite of symptoms requires a multi-discipline treatment team composed of pediatrician, pediatric neurologist and mental health/behavioral health professional. A sound program of systematic behavior management is required, along with pharmacological treatment (which cannot, in the case of your son, be directed only toward amelioration of the motor tics).