help! for a 12 year old in crisis

[jankitch55]

I am a local authority foster carer with a young person who is in crisis. We are currently going through appropriate channels to get the help he needs, but it is a long and drawn out process, in the meantime we are trying to make the best of a bad situation. to give you an idea, 12 years old, regressed  at times to about 2. No known history of abuse of any sort. diagnosis of ADHD on meds - medikenect and risperidone. very poor self esteem, very poor social skills, very poor self care skills. regular behaviour - temper tantrums of the type most people would never encounter with a vocabulary that turns the air blue, even for someone as open minded as us!, a lack of toilet training - when he first came to us had not been successfully toilet trained depute being 11. This has largely been rectified, although we have occasional accidents in the wee dept. however, most stressful for us and most worrying for him is best illustrated by an example all too often seen by us in the last two to three months ( he has lived with us for 15 months, has regular supervised contact with mum and older sibling, doesn't know father) tonight just after he had gone to bed we were told that he had been to the toilet and needed help. what greeted us was a bath room covered in ****. it was smeared all over the walls, it was all over every fitment, the shower walls, the floors, the sink, the outside of the toilet, the ceiling, the floor outside the bathroom ( carpeted) all the bedroom door handles, all the toiletries in the bathroom and finally, he was covered in it up to his armpits. his initial reaction was that it had got that way trying to clean it up. The toilet bowl under the waterline was the only place that there wasn't any! he did then inform us, that he had actually **** into his hands. he doesn't know why he does it, and we would disagree if anyone said he was doing it for attention. This child is  in crisis. we showered him and got him back into bed. he wasn't told off at all. we then had to start the gargantuan task of cleaning and we thank god that tonight at least, the other young people in the home didn't add to the problem, but actually offered their help. obviously we are seeking help from CAMHS, are reading and implementing suggestions from 'The Incredible Years', but are looking for any practical help out there to help him and to help us better cope, while the CAMHS Wheels get into gear.any suggestions would be gratefully received. this is not the only problem we are seeing but it is certainly one of the most difficult  we have to deal with on a regular basis and remain sane!

[jankitch55]

Please excuse the typo's! auto correct on the iPad is the bane of my life!

[jankitch55]

well, the psychiatrist said that the risperidone was excellent at controlling impulsivity and that it would last overnight, til the following morning if we give it to him each evening. he didn't expect to see a difference on the 1/2mg dose(10 days on that dose) but that now we have upped it to 1mg within four weeks from his starting to take it we should see a marked improvement. if not he will try 11/2ng a day. he said it is very important to get both the risperidone and medikenect working complimentary to each other and not against each other. in the meantime we are waiting to see if a group of psych experts are available to offer some therapy for him (art/play therapy) and some support for us. A half term holiday is coming up at the end of May and we are organising ourselves so tat we can sit down with him then and set some boundaries and behaviour modifications that he can begin to work on. We are following advice grim the ADHD Book and his life is going o be far more rigid, with rules and consequences as well as rewards and praise. Hopefully, this will make life more pleasant for everyone, not just him. I sure hope so, we are exhausted! we live in a 3 storey house, and my husband is getting very fit running up and down two flights of stairs to their bathroom/ bedrooms to ensure we don't have too many repeats of the poop incidents. since we moved to supervision and our ensuite these problems have lessened but not disappeared and we have to be alert all the time with him! smalls steps, but at least they are going in the right direction. will continue to use this site, it is very cathartic!

[Sandman2]

   Yes, I have had enough exchanges with wonderful people from Britain to understand that the treatment of ADHD over there is not quite the same as here.
  Glad you liked the ADHD book.  I am sure that you will find it useful for years to come.
  Quick thought on the meds.  It sounds like his ADHD meds are running out by 3:30.  His doc should know that.  Its a pretty easy fix.  Also meds like Vyvanse will last much longer.  I looked up the med for his constipation.  It has several side effects like Diarrhoea.   And it is not recommended to take it any longer then two weeks. http://www.netdoctor.co.uk/digestive-health/medicines/movicol.html
   I wonder if a simple stool softner that contains docusate sodium might be a better way to go.    http://www.webmd.com/drugs/drug-323-Docusate+Sodium+Oral.aspx?drugid=323&drugname=Docusate+Sodium+Oral
   Risperidone does work fairly quickly
     http://en.wikipedia.org/wiki/Risperidone
   I guess I am kind of curious as to the difference that you see in him since you have restarted the risperidone.  It is a very powerful medicine.
  

[jankitch55]

I thought that I would just let you know that I have bought the ADHD book you recommended - what a brilliant guide! Along with 'The Incredible Years' (also brilliant)I feel that now me and my husband can sit down and forge a workable plan to discuss with the child to help him manage his behaviours better! things are not going to change overnight, but we can start to make small steps. Thanks, I will of course still use this forum for help too as you have helped so much too. By the way, not everything has translated so well to British systems, both with education, medical and after school, but most of it was globally applicable if not quite the same terms are used. The books versatility allowed me to substitute other ideas when something was suggested that really doesn't happen over here (going out for breakfast, springs to mind - we Brits just don't do this as a family, and were surprised when we were visiting family in Canada to learn how regularly it appends over there!) Anyway, thanks again for all your suggestions! tonight I didn't give him his risperidone til 6 pm and noticed two things- 1 his behaviour from 3.30 til 6.30 was very hyperactive, to the extent that others mentioned on how 'high' he was and secondly, that when he came for his goodnight hug before being taken to bed by my husband he said he was glad to be going to bed as he was really really tired! was this a direct result of the time he takes his meds? I didn't think they worked that quickly?

[jankitch55]

The only meds he has other than the two I mentioned are a sachet of Movicol for his bowel movements as he gets very constipated

[jankitch55]

well, we saw the psychiatrist today and his risperidone is one 1mg per day. he said we can split it in to am and pm 1/2mg or just 1mg a day. he said if we gave it late afternoon t would still be effective in the morning, reducing some of his silly behaviour first thing in the morning, which can be quite bizarre. seeing him again in 4 weeks so will ask for more clarification about what time to give it. in fact as I type this I thought why wait til then, I will call him on Monday, he is difficult to get hold of, but it's got to be worth a try! Thanks, will check out the website you suggested too.

[Sandman2]

   Quick  note as you are heading for the psyc.  The timing of the risperidone kinda puzzles me.  If its for sleep, its a bit early and there are other meds that are not as powerful that would work better.  If its for behavior - why not earlier in the day?  Anyway, sending you my favorite site for meds of this type.  Try to overlook the name.  The author has compiled great, useful information.
   Its --     http://www.crazymeds.us/pmwiki/pmwiki.php/MedClass/MedList

[jankitch55]

thanks for your input, much  appreciated. we have been experimenting with his meds particularly the risperidone, he was off it for about 3 months and now we are in the process of reintroducing it. he takes 1/2 mg at about 3.30 each afternoon. tomorrow we all go to see his psychiatrist and his meds will be reviewed again. we anticipate they will go up to 1 mg.  it is important to get the dosage of both his ADHD drugs working in balance with each other. hopefully tomorrow we will also be a little closer to getting him some therapy - we might need it more if it isn't forthcoming soon!  in the meantime we are trying to supervise as much as possible his toilet and showering routines by using our en suite, with us in the bedroom - it seems to be working at the moment and it keeps the other young people happy using their bathroom! thanks too for your literature and forum suggestions - I will certainly be giving them a good look. We are trying so hard,  this young boy needs our help and we will fight for him as long and hard as we can, we just need to be careful of our own stress levels - believe it or not, using this forum is definitely helping me!
thanks again, it helps to hear others thoughts and ideas.

[Sandman2]

   A few other thoughts in that some of this may be related to the ADHD.  In the book, "The ADD/ ADHD Answer book," by Susan Ashley, she says (p 72) that the rates of daytime wetting are 3X higher for boys and the rate of nighttime wetting is 5X higher. "  It is not unusual to wet the bed until 10 to 12 years old."   And bowel movements are also more prevalent in kids with ADHD.
   Part of the problem is that when off the medication, the self control is less.  And its possible that the resperidone is also part of the problem.  Especially, if he is taking it later in the day.
   The standard for any child with ADHD is a very regulated schedule and I think that this should also go for bathroom visits.   By the way, I am also the CL on the ADHD forum - http://www.medhelp.org/forums/ADD---ADHD/show/175    feel free to post any questions there too.
    In term of this tantrums, etc.  You might want to check out the book,  called "Raising Lions", by Joe Newman.  If you go to his web site and subscribe to his newsletter you can get $3.00 off the book.  The site is http://raisinglions.com/
   By the way, you guys handled the night time crisis very well.  It reminds me of a kid who was extremely frustrated and lashed out.  Hopefully, it won't happen again.  Oh, one last thought - when was the last time he had any change in his medication dosage?  If he has been on the same dosage for awhile (and has been physically changing), it may not be as effective or long lasting as it once was.  
   Hope this helps a bit.  Best wishes.

[jankitch55]

thanks, we are already trying these, are very understanding, but our stress levels are pretty high dealing with him on a day to day basis. thanks anyhow, your insight helps us to be assured that we are doing all we can, even if the other young people in the house feel like killing him! Just hope that CAMHS don't drag their feet!

[IChris]

Sounds like a classical stress disordered kid, and cognitive behavior therapy may be tried.

The reason for his soiling issues may be complex.
-One possibility is that it is a way to relax; giving up all responsibilities to manage a high stress level.
-Another one may be a way to feel loved and cared for (without demanding attention; more an emotional simulation task)
-A third may be a way to get self control (which obviously end up in a stage without self control, but as an impulsive kid may have hard to predicate)
-A forth may be to get sensory stimulation in a given way.

Many other reasons may exist as well. The first task at hand is to understand why he do it, then one can work on solutions to it.