Adhd, Ptsd, bpd, dyslexic, help for a 8 year old boy

[squeka]

We are on Medicaid. Im a single mother with 4 kids,1 who was sexually abused by her step father,1 whos father sexually abused his 1/2 sister and who has been diagnosed with adhd, ptsd, dyslexia, and possible boderline personalit dis, 1 who is 100% disabled with Rett Syndrome,hypotonia, and full sibling to the last three,1 who is 4 full sibling to the last two seems to be perfect,socially better than her 8 year old brother.My son with Adhd was diagnosed at 7 from a neuropsychologist who cost my parents the price of a small car.  He was only able to recieve and IEP under the schools ED, emotionally disturbed label.  Only 1% off of their score to be labeled dyslexic.He does see a counselor once a week, and a psychiatrist 2 a month through county health. He has been on numerous drugs, currently he is on 36mg of concerta, 1 mg risperdal, 15mg of mirtazapine. He is in the LD class for his ED. He believes that movies are real, and asks all the time if the person in it really went through what is happening in the movie, I've tried so many times to explain it to him in so many different way's. He still asks, did he really get hurt, no it's just a movie hon, I know it is but did he really get hurt, no hon he is just an actor. But did he get hurt. No he is just pretending like you do when you get dressed up. Then he will get mad, call me a liar, or have a small temper tantrum over not telling him the truth.  He misunderstands things such as a date or time, and when we(family and teacher) try to explain that he may have heard it wrong or that we may have said it wrong and it was a mistake, he insists that we are lying and that he is right. He has a love hate relationship with his little sister, he used to beat up on his big sister until she was able to do it back now he say's and thinks she is going to kill him. He wants me to get rid of his lil sister, he is violent with her and never alone. Then they can be best friends.He has lost all of his friends in the neighborhood,either because he wont play by their rules or they call him names or make fun of him. Kids his age and younger. He loves violence, he talks about it, and would obsess over guns.water guns, nerf guns, almost scarry more than the normal cowboys and indians american boy.Everyone thinks that I dont discipline him enough not my parents though. I can take away his toys, hold him in the house for a year, it doesn't matter it doesn't work.I've tried positive rewards, letting him pick the rewards,etc. it doesn't work He used to get beat by his father and watch his father beat on his sister when I wasn't around.The teacher blames everything on ADHD or his meds.The dr's don't want to speculate about the diagnosis, but throw meds at him. He will urinate in his clothes for fun and because he is busy,not wet bed, in toys on floor. What is wrong with him. He needs help and Im out of ideas.Isnt violent with other kids,talks violet,he gets feelings hurt by them. Very gentle with our guinea pigs & hamster.

[mommie2]

My son was diagnosed with bipolar disorder with psychotic tendancies. I tried all sorts of positive reiforcment and punishment which non work, like you. He had tried a couple of meds and they were not working either. I was at my emotional breaking point. I love my son but I also have 2 other children and I was concerned for them. My son tried to punch a teacher at school so that was it for me. I took him to a place called halifax behavior services. They kept him for 8 days and in this time they stabilized him through medication, numerous counseling and a behavior plan. Being in there 24 hours a day they can monitor new meds and get him to a dosage that works for him a lot quicker than at home because they can monitor his vital signs and his reaction to the meds. He had group and individual counsleing everyday sometimes mor ethan once in a day and they help him to realize how to act in schooll. He came out a different child. It was hard for me to let my 9 year old to stay away from home but it did him a world of good, things are much better in my home now. I also have medicaid, you should look for a crisis behavior center in your area. The objective is to keep them for a short time to get them stable. Good luck.

[Kevin Kennedy, Ph.D.]

Residential treatment is a non-hospital form of 24-hour care where a child is literally surrounded with structure, from the moment he wakes up until he falls asleep. If your son is managing at home, and does not require out of home placement, an alternative is a private, therapeutic day program, where his clinical (as well as his learning) needs can be addressed. In order to qualify for such a placement, a child usually has had to exhaust whatever resources are available within the public school system. At that point, children are referred to what is often called an out-of-district placement, schools that are operated by private agencies or organizations.

[squeka]

Please Help me to understand what a structured residential treatment is.  He is in a program that only accepts seriously affected children, through medicaid.  Im wondering if you are suggesting hospitalization to identify behaviors and go from there.  One of the major problems is the teachers in his LD class.  I do feel she is a good teacher, and she works well with him, but, she wants to put everything off on his adhd and say oh he couldn't concentrate, or he was distracted.  Those are not just adhd issues.  We have an Iep on Thursday and Im trying really hard to address the issues without blowing up at them. They want him to fit into a little box and behave.  Yet they don't want to look at the fact that anything could have made him act a certain way on that day. They have a behavioral support plan, he gets positive reinforcement, small class of 9 kids, there is a teachers aid all the time. He gets alot of help, yet he still has problems with non compliance and hates school and hates school work. Refuses to do homework to the point of emotional break down. I really feel, mothers instinct that he isn't getting enough saftey, feeling that he is doing bad and if feeling rejected. Yet Im reassured over and over by the teacher that she is positive, yet he needs to learn to be responsible for his actions. I can't pin point what needs to change.  Any ideas?  Thank You so so much for your help.

[Kevin Kennedy, Ph.D.]

As I'm sure you suspect, your son displays serious emotional disturbance. Apparently he carries multiple psychiatric diagnoses and also learning disability. To be frank, it does not sound like the providers are simply 'throwng meds at him' - they are trying to address the various symptoms that you so aptly describe in your note. The doctors are right in being careful about the diagnosis - it is often difficult to diagnose serious emotional disturbance in such a young child. The important thing is to to pinpoint the most serious symptoms and to devise a medication plan to address those target symptoms. I often say to parents that we do not medicate diagnoses - we medicate symptoms. It's not that the diagnosis is unimportant. Rather, diagnosis at such a young age, when symptoms can represent more than one condition, can be difficult. It is particularly difficult to diagnosis any condityions along the spectrum of personality disorder in children so young. The reason for this is that personality disorders, by their very nature, represent enduring personality characteristics, and young children are still developing; their personality structure is still evolving. If people suspect personailty disorder-type conditons in very young children, the diagnosis is often conduct diosrder or oppositional defiant disorder. The medication plan you describe sounds quite reasonable. The Mirtazipine is unusual in children so youg, but that does not mean it is a bad idea to use it. It targets both noradrenaline and serotonin in the brian, and both of these chemicals can be instrumental in depression. I do think it is very possible that your son may require a structured residential placement, such as residential treatment, to address his conditions, He clearly requires a degree of structure beyond what can be provided in a family.