View Full Version : meds for homework meltdowns


qanda
10-22-15, 12:44 AM
My 14 year old daughter is having homework meltdowns. She is currently being tested for ADHD, diagnosed anxiety/panic attacks. Currently taking 7.5 mg Lexapro and was weaning off but we are reavaluating.

She has extreme meltdowns now from her 9th grade homework. What should take 1 hr takes much longer. It seems it's too hard. Maybe she just can't focus. Just the mention of homework leads to anxiety, then the start leads to anxiety, and then mid through leads to a full meltdown, with her saying she wants to die, hope she goes to sleep and never wakes up, etc.

Do meds help with this? I am hoping so much they do, if in fact she does have ADHD of course.

TangledWebs
10-22-15, 01:59 AM
My 14 year old daughter is having homework meltdowns. She is currently being tested for ADHD, diagnosed anxiety/panic attacks. Currently taking 7.5 mg Lexapro and was weaning off but we are reavaluating.

She has extreme meltdowns now from her 9th grade homework. What should take 1 hr takes much longer. It seems it's too hard. Maybe she just can't focus. Just the mention of homework leads to anxiety, then the start leads to anxiety, and then mid through leads to a full meltdown, with her saying she wants to die, hope she goes to sleep and never wakes up, etc.

Do meds help with this? I am hoping so much they do, if in fact she does have ADHD of course.

Gosh, that sounds rough. ADHD meds could help, yes. Though, I would recommend she see a therapist and learn healthy coping skills in the meantime, like distress tolerance.

Distress Tolerance:
http://www.getselfhelp.co.uk/distresstolerance.htm

Impromptu_DTour
10-22-15, 02:12 AM
A little ranty.. you can skip down to the if you like.

Sure the lexapro can help with the anxiety, and if you and her choose to go that route, add medication is an option as well. I identify myself as an engineering student with ADHD who needs them to function on these levels... my education is too valuable to me to risk having it tumble down around my ears by not being responsible with my condition. but i'll be honest. When it comes to these kind of things, my experience is that medicating can help level the playing field, but they wont win the game for you.

Lexapro and Adderall aside, one thing that isnt talked about enough are developing healthy study rituals, habits, strategies, work arounds, and stress management. I want to emphasize "strategies". But the stress management is pretty important too. I dont think people really recognize how challenging it is for someone with ADHD (or poor stategizing and planning skills regardless of the presence of ADHD). Im not talking about making a list and following it (though lists, whiteboards and paper reminders help me quite a bit). Im talking about strategizing on a much more internal core and automatic level... like.. all the way down to how a person might even simply begin to shift their attention to changing their attitude about moving to a studying frame of mind. Theres a series of steps that happen, and for practiced and good students, that flow is automatic when the realization is there that you have to work now. Thats not there for everybody.

As a student who struggled (struggles!) greatly in school, one of my chief difficulties and complaints, is that I wish I understood earlier, and was able to vocalize was that being a responsible and proactive student.. is freaking exhausting. For me, its because I have an inhibited Executive Function and Self-Regulation.

Executive function and self-regulation skills are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses.

The truth is, medication is a lifesaver for people, and its also ineffective for others at managing this area of our lives. The truth is ADHD is also a developmental disorder whose magnitude affects people differently, and when it comes to moving from task to task, and internally developing strategies and methods that are so subtle people are incapable of even communicating an awareness of how those systems are doing their job.. because i dunno, i dont think we arent ment to be cognizant of that level of psychological functioning. Kind of like how we dont think about breathing.

However many of us who have ADHD lack this (not the breathing part, i seem to have that one figured out ok).. and have to figure out how to stimulate that process to happen. And wihtout a working framework on how that process works, it takes trial and error and practice to rig something up, and then practice and execute until it becomes natural enough that it takes less effort to, in this case, study effectively. Sometimes medication is enough, but often its because of poor development of stategies having not taken root, which are contributing to the magnitude of trouble people with ADHD can have at this "thinking" stuff.

Being a student is not easy already, its not something that comes naturally to many of us (ADHD or not). And in all cases it takes some measure of practice, effort, and strategizing and changing up strategies that don't work. Theres alot of experimentation that goes on here. And a lot of it is behaviour and self-discipline.... and rewarding yourself.

It doesnt help that the millisecond that stress/frustration and a sense of defeat creep in the mix, the whole attempt pretty much is shot to hell until the emotional aspect can be dealt with and filtered out.

I dont know what will work for your daughter, but it does very much sound like this is a situation where medication likely would help with some of the symptoms, but the brutal truth is the rest is behavioral modification, self-coaching, and being very patient with herself, and you continueing to be patient with her, while figuring out a system that works. So as to say, what it takes for her to be the successful student that she wants to be.

Myself? I medicate of course. I wouldnt be here without it. But I also recognize that 9.9 times out of 10, i cannot study at home because i am distracted by an environment that represents comfort and relaxation. So my mind, begins dumping those neurotransmitters and my motivation craps out. it doesnt help that I also procrastinate by finding housework to do.. so taking myself out of that environment and into an environment that is specifically for studying, is a much more successful approach for me. And much like how the saying goes "Keep the activities of the bedroom exclusive to the bedroom, and the bedroom only for those activities", is kind of a big part of it.

I also limit my socialization while deep in periods of school, because ive learned that often, friends who are not in school (or dont care enough about it), work against me, and dont respect my needs.

I am a creature of habit, and ritual. And ... well i dont have much money but id wager that your daughter is too. So.. i have to keep on top of myself to be cognizant of developing new routines and sub routines, and being aware that i might need to change those routines all together. For instance, im way behind in my reading.. that reading is not going to happen at the time of day that i have been leaving it to.. which is the evening after figuring out code, and physics lab writups and essays. Learning new material at.. any time after 9pm is seems is pointless and an instant waste of energy and time. So.. i need to change my routine (and make it my ritual/habit) to do my reading in the morning.. because even though im not a morning person, I digest new information faster and better in the morning.

Theres a lot of self learning that I had to do, to really identify why i was failing.. and coincidentally, i just wrote a report on a TED type talk by a guy named Josh Foer, "The OK Plateau", which is basically a talk about becoming an expert, or pursuing expertise in a skill (from a generic framework). I dunno.. you might check it out.. its got some value to me. Might as well share that. He talks about how people successfully striving for expertise, push themselves outside of their comfort zones, because you cant grow without challenge.. but also they mentally approach "failure" differently. They study how they failed, and identify why they did, so they can change their approach. Its not so much "winning" by finally not failing... moreso than it is debugging all of the unproductive approaches.. and actually gaining experience at approaching a task, so that when you do succeed, its because there was no way for you not to, because you've already corrected your behaviors, skills and understandings regarding your obsticle.

But the summary of my .. "this" which i ranted on, im sorry. i did medicate today, but i didnt sleep last night.. anyway. medication has the potential to help with a number of other potentiators, from increasing her dopamagenic response to correcting emotional disregulation, to attenuating her ability to focus, and even promote drive. but she'll still have to face and manage her internal triggers, and correct how SHE is responding and recognize specific mental paths that she'll walk down when she starts failing at studying.. and stop herself, and try a different approach.. even if its as subtle as recognizing that she needs to switch how shes thinking, or be aware that her perspective might need to switch up (The pills are saviors for many people, but they're not magic.). and you guys will need to develop an approach to figuring out how she can be a successful student, methods, whiteboards, what topics are best studied when, schedule, routine, habit (sleep is a big factor). She might need to get strict with herself. She might need tutors.

I dunno.. learnins not easy. ADHD or not. And people like to forget to tell you that its not as straight forward as sitting down, reading your textbook, and regurgitating trivial nonsense that you'll never use ever again. Theres alot of mental work that goes on that people dont have any trouble forgetting about, especially when harping on students who genuinely struggle. Its a skill, and its different for everybody. Sometimes it needs extra attention to develop the methods and strategiez necissary to be successful and not fight the current all the way through school.

I think a good place to start is to help her develope a way to re-frame her emotional response to being frustrated. It takes time to be frustrated, and for us ADD folks, it takes alot of time, because theres generally alot of detours in that distraction.

Next place to go to, make a "sterile" studying environment. Dedicated for studying, lots of light.. lots of desk space (im a sucker for surface area and bright office neon tube lighting.), plenty of time (because studying is going to take longer).. and making a system for studying. And if you can get her to, if shes having trouble with analytical coursework (math, science, etc). rewrite her notes in a way she can understand them, if thats writing out in a literary sense what shes actually doing in math.. then so be it. but those are her notes.. they're for her benefit. She may as well make them useful. And practice.. i hate to say that its super important. Aha moments dont just happen without some kind of potentiator.

OK IM DONE. sorry. Good Luck.

sarahsweets
10-22-15, 03:08 AM
My 14 year old daughter is having homework meltdowns. She is currently being tested for ADHD, diagnosed anxiety/panic attacks. Currently taking 7.5 mg Lexapro and was weaning off but we are reavaluating.

She has extreme meltdowns now from her 9th grade homework. What should take 1 hr takes much longer. It seems it's too hard. Maybe she just can't focus. Just the mention of homework leads to anxiety, then the start leads to anxiety, and then mid through leads to a full meltdown, with her saying she wants to die, hope she goes to sleep and never wakes up, etc.

Do meds help with this? I am hoping so much they do, if in fact she does have ADHD of course.

Is she in therapy? Does she have an IEP or receive accommodations for her issues? This may be the better choice in the short term. Personally I would be up the schools as* until they made some allowances because she doesnt deserve that kind of stress over homework.

Daydreamin22
10-22-15, 03:27 AM
stimulants mixed with anxiety are not a good thing. Also, anxiety will give you just as much if not more of an inability to focus than add does.

It sounds like next semester your daughter needs to get tutoring and stay on top of the homework from day one.. like do all of the assignments. I'd try stepping it up with her OWN abilities (not the meds) first. It might be hard but you can try your hardest and feel good that you did before putting her on meds. Especially stimulant drugs like amphetamines. They're a controlled II substance. I can't give you enough information to have you be properly informed but i'm trying.

Maybe it's the work that isn't getting done that's giving her anxiety.

Maybe if she started exercising everyday it would help her melt downs..

do other coping skills.

She can get dependent on meds. If she's made it so far you really might want to try coping skills. Maybe this is just something she's dealing with. Maybe there are successful adults out there who look back and might be recall that one time in 9th grade when she was having a horrible time. Just giving you perspective. Lots of times, when people go on medicines, they aren't able to function like they did before they ever went on them. People sit and stair at a book, not being able to read it. Dependency is horrible when you realize you were better off with the meds. Remember what's important in life. People, relationships. Meds can interfere with those. They did in my life.

TangledWebs
10-22-15, 05:20 AM
I was just thinking about the times in my life where I had very similar reactions (i.e., saying, "I wish I were dead, and I hope I go to sleep and never wake up") and meltdowns as your daughter. The mistake my parents made when handling my meltdowns was instead of being supportive and understanding, they would use name-calling, criticism, contempt, and also withhold their love as punishment.

I was called moron, dumbas*, stupid, screw up, fu*k up, failure, worthless, etc., at around your daughter's age. Even as an adult, I continue to self-criticize and struggle with self-compassion. I knew I was a handful, and I hated myself for causing my parents and family such anguish. With that being said, you sound like a very supportive, caring mother, and I applaud you for that! :)

Emotion Regulation:
http://www.getselfhelp.co.uk/emotionregulation.htm

ADHD Meltdowns:
http://www.additudemag.com/adhd/article/5762.html

Powderbucket
10-22-15, 05:28 AM
Hello.

I am 26 years old now but I still study. Up until 5 or so months ago, I used to have these stressful meltdowns. As a kid, I was very overwhelmed and frustrated at school and I was never good and getting the pressure. I was put on Concerta 36mg six months ago, and studying has completely changed for me. I am so relaxed when I study now. I feel like my stress is out the way and I, for once, have the ability to think clearly I use my brain towards my work. Personally, ADHD medication changed studying for me monumentally and I am so grateful I'm on it.

TangledWebs
10-22-15, 04:53 PM
Hello.

I am 26 years old now but I still study. Up until 5 or so months ago, I used to have these stressful meltdowns. As a kid, I was very overwhelmed and frustrated at school and I was never good and getting the pressure. I was put on Concerta 36mg six months ago, and studying has completely changed for me. I am so relaxed when I study now. I feel like my stress is out the way and I, for once, have the ability to think clearly I use my brain towards my work. Personally, ADHD medication changed studying for me monumentally and I am so grateful I'm on it.

I am definitely able to relate! I was prone to stressful meltdowns as well. Adderall XR and learning healthy coping strategies has done wonders.

Lunacie
10-22-15, 06:14 PM
stimulants mixed with anxiety are not a good thing. Also, anxiety will give you just as much if not more of an inability to focus than add does.

It sounds like next semester your daughter needs to get tutoring and stay on top of the homework from day one.. like do all of the assignments. I'd try stepping it up with her OWN abilities (not the meds) first. It might be hard but you can try your hardest and feel good that you did before putting her on meds. Especially stimulant drugs like amphetamines. They're a controlled II substance. I can't give you enough information to have you be properly informed but i'm trying.

Maybe it's the work that isn't getting done that's giving her anxiety.

Maybe if she started exercising everyday it would help her melt downs..

do other coping skills.

She can get dependent on meds. If she's made it so far you really might want to try coping skills. Maybe this is just something she's dealing with. Maybe there are successful adults out there who look back and might be recall that one time in 9th grade when she was having a horrible time. Just giving you perspective. Lots of times, when people go on medicines, they aren't able to function like they did before they ever went on them. People sit and stair at a book, not being able to read it. Dependency is horrible when you realize you were better off with the meds. Remember what's important in life. People, relationships. Meds can interfere with those. They did in my life.

It can be hard to tell whether symptoms are caused by anxiety or adhd.
That's where report cards and notes from parents or teachers on what kind
of symptoms were present as a child are helpful.

Treating the adhd can allieviate anxiety and depression if the adhd is the
underlying issue.

Common side effects in the first week or two of treatment with sitmulants
can look like anxiety, but are effects many notice whether they have anxiety
or not. Things like rapid heartbeat and dry mouth generally diminish or vanish
after a week or so.

ADHD can and does interfere with relationships. Meds can help.

When people don't function as well on meds as they did before meds, they
are usually taking the wrong medication for them. Time to try a different one.

Being dependent on these meds means they are doing what they're supposed
to do. It's no worse than being dependent on food, water, air or sleep.

This doesn't have anything to do with being pro-meds. I don't take stimulant
meds and my granddaughter has chosen not to take meds either. It's really
all about trying to color things darker than they have to be ... fear mongering.

KarmanMonkey
10-23-15, 09:14 AM
Some great advice here, but I just wanted to add that she doesn't necessarily need to be the one to change... I would get overwhelmed by the volume of homework when I was in my earlier years, and thankfully my mom advocated with my teachers to pick quality over quantity when it came to homework.

I didn't need to do 10 of the same type of math question if I could show that I didn't need the practice by doing 2-3.

If the teacher would be unsure based on how much I did, they could always quiz me.

The key thing, though, was that I wanted to do well, and I wanted to understand the concepts, so if I needed more practice I'd do more than what was required of me (the reduced amount) so I knew I had it down. I'd need to do the extra after changing subjects, but I'd get back to it.

It's like cleaning my desk at work. If I tell myself I'll deal with it all today, it won't get touched, but if I tell myself I'm going to file 3 things, I'll likely end up filing 30.

If you google hallowell 50 tips for classroom management of adhd, you'll get lots of useful tidbits, many of which require little or no work on the teacher's part.

Finally, when I was in university I learned that while I got very little benefit from working on a subject for more than 10min, I got great benefit from laying out all my courses and frequently switching between them. As the expression goes, a change is as good as a rest :-)

qanda
10-23-15, 06:34 PM
Thanks for all the responses. My daughter is on her 5th therapists, but this one we really like lol. We switched so much because over the 2 plus years the first two gave no coping strategies, just talk. The other demanded to be called doctor, dressed like a business women, and tried cognitive behavioral therapy but not in a kid friendly way. The 4th one was teaching some coping strategies but not many. This new one is teaching her "grounding" which seems to actually work sometimes. I agree that she needs to develop some coping skills, no doubt. She is using them when anxiety is low to in the middle, but when it hits a 10 she can't calm down at all.

She told me doing HW is like asking her to stare at a dot for an hour. So it seems staying focused is a huge struggle for her. She hasn't been diagnosed yet so we will see.

Her child psychiatrist had a teacher fill out a form and her as well and he will review these Monday. I also emailed 2 teachers from last year with some bullets addressing behaviors related to ADHD. So far, her last year math teacher said my daughter met all the behaviors for inattentiveness, no behaviors for being hyper (surprising to me) and only a couple for impulsiveness. Her this year science teacher filled out the form from the doc and did not really see any signs of ADHD.

I definitely have seen trouble focusing throughout all her school years when it comes to homework and lots of frustration as well, but with all the HW she has now, she simply can not take 3 hours to do an 1 hour assignment as she has too much to get through. So if she does have ADHD, hoping the meds will help with that without ramping up the anxiety she already has.

dvdnvwls
10-24-15, 01:19 AM
After I typed this, I realized that sarahsweets and KarmanMonkey said more or less the same thing... but I think it bears repeating.

Maybe the student is not the part of the system that needs fixing. Maybe it's the work that's wrong and needs to change.

Daydreamin22
10-26-15, 09:19 PM
This article is pretty informative. It's a Harvard/NIMH website that I have found trustworthy and ethical in the past. Hope it helps.
http://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-medications.htm

aeon
10-26-15, 09:46 PM
This article is pretty informative. It's a Harvard/NIMH website that I have found trustworthy and ethical in the past. Hope it helps.
http://www.helpguide.org/articles/add-adhd/attention-deficit-disorder-adhd-medications.htm

An excellent resource. I found it to be very balanced and comprehensive.

The only things I would like to see in terms of changes would be a degree of separation in the stimulants section for amphetamine-based meds vs. those based on methylphenidate with specific info for each, as well as having a specific percentage for listed side effects because people usually do not understand the use of the word “common” when referring to percentage experiencing said effect, thinking it more common than data would indicate.

That said, those are niggles at best.

Overall, that has to be the single best introductory information page for ADHD medication I have seen.

:goodpost:


Thanks,
Ian

qanda
10-27-15, 01:53 AM
We saw the Child Psychiatrists today. We brought back an answered questionnaire from my daughters teacher and from ourselves. Teacher questionnaire was not much help as her teacher said she found it difficult to answer many of the questions. I did send my daughters teachers from last year my own check list of symptoms I found on the internet. Her math teacher saw all the problems associated with inattentiveness and none for hyperactivity or impulsiveness, while her English teacher did not see much of anything regarding AHDH. Not too surprising as my daughter likes English but finds math very challenging. My husband does not think my daughter has ADHD but has never read about the symptoms, nor did he bother to fill out the questionnaire. So from my daughters own answers, and mine, the doc said it looks like she has it (inattention, not hyperactivity). She used to be very hyper but this past year has calmed down a lot.

My daughter is on Metropolol, a high blood pressure med that we tried to help with her anxiety (the physical symptoms) and Lexapro which we had slowly been weening off of. She also takes an inhaler for ashthma and 1.5 mg melatonin at night.

Her doc said Lexapro should not be used with an inhaler so she is weening off the remaining 7.5 mg over the next few weeks. And he just read a study that melatonin messes with hormones so wants her off that.

And her therapist gave us a name of a neuropsychologist for further testing, but it will most likely take a few months for an appointment.


We are trying all lights out 2 hrs before bedtime to help her get sleepy. I read the blue color in the lights stops melatonin production, and when she was away at camp she said she got sleep early. I ordered some bulbs that are yellow in color and block blue light. And blue light filters for her phone and ipad. The TV is a challenge though. I can't find a filter for that. But some sites say the TV emits less blue light than bulbs and computers. So we will see how it goes.

Oh, and her Child Psychologist wants her to take 1000 mg of EPA fish oil for a few weeks to see if that helps with her ADHD, as he has been reading studies of how it helps and currently read a recent study from Austrailia on high EPA and ADHD. No ADHD meds currently.

namazu
10-27-15, 02:09 AM
Maybe you mentioned this somewhere already and I missed it, but besides the psychiatrist's evaluation for anxiety and ADHD, has your daughter been evaluated for learning disabilities or processing disorders?

If her teachers aren't seeing many signs of ADHD -- though inattentive symptoms tend to be more subtle -- and her difficulties seem to center around school-work, this might also be something worth looking into.

As others have said, it could be the school environment, or anxiety or ADHD, or something else as well, and of course these issues often coexist.

But for any kid who's so upset about homework that they talk about wanting to die, it's worth looking into the possibility that there's some aspect of her learning -- even if she's a bright kid in general -- is delayed (be it number sense, lining up columns, writing, whatever). If that were the case, there could be some specific educational strategies that would be appropriate to help remediate or circumvent any specific difficulties.

It's hard to watch a kid struggle and to want to help but not know how. It sounds like you're being a good advocate for her and seeking out the help she needs. Best wishes to you and your daughter!


EDIT: Yes, you did mention it above, with the referral to a neuropsychologist. I hope that the wait is worth it -- well, the wait always stinks, so never mind about that -- but I hope the end result will be some additional useful information that will help you and your daughter figure out how to deal with whatever's going on.

Daydreamin22
10-27-15, 05:57 AM
An excellent resource. I found it to be very balanced and comprehensive.

The only things I would like to see in terms of changes would be a degree of separation in the stimulants section for amphetamine-based meds vs. those based on methylphenidate with specific info for each, as well as having a specific percentage for listed side effects because people usually do not understand the use of the word “common” when referring to percentage experiencing said effect, thinking it more common than data would indicate.

That said, those are niggles at best.

Overall, that has to be the single best introductory information page for ADHD medication I have seen.

:goodpost:


Thanks,
Ian

Great! I'm really big on finding good sources. That's one of my favorites in many areas! It's been really helpful in informing me on a few other areas as well.

shane_udhf
10-27-15, 10:46 AM
She has all this going on with the homework, but what about her work in class such as test etc.....does she get this anxiety here also.

Lunacie
10-27-15, 12:27 PM
namazu makes a good point on possible learning disorders. They are very
common alongside adhd.

Unfortunately, it's still difficult to get a diagnosis for something like dyslexia,
and the schools don't seem to offer much in the way of accomodations or
assistance. So imagine how difficult it would be to get a dx of dyscalculia,
which is a similar problem with numbers instead of letters, much less get any
accomodation from the school. I have dsycalculia, and suspect my grandkids
do too. They struggle with math but are great at English, reading, spelling.

The youngest may have dysgraphia, but is doing occupational therapy for her
problems with fine and gross motor skills which may improve her handwriting.

qanda
10-28-15, 10:35 AM
Daughter has not gone to school day 2 now. Won't do her homework, let alone work she is missing in class. Trying to make her = huge meltdowns, her blaming me for making her feel worse than she already does by putting these stressors on her. I am afraid she will fail 9th grade. My husband is a jerk. She can't fall asleep, doc doesn't want her to take melatonin, so I read blue light from bulbs, ipad, etc stops melatonin production. So bought some Yellow lights that have NO blue light in them, keeping rest of lights off, but this is too much of an inconvenience for him. I mean really? How selfish can a parent get? So my daughters a wreck, my husband is threatening to call 911 cause she won't go to school and doesn't want to go to my moms house either, and I am feeling so sorry for her and hating my husband right now for not even trying to make things better because if it inconveniences him then he simply won't do it. Sorry, just needed to vent!

Abi
10-28-15, 10:42 AM
Why doesn't your doc want to prescribe melatonin? :scratch:

qanda
10-28-15, 10:44 AM
She has been taking it for years. But he read a study lately that says it messes with hormones in animal studies, so he is advising all kids to stop taking it.

Abi
10-28-15, 11:11 AM
Don't know much about melatonin.

How about a short-term use of a low dose of benzo? Maybe it will calm her down.

I was like her as a kid and I wish I had had benzos then.

Lunacie
10-28-15, 11:49 AM
First of all, Melatonin IS a hormone. It helps to regulate other hormones.

I think your doctor misunderstood the research on how it affects women's hormones.

Here's a link to the study (I don't know if it's the same one the doctor read):
https://umm.edu/health/medical/altmed/supplement/melatonin

Melatonin also helps control the timing and release of female reproductive hormones. It helps determine when a woman starts to menstruate, the frequency and duration of menstrual cycles, and when a woman stops menstruating (menopause). Preliminary research suggests low levels of melatonin help identify women at risk of a pregnancy complication called pre-eclampsia.

I don't know if there is a test that can be done to determine if one's melatonin levels are normal or abnormal.

If they are abnormal, that will affect sleep and menustration and other hormonal things.

So taking melatonin to regulate those things could actually be helpful.

Could have helped me when I was having painful periods that were very heavy.

Could have helped my daughter who had pre-eclampsia with both pregnancies.



The psychiatrist prescribed a low dose of Trazadone to help me sleep.

It's actually an antidepressant that was found to work better for sleep issues than for mood disorders.

There are going to be side effects with any medication, some people will get them and some people won't.

qanda
10-28-15, 01:51 PM
Abi,
We tried Benzos and they did not calm her. Her doc first tried Klonopin and it just put her to sleep at even low doses. Then tried Xanax but it did not help. Even at high doses. In fact, at a high dose she was literally trying to climb the walls, so a negative reaction with no calming. From other forums, it seems rare, but with some Benzos do not work for them. I soooo wish they did though. I appreciate all the ideas though. We are desperate for help here!

qanda
10-28-15, 01:54 PM
Here is the email I sent her child psych:

Dr. XXXX,
I have been reading about this new diagnosis. It fits my daughter to a T except she does not freak out in school (although she feels like she might and this is what keeps her from going). I can say this, my daughter is at least a bit irritable very frequently, and REALLY irritable frequently.

There is a current study giving these kids a stimulant with an SSRI to see if it helps, but no results yet.

Thoughts on this? Below is an article on it and below that the study on SSRI and ADHD med in combo(no results from study yet)

October 25, 2014
Disruptive Mood Dysregulation Disorder Current Concepts and Controversies

Disruptive Mood Dysregulation Disorder: Current Concepts and ControversiesDisruptive Mood Dysregulation Disorder: Current Concepts and Controversies
Including disruptive mood dysregulation disorder (DMDD) in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was a controversial decision that continues to be the subject of much debate. But now that DMDD is a separate diagnosis, researchers hope to learn more about this devastating childhood disorderthat is disruptive to both children and families.1
DMDD was added to the DSM-5 in 2013 to address the problem of overdiagnosing and overtreating bipolar disorder in children. It is hoped that new diagnostic criteria for children with extreme irritability and frequent temper tantrums will lead to targeted and more effective interventions.2,3
“DSM-5 is bringing more attention to DMDD, which was once too often diagnosed as childhood bipolar disorder,” said Ellen Leibenluft, MD, chief of bipolar spectrum disorders at the National Institute of Mental Health in Bethesda, Maryland.
“Controversy existed because pediatric bipolar disorder was skyrocketing. It was believed that irritability in children with DMDD was a manifestation of mania or elation seen in older people with bipolar,” she added. “What our research shows is that children with extreme irritability do not grow up to have bipolar disorder. They are more likely to grow into anxiety disorder or unipolar depression.”
What Do We Know About DMDD?
DMDD may affect between 2% and 5% of children, but the exact incidence is not known. Children with DMDD have extreme temper tantrums and remain irritable almost all day, every day.4 Unlike pediatric bipolar disorder, which occurs more often in girls, DMDD is more prevalent among boys. A diagnosis is made when the behaviors happen in different settings and have been observed by parents, teachers, and peers.5
“Irritability is extremely common. It is one of the most common reasons children see a psychologist or psychiatrist. The bar for diagnosing extreme irritability of DMDD has been set very high,” said Leibenluft.
To be considered for diagnosis, symptoms must begin before age 10 years, but the disorder should not be diagnosed before age 6 years.
Symptoms of DMDD include:
Three or more severe temper tantrums per week. These are tantrums that are grossly out of proportion to the cause, and inappropriate for the child's age.
Persistently irritable or angry mood between tantrums without sustained periods of relief.
No evidence of mania or hypomania.
Symptoms must be present for at least one year and happen both at home and outside the home.

What Don't We Know About DMDD?
Controversy over DMDD continues, because there is still a lot that we do not know.
“Our group is the only group that has done a lot of research, and it was done with previously collected data. DMDD most closely resembles another disorder called oppositional defiant disorder,” said Leibenluft. “It is still possible that DMDD is really just the top 15% of oppositional defiant disorder.”
“The development of this disorder has been controversial, in part because there are no published data using the proposed diagnostic criteria for youths,” added Christopher Bellonci, MD, associate professor of psychiatry at Tufts University School of Medicine in Boston. “The scientific support for disruptive mood dysregulation disorder comes primarily from studies of related, but not identical, mood dysregulation.”
DMDD may overlap many other mood disorders in children including oppositional defiant disorder, ADHD, anxiety disorder, bipolar disorder, autism, and intermittent explosive disorder. That can make it difficult to tease out a diagnosis of DMDD.6
Another area open for debate is how to treat DMDD. “Because DMDD is a brand-new diagnosis, there are no evidence-based treatments for the disorder,” Bellonci said. “Further research is needed to confirm the validity of the disorder and then to develop psychosocial therapies to address the condition, especially given the high rates of impairment.”
“The best we can do at this point is individualize treatment,” Leibenluft said. “ADHD-type symptoms may be treated with stimulants, anxiety may be treated with a [selective serotonin reuptake inhibitor]. Cognitive behavioral therapy, psychosocial interventions, and diagnosing speech and language problems all may play an important role.”
When Does Irritability Become a Disorder?
“Severe temper tantrums occur in 81% of preschoolers. Over 20% may have severe tantrums more than three times per week,” Bellonci said. So how do you know when temper tantrums and other symptoms of irritability are red flags for DMDD or a related childhood disorder?
“It really comes down to the degree of impairment,” Leibenluft said. “Children with DMDD are often asked to leave school. They don't maintain friendships. Their parents are afraid to take them out to dinner or on vacation. DMDD is severely disturbing and disabling.”
It also isn't clear if children with DMDD will outgrow the disorder, Leibenluft added. However, giving DMDD its own designation in the DSM-5 will lead to more research into the disorder.
If you know a child who might benefit from being part of this research, contact NIMH at 301-496-8381.
Chris Iliades, MD, is a full-time freelance writer based in Cape Cod, Massachusetts.
This article was medically reviewed by Pat F. Bass III, MD, MS, MPH.
References
Interview with Ellen Leibenluft, MD, Chief, Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health
Ryan ND. “Severe Irritability in Youths: Disruptive Mood Dysregulation Disorder and Associated Brain Circuit Changes.” Am J Psychiatry. 2013; 170: 1093-96.
“New Diagnosis in DSM-5 Can Improve Treatment For Chronically Irritable Kids.” Psychiatry Advisor. Posted Sept. 4, 2014.
Grohol JM. “Symptoms of Disruptive Mood Dysregulation Disorder.” Psych Central. Accessed Oct. 15, 2014.
“Disruptive Mood Dysregulation Disorder.” Child Mind Institute. New York, New York. Accessed Oct. 15, 2013.
Interview with Christopher Bellonci, MD, Associate Professor, Psychiatry, Tufts University School of Medicine, Boston


This is the study (not complete yet - recruiting phase right now:
A Controlled Trial of Serotonin Reuptake Inhibitors Added to Stimulant Medication in Youth With Severe Mood Dysregulation
This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2015 by National Institutes of Health Clinical Center (CC)
Sponsor:
National Institute of Mental Health (NIMH)
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Mental Health (NIMH) )
ClinicalTrials.gov Identifier:
NCT00794040
First received: November 18, 2008
Last updated: April 16, 2015
Last verified: February 2015
History of Changes
Full Text ViewTabular ViewNo Study Results PostedDisclaimerHow to Read a Study Record
Purpose
Severe mood dysregulation (SMD) is a very common syndrome in children. Its symptoms include very severe irritability, including persistent anger and frequent outbursts, as well as distractibility, hyperactivity, and other symptoms of attention deficit hyperactivity disorder (ADHD). Many children with SMD receive the diagnosis of bipolar disorder (BD) in the community, although they do not have clear manic episodes (with symptoms such as extreme happiness and decreased need for sleep). Because SMD has not been studied in depth, we do not know which medications are most helpful to those with SMD. This study will evaluate the effectiveness of the stimulant medication methylphenidate (MPH, more commonly known as Ritalin ) when combined (or not combined) with the antidepressant citalopram (Celexa ) in treating symptoms of SMD in children and adolescents. This study will provide information about how to treat SMD in youth.

This study will include approximately 80 patients between 7 and 17 years of age with SMD. The patient s symptoms must have started before age 12.

The study will consist of four phases carried out over 4 to 5 months. During Phase 1, the patient will undergo blood and urine tests, and will gradually taper off his or her medication. The duration of this phase depends on the patient s medication before starting the study. In Phase 2, the patient remains off all medication for 1 week. In Phase 3, the patient will be treated with MPH for 2 weeks, and then will be randomly assigned to receive either MPH plus citalopram or MPH plus a placebo for a further 8 weeks. In Phase 4, the researchers will evaluate the effectiveness of the medications taken, and begin an open treatment phase using medications that they deem appropriate for that patient (this may include MPH with citalopram and/or other medication combinations).

Most patients will be admitted to the Pediatric Behavioral Health Unit at the National Institutes of Health Clinical Center during the medication withdrawal part of the study (Phases 1 and 2). From Phase 3 on, a patient may participate as an inpatient, outpatient, or in day treatment, depending on what is in his or her best interests.

Abi
10-28-15, 01:55 PM
Last resort - low dose atypical antipsych.

aeon
10-28-15, 02:56 PM
The psychiatrist prescribed a low dose of Trazadone to help me sleep.

I’ve been prescribed that too, and I take it as necessary. It works for me, and works well without any problematic side-effects.

I’d certainly recommend trazodone/Desyrel long before I would ever consider a benzodiazepine, like temazepam/Restoril,
or z-drug, like zolpidem/Ambien, especially in a child.


Cheers,
Ian

qanda
10-28-15, 03:43 PM
low dose atypical antipsych - is Clonodine (sp?) that? I have heard of that being used for sleep.

Abi
10-28-15, 03:48 PM
No Clonidine is alpha blocker I think. Could be worth a try.

dvdnvwls
10-28-15, 03:50 PM
Clonidine is primarily used to relieve high blood pressure but does have calming effects and is sometimes also used for ADHD.

qanda
10-28-15, 04:01 PM
Yes, she does get anxiety in school. But it seems more so that she either wakes up with it or not, and if she wakes up with it, no chance she will make it into school, no matter how we try with breathing and such to calm.

kilted_scotsman
10-29-15, 06:33 AM
Kids can get really anxious about school..... this can come from a huge range of environmental factors.... obvious ones like bullying, but there are other subtler ones, around the peer group relational dynamic. There can be huge hidden pressures around "fitting in" which are horrendous for someone a little "different" to cope with.

This can exacerbated by home issues if the child isn't being helped to develop a strong "sense of self" to enable them to navigate the school world.

You say your husband is a jerk..... this rang HUGE alarm bells for me. If I was the the therapist I'd be looking at developing a strong trusting relationship with your child over a long period..... strengthening their ability to view themselves as a person..... I would NOT be leaping into coping strategies and focusing on "the problem" because "the problem" is likely to be a symptom of something deeper.

I am glad you have found a therapist you think is OK..... however I am worried that you discarded 2 therapists because "they just talked".

I am concerned that you are "solution focused" you are looking at the homework issue as a nut that has to be cracked... and are hitting it with increasingly large hammers.... which can only INCREASE your daughters stress around homework and school.

This isn't about homework..... hopefully you have found a good therapist and are prepared to support your daughter by not expecting the therapist to "cure" the homework problem or even make it the focus of therapy.... so talk to the school and get them to back off on the homework for 6 months or more.

Part of building the trust relationship essential to good therapy is that your daughter HAS to trust that she can say stuff WITHOUT it getting back to you..... confidentiality is ESSENTIAL in this situation.... so don't push the therapist or pump your daughter for information about what happened in the session.

FYI I am 5 years into psychotherapy training..... and know that there are good therapists and complete nutters in the profession....... but one persons nutter is another's godsend... only the client can tell them apart. I am concerned that you judge the therapists depending on whether they attack the problem as you see it..... my personal view is that you are seeing the symptom and not willing to acknowledge any underlying problem.... and there is a potentially big one.... you called your partner a jerk.

Therefore I would advise you to show your daughter that going to a therapist is OK by you (and possibly your partner) entering therapy to sort out YOUR OWN PROBLEMS.....

If you do this willingly.... you and your partners commitment to change your ways in order to help her will help her with her issues.

In short.... ADHD has a genetic component..... only by acknowledging that either you and your partner haven't managed to deal effectively with YOUR issues will you learn the strategies you need to teach your daughter to help her deal with hers.

As a parent you need to lead by example.... so find your own therapist and talk over the issues with them.... you'll learn a lot... both about therapy and about yourself.

sarahsweets
10-29-15, 09:05 AM
Daughter has not gone to school day 2 now. Won't do her homework, let alone work she is missing in class. Trying to make her = huge meltdowns, her blaming me for making her feel worse than she already does by putting these stressors on her. I am afraid she will fail 9th grade. My husband is a jerk. She can't fall asleep, doc doesn't want her to take melatonin, so I read blue light from bulbs, ipad, etc stops melatonin production. So bought some Yellow lights that have NO blue light in them, keeping rest of lights off, but this is too much of an inconvenience for him. I mean really? How selfish can a parent get? So my daughters a wreck, my husband is threatening to call 911 cause she won't go to school and doesn't want to go to my moms house either, and I am feeling so sorry for her and hating my husband right now for not even trying to make things better because if it inconveniences him then he simply won't do it. Sorry, just needed to vent!
yikes, I missed this part. It makes sense why she is having issues with school work, if that is the environment she is in.

qanda
10-29-15, 10:38 AM
My daughters therapist is very concerned by me and my husbands problems. I fear she will see it his way, which is just completely unreasonable in my eyes. We will see her Friday so we'll see.

His way is: I am the reason for her problems. She does not have adhd, it's just me looking for answers and labeling her with one more problem. She does not have insomnia, and If I just insisted she lay in bed, and refuse to come in and stay with her when she asks/begs because she has anxiety, all would get better.

kilted_scotsman
10-29-15, 06:29 PM
Good therapists never take sides, they never see things one way.... everything is a shade of grey.......

However they DO act like devils advocates sometimes.... there is a difference!

From what you say I am thinking the therapist is on the right track.... and that if you are really intent on helping your daughter..... both you and your husband have some VERY hard work ahead of you.....

if you can't walk through that fire.... why do you expect your daughter to.

qanda
10-30-15, 08:53 AM
How do I watch him talk to her in a way that spikes her anxiety? You know how you can say the same words, but with an aggressive tone of voice, body language, or a comforting, caring voice and body language. This is what we deal with. My husband simply can't speak to her in a caring, keep her calm kind of way. His voice and body language show he is annoyed, at his wits end. And this makes her anxiety rise, always. It's hard to watch.

For example: this morning, he asked her about school. Husband: "So, have you thought about going to school?" Daughter: "I can't talk about this right now?" Me: "Honey, we need to talk about this so we can make some plans for the future." Daughter: "Ok, I understand." "I am afraid I will lose it at school, like I do at home. I 've been on the verge, so close to losing it at school, and I would be mortified if that happen. I felt like I would lose it at grandmas house yesterday morning. I still don't feel good enough to go to school." Husband: Well you know what this means right? It means you will need to get tutored the rest of the year, just like what happened in 7th grade. And we can't switch schools again. That's not an option this time. So do you understand that if you don't go to school then you will be tutored all year, is that what you want?" Me: Let's not look at the WORSE case scenerio. Daughter just started a new med (50 mg Zoloft) which might help her anxiety, but it may take 2-4 weeks. She may also just feel better, like in the past." Husband: Daughter needs to hear the truth. That's the problem around here. No one is willing to talk about the truth. She needs to help herself and she's not."

When he talks I cringe. His body language, voice, is irritated, frustrated. He feels he should be able to be a "father" and this would have never been permitted in his house. Being a father means discipline, the kid doing what you say. Hope the therapist can help us.

Abi
10-30-15, 09:06 AM
Ugh.

He's doing more harm than anything :mad:

Does she have any objection to getting an in house tutor? It may not necessarily be a bad idea?

Lunacie
10-30-15, 09:40 AM
How do I watch him talk to her in a way that spikes her anxiety? You know how you can say the same words, but with an aggressive tone of voice, body language, or a comforting, caring voice and body language. This is what we deal with. My husband simply can't speak to her in a caring, keep her calm kind of way. His voice and body language show he is annoyed, at his wits end. And this makes her anxiety rise, always. It's hard to watch.

For example: this morning, he asked her about school. Husband: "So, have you thought about going to school?" Daughter: "I can't talk about this right now?" Me: "Honey, we need to talk about this so we can make some plans for the future." Daughter: "Ok, I understand." "I am afraid I will lose it at school, like I do at home. I 've been on the verge, so close to losing it at school, and I would be mortified if that happen. I felt like I would lose it at grandmas house yesterday morning. I still don't feel good enough to go to school." Husband: Well you know what this means right? It means you will need to get tutored the rest of the year, just like what happened in 7th grade. And we can't switch schools again. That's not an option this time. So do you understand that if you don't go to school then you will be tutored all year, is that what you want?" Me: Let's not look at the WORSE case scenerio. Daughter just started a new med (50 mg Zoloft) which might help her anxiety, but it may take 2-4 weeks. She may also just feel better, like in the past." Husband: Daughter needs to hear the truth. That's the problem around here. No one is willing to talk about the truth. She needs to help herself and she's not."

When he talks I cringe. His body language, voice, is irritated, frustrated. He feels he should be able to be a "father" and this would have never been permitted in his house. Being a father means discipline, the kid doing what you say. Hope the therapist can help us.

This sounds so much like the father of my grandkids. :(

Fortunately he only sees them every other weekend. He's been to a few therapy sessions, not enough I guess.

The oldest is struggling with school (online) and has horrible anxiety. She's at a place where she rarely sees her father.

The youngest is doing much better in school, sees her dad every other weekend, and has less anxiety now.

For the youngest, a change in school (and teacher) was very helpful.



Why does your husband say switching schools is not an option now?

Have you looked into online schools?

kilted_scotsman
10-30-15, 10:14 AM
Everyone... even your husband and your daughter are doing the best they can.

It is difficult as a parent to see your child in difficulty.... remember the usual response men have been taught is to offer solutions to the problem.... to solve the problem..... this is where your husband is probably coming from..... he's programmed to do it.

The difficulty we all have is letting go of our programming.... your daughter, your husband and yourself.... all of you are locked into your programs..... which are contradictory and pushing you all deeper into stuckness.

Hopefully your daughter now has a mentor.... her therapist, to help her move through this.... it is easier when one is younger.... there's not as much to let go of..... it's tougher the older we get.....

so..... to help your daughter.... both you and your husband need to be willing to let go of your programs and be willing to move into a place of vulnerability.... so that you can teach your daughter how to handle.... not knowing... there being no obvious solution... and staying with the uncertainty of life .... and able to sense and act upon the best way forward in the present moment.... regardless of how "different" or unusual that may seem to you, your family and those around you...

Learning to live with ADHD is learning to live with and embrace uniqueness and difference.

Programming is all about trying to live the program that others have mapped out for you... Its important to understand that the emphasis we put on things is unlikely to be actually "our" emphasis but an emphasis inherited from generations previous.

Your daughter is stuck in a program that is generating terrible anxiety for her, your husband is stuck in one too.... and so are you.....

Deal with your own programs.... and you can help your husband and daughter deal with theirs.

kilted_scotsman
10-30-15, 08:23 PM
This is just a suggestion.... I have zero idea if this would be appropriate in your situation.... and the likelihood is it isn't.... but it's an example of the way you can shift the dynamic.

You do her homework for her..... as it's supposed to be done, layout and all. she can copy it if she wants to..... this gives you the info about how tough/repetitive the work is and her reaction to the unusual offer of help.

If you're daughters homework is anything like my kids maths homework was at that age..... you might need a little help!! Then you ask her for help.... modelling a good way of doing so.... a request.... not a demand....so she is free to refuse.

This is showing your vulnerability... showing neither you nor your partner know all the answers.... potentially the power dynamic is reversed.... she may (eventually) start teaching you a bit.... or if she doesn't know... you cooperate to find the answer...... homework becomes a joint effort.

The objective is to reset the family dynamic around homework from conflict to cooperation..... so your partner has to agree to go along with the experiment..... and you are demonstrating a willingness to "enter her world".

qanda
10-30-15, 08:32 PM
I actually can do her homework in most cases, just because I have to help her so much I feel like I am learning the 9th grade curriculum with her lol. I often do the homework before hand anyway, just so if she has a question I can answer it promptly, as it could take 15 minutes on the computer to figure out an answer and that kind of pause in homework makes her just abandoned ever going back to it. But of course I do get stumped sometimes, so I could see having some questions for her. Just curious, what 's your opinion if she does not copy it. I foresee her refusing to do even that.

qanda
10-30-15, 08:42 PM
We went to the therapist appointment and she spoke with my husband and I privately for most of the hour. In the end, although I won't say it to him, she saw things for what they are. A husband who was unwilling to look at ways to help that I had found through research, unwilling to educate himself, and gets frustrated and mad because things aren't getting better. I on the other hand am on this forum and see that finding a med that is helpful may take several tries so I am still hopeful we will find one or a combo.

His attitude has caused a divide, and my daughter no longer even wants him around when she has anxiety because at times he can make her feel so much worse. I hope he can change. I agreed to include him when I have an idea, and we can make the decision to try or not try it together. But in my defense, when I tried in the past he would refuse to read the information or studies I found, roll his eyes, get mad.

Funny that her Child Psychiatrist has her on 1,000 mg EPA fish oil for ADHD based on recent research. I don't know if it will work, as I think only half of people even saw improvement and it took several months, but no harm in trying. I tried fish oil with her before, but my husband thought this ridicules and it's hard to keep a child on board taking lots of pills when one parent isn't supportive.

Lunacie
10-30-15, 09:08 PM
We went to the therapist appointment and she spoke with my husband and I privately for most of the hour. In the end, although I won't say it to him, she saw things for what they are. A husband who was unwilling to look at ways to help that I had found through research, unwilling to educate himself, and gets frustrated and mad because things aren't getting better. I on the other hand am on this forum and see that finding a med that is helpful may take several tries so I am still hopeful we will find one or a combo.

His attitude has caused a divide, and my daughter no longer even wants him around when she has anxiety because at times he can make her feel so much worse. I hope he can change. I agreed to include him when I have an idea, and we can make the decision to try or not try it together. But in my defense, when I tried in the past he would refuse to read the information or studies I found, roll his eyes, get mad.

Funny that her Child Psychiatrist has her on 1,000 mg EPA fish oil for ADHD based on recent research. I don't know if it will work, as I think only half of people even saw improvement and it took several months, but no harm in trying. I tried fish oil with her before, but my husband thought this ridicules and it's hard to keep a child on board taking lots of pills when one parent isn't supportive.

Sorry your husband is so resistant. :(

I take 2,000 mg of fish oil daily, two capsules each morning.

It only took a couple of weeks for me to see a difference, but everyone is different.

You may want to increase her dose if she doesn't have any side effects, and give it a little time.

qanda
10-31-15, 08:41 AM
How much EPA in yours? Her child psych wants 1,000 EPA. I found a brand that has that in 2 pills but they are huge. Luckily my daughter is a trooper when it comes to taking pills.

She has taken fish oil in the past and we saw no benefits, but I think the EPA was much lower.

kilted_scotsman
10-31-15, 04:34 PM
If your daughter refuses your help.... eg doesn't copy out the work you do it doesn't matter... don't push the issue...... the action is just a signal that you'd like her to show you a bit of her world....

This kind of thing is about patience.... and also understanding that it's normal for teenagers to be anxious, rebellious and confused. your daughters behaviour is a NORMAL, natural reaction to her SENSE of her environment....

Finding out WHY this is the case is the work of your daughter's therapist.......the "reasons" may appear illogical to outsiders, even to your daughter.... but in her subconscious they make perfect sense... or she wouldn't be doing what she's doing.

The process may look like this
1) Build a trusting relationship
2) Look behind the presenting symptoms and explore the bigger picture
3) Examine the possibilities for change
4) If the client moves toward change.... support that movement

Many therapists find that building the relationship takes most of the time (sometimes 90% of the time).... once the trusting relationship is present the rest of the work may happen surprisingly fast. Other times it's (4) that takes the time, supporting tiny incremental steps toward change.

To outsiders (and the client) (1) looks/feels like chatting..... as does (4)

A therapist is someone who gets closer to you than even a lover.... there is more trust, more emotional intimacy, more vulnerability.... so the establishment of trust is essential.... your daughter will now need lots of reassurance around confidentiality and also reassurance that you are not going to swoop in and terminate the therapist if the work isn't overtly focussed on your short term goals.

Therefore it's worth making confidentiality explicit..... over here we have rules around when a therapist MUST disclose information... outside those legal conditions confidentiality is agreed between client, therapist and other interested parties..... with the client normally having the last word. In other words you are not in the loop...... unless your daughter decides to include you.... no pumping for information.... no questions about what happened....nothing.... zip.....nada...

Next we have length of the work.... after terminating 4 therapists it's probably best if you bite the bullet and say that you are prepared to fund weekly therapy for say 2 years.... no more terminating therapists because they're not doing what you think they should be doing. your daughters relationship with her therapist is HERS not yours.... even though you are footing the bill.

This is probably why the therapist asked to see you and your partner.... you would be constantly "present in the room" for both your daughter and her therapist because of what has happened in the past.

The therapist would have to work out how to manage the relationship with you and your partner to reduce the likelihood of you suddenly terminating the relationship, and balancing that with an assessment of how much harm would be caused to your daughter if you decided to terminate after the relationship building process had begun.

There are some therapists who would not take on a case like your daughter's for this very reason. Therapists are always conscious of the "ending".... sudden unexpected terminations of therapeutic relationships are regarded as potentially harmful, particularly if repeated.

You're not looking for a therapist to help her with anxiety and doing her homework..... you're looking for someone who'll be a friend and confidante at this crucial and difficult time, someone she'll remember for the rest of her life....

This isn't about homework or school, it's about putting in place the emotional foundations that will support her in whatever she chooses to do right past the time her own children leave home.