Hello. Many of you may remember me from late 2006. I wasn't able to come back, for reasons which are too much to explain right now. As you may no,
my son has officially been diagnosed with ADHD and O.D.D. He was fine for about a month afterwards, but after that, he became very nasty towards everyone. He now goes through violent mood swings. He could be happy 1 second, than another, he lashes out. He is currently taking Ritalin and Risperdal.
They seem to be helping a little, but he still lashes out. He also has a hard time eating when on the meds. there was an incident 3 weeks ago where came after me with a stick and kept saying "I'm going to kill you!!!" Ever since then, i've been kind of scared of him. As of this point, I do not know what to do, and im looking for ANY advice!

-Mike

Mike,
I suggest you check out the 'Dore and personal experience' thread. You are fortunate, if you decide to go that direction, that you live in a Dore city.

What kind of doc is managing the meds? It sounds like there needs to be an adjustment. Risperdal helps with anxiety and mood issues, but the stimulant can increase anxiety and emothional lability which can come out as anger/rage (this is the case with my youngest). You might ask to change to a different stimulant, or go without a stimulant and get the mood issues under control, then start working on the ADHD symptoms again. Has there been any talk of bipolar?

Mike,

I highly suggest you get in touch with a certified behavior analyst. The person can help determine the cause(s) of the behaviors and to help put a plan into place to stop the behaviors.

If you're interested, go here: http://www.bacb.com/consum_frame.html
and look at the certificant registry to find one in your area.


Also, along w/ Vickie - talk w/ your child's doc. 1 - to make sure he/she is aware of what's going on and 2 - to make sure meds are working (if on meds).

What kind of doc is managing the meds? It sounds like there needs to be an adjustment. Risperdal helps with anxiety and mood issues, but the stimulant can increase anxiety and emothional lability which can come out as anger/rage (this is the case with my youngest). You might ask to change to a different stimulant, or go without a stimulant and get the mood issues under control, then start working on the ADHD symptoms again. Has there been any talk of bipolar?His psychiatrist is managing his meds. I suppose that would make sense, but I don't know much about medication. There has been no talk of bipolar, but now that you mention it, it seems like it could be possible. Unfortunately, we won't be seeing his doc for 3 weeks.

Hi May June,

I am sorry to say that I have not taken the time to look at your previous thread, but have you called your son's therapist to let them know what your son threatened? I also do not know how old your son is, but if he is older than 11 or 12, then you might want to call the psychiatrist and also let him know that he has been voicing homicidal thoughts, and actions towards you. This could easily spiral out of control. After having been the charge nurse for 2 years at an inpatient acute facility for adolescents (in NY state), I can say that I have seen many, many admissions for just this type of thing. It does not sound as if the meds your son is on are effective. I am assuming that if this is distressing enough for you to post about, that you should definitely call his psychiatrist tomorrow to let him know what is going on. Has your son been hospitalized in the past? Feel free to PM me (tomorrow - lol - sorry getting tired tonight), as I have lots of experience in this area and would be happy to offer more help/suggestions.

At Heart

Hi May June,

I am sorry to say that I have not taken the time to look at your previous thread, but have you called your son's therapist to let them know what your son threatened? I also do not know how old your son is, but if he is older than 11 or 12, then you might want to call the psychiatrist and also let him know that he has been voicing homicidal thoughts, and actions towards you. This could easily spiral out of control. After having been the charge nurse for 2 years at an inpatient acute facility for adolescents (in NY state), I can say that I have seen many, many admissions for just this type of thing. It does not sound as if the meds your son is on are effective. I am assuming that if this is distressing enough for you to post about, that you should definitely call his psychiatrist tomorrow to let him know what is going on. Has your son been hospitalized in the past? Feel free to PM me (tomorrow - lol - sorry getting tired tonight), as I have lots of experience in this area and would be happy to offer more help/suggestions.

At HeartHe is 9, and yes, we did go see the therapist. Then we went to see the psyc and he prescribed Risperdal to help control his mood. I think you are right, that his meds are not working. He has never been hospitalized before. My wife and I are seperated, and he is going to her house for the weekend, so I will not see him until Monday, which is when the appointment with the psych is scheduled. I hope things we'll get better before the hecktic 4th Of July.

Thanks for all your help
-Mike

He might need to try a differnet medication or get a higher dosage. He may have other problems then what he is being treated for also

It sounds also, as if your son needs some intensive therapy in the area of anger management. I am surprised that he was not placed on Abilify instead of Risperdal. I have not seen Risperdal work very well in children in his age range (however, everyone is different, and it seems that every Psychiatrist has different preferred meds...

Is the psychiatrist that you are taking him to a Child/Adolescent Psychiatrist? Though all Psychiatrists can treat every age range, sometimes it is best to take you child to someone who specializes in children (just as many of us take our children to pediatricians, rather than just a GP). Meds are not the only answer for behavior problems. Often intensive therapy, with both child and parent, is the most helpful. I hope you have a good therapist.

At Heart

Do you have a children's hospital or university that has a child developement team? These groups often offer classes for parenting challenging kids, social skills classes and other things that can help. A therapist can also work with you on adjusting parenting to meet your son's needs. We were seeing a psychologist for counselling my yongest and she helped us refine a positive reinforcement behavior plan that helped alot.

Well we went to the doctor today. long story short, same meds, but up'd the dosage on the Risperdal to control his mood. The doctor said he is probably NOT bipolar.

Hey there May/June,

I wish you luck. What does his therapist say?

Hey there May/June,

I wish you luck. What does his therapist say?Thank you. Therapist says its most likely just anxiety or excitement due to summer vacation, 4th of july, getting worked up over all the work that
needs to be done, needing attention, etc and that the meds should help.

I just wanted to ask - has your therapist helped you to learn more effective ways of dealing with children with ODD. I know that others have mentioned consistancy - but I think that even more important than that is to not set up huge power struggles with your child. You do that often by telling them when they do something bad that they will only get one further warning to stop or else. I could give you examples of how we would handle your child in a professional setting, if you gave me an example of his bad behavior. Following through with whatever you tell them is the most important thing to really recognize. For instance if you tell your son, if you do that one more time I am going to....., and then you don't ...... when he does it again - he knows that you are all talk and no action. He has no reason to do what you tell him then. If my children are yelling at eachother in the car - I often have to mediate between them - I will tell them that they will only be told one more time to stop or else they will walk home from school (or whatever). If they still do not stop, I have pulled over the car and told them to get out and walk home. Of course I am referring to 13 and 11 year old children...

Essentially the treatment of choice for ODD is behavior modification - with a system of rewards and punishment for behavior. Sometimes though - depending on how long you have observed the symptoms, there may be an underlying problem that is not being addressed (perhaps jealousy of the newborn - even though he appears to idolize the baby - he may still be jealous of the amount of your time that the baby gets). I truly don't know if there is something underlying this, or if this is just him. Meds can be helpful - but behavior modification will probably be the most helpful.

Again, I wish you luck.

At Heart

I am sorry that you are going through this rough time with your son.:(

Your are in my thoughts and keep us posted on his progress. Take care of yourself as well - that is just as important.

((((((HUGS))))))

Sorry for the delayed reply. been busy for 4th of July. At Heart: The therapist basically said what you did: follow through with the punishments. Its often very hard to do that, since I work out of my home, and things come up all the time. As for examples of behaviors, he often does things that i specifically tell him NOT to do. It seems like he only does it just to disobey me and make my angry. He is very picky about everything. FOr example, if I make a PB&J sandwich for him for lunch, he says "I want ham!" and i'll say "There is no ham" and he'll throw a huge fit everytime he doesn't get his way. I think that a lot of what he does wrong is purely just to get attention from others. I think he actually likes having "problems".


Thanks
-Mike

Hi May/June,

What does he do when he throws the fit? What do you do when he has these behaviors? Sometimes the best thing can be what we call "planned ignoring". If he is seeking attention for these behaviors and he doesn't get it...it may stop. Likewise, when he has good behavior, give him lots of attention. I know this is hard with other little ones - but it will only get harder if you don't make a huge effort now. I know how hard this can be. I have dealt with kids just like this (although probably on a much worse scale...), and have had good luck with praising positive behavior and sticking with the rules, or ignoring the bad behavior. Sometimes though, when others are aware of the bad behavior, we have to follow through with the rules/punishments, even against our better judgement because if we don't follow the rules, it becoms chaos.

Feel free to PM me...

Take care,

At Heart

Hi May/June,

What does he do when he throws the fit? What do you do when he has these behaviors? Sometimes the best thing can be what we call "planned ignoring". If he is seeking attention for these behaviors and he doesn't get it...it may stop. Likewise, when he has good behavior, give him lots of attention. I know this is hard with other little ones - but it will only get harder if you don't make a huge effort now. I know how hard this can be. I have dealt with kids just like this (although probably on a much worse scale...), and have had good luck with praising positive behavior and sticking with the rules, or ignoring the bad behavior. Sometimes though, when others are aware of the bad behavior, we have to follow through with the rules/punishments, even against our better judgement because if we don't follow the rules, it becoms chaos.

Feel free to PM me...

Take care,

At Heart
Hello,

usually when he throws fits, he screams, curses, and throws things. I never give in to what he is throwing the fit over. I usually try to calm him down (have had to restrain him many times until he got tired) and tell him to go to his room until i tell him to come out. usually, its about an hour. during that hour, theres no video games, computer time, or TV. He just has to sit there. Its becoming VERY frustrating for me, seeing as i can't always tend to him and work at the same time. The planned ignoring sounds like an excellent idea. I'll definitely give it a try.

Thanks
-Mike

Hey there Mike,

You might want to try doing some bargaining with him. If he can behave well, offer him something he wants. A very important part to punishing a child for bad behavior is to have a "post mortem" about the subject after everything has calmed down. Does your son ever tell you why he goes off on tangents like that? Is it usually to get something - or because you are telling him no? Restraining is a good idea too - that way he understands that what he is doing is not going to be allowed. Communication is probably the key here. There has to be a reason for all behavior - be it attention seeking, anxiety, anger, frustration, etc... I am sure you get the idea.

As for the planned ignoring - what we would often do with patients is make a contract such as:


_______________ will not curse, or throw things when becoming angry. If ________________ becomes angry, he/she will go to a staff member to talk, one on one, or go to time out. If ______________ does throw things or curse, priviledges will be taken away until earned back by good behavior.

I think you get the idea. Often we will incorporate ideas of the child/adolescent, such as when becoming angry will go do ____________ (for some it might be punch a punching bag, or ride a bike, or whatever they suggest that is within reason). Kids will often get in a rut, and get stuck until we can show them a way out of it.

Is your son out of school for the summer? Do you think any of this has to do with boredom?

Good luck,

At Heart

I have tried the bargaining, but he never kept his end of the bargain. He never tells me why he throws the fits, but its always either because he doesn't get his way or when I tell him not do do something. The restraining helps quite a bit. It makes him calm down faster and just relax. I try to talk things out with him, but he doesn't care and won't talk. He is too stubborn. The contract is a good idea, I'll definitely give it a try. Yes, he is out of school for the summer. He seems to find things to do, but I can't always watch him. He plays video games, and he does go over to a friend's house several times a week. Its kind of hard to say if he is bored.

I appreciate all the help and advice you've given me!

Thanks
-Mike

Did this irritability worsen with stimulants? (If they DO make him irritable and more ODD-ish (poor you), it is sort of a bandaid to add a very serious drug like Risperdal, right?...)


What is he like on a drug holiday? (e.g. off the drugs for 48 hours/weekend)
How does he say he feels off the meds, when you ask him?

Did this irritability worsen with stimulants?No, it was pretty much the same.

Other options:

-mindfulness training (ODD/CD kids often have hot brains/dysregulated limbic systems)
-DBT (Dialectical Behaviour Therapy; good for people who are irritable)
-empathy training
-addressing any Alexithymia Issues (angry kids often don't know they are irritated until it is full blown. Giving them words for their emotions can help reduce frustration and physical outbursts, etc).

NB don't bargain with a child. you are getting into a power struggle, and allowing him to dominate/win, and get "power over", versus "power with".

The parent is the parent, the child is the child.

DBT literature covers the topic of "power relations"...

Search for books by Marsha Linehan. She is the founder of DBT.

Hi QueensU girl and Mike,

I thought I might chime in again, because I teach DBT to adolescents - and have actually taken classes from Marsha Linehan and some of the others who teach DBT. Typically DBT is used for Borderline Personality Disordered patients, and has for the past couple of years, even started being used with teens (though typically a person is not diagnosed with BPD until they are almost adult). DBT is not yet reccommended for use with children. Some of it's principles are pretty sound, and great, but way above a 9 year olds ability to understand and apply.

I am not suggesting bargaining as a way of setting up a power struggle with your son, I am actually referring to determining what type of rewards for good behavior might help your son be interested in changing his behavior.

Has your son's therapist discussed behavioral therapy with you? Sometimes it takes a change in our perspective to help a child behave. Much of the following is paraphrased from another website - about.com - behavioral therapy. This is exactly the approach we encourage parents of our patients (adolescent behavioral health - acute inpatient psychiatric services) to take with their children when going home.

The term “Behavior Modification” is casually thrown out in many discussions on ADHD and ADD, but what is it exactly?

Behavior Modification is used to describe a program that relies on rewarding positive behavior in order to increase the frequency of such behavior. To set up a program for your child takes careful planning, commitment, patience and working together with all who care for your child.

The first step.

Take some time to evaluate your relationship. Tensions that have built up over time can cause any new approach to fail. If you have developed patterns of becoming exasperated and angry each time your son misbehaves, or if you find yourself yelling and punishing with much frequency, but without results, try to first take some time to repair the relationship.

Several times a day, catch your son doing something right. If necessary, set up the situation for him to succeed and compliment him. Changing your phrasing in the way that you talk to him can have a tremendous effect. If you have sent your son to straighten up his room and 15 minutes later you walk into the room and notice that very little has been accomplished, would you immediately point out all that he has not done? Try to change your perspective, give praise for any little item that might have been completed, and instructions for what is to be done next. For example, instead of saying “You haven’t done anything yet, didn’t I ask you to straighten up? What have you been doing?” you might try “Wow, it looks like you picked up the blocks that were in the middle of the floor, now, let’s pick up the other toys and put them in the toy box. I’ll be back in 5 minutes to see how you are doing.” Every 5 minutes, stop back to praise and give another instruction. If only one toy was moved during the 5 minutes you were gone, let your son know you have noticed his effort. Even if it takes him 3 hours to complete a chore that you may have been able to do in 10 minutes, at the end of the time, you have a child that can look at the room with pride.


As you begin to change your perspective of your son, and begin to see the glass as half full, you will notice that his perspective of you begins to change. A child that once felt no reason to please a parent will now try to find ways to receive your praise.

Step 2-Choose A Behavior

Children with ADD/ADHD tend to get “information overload” easily. In order to help them develop better habits and behaviors, you will need to choose one specific behavior to work on at a time. Later, as you develop a program, you can add one or two more behaviors, but in the beginning, work only with one.

You may want to choose not talking back, not running in the house, not being aggressive toward siblings, not throwing a temper tantrum. Start with the behavior that has the largest negative effect on your sons life and self esteem.

Once you have chosen a behavior, make sure it is specific. You may need to break this behavior down into smaller steps. For example, if the behavior that you would like to work on is not talking back, what do you mean by this. Be as specific as possible so that your son can understand exactly what you expect. Do you mean that your son is not to talk back to you, your spouse, the neighbors, or do you want to start with one person? What types of things do you consider talking back? What might your son be able to say instead of what normally comes out of his mouth? Write down acceptable phrases and those that are not acceptable.

Be realistic with your goals. Make sure the goals you have decided on are attainable. If possible, set your son up for some early successes. Create scenarios in which you can praise your son for how he reacted and how he spoke.

Once they have accomplished a goal, you need to have a reward for them. Rewards do not need to be monetary, however, you may want to include a tangible reward for an extended period of time of compliance. Smaller goals may have rewards such as stickers, stars, or just a “You have been doing a wonderful job.” Start rewards often, the more intense the behavior was at the beginning, the more often the rewards should come. In the beginning, you might want to provide feedback on attitude many times each day. (Making sure to take notice each time your son speaks to someone with respect.) Set rewards up accordingly. If you are giving stickers, you might want to start out with a sticker on a chart for every 15 minutes your son did not speak back. After a certain number of stickers, they can receive some type of tangible reward such as a tape rental, having a friend over, etc.

Next step is the consequences for not following the plan.
Consequences should be delivered calmly each time. Once you allow yourself to become frustrated over the behavior, you son knows he can still provoke a reaction. Using a time out works, if the time out is delivered calmly, without ceremony and is a “real” time out. During time out, there should be no conversation of any kind, the child should not be able to participate in any goings on in their surroundings or in any discussion. They should be gently removed from the environment and be left alone for a few minutes.

Many times, once a behavior program has been set up, parents complain that behaviors become worse. This is actually normal. Your son has learned to rely on your reactions. He has come to understand and to associate your reaction with your caring. It is only normal, therefore, that he will crave the security of your reaction. Be persistent, however, and soon your son will begin to perceive your new reaction as the correct one. Your son will begin to try to attain the reward, knowing that the reaction for “misbehaving” is no longer there.

Be Consistent
This can’t be said often enough or strongly enough. Consistency is the key. If you are not consistent with your rewards, your son will not have the same motivation to act correctly. If you are inconsistent with your consequences, your son will still act out, taking the chance that this time you will not deliver a consequence.

Add Variety
You can add variety to your behavior program without changing the rules. You can change the rewards each day. One day it can be staying up late, one day it can be an ice cream sundae after dinner, another day it can be to have a friend over. Older children may want to work toward something special they have been wanting. By adding variety, your son will not become as bored with the new way. Rules should remain the same, but changing the delivery can help to keep it fresh.

Continue to Another Behavior
Once you feel your son has mastered the initial behavior and is doing well, move on to something else. Use the same steps to set up specific goals, rewards and consequences.

Although this process works with all children, it seems to work especially well with children with ADD/ADHD. Setting up a behavior modification program provides the structure that children with ADD/ADHD often need to succeed. In addition, children with ADD/ADHD tend to have difficulty relating a consequence to an action if they do not occur simultaneously or shortly after. Providing immediate feedback and rewards/consequences helps to keep a child focused and on track. Finally, using short term goals helps. It is much easier for a child to behave for 15 minutes than it is for them to behave for an entire day. Breaking the day down to short intervals can help in creating a desire to succeed.

I know this is a lot of information to take in, but it is extremely helpful. I hope that some of it helps you.

Thank you so much for your help and information!

You are very welcome. I know what a struggle it is to deal with an out of control child (and I have to thank goodness that it is only from professional experience, that it is not from my children). As a parent, I know that it is much easier to tell you how, than to actually do it. As people, we are not perfect (particularly as parents). Our children quickly learn what buttons to push with us, to get the desired outcome. Hopefully we can steer them into seeking our approval, not our dissappointment or anger.

I wish you luck.

At Heart

You are very welcome. I know what a struggle it is to deal with an out of control child (and I have to thank goodness that it is only from professional experience, that it is not from my children). As a parent, I know that it is much easier to tell you how, than to actually do it. As people, we are not perfect (particularly as parents). Our children quickly learn what buttons to push with us, to get the desired outcome. Hopefully we can steer them into seeking our approval, not our dissappointment or anger.

I wish you luck.

At HeartYou are 100% right :)