Should I get a second opinion?

[Ravin]

DD has been in counseling for about 9 months now, her educational evaluation through the public school didn't turn up anything unusual, and we're looking at meds for her issues. While her tantrums and bad attitude were part of what convinced us we needed professional help, with the changes we've made to keep things more consistent in her routine and discipline, the tantrums have calmed down.

 

The thing is, the psychiatrist who did her evaluation (same clinic as the psychologist and home therapist she's seeing) wants to put her on Risperidone. Apparently this is prescribed for adults with schizophrenia and in kids, usually, for rage tantrums associated with autism. Now, DD's tantrums are trying, but they aren't at that rage level yet. She usually calms down within a few minutes (30 at the very worst, usually 5 or 10). She generally listens when told to stop kicking furniture, etc. I've seen what happens with uncontrolled full-blown rage tantrums in older kids (my mom has holes in bedroom wall thanks to a 17 yo. foster daughter, and another one at 12 had to be removed from placement with them because my stepdad feared for mom's safety because she'd gotten to be taller and stronger than mom and lashed out physically at people). DD isn't on that scale.

 

DD also isn't on the spectrum; we thought she might have some ADD issues, but that didn't come out in the ed eval. Also, her tantrums aren't the main thing that has us contemplating the resort of medication. I'm worried that the doctor focused too much on the tantrums and ignored what I told her about DD's obsessive thought patterns (obsessed with swear words and, less often, with death/dying), physical tics (which come and go, and have in the past included nodding, shrugging, making annoying sounds, and currently consists of grimacing), talk about wanting to end her life/die, and depression. Most recently, she's gotten into the habit of picking at scabs/scrapes; we have to cover things with band aids if the skin is even slightly broken or she picks it until it bleeds.

 

DD is painfully aware that her issues aren't normal (far more so than I would have been at that age; if anyone in this house is on the autism spectrum it's me), and desperately wants to be normal. She's asked for medication to make the bad thoughts go away.

 

The psychiatrist said something about avoiding antidepressants because of the family history of bipolar (my sister).

 

I also get the (unspoken) impression by her (and more vocal though not specific by the psychologist) that they think part of the issue is DD being manipulative because the worst of her behavior tends to come out when I'm around and not when she's with anyone else, including at school. I think it has more to do with her feeling safest around me. This is not a child with poor or disorganized attachment.

 

Am I wrong in thinking maybe we should seek a second opinion? I'm going to make an appointment with the psychiatrist next week to see if talking to her with an emphasis on my concerns changes her conclusion. We're having to rely on the medicaid behavioral health system; my other option is to take her to the university, where we'll have to pay full price for evaluation but services are on a sliding scale. Not that we can afford it, but if it's what we have to do, well, it's what we have to do.

[chiguirre]

I'd definitely get a second opinion. While we've had a great experience with GW on risperidone, I'd investigate a lot before giving it to a child who already had tics because that's one of the side effects with long use that we need to watch for. In any case, I'd look for a pdoc that I feel comfortable with, they're worth seeking out. I agree that most kids hold it together better in public and then let fly with mom.

 

Good luck finding help for your dd!

[Dobela]

I always think second opinions are a good idea, especially when you have doubts about the first results.

[Crimson Wife]

DD also isn't on the spectrum; we thought she might have some ADD issues, but that didn't come out in the ed eval. Also, her tantrums aren't the main thing that has us contemplating the resort of medication. I'm worried that the doctor focused too much on the tantrums and ignored what I told her about DD's obsessive thought patterns (obsessed with swear words and, less often, with death/dying), physical tics (which come and go, and have in the past included nodding, shrugging, making annoying sounds, and currently consists of grimacing), talk about wanting to end her life/die, and depression. Most recently, she's gotten into the habit of picking at scabs/scrapes; we have to cover things with band aids if the skin is even slightly broken or she picks it until it bleeds.

 

This actually sounds like possible OCD to me. Antidepressants are the medication of choice for OCD. Some antidepressants can also be helpful in treating ADD symptoms. I'm not a psychiatrist so I don't know which medication would be best for both the OCD symptoms and the ADD symptoms.

 

I would definitely seek a 2nd opinion.

[Trillian]

I think a 2nd opinion can never hurt and you should definitely be comfortable with your doctor.

 

However, Risperidone is used for treating tics. DS is taking it for Tourettes and I had to have a follow up with the neurologist because he had new facial tics and I had the questions, "If a side effect can be tics, how am I supposed to know if the tics are a side effect or his." The neurologist explained the tics from the medication are quite different from what we usually think of as tics, longer lasting (20 min to hours) and are more of a stiffening than a fast tic motion.

[herekittykitty]

I think a second opinion is a great idea. This is your child, and so much of this is subjective, so I'd definitely seek out someone else.

 

Also, it sounds like you are not totally on board with what the psychiatrist's recommendation, and your opinion counts! I wouldn't go forward with the med until you feel more comfortable.

[Tiramisu]

I wonder if the right psychiatrist could help in figuring out if there's an antidepressant out there that would help with the depression and OCD symptoms and carry less of a risk of triggering bipolar.

 

:grouphug: for all you're going through.