Daughter having significant OCD setbacks, medication refusal...totally lost

[mindinggaps]

Hi all, I'm dealing with a mental health crisis in our household and this is a bit of a vent, but also wondering if anyone has gone through something similar or has any ideas or advice. My 7 year old daughter was diagnosed with OCD earlier this year and has been on Prozac for about 6 months now, which has been life saving. She has also been doing therapy, but frankly without the medication, it's an extreme struggle.

Over the past week she has suddenly decided she no longer wants to take her medication. I have asked lots probing questions to try to understand what is going on, but cannot really get an answer. We've discussed side effects with her psychiatrist and ruled that out for the most part. Without the meds, her OCD is out of control and her daily function is ruled by her obsessions. We're at a loss right now - I don't really want to force her take the medication and options are being discussed with her psychiatrist and therapist. But honestly, I have no idea what to do.

My husband was staunchly against medication and expressed this to me extensively. I am somewhat worried that his opinions were impressed upon her, and she has seen or heard something which has exacerbated underlying embarrassment or shame caused by this.

[TheReader]

Big hugs. I have no advice as far as how to proceed with getting med compliance from a 7 yr old, but I have been there with a mental health crisis in one of my kiddos and it's hard. So hard. 

Hugs & prayers. 

[Kassia]

Also sending hugs and wishing I had some good advice for you.  What a difficult situation.  I hope you can get her to take the meds again very soon.  Did she have any withdrawal issues?  

Edited July 13, 2023 by Kassia

[Kidlit]

I'm PM-ing you

[fraidycat]

I have no advice, but want to offer hugs. 

[mindinggaps]

Thank you everyone for the kind words. Honestly, it does help. My honest fear right now is that if we cannot get her back on the medication, she may end up in the hospital. The only silver lining in all of this is that it's summer which is an easier time of year to be dealing with this particular crisis.

[maize]

That's super hard if the child doesn't have the awareness to see how much smoother life is with medication.

OCD is a beast of a disorder; every one of my kids has some level of OCD symptoms and when functioning is severely impacted medication can be a lifeline.

For the future, you can also keep TMS in mind as a potential treatment. Unfortunately it isn't available to 7 year olds.

[mom31257]

I’m so sorry you are facing this! I hope you can convince her to comply willingly. 

How does your husband feel now that he has experienced her being on medication? 

[historically accurate]

I'm so sorry, mindinggaps!

I had a child who had to take bad-tasting medication for years as a preschooler/kindergartner, so we switched up "prizes" at different times when she would get a bit feisty over taking it although she didn't fight us every single day. Here are some options we tried - none worked for long (mostly because I suck at keeping to set plan), but they all worked for some short term:

• Sticker chart - 2 or 3 days of taking the med gets her a dollar store trip or a prize like happy meals or some such
• Treat right after swallowing - I used to pass out chocolate chips or m&m's right after meds when my kiddo was little.
• She gave a stuffed animal or a doll their "medicine" at the same time she took hers.
• We had medicine time right before something fun (TV time in our case usually). She didn't move onto the next item on the schedule until the meds were done. Note: parent can't do any drama or bargaining here, just, "oh, you don't want your meds? Well, you can't do TV until you take them - see how the TV is right after the spoon on the schedule? You can't get to the next picture on the schedule until you do this one. You can go rest for a while until you're ready to take the medicine. Love you, have a great rest!" Weirdly to me anyway, this one worked the best - it may work for you because I would assume a child with OCD would like schedules. Mine loved having a written out schedule, and worked hard to keep it moving.
• Massive praise (even to the point of The Medication Dance Party for the whole family sometimes) whenever she took the medication willingly. If it was a very, very hard day, we said something like, "Thank you for taking your medicine. It's going to really help your body. You're getting so strong and healthy."

I hope you figure something out quickly and hugs to you - it can be so difficult.

[Ottakee]

Why does her refusal look like?

Did the pharmacy change generics on you at all?  I have one child that reacts very differently to different generics of the “same” medication.

[Ottakee]

Would she go along with the “this is the medicine that the doctor says you need so you need to take it but we can make an appointment to discuss this with your doctor (and then do) but until we see the doctor you have to take it” type thing?

 

i have had kids on psych meds since they were 3.

[heartlikealion]

I know your spouse is against the medication -- have you asked him what he wants to do (pointing out that the therapy alone doesn't seem to be helping)? I'm just curious what he has to say and if he'd reconsider.

In general, I'm against medication (like see it as a last resort), but I struggled for years with OCD and can see both sides. It was horrible. I had the germ thing (excessive hand washing, etc) and recurring thoughts (sometimes the spiritual OCD). My current medication is a catch all of anxiety/depression/OCD and helps keep things at bay. 

I remember feeling so helpless because of my OCD when I was younger. I didn't know the name or what it was but I can remember issues as far back as elem school. 

I hope you get some relief for everyone. I don't know if therapy would have helped me at that time or not. Not all therapy is the same and not all patients gravitate toward the same style. 

[Drama Llama]

I am so sorry you are going through this. 

I have a little bit of a different take on the question of forcing a kid to take medication.  Choosing medical treatments for my kids is one of the hardest things I've had to do as a parent.  It is so anxiety provoking, and it feels like a huge burden.  When I have made decisions that didn't have good outcomes, it's been so heart breaking and guilt inducing.  So, there is absolutely no way I would transfer that burden to my kid.  It's not a fair thing to ask of any kid, but particularly one this young.

So, medication isn't negotiable in our house.

The strategy that works for us is waiting.  Once it's time, we sit and wait, and nothing else happens until the med or procedure or whatever is finished.  We don't talk about it, or why it has to happen.  Because it's not their choice, they don't need to understand my decision.  And it can feel like forever, but it never actually takes forever.  And then, when it's taken, we celebrate or reward or whatever, no matter what went down while we were waiting.  

[freesia]

35 minutes ago, BandH said:

I am so sorry you are going through this. 

I have a little bit of a different take on the question of forcing a kid to take medication.  Choosing medical treatments for my kids is one of the hardest things I've had to do as a parent.  It is so anxiety provoking, and it feels like a huge burden.  When I have made decisions that didn't have good outcomes, it's been so heart breaking and guilt inducing.  So, there is absolutely no way I would transfer that burden to my kid.  It's not a fair thing to ask of any kid, but particularly one this young.

So, medication isn't negotiable in our house.

The strategy that works for us is waiting.  Once it's time, we sit and wait, and nothing else happens until the med or procedure or whatever is finished.  We don't talk about it, or why it has to happen.  Because it's not their choice, they don't need to understand my decision.  And it can feel like forever, but it never actually takes forever.  And then, when it's taken, we celebrate or reward or whatever, no matter what went down while we were waiting.  

I agree with B&H. I understand wanting to respect you dd, but 7 is too young for her to make this decision. Wait calmly and confidently. 

[MercyA]

A 7-year-old is way too young to decide whether or not she will take needed medication. I would say something like, "Doctor, Dad, and I have decided that you need to take this medication for now. I understand it is hard for you, so to make it a little easier, I am going to give you a reward sticker every time you take the medication. [Show her fun stickers and chart.] When you have X stickers, we can do [this] or you can have [that]."

And then to allow her to have some degree of choice, say, "What do you think would be some good rewards?"

Best of luck getting her over this hump.

Please keep us updated.

Edited July 13, 2023 by MercyA

[Kidlit]

Chiming in to say with a boatload of btdt experience that there is no reasoning with a 7 yo in the throes of panic and anxiety.   In my experience, the anxiety activation alone is enough to hijack a child's will to make it nearly impossible for that child to make a reasoned decision in the moment.  
 

ETA:  Agreeing with other posters that "being the rock" and insisting on the desired action is the best you can do and will hopefully (eventually) reach the desired outcome.  
 

big (((hugs)))

Edited July 13, 2023 by Kidlit

[Farrar]

I agree with those saying it's "non-negotiable" that child that young take the medication. But there's a difference between drawing that line between a kid who will ultimately comply and a kid who just won't. Seven is too old to hold a screaming, kicking kid down and force a medication in her mouth. It just is. And there's a trauma involved in that which isn't necessarily productive, no matter how necessary the meds are. I have a feeling this is the sort of choice we're talking about.

OP, hugs. I hope you get some solutions soon.

[Kidlit]

Just now, Farrar said:

I agree with those saying it's "non-negotiable" that child that young take the medication. But there's a difference between drawing that line between a kid who will ultimately comply and a kid who just won't. Seven is too old to hold a screaming, kicking kid down and force a medication in her mouth. It just is. And there's a trauma involved in that which isn't necessarily productive, no matter how necessary the meds are. I have a feeling this is the sort of choice we're talking about.

OP, hugs. I hope you get some solutions soon.

Yes, this.  

[mindinggaps]

Firstly, I want to say a huge thank you to everyone for their support, thoughts, and best wishes. I truly appreciate it and there are a number of excellent suggestions here.

2 minutes ago, Farrar said:

I agree with those saying it's "non-negotiable" that child that young take the medication. But there's a difference between drawing that line between a kid who will ultimately comply and a kid who just won't. Seven is too old to hold a screaming, kicking kid down and force a medication in her mouth. It just is. And there's a trauma involved in that which isn't necessarily productive, no matter how necessary the meds are. I have a feeling this is the sort of choice we're talking about.

OP, hugs. I hope you get some solutions soon.

Just for some additional context, this is more the situation we are dealing with. Her medication is liquid and right now her refusal manifests as literally sealing her mouth shut and physically denying it. Reasoning with her on any level is pretty challenging since she's in a state where her OCD is running rampant. I do think we can try to make some further efforts that are on the gentle side with the hope that something will work, but in her elevated state right now, finding anything which sticks is a struggle at the moment.

In terms of what caused this, it's a bit of a mystery to us. For the most part she's been very receptive to the medication and has in the past expressed that she feels it is helping her. My immediate concern were some side effects that may have made her want to stop, but we've discussed that with the doctor and it doesn't seem to be the issue. As much as my husband was initially opposed to the medication, he has come around here and this is no longer a source of significant tension. My hypothesis is that she heard or saw something which set her down a mental pathway that medication is bad for her (seeing how her OCD has manifested in this past, this would not surprise me). Possibly she did previously sense that her father had reservations and whatever triggered this is tied to that on some level. No one has really been able to ask the right probing questions to get any clarity. Regardless, once she started refusing and missed some doses, her OCD skyrocketed further, exacerbating the issue.

[heartlikealion]

Maybe she needs a chaser… something yummy after (although that’s clearly not the root cause. She was taking it fine before).

No ____ til after your medicine? (Screens or something) 

[maize]

Could she swallow a pill? My 10 year old takes fluoxetine in pill form, and his 10mg pills are pretty tiny. Maybe present it as a "new" medication in place of the now-detested liquid medication. She doesn't have to take the liquid if she will swallow the pill.

[Drama Llama]

1 minute ago, mindinggaps said:

Firstly, I want to say a huge thank you to everyone for their support, thoughts, and best wishes. I truly appreciate it and there are a number of excellent suggestions here.

Just for some additional context, this is more the situation we are dealing with. Her medication is liquid and right now her refusal manifests as literally sealing her mouth shut and physically denying it. Reasoning with her on any level is pretty challenging since she's in a state where her OCD is running rampant. I do think we can try to make some further efforts that are on the gentle side with the hope that something will work, but in her elevated state right now, finding anything which sticks is a struggle at the moment.

In terms of what caused this, it's a bit of a mystery to us. For the most part she's been very receptive to the medication and has in the past expressed that she feels it is helping her. My immediate concern were some side effects that may have made her want to stop, but we've discussed that with the doctor and it doesn't seem to be the issue. As much as my husband was initially opposed to the medication, he has come around here and this is no longer a source of significant tension. My hypothesis is that she heard or saw something which set her down a mental pathway that medication is bad for her (seeing how her OCD has manifested in this past, this would not surprise me). Possibly she did previously sense that her father had reservations and whatever triggered this is tied to that on some level. No one has really been able to ask the right probing questions to get any clarity. Regardless, once she started refusing and missed some doses, her OCD skyrocketed further, exacerbating the issue.

To be clear, when I am advocating just waiting, I'm both the parent of 2 kids with PTSD and anxiety diagnoses, and a special educator who used to specialize in early elementary kids with psychiatric diagnoses.  

I've waited for a very long time the first few times I've needed to do this with kids.  Hours.  But in my experience, panic is incredibly energy dependent, and it's not sustainable for ever.  And when it starts to run out of energy, if the adult has been calm and patient and isn't reasoning or engaging, that calm can be contagious.   But that means not reasoning, or discussing it, but maybe reflecting back the emotions you see with statements like "I can tell you're scared.  I'm sorry.  I'll wait till you feel braver."  It helps if you're in a space where there isn't anything else to do.  

 

[SKL]

I agree that it's not negotiable.  Others have given good ideas.

The only thing I'd add is that sometimes, it might help to ask the child something like, "what do you think would help you get back to taking your medicine?"

Maybe there are alternative forms that would work better for the child.  A different flavor or color of liquid, a small pill, or I don't know what else.

Any chance that it would go down easier if it was administered by a different person?  Or at a different time of day, different place ...?

[wendyroo]

15 minutes ago, BandH said:

To be clear, when I am advocating just waiting, I'm both the parent of 2 kids with PTSD and anxiety diagnoses, and a special educator who used to specialize in early elementary kids with psychiatric diagnoses.  

I've waited for a very long time the first few times I've needed to do this with kids.  Hours.  But in my experience, panic is incredibly energy dependent, and it's not sustainable for ever.  And when it starts to run out of energy, if the adult has been calm and patient and isn't reasoning or engaging, that calm can be contagious.   But that means not reasoning, or discussing it, but maybe reflecting back the emotions you see with statements like "I can tell you're scared.  I'm sorry.  I'll wait till you feel braver."  It helps if you're in a space where there isn't anything else to do.  

 

This is what we have to do with Elliot. It is very important that tantrums never, ever “work”, so when the adults announce what is going to happen, then we need to be ready to consistently wait for however long it takes for him to comply. This could be six hours of violent destructive tantrums to avoid wiping up some milk he spilled - but so be it. Eventually he will calm down (and then ramp back up, and then calm back down, etc) until he is ready to do what needs doing. 

It is unfortunate that your daughter has already gotten used to not taking the medicine, because now she knows that not taking it is an option. It is helpful to consider things they might push back against and determine how you will respond in advance. That way, you can stand firm right from the first boundary testing which can quickly nip it in the bud. 

[MEmama]

1 hour ago, BandH said:

To be clear, when I am advocating just waiting, I'm both the parent of 2 kids with PTSD and anxiety diagnoses, and a special educator who used to specialize in early elementary kids with psychiatric diagnoses.  

I've waited for a very long time the first few times I've needed to do this with kids.  Hours.  But in my experience, panic is incredibly energy dependent, and it's not sustainable for ever.  And when it starts to run out of energy, if the adult has been calm and patient and isn't reasoning or engaging, that calm can be contagious.   But that means not reasoning, or discussing it, but maybe reflecting back the emotions you see with statements like "I can tell you're scared.  I'm sorry.  I'll wait till you feel braver."  It helps if you're in a space where there isn't anything else to do.  

 

You're lucky.

Mine would have waited it out for literal years.

[Drama Llama]

Nm

Edited July 13, 2023 by BandH

[Lecka]

I‘m so sorry she is struggling.

 

I think try as hard as possible to come to an agreement that your husband is okay with and that he will be able to handle and support.  I am glad you already are in with a therapist and psychiatrist.

 

I had some things with two of my kids when they were 6-7, and I had my own idea of likely things centered around myself and my husband.  I don’t discount that, but when they were 8-9 and they looked back and said what was going on with them, from their 8-9 yo perspective, it was things that I was totally unaware of or things that I had no idea were impactful.  
 

I also think there’s a long game, and long-term goals of her cooperating with treatment and medication in the long-term.  As much as possible she needs to have buy-in.  
 

I also think there is a struggle with adherence or compliance to medicine or treatment, with all kinds of physical and mental issues, at all ages.  
 

My niece has type 1 diabetes and it turns out there are issues with not wanting to have to deal with it and be different from others.  There can be struggles and — this is such a physical condition, objective, and even with parents on the same page and never any doubt or hesitation, there can still be issues with kids just not wanting to have diabetes.  I have only heard about it from my sister, but it’s a big part of the diabetes education they do (from what she says) and a big reason they had my niece go to diabetes camp (a summer camp for kids with diabetes, and the counselors all had diabetes).  
 

It was a hard part of parenting for me to accept my kids were old enough to have outside influences and their own thoughts, and less of — well, my husband and I are the primary output, and they aren’t having independent thoughts.  It can already be happening at age 6, even though parents are a primary influence and there will not be too many influences separate from parents.  Still — they are thinking about things in their own way.  
 

I also wonder if there is a problem with her current medication.  Maybe this whole thing is an expression of having OCD and a sign of the medication not being as effective as hoped.  It’s possible.

It can also just be a hard time with little explanation in the short term.  
 

As much as possible I hope your husband can be a full partner now, and you guys can cooperate about a plan.  If your husband can’t handle your daughter being distressed and you can handle it more — then what?  Well, can you make a plan ahead of time — I think that is the best thing to do.  
 

It is a learning process and I hope you find a good plan and that the plan goes well!  
 

If your daughter has more severe needs — that is not your fault.  That is just the situation.  It doesn’t really work, sometimes, in a way that good, solid parents don’t have kids who have more severe needs.  Or a severe period of time.  This is just not how real life works, as unfair as it is.  

 

[Not_a_Number]

3 hours ago, mindinggaps said:

My immediate concern were some side effects that may have made her want to stop, but we've discussed that with the doctor and it doesn't seem to be the issue.

It seems pretty likely it's a side effect. That, or someone said something about her taking it -- it doesn't have to be your husband, it could be a kid or a teacher or some other adult. 

I haven't had any luck imposing my will on my kids and it has been bad for our relationship when I do. Even when they comply, they wind up feeling disrespected -- yes, even the little one. 

What I'd probably do is try to figure out what's going on with her at some point when she's (relatively) calm. It's easier to find this out if you don't come in with solutions or acting like you already know what's going on, but just ask her what's up. Is there a point at which she might be receptive? It would certainly NOT be when she's due to take her medication. In fact, if you go this route, I'd not even MENTION the medication for a few days. 

Edited July 14, 2023 by Not_a_Number

[Not_a_Number]

I'm really sorry you're dealing with this, by the way. I hope you get it figured out soon. You have lots of sympathy from me. 

(Should have said that at the front . . . I get too focused on the problem solving. My bad.) 

[bookbard]

I'm sorry. This is so hard. I have a daughter who really, really struggles with meds and any time I've tried to force things (or hide it in food) it has backfired enormously. 

The only thing I can think of is whether you can have a fresh start with new meds. Maybe the old prescription, but different flavour. Or even a new packet. And say, 'listen, you've said you don't want to take meds. We're starting again. This is when we're taking it, this is how we're taking it, this is what's happening after.'  Don't form it as a question 'how would you like to?' Instead, form it as what is happening.

[PeterPan]

Do you have something *else* you give her that is calming that could get her relaxed enough that she can comply with the other med? For instance, when my kids were young we used a chamomile tincture. It tasted fine and was something they were used to taking. If she likes drinking tea, then a 7 yo strength (be careful obviously) of chamomile tea would work. With my ds honestly, if I'm doing that, I make it super strong because I know he's only drinking two sips and then going to put it down. But just that bit is enough.

If you're looking for out of the box ideas, I'll also suggest that you look beyond OCD for the explanation for this. Has anything been added to her world lately or subtracted? Peaches are in season so my ds has been eating a lot of them. Peaches are super high in methyls, so you're cranking up the dopamine more than what his meds can stabilize. She's on prozac and tolerating it, but even so you could add in more and push her over. You could think about what has changed like that to see if there's any connection. 

You're being a lot nicer than I am about meds, frankly. I turn on the news and I tell my son the truth, that people who don't take their meds and hurt people go to jail. In your case, I would consider whether it's time to visit the hospital, the children's behavioral ward, and just be really frank. Children who don't take their meds and have behaviors that people can't live with get checked in till they get enough meds to feel better. There's no point hiding the truth. 

Are you working on pill swallowing? My ds had moderate/severe verbal apraxia, so learning to swallow pills was more of a journey. We started with nerds, the teeny tiny candies, and we worked our way up. You might want to work on pill swallowing so you can move on from the liquid thing. With my ds, matter of fact and not drawing attention to it is a good thing, and small pills help with that. A liquid would just be a lot of drama in our house so it's not surprising that she's done with it. 

That might even give you a path forward: take the liquid till we can get you swallowing pills well enough to change. Then she has choice (liquid vs. pills).

[wendyroo]

8 minutes ago, PeterPan said:

A liquid would just be a lot of drama in our house so it's not surprising that she's done with it. 

Yeah, we have never done liquid meds past toddlerhood. My kids take so many meds that it was a top priority to get them swallowing pills. I started them at age 3 swallowing frozen peas...when they were little enough to accept it as a game. They were all pros by the time they started their neuropsych meds.

Our psychiatrist takes med refusal very seriously. When Elliot got out of inpatient care, they had completely screwed up his meds and he was wildly, dangerously dysregulated. DH and I were force feeding him his risperidone three times a day (Elliot was almost 9 at the time, so this was very unpleasant for everyone involved) just trying to keep everyone in the house safe. Our psychiatrist prescribed a mild sedative in dissolvable tablet form. We used those to get him just regulated enough that we could get him back on his old med routine...and after that he went back to voluntarily taking his meds.

[Spryte]

1 hour ago, PeterPan said:

 

If you're looking for out of the box ideas, I'll also suggest that you look beyond OCD for the explanation for this. Has anything been added to her world lately or subtracted?  

Oh goodness, this. If you're looking out of the box, this.

“What’s changed in his environment?” was our doc’s first question when kid was that age and there were sudden episodes like that. For us, it was often remodeling — new flooring off gassing could set things off (VOCs), trigger asthma and fight or flight responses, all kinds of things. It was sometimes a food, an allergen outside, all kinds of things. Identifying them helped us get things regulated.

FWIW, ours learned to take pills at 6. Tic Tacs dipped in chocolate pudding. Maybe worth a shot.

[KSera]

5 hours ago, Not_a_Number said:

I haven't had any luck imposing my will on my kids and it has been bad for our relationship when I do. Even when they comply, they wind up feeling disrespected -- yes, even the little one. 

What I'd probably do is try to figure out what's going on with her at some point when she's (relatively) calm. It's easier to find this out if you don't come in with solutions or acting like you already know what's going on, but just ask her what's up. Is there a point at which she might be receptive? It would certainly NOT be when she's due to take her medication. In fact, if you go this route, I'd not even MENTION the medication for a few days. 

Some meds require a parent to impose their will on their child—there are many conditions that just absolutely require meds be taken, or there is immediate harm to the child. That includes some psych meds—antipsychotics for example. A medication like Prozac can begin causing withdrawal symptoms after just one missed dose. Just skipping meds isn’t always an option. 

4 hours ago, PeterPan said:

In your case, I would consider whether it's time to visit the hospital, the children's behavioral ward, and just be really frank. 

I agree with looking to see if anything has changed, but the above isn’t going to be a thing. In the US at least, I can’t imagine there’s going to be any behavioral health hospitals that are going to allow random visitors to come by to scare kids straight. They are secure wards and adhere to strict privacy policies. 

[DawnM]

My 5 year old's ADHD meds go into a pop tart and he gets 1/4 of a poptart every morning so we can get his meds in him.   

Could you hide it in something she will eat?   

I mean, we are honest with him and hand him the pop tart and say, "Take your medicine" so he knows it is in there, but maybe for a while you can sneak it?  

It is hard when your DH isn't on board.   Mine was anti-meds for a long time.   He was with my oldest who tried meds and then went off (autism).   But with A, DH is all for them as he can clearly see the difference.   (every time I have to give the meds I get angry at what his birth mother has done to this little guy!). He can't even function without meds.   He will zoom all over the house and never be able to concentrate and it is horrible.

[Drama Llama]

6 hours ago, KSera said:

Some meds require a parent to impose their will on their child—there are many conditions that just absolutely require meds be taken, or there is immediate harm to the child. That includes some psych meds—antipsychotics for example. A medication like Prozac can begin causing withdrawal symptoms after just one missed dose. Just skipping meds isn’t always an option. 

 

Yes, this.  Unfortunately some of us have a lot of experience with situations where kids need meds, or medical procedures, even ones that kids are terrified of.  So, we have worked really hard to find solutions.  That doesn’t mean we’re lucky, or that we don’t respect our kids.  

I am not a parent that forces my kids to do much.  I have never forced a bite of food, or a math problem, for example.  And when I do pick something to insist on, whether it’s a medical procedure or wearing a seatbelt, or not hitting your brother, I do so patiently and without yelling.  

[Bootsie]

Having strong-willed children, I know this can be a real struggle.  When DD was that age and was on the verge of being hospitalized because she was refusing a liquid medication (if we did get it in her she would spit it out) the solution was to mix it with a bit of a smooth food.  In her case applesauce was what worked, but the pediatrician also suggested pudding, yogurt, or even ice cream.

DS had a medicine that we had difficulty getting down and tried everything.  His was a bit of a different situation in that it was not an acute medical situation with immediate serious consequences for not cooperating but it was a chronic condition that would need long-term cooperation with the medicine.   We tried stickers, rewards, waiting, mixing the medicine with other things... everything we could think of but as soon as we got the medicine down he would throw up.  We got a lot of "you just have to tell him its non-negotiable..." and advice on how to handle his behavior problems from the medical community--until he was in the hospital with a feeding tube.  Some of the medicine was added to the feeding tube, unbeknownst to him, and he started throwing up.  He wasn't just being difficult because he didn't like the taste or texture, his body really reacted that way to the medicine.  It was a fairly common medication and the doctors had never seen this type of reaction.  But, at that point they realized that they could not make him take the medicine even with a feeding tube.  

Good luck!

[maize]

14 hours ago, Not_a_Number said:

It seems pretty likely it's a side effect. That, or someone said something about her taking it -- it doesn't have to be your husband, it could be a kid or a teacher or some other adult. 

I haven't had any luck imposing my will on my kids and it has been bad for our relationship when I do. Even when they comply, they wind up feeling disrespected -- yes, even the little one. 

What I'd probably do is try to figure out what's going on with her at some point when she's (relatively) calm. It's easier to find this out if you don't come in with solutions or acting like you already know what's going on, but just ask her what's up. Is there a point at which she might be receptive? It would certainly NOT be when she's due to take her medication. In fact, if you go this route, I'd not even MENTION the medication for a few days. 

It seems to me that this recommendation pre-supposes that the child is functioning more or less rationally. 

How much experience do you have with OCD? OCD is not rational. If OCD is driving behavior, trying to find a rational cause is not going to work. There isn't one. 

Stuff that severely impacts brain functioning is like that because the brain itself becomes glitchy and rationality goes out the window.

And unfortunately continuing to wait to re-introduce medication causes the irrationality to spiral ever downward.

I don't have a  magical solution here and Im not at all an impose-my-will person, but sometimes getting the medication into the person with the glitchy, not-rational brain really does have to be a top, urgent priority. Trying to find a rational path through or waiting days at a time hoping for rationality to emerge isn't going to help.

Edited July 14, 2023 by maize

[Innisfree]

35 minutes ago, Bootsie said:

because she was refusing a liquid medication (if we did get it in her she would spit it out) the solution was to mix it with a bit of a smooth food.  In her case applesauce was what worked, but the pediatrician also suggested pudding, yogurt, or even ice cream.

Applesauce was what we used to make swallowing pills easier, so it works for them, too. Just put the pill on a spoonful of applesauce and swallow it all. 

OP, I have experience with medication refusal, but not much helpful advice. Dd2 started refusing to take her medication when she was older, about 12 or 13. Fortunately her ability to regulate her behavior was improving by that time, so she has been able to manage without it. That wouldn’t work so well for OCD. 

One thing we did learn before that point was to have consequences *which were completely under our control* available as a last resort. For us, consequences couldn’t be something like “stay in your room”, or anything that she could just refuse to comply with. It had to be something like “you may not attend your riding lesson” which was highly valued and under our control. We paid for lessons for several years just because they were so essential for behavior management, even though we only actually had to miss two or three lessons during that time. So, keep that in mind as a possibility, if necessary: something she cares about enough to comply, even when she really doesn’t want to; but something it’s in your power to withhold. No fuss, no recrimination, it just won’t happen if X doesn’t happen first.

[sassenach]

Peds nurse here. The medication has to get in. I would try to sneak it into her food. Ask for an rx for tablets and then crush and mix it into something. I love Dawn's pop tart approach. If that's not successful, a hospitalization would mean someone else will force the medication down, get her to a more stable place and then try to transition to unforced administration.

I work in oncology and the absolute hardest is when we have a kid refusing and a parent who wants to negotiate. It's more trauma for everyone. The kid ends up crying and resisting for an hour while the parent tries to talk them into it. Let us hold the kid and pop it into their mouth and this whole thing is over in less than 5 minutes. Eventually those kids either get better about taking it or end up with nasogastric tubes because the medication is not optional. Of course, it's way different in your situation because the resistance is part of the disease and I know you're trying your best to not add more trauma/mental blocks to the problem.

Bottom line is that this is a lifelong disease that requires medication. She simply must take it and it's important that you work on your own mental hurdles (fear of a hospital admission, if necessary) so that you can get her the lifesaving treatment that she needs.

Edited July 14, 2023 by sassenach

[ScoutTN]

@mindinggaps Update us when you can? Hope the situation is improving. 

[Drama Llama]

@mindinggaps Do you have a sense of whether the objection is to the taste of the medicine or  to a fear of what the medication does?  
 

I feel like those are two different sets of strategies.

[Lecka]

I would add to that “I don’t need this medicine, there’s nothing wrong with me, why do you think I need it?”

 

Or something directly related to OCD and just not wanting to take it because there’s something wrong with taking it?

 

Or something else?

 

 

 

[Innisfree]

8 minutes ago, Lecka said:

I would add to that “I don’t need this medicine, there’s nothing wrong with me, why do you think I need it?”

Yes. 

[Alte Veste Academy]

I feel for you on the medication issue. We have a pretty serious case of OCD here as well, and the meds take the edge off at least.

On the therapy side, have you had her see someone who does Exposure and Response Prevention? That’s having more success here, but meds do need to be on board for it to even be possible. 

Many gentle hugs for you. It is HARD.

[Drama Llama]

58 minutes ago, Lecka said:

I would add to that “I don’t need this medicine, there’s nothing wrong with me, why do you think I need it?”

 

Or something directly related to OCD and just not wanting to take it because there’s something wrong with taking it?

 

Or something else?

Oh yes, there are lots of reasons.  I was just thinking that in general there are two giant buckets of reasons. 
 

1) I don’t want that in my mouth (strategies like switching to pills, following it with a treat, mixing it with something etc . . .)

And 

2) I don’t want that in my body because I have anxiety about that, or it has effects I can’t verbalize that feel wrong, or it makes me feel like there is something wrong with me, or I feel guilty that I can’t control my symptoms or anyone of a bunch of other reasons.

 

[MEmama]

5 hours ago, BandH said:

That doesn’t mean we’re lucky,

To be clear, I didn't say that dismissively. My only point is that all kids are wired differently, none of these tricks and strategies would have worked on my kid at any age. I've never seen anyone who can dig in like this one could; thankfully he rarely did so when it was important. 
 

That's not making light of anyone else's experiences, I only know my own--essentially zero of which I shared here.

[mindinggaps]

Dear everyone, once again thanks for all your insights and best wishes. Jumping in here to provide a bit of an update and some context. Unfortunately, I still haven't been successful in getting the medication into her, However, last night she did explain to me that she is afraid that the medication will hurt her and this is the reason she won't take it. This was my hypothesis, but I am extremely glad to know this and more importantly, that she told me . Without a doubt, this is a symptom of her OCD and is exactly in line with types of fears and mental obsessions she has struggled with. Regarding the source of this sudden obsession, I don't know. I gently probed but anyone familiar with OCD will know that these types of things are completely irrational and sometimes don't have a clearly identifiable root cause.

In terms of the plan moving forward, while I am sure some will strongly disagree, there are some things I won't do. I will not physically force her to take it, nor will put it into her food or drink without her knowledge. I believe that both of these approaches will cause longer term trauma and issues. She always feels safe talking about her OCD with me and if she discovers that I actively did something which is right now literally her greatest fear, I think the consequences and violation of trust could be severe to her broader well being.

Right now, we are trying our best to be patient and keep trying. There have been many excellent suggestions and we are giving some of these a shot. To be clear, I have always communicated to her that she needs to take it. It was never presented as being optional, but me telling her this is equivalent to me telling someone with severe OCD not to repeatedly wash their hands. It just doesn't matter. Certainly I can say that anyone who suggests just telling her she must take it and waiting until she does probably hasn't dealt with OCD. This fear is totally dominating her mind right now and it won't just go away or subside - this is the disease she is struggling with and she cannot just turn it off in her mind. Consequences also are hard to implement because of the irrationality of it - she doesn't care. As long as she doesn't have to take it, any consequence is fine in her mind right now.

Right now, I am talking to her and trying to work through it. Longer term she also needs to be willing to take medication, so ideally we reach an outcome here that isn't a daily battle. Her life is hard right now, but she is not in imminent danger so I wouldn't quite equate it to a cancer treatment or anything like that. I will also soon speak to her psychiatrist, but the last message we received was don't force it into her.

Also, yes she is in ERP therapy.

[KSera]

3 minutes ago, mindinggaps said:

Also, yes she is in ERP therapy.

Is she working on it on there? It seems it would be the top target right now. 

[KSera]

3 minutes ago, mindinggaps said:

Also, yes she is in ERP therapy.

Is she working on it on there? It seems it would be the top target right now.