Advice dealing with anger issues for daugher with underlying mental health concerns?

[mindinggaps]

Hi all - I'm reaching out to see if anyone has any thoughts or advice on how to deal with anger issues in our young daugther. The situation is somewhat complex, since the problem is intricately linked to her fairly severe OCD. She is medicated with Prozac and sees a therapist regularly who focuses on ERP for her OCD. Unfortunately, even with these tools, while her OCD is generally fairly well controlled she can still react with aggression or anger when she is feeling anxious or obsessive. Obviously, the ultimate solution is to continue to make progress with the underlying condition however, I am wondering if anyone has resources or suggestions particularly for anger? I'd really like her to learn more healthy coping skills and generally to manage better in the event she is struggling with the OCD.

We have talked with both her therapist and psychiatrist on this matter. The psych of course says we can introduce another medication specifically for this but we'd rather not go in this direction right now. She responds well to Prozac but is on the max dose for her age. We did run a trial of adding on a small dose of Abilify but this didn't go as planned. I'm pretty hesitant to mess too much with things here. The therapist is really specialized on OCD and that is what they are targeting there. We could add on some additional therapy for anger.

Thoughts, resources, advice are all welcome.

[SKL]

Have you checked out this book?  https://www.amazon.com/Talking-Back-OCD-Program-Parents/dp/1593853556/ref=sr_1_15?crid=2D5UHF79IVL1V&keywords=ocd&qid=1700407914&sprefix=ocd%2Caps%2C77&sr=8-15

[PeterPan]

55 minutes ago, mindinggaps said:

small dose

How small? Small in our house was *half* of the smallest pill. We actually saw results on *¼* of the smallest pill. People can be that sensitive.

Prozac is a methyl donor. Have you run genetics to look at her methylation cycle? Not the stupid color coded jazz but actual methylation cycle genes. The aggression is usually connected to dopamine, which gets revved by the methyls. Some people are complex and have both MTHFR *and* COMT defects, so they seem to tolerate some methyls and then can get worse. That's why the color coded genetic testing is never adequate. 

Down the behavioral rabbit trail. Have you explored whether severe OCD=ASD? Would calling it ASD change how you're approaching it? Might open some doors like working

-interoception=self awareness

-neurodiversity (as in some things we just accept, which I get isn't a practical or complete answer but could be a partial answer)

Also, you could see whether there are *other* genetic nuances going on revving the anxiety that revs the OCD and irritability cycle. There are some genes with zinc and b6 that can be affected. Zinc modulates GABA, so it directly affects anxiety. If you're seeing a lot of acne and anxiety together, that's a big red flag to be looking at zinc. The b6 is a little more complex because it can be affected by methylation or by pyroluria/nbpf3 gene necessary to convert it to the active form P5P. In our house, b6 as p5p is pivotal for one person and a disaster in any form for the other, which to me means when you need it you need it and when you don't you don't. 😉 In our house zinc has been good for everyone but the *dose* varies with the person and their genetics. (more affected genes, higher dose)

Has your person recently had covid or other illness? It can use up zinc, resulting in an uptick in mental health symptoms. Also it can affect thyroid and selenium, which can leave her more tired and amp the irritability. It can increase fibromyalgia type pain, again increasing irritability.

Another thing that has worked well here is 5HTP, but again that's really niched. I can't remember if it's you or someone else who posted with a complex situation where they tried it and it just was really bad in their brain chemistry. If you're that person, I'm sorry the chemistry is that complex and that it's hard. 😞

The age is hard, the self awareness is low. Just keep trying and be kind, super kind. My ds has FINALLY started coming to the other side of being a pleasant human. He's 15 now and I decided that for half of 13 and all of 14 that we would just MAKE PEACE. Like whatever it takes. Like if it means we make cookies every day and go to parks every day and play chess and do very little seeming academics, that's ok. (That's not exactly what we did, but it's the idea.) Some people just have really, really hard brain chemistry and the shifting hormones make it crazy anyway. I think it's ok to make peace while you try to figure it out. If the person would have been non-productive in any other setting (ie. it's them, not you), then why should you amp the stress? 

 

Edited November 19, 2023 by PeterPan

[mindinggaps]

@PeterPan Thanks for the comments and insight. Just a couple pieces of quick information:

6 minutes ago, PeterPan said:

How small? Small in our house was *half* of the smallest pill. We actually saw results on *¼* of the smallest pill. People can be that sensitive

I need to double-check, but I believe it was 1mg that was trialed.

8 minutes ago, PeterPan said:

Down the behavioral rabbit trail. Have you explored whether severe OCD=ASD? Would calling it ASD change how you're approaching it? Might open some doors like working

We've definitely been down this path quite thoroughly and are confident in the diagnosis. She's been screened for ASD at multiple points in her development by multiple physicians and psychiatrists and the symptoms she experiences are not in line with ASD. So we are confident in the diagnosis for sure.

[Ottakee]

Here anger comes out of anxiety.

[PeterPan]

1 hour ago, mindinggaps said:

@PeterPan Thanks for the comments and insight. Just a couple pieces of quick information:

I need to double-check, but I believe it was 1mg that was trialed.

We've definitely been down this path quite thoroughly and are confident in the diagnosis. She's been screened for ASD at multiple points in her development by multiple physicians and psychiatrists and the symptoms she experiences are not in line with ASD. So we are confident in the diagnosis for sure.

The smallest pill is 2mg, which would completely zombify my ds. 

I'd suggest pursuing the interoception, because improving it will bring more self awareness and self advocacy for her mental health. 

1 minute ago, Ottakee said:

Here anger comes out of anxiety.

The great irony is that the meds don't deal with potential underlying physical causes for the anxiety. It's just one of those things I whack around my brain, how we got in this position with psychiatry, sigh.

[itsheresomewhere]

1 hour ago, mindinggaps said:

@PeterPan Thanks for the comments and insight. Just a couple pieces of quick information:

I need to double-check, but I believe it was 1mg that was trialed.

We've definitely been down this path quite thoroughly and are confident in the diagnosis. She's been screened for ASD at multiple points in her development by multiple physicians and psychiatrists and the symptoms she experiences are not in line with ASD. So we are confident in the diagnosis for sure.

For a female-  it is not uncommon for a female to be diagnosed later as ASD when they were told they weren’t when they were younger. Don’t be surprised if it happens down the road.  

[maize]

2 hours ago, itsheresomewhere said:

For a female-  it is not uncommon for a female to be diagnosed later as ASD when they were told they weren’t when they were younger. Don’t be surprised if it happens down the road.  

This is true.

It is also true that ASD and OCD can coexist.  I have an autistic son who also struggles with severe OCD, and the OCD is definitely worthy of its own diagnosis beyond just the ASD diagnosis. It's been by far the most debilitating of the various challenges he deals with.

[bookbard]

Have you read The Explosive Child? It is probably the most practical and well-known book on dealing with anger in children. It's been around for a long time. 

[chocolate-chip chooky]

I can completely relate. It was a horrible combination of OCD and rage. 

For us, the rage was self-directed. It was self-hate and immense frustration, and it was explosive. It was related to perfectionism and also about feeling out of control and at the mercy of OCD.

Things that helped were acknowledging the feelings and having ways to safely express and release the rage. I had piles of balled up socks and a safe area to throw them at each other. I had pillows she could punch. I also had balloons to whack at in the hallway. The rage needed to be used up physically, and then it would usually result in a big cry.

Mistakes I made: I gave her things she could tear up, but that was a fail, because once she calmed down, she could see destruction, which added to her feelings of 'what's wrong with me??'

The good news - it passed. It wasn't forever. It felt like forever at the time. 

I really hope you find the solutions that work for you and your daughter 🌻

[mindinggaps]

Thanks everyone for your comments and support.

20 hours ago, PeterPan said:

The smallest pill is 2mg, which would completely zombify my ds.

This is the issue we had with 1mg and we discontinued quite quickly. To be honest, if we can avoid further medication, we would like to. The underlying issue is very clearly anxiety and OCD so we do feel tackling that is essential. She has responded extremely well to Prozac and it keeps the OCD in check - layering on medications is an option, but it doesn't really feel like a panacea. It's also a pretty tough cycle to test, monitor for side effects and iterate. It's sort of a last resort solution at this point but obviously it is an option.

17 hours ago, bookbard said:

Have you read The Explosive Child? It is probably the most practical and well-known book on dealing with anger in children. It's been around for a long time. 

Yes, we've picked this up!

16 hours ago, chocolate-chip chooky said:

For us, the rage was self-directed. It was self-hate and immense frustration, and it was explosive. It was related to perfectionism and also about feeling out of control and at the mercy of OCD.

This is pretty much exactly it. Perfectionism and feeling controlled by OCD are very much the under current pushing her over the edge. @chocolate-chip chooky as always, I appreciate your thoughts and empathy. It is helpful to know that there is hope on the other side.

[fraidycat]

I would try using EFT with her. 
 

https://biglifejournal.com/blogs/blog/tapping-confident-kids-eft

https://www.thetappingsolution.com/tapping-solution-kids-how-to-tap/

Edited November 20, 2023 by fraidycat

[scbusf]

I will just tell you our experience. My DD is currently 15 (turning 16 in January). For years, we have taken her to counselors. For many years, the counselors, us, and her Psychiatrist thought that DD's anger issues were driven by her anxiety and OCD. Just 2 months ago, she was finally diagnosed with ASD. It hasn't really changed our treatment plan, but we have so much more knowledge now about the cause.

[PeterPan]

17 hours ago, chocolate-chip chooky said:

feelings of 'what's wrong with me??'

Ironically, that is connected to their level of social thinking. So someone else with the same chemistry but a different level of social thinking (more debilitated if we're being blunt) might not ever make that connection. My ds does *not* do the self-loathing thing, and I kind of gloated for a while like oh I'm a great parent,  my kid doesn't hate an aspect of himself. Then I realized it's just that he doesn't have the social thinking to make the connections and get there. 

So that's a really hard thing, but I think also being honest with the person about the levels of social thinking and SHOWING them (that kind of metacognitive awareness) why it's happening has been helpful for some people. It's at least feedback we get here on the board. The social communication profiles article is on the Social Thinking website for anyone who needs it. 

https://www.socialthinking.com/Articles?name=social-communication-learning-style

[dsmith]

On 11/19/2023 at 11:13 AM, mindinggaps said:

@PeterPan Thanks for the comments and insight. Just a couple pieces of quick information:

I need to double-check, but I believe it was 1mg that was trialed.

We've definitely been down this path quite thoroughly and are confident in the diagnosis. She's been screened for ASD at multiple points in her development by multiple physicians and psychiatrists and the symptoms she experiences are not in line with ASD. So we are confident in the diagnosis for sure.

Just for reference, my adult son who is over 250 lbs takes 2mg every other day. He could do 1 mg every day but we wanted to avoid pill splitting. He started at a lower dose, but I don't remember what it was. It may have been a liquid when he started. 

[PeterPan]

1 hour ago, mindinggaps said:

This is the issue we had with 1mg and we discontinued quite quickly. To be honest, if we can avoid further medication, we would like to. The underlying issue is very clearly anxiety and OCD so we do feel tackling that is essential. She has responded extremely well to Prozac and it keeps the OCD in check - layering on medications is an option, but it doesn't really feel like a panacea. It's also a pretty tough cycle to test, monitor for side effects and iterate. It's sort of a last resort solution at this point but obviously it is an option.

Did they run her thyroid? My ds' thyroid was slightly low and our pdoc finds that there's sort of, as you say, this layering effect. You take someone who is more sensitive and you make them a bit more tired on top of the (mild) low thyroid symptoms they're already experiencing and you get this straw that breaks the camel's back. For us, the abilify was non-negotiable because it targets the direct gene that is his issue. He has to have a med and the meds will have side effects. How old is your dc? Have they gone through puberty? The social worker warned us that everything we got in balance before puberty would completely go out the window, which is what happened. In a matter of months we went from ok to oh my lands this is really really not working, and it was really, really ugly. And we had some serious talks like this is puberty, your body is changing rapidly. 

So there is a school of thought, and what we were advised, to do less meds (just enough) before puberty, get through puberty safely, and then get into a more long term routine with his new brain chemistry. It's something to consider, depending on where you are in that progression. You might go for good enough, knowing it will all change and get cu-razy in a couple years and then be better on the other side.

Back to thyroid. My ds had a back experience with his blood draw (grr) so he is not motivated to have his thyroid rechecked enough to do meds. We know the psych meds push it lower, and it's something HE has to be ready to do. For now, I upped his selenium. I'm hoping with time he can re-approach the blood draw and be ready to make that choice. There is no forcing an adult size teenage male, kwim? The selenium is enough to keep his energy in the tolerable range and I dose at the upper end of the normal recommended amount. (2 capsules=400mcg) Prozac also affects thyroid, right? Have they discussed fluvoxamine? They don't seem to prescribe it for adolescents and the (spare, not my regular) doctor was loathe to prescribe it. Down side is it has fluoride, which again is rough on the thyroid, but it's a really good med for the symptoms and on label for OCD. It's just sort of old school and not always preferred. Are you using fluoride toothpaste? That could be something to look at if her thyroid and energy are affected. 

That's just spaghetti at the wall, throwing little things out to look into. Maybe some *little* things like that could get it a little better. 

 

[wendyroo]

4 minutes ago, dsmith said:

Just for reference, my adult son who is over 250 lbs takes 2mg every other day. He could do 1 mg every day but we wanted to avoid pill splitting. He started at a lower dose, but I don't remember what it was. It may have been a liquid when he started. 

On the other end of the spectrum, my 130 pound 12 year old takes 4mg of Abilify daily plus 3 mg of Risperidone.

[PeterPan]

2 minutes ago, wendyroo said:

On the other end of the spectrum, my 130 pound 12 year old takes 4mg of Abilify daily plus 3 mg of Risperidone.

That the combo works is what matters. Risperidone is a methyl containing med, so for your ds mix it may be taking that much Abilify to balance out the effects. We upped my ds' Abilify slightly so he could eat high methyl foods (orange juice, etc.) and stay (relatively) stable. He's finally self aware enough that he can FEEL the surges happening with caffeine, etc. and can ask for something to get him stabilized.

The chemistry is hard, and they do make these trade-off combos.

[OH_Homeschooler]

My daughter has BPD and as a caregiver, one thing that can be done to defuse a lot of negative situations is validation. It's not always easy to find something to validate when someone is going off in a rage about something you don't understand, but it gets easier with practice. The important thing is to validate their feelings, not feeling obligated to validate their decisions or behaviors. 

https://www.happierhuman.com/validating-statements/

[mindinggaps]

5 hours ago, fraidycat said:

I would try using EFT with her. 
 

https://biglifejournal.com/blogs/blog/tapping-confident-kids-eft

https://www.thetappingsolution.com/tapping-solution-kids-how-to-tap/

Thanks! We are exploring therapy options specifically focused on areas outside of OCD, so this is helpful.

2 hours ago, OH_Homeschooler said:

My daughter has BPD and as a caregiver, one thing that can be done to defuse a lot of negative situations is validation. It's not always easy to find something to validate when someone is going off in a rage about something you don't understand, but it gets easier with practice. The important thing is to validate their feelings, not feeling obligated to validate their decisions or behaviors. 

https://www.happierhuman.com/validating-statements/

Again, thanks! I am in therapy myself and trying to learn parenting techniques which can help her in various ways. This has been very useful.

On the ASD side, again I'll emphasize that her symptoms don't really add up with that and she's had multiple evaluations at different stages of development, but I do understand people's concern here. Overall, we are definitely trying to focus on solutions that don't require additional medication at this stage since she is young. Lowered Abilify, Seroquel, Risperidone, gabapentin and Lamictal have all been thrown out by the psych, but we're not really ready for this step yet. Perhaps that's not the best approach, but we are cautious here..

[mindinggaps]

Just to follow-up, a couple people have asked me for details on her current treatment. She is 7 years old and takes 40mg of Prozac. This is definitely a large dose (max for her age), but she does not have side effects. pushing up with the medication was recommend by the psych and gave huge benefits for her OCD and in particular some of the compulsions (hand washing for example). Certainly one of the reasons why we don't want to introduce another med is because she is fairly heavily medicated with the Prozac already.

[Ottakee]

9 hours ago, mindinggaps said:

Just to follow-up, a couple people have asked me for details on her current treatment. She is 7 years old and takes 40mg of Prozac. This is definitely a large dose (max for her age), but she does not have side effects. pushing up with the medication was recommend by the psych and gave huge benefits for her OCD and in particular some of the compulsions (hand washing for example). Certainly one of the reasons why we don't want to introduce another med is because she is fairly heavily medicated with the Prozac already.

You say she doesn’t have side effects but also say she is heavily medicated.  Do you just mean she is on a high dose?  Or is it that she has a lot of effects from the med?

Heavily medicated usually means a lot of side effects, tiredness, cognitive dulling, etc.

Could it be that she is a just a fast metabolized of the Prozac?   I have one that is on a very small dose of Risperdal  and it is highly effective, but is on a very high dose of a different med as she metabolizes them differently.

[Spryte]

A few random thoughts:

Definitely read the Explosive Child.

Is she gifted? That can lead to some big difficulties, too. I’ll have to glance at our bookshelf for titles that helped and come back.

ASD. I know you have ruled it out. We ruled it out, too — so much testing. A lot of PG kids can hide it until they hit young adult years, apparently. DS was diagnosed at 19 and it sure explains a lot in hindsight.

Does she take anything other than the Prozac? Antihistamines? Allergy pills? Singulair was a nightmare for us. And most allergy pills. Also, red dye. I can’t overstate the effect. DS recently had a pill with red dye, as an adult, and said it made him feel like jumping out of a window, but he knew it was chemical and could manage. He could not manage that at 7.

ETA: I cannot recall what led us down this path, but we found through bloodwork that DS had high heavy metals and VOCs. Treating that, and using special air filters to reduce VOCs, along with a lot of environmental changes helped tremendously.

Edited November 22, 2023 by Spryte

[mindinggaps]

19 hours ago, Ottakee said:

You say she doesn’t have side effects but also say she is heavily medicated.  Do you just mean she is on a high dose?  Or is it that she has a lot of effects from the med?

Heavily medicated usually means a lot of side effects, tiredness, cognitive dulling, etc.

Could it be that she is a just a fast metabolized of the Prozac?   I have one that is on a very small dose of Risperdal  and it is highly effective, but is on a very high dose of a different med as she metabolizes them differently.

Thanks for this comment. She is on a high dose but does not experience significant side effects from the medication, so I do believe my use of the term heavily medicated is a bit inappropriate. I would say the medication is working extremely well overall for her. However, I think I sometimes feel a hint of guilt or uncertainty associated with the fact that she is on a higher dose. That phrasing is more my own internal struggle, which isn't a great framing for sure.

[mindinggaps]

Hi all, for those who are interested or following along, I'm sharing a bit of an unfortunate and discouraging update. Over the past few weeks things have continued to deteriorate. She is currently in public school and several times her behavior has resulted in her being removed from the classroom, twice with me being called in to take her home. My immediate hunch was that there must be some underlying issue since school has never been a problem. She does well academically, integrates with her peers and has mostly been happy in this environment. I spoke to her teachers about potential bullying or new stressors but nothing could be pinpointed. I did ask them to keep a careful eye on things, but after another incident, we also booked an emergency psych appointment.

The psych said we need to adjust her medication with the addition of an atypical antipsychotic and/or mood stabilizer. I pushed back on this because I would like to use therapy as much as possible. She is getting benefit from ERP and we are exploring other additional options. The psych said we are at a point where pharmacological intervention is required. I'm pretty upset and distraught about this. I really don't like the idea of her being on multiple drugs at her age and we've really done what we can to try to avoid it. Just figuring out what to do right now, but that's where we are at.

[maize]

That is discouraging. Mental health issues are so very hard, and setbacks sometimes feels like three steps back for every step forward.

Does she enjoy school? Could it be a source of stress even though it seems to be mostly going well? She's so young that she may not be able to analyze and verbalize what is going on, but I wonder if it is just overwhelming her ability to cope. None of my own kids have done well with the day in and day out stress of school; most have tried it at one point or another but we have always ended up bringing them back home.

[mindinggaps]

3 minutes ago, maize said:

Does she enjoy school? Could it be a source of stress even though it seems to be mostly going well? She's so young that she may not be able to analyze and verbalize what is going on, but I wonder if it is just overwhelming her ability to cope. None of my own kids have done well with the day in and day out stress of school; most have tried it at one point or another but we have always ended up bringing them back home.

Certainly up until very recently every indication has been that she loves school. This is why I was initially perplexed and believed there must be something deeper here, although it's possible it has just become increasingly stressful.

[KSera]

3 minutes ago, maize said:

That is discouraging. Mental health issues are so very hard, and setbacks sometimes feels like three steps back for every step forward.

Does she enjoy school? Could it be a source of stress even though it seems to be mostly going well? She's so young that she may not be able to analyze and verbalize what is going on, but I wonder if it is just overwhelming her ability to cope. None of my own kids have done well with the day in and day out stress of school; most have tried it at one point or another but we have always ended up bringing them back home.

I'm wondering this as well. Bright lights, noise, all kinds of things which can be over-stimulating if someone has sensory sensitivities. My recollection is that so far no one has said they think ASD is at play, but that your descriptions made it sound like it should be kept in mind as a possibility. I'd say it's possibly more common than not for bright, verbal girls on the spectrum to have that missed at this age.

The winter break might be a good opportunity to see if she does better or worse when she is home from school for a prolonged period.

[MercyA]

Please do not be afraid to try lamotrigine (brand name Lamictal). It's a mood stabilizer that often has few side effects. 

If she had a broken leg and one painkiller wasn't doing the job but two would allow her to function much better, would you refuse to give her the second drug? On what basis? Mental illness is a physical problem and sometimes physical problems need more than one intervention. You would not just say to the person with the broken leg, "Try harder to walk" or "You just need to do more therapy," particularly if the pain was intense and greatly interfering with their daily life. Right?

Not trying to be harsh, but please make sure you are looking at this with nuance and not as a black and white ("only one drug") issue. 

❤️ Hugs.

Don't quote please.

Edited December 7, 2023 by MercyA

[PeterPan]

55 minutes ago, mindinggaps said:

pharmacological interventio

Has she been on an atypical antipsychotic up to this point? And she's in her teen years? 

The brain is constantly changing in teens. I would give her the meds. You may LIKE it and it may go MUCH BETTER than you ever dreamed. Seriously. 

There is no talking through chemistry.

I will kiss the feet of the inventors of Abilify. Just tell me where to show up. And it's stupid cheap and it works and when taken at careful, LOW DOSES it has modest side effects.

Have them run baseline thyroid, etc. labs. My ds turned out to have another vitamin (that shows in normal, run of the mill bloodwork) that was low. So run baseline bloodwork and then proceed forward with confidence. The reason the meds work for some people so well is because they are targeting the pathways affected. So yes, the med could be bad voodoo for some people. We had run meds and I knew what it targeted was exactly what is going on. Gave the med, MIRACLE. 

You've got this. 

[Acadie]

Because you've expressed such a strong desire to minimize/avoid more pharmaceutical intervention if possible, I want to mention that histamine intolerance or mast cell activation can cause or exacerbate neuropsychological symptoms for some people. 

Is she sensitive to food dyes? Have you ever tried a low histamine diet? 

Covid infections seem to be either exacerbating or possibly initiating mast cell activation and neuroinflammation for a subset of people, so a recent illness could be one factor to consider in trying to sort out what has shifted. 

Sending all good energy to you and your girl. 

[KSera]

49 minutes ago, PeterPan said:

And she's in her teen years?

she's 7

[freesia]

I guess I just don’t understand what your concern is about adding meds. Clearly she is suffering right now and being taken out of class means things aren’t working for her and she’s not coping so she she’s experiencing tons of negative “side effects” from her behavior—psychologically and emotionally and probably socially. Do you think the medical side effects will be somehow worse? How? Have you articulated what is so bad about meds? I’ve seen this before in friends and mostly it’s just a vague feeling from people telling them it’s bad. I’m tired of seeing kids suffer for years bc the parents feel it’s bad to medicate and if everyone just tried harder they can overcome “this.” All that ends up happening is the child and parent feels like a failure. Nothing at all is gained. Do you somehow think that you can’t keep working on the other avenues if you add something? 
 

ETA:I didn’t mean that to come out as harshly as it did. I do want you to think, though. If you have clearly articulated to yourself what is so bad or worse exactly and specifically and weighed it against the negatives in her actual reality, then that’s good. 

Edited December 6, 2023 by freesia

[chocolate-chip chooky]

@mindinggaps

I understand your concern, and I would feel the same.

If I was in your shoes, I'd do my best to get a second medical opinion. If the second opinion matched the first, I'd wrap my head around the new med regime and get on with it. If she needs it, she needs it.

Are you able to tell us anything more about the issues at school? If you don't want to lay it out publicly, feel free to PM.

I'm so sorry this is all so hard. I'm thinking of you.

[FreyaO]

I don't have experience with medicating young children, so I won't comment on that question.

However, regarding the recent changes in school.... it sounds like a burnt-out child to me.

It's totally possible for a child to like, or even love, the other kids, teachers, the whole experience, and be stretched out thin at the same time. It's very common for a bright girl to try to please those around, until she can't do it anymore. Maybe she could for 2-3 months, now she is overtired.

How long is her day - does she stay for after school? How many kids in the class? How many transitions? Not that it matters, one's limits may be within what is considered "normal" for most.

If you are hesitant on the meds, could you give her a long break as a first step? Start the holidays 10 days early? Pick her up early? Keep her home every Wednesday or Friday?

[Ottakee]

Lamictal was a huge help here.  Along with Risperdal.

don’t feel bad that she metabolizes his meds quicker than some other children and needs a higher dose. For some kids after puberty that slows down and you actually can lower the dose it is all very individual.

[Terabith]

I’m so sorry she’s struggling!  

[KSera]

1 hour ago, freesia said:

I guess I just don’t understand what your concern is about adding meds.

I can understand the hesitancy to not start an atypical anti-psychotic unless definitely necessary. They are incredibly important medications for people who need them, and the risks are worth the benefits for those, but they do carry a risk of serious side effects which are sometimes permanent, even after stopping the medication. So, it does make sense to me that a parent of a young child would feel pretty conflicted about whether her child has reached the point where the risk/benefit ratio has tipped in the direction of the risks being clearly worth it. The risks of some of these side effects can be significantly lowered by using only a very low dose, and being alert to adverse effects and tapering off if they are seen.

[itsheresomewhere]

Most of us do have regrets for not trying medications when they were needed.  If I were in yours shoes, I would try it. It can also help your child’s progress with therapy as some can make more progress with medication and changing up medications. 

[mindinggaps]

56 minutes ago, KSera said:

I can understand the hesitancy to not start an atypical anti-psychotic unless definitely necessary. They are incredibly important medications for people who need them, and the risks are worth the benefits for those, but they do carry a risk of serious side effects which are sometimes permanent, even after stopping the medication. So, it does make sense to me that a parent of a young child would feel pretty conflicted about whether her child has reached the point where the risk/benefit ratio has tipped in the direction of the risks being clearly worth it. The risks of some of these side effects can be significantly lowered by using only a very low dose, and being alert to adverse effects and tapering off if they are seen.

This is exactly it. I was very hesitant to start her on medication at all, but I did come to understand that the risks for fluoxetine in young children are very low. It has been widely studied, is regarded as safe and effective with limited risk for longer term side effects or issues. However, for other classes of drugs, this isn't necessarily the case. Ultimately, I would like to avoid it.

@chocolate-chip chooky Thanks - sometimes the most obvious option escapes you when in the midst of dealing with these things. We will seek a secondary opinion before making any decisions.

[Terabith]

I am very much in favor of medication, but I admit that I would be very hesitant about atypical antipsychotics for a seven year old.  I would be less concerned about something like lamictal, but it doesn’t have the safety profile of Prozac, and I would both want a second opinion and to try non pharmaceutical interventions including maybe a break from school before I would want to add something like that. I would also want an occupational therapy evaluation from someone who is competent in sensory issues. 

[KSera]

12 minutes ago, Terabith said:

I am very much in favor of medication, but I admit that I would be very hesitant about atypical antipsychotics for a seven year old.  I would be less concerned about something like lamictal, but it doesn’t have the safety profile of Prozac, and I would both want a second opinion and to try non pharmaceutical interventions including maybe a break from school before I would want to add something like that. I would also want an occupational therapy evaluation from someone who is competent in sensory issues. 

💯this

[Wanttohomeschool]

Might want to look into the Keto diet.  https://www.metabolicmind.org/

[Mrs Tiggywinkle Again]

If I could change one thing in my life, I would have started DS on Abilify or Lamictal years earlier than we did.

My kid takes four pills every night before bed.

My kid has gone from 13 school suspensions in one month at the age of 8 to a high honors student who has friends,  has almost no anxiety and is usually pretty pleasant to be around.  Therapy overall did nothing for us, because while therapy can give coping strategies, it cannot fix a chemical problem.

[BeachGal]

I don’t want to sway you from using meds but some other thoughts to consider if you haven’t already:

• Did her OCD begin after an infection?
• Has she been tested for lyme disease?
• You might want to do a diy omega 3 index test. Omega Quant is a reliable company and a test is not too much $$.
• I think she might be too young, but for now you could follow research using transcranial direct current stimulation, tDCS, to treat OCD.
• The microbiome research and OCD might be worth following as well.

           https://www.nature.com/articles/s41598-022-05480-9

 

[PeterPan]

2 hours ago, Ottakee said:

Lamictal was a huge help here.  Along with Risperdal.

don’t feel bad that she metabolizes his meds quicker than some other children and needs a higher dose. For some kids after puberty that slows down and you actually can lower the dose it is all very individual.

Oh that's interesting. Our pdoc was just telling me that kids "stabilize" as they go into adulthood, and I wasn't quite sure what she meant. I hadn't pondered changes in metabolism.

[Ottakee]

1 hour ago, PeterPan said:

Oh that's interesting. Our pdoc was just telling me that kids "stabilize" as they go into adulthood, and I wasn't quite sure what she meant. I hadn't pondered changes in metabolism.

Some kids need more, others less in meds.  One of mine was on a crazy high dose of a seizure med as she burned through it so fast but then on a tiny little dose of another med.

our doctor has said that the earlier and quicker you get them stabilized the better…..sorta like a diabetic.  Early treatment and close monitoring of the insulin makes for much better outcomes than waiting longer and not dialing it in.   Not a great example but all I can think of now

[wendyroo]

8 minutes ago, Ottakee said:

our doctor has said that the earlier and quicker you get them stabilized the better…..sorta like a diabetic.  Early treatment and close monitoring of the insulin makes for much better outcomes than waiting longer and not dialing it in.   Not a great example but all I can think of now

This is the route we have taken with my kids. We started ADHD and anxiety meds for all of them somewhere between 5 and 6...right about the time they were transitioning from preschool classes and expectations and theories of mind, and they were starting to suffer academically, emotionally, behaviorally and socially from their delays and deficits and growing anxieties.

With two of my kids (who ended up with ASD and ODD/DMDD diagnoses), that was not enough to stabilize them even at that age, so at 7 they were on Risperidone as well, because our psychiatrist feels strongly that early stabilization is crucial to get kids to a place from which they can grow and develop coping strategies.

Unfortunately, with Elliot that has not worked, because even at 12, on a cocktail of psychotropic drugs, he is not safe or stable. And that lack of stability means that my two younger kids now have PTSD diagnoses from the trauma of living in a house with Elliot's violence. Instability can have just as many long-term consequences and side effects as medications. And one of the huge downsides is that intensive therapy does nothing for Elliot, because he is not in a receptive place where he can (or wants to) adjust his thinking or behavior.

But for Audrey, early medical intervention has made all the difference in the world. At 6-turning-7 she was suicidal, attempting to run away on a weekly basis, refusing all school work, kicking holes in walls, and throwing extended violent tantrums. On .5mg of Risperidone (plus large doses of Focalin and Fluoxetine), she is a happy, thriving just-turned-8-year-old. She is on a gymnastics team and in girl scouts, and is doing so well across the board. Of course we will reassess her meds and dosages over time just like we do for all the kids, but I am so glad to have her on a stable, functioning foundation right now. Unlike Elliot, therapy is now hugely beneficial for Audrey - every week I see her taking coping strategies and social strategies she has learned in therapy and applying them to her life. But this is only possible for her because her brain is regulated enough to allow her to implement new skills, and because she has been stable enough over time to build friendships and communities that she values and wants to maintain. 

[Lecka]

I think it’s time to request an IEP and look hard into IEP supports.  
 

Some of this really depends on the individual kid.  
 

Here is just a thought experiment:

 

One child does pull-out to be in a smaller group and does great with it.  It relieves stress and there can be a lot more freedom to move around or do some exercise, depending.  (Sometimes pull-out can be louder or more disorganized than a classroom, it can just depend.)

 

Another child feel separated from the social life of the class and hates it.  
 

For some kids there is not a need to have a goal or requirement of “stay with the group” because they don’t care.  That is a big thing to let go of, though.  It’s a big deal and it is not something to do lightly.  But it’s great for a lot of kids.

 

But other kids really want that and do care, and it’s positive, and seems like it’s in their favor and realistic and all those things.  
 

Do Child A and Child B need the same effects of medicine?  No.  Parents are allowed a lot of choice in this.  

 

As things stand now — it’s time for an IEP.  It’s time to be a strong advocate.  Whatever is going on right now isn’t working anymore.  
 

Personally, I think some kids do well with more accommodations and the avoidance or minimization of medication.  And other kids I think would be better off with the medication.  Some of this is from — oh, the next year or 2 years later the kid is on medication and you’re like — wow, they are doing amazing, they are thriving socially, they are so engaged.  But sometimes medication doesn’t seem to make that much of a difference.  
 

As far as heavy advocacy at school, or home-school, let’s be honest and say some kids totally thrive outside of school and their problems can be minimized and their strengths emphasized.  
 

But other kids take their problems with them and then — it can be hard to find activities.  It can be hard when activities change, it can be very disruptive.  School can be so consistent.  School can provide the same faces and routines.  

For me, a “test” of this is summer…. Does a child thrive in summer with a more relaxed schedule and maybe swim lessons and Sunday School, or something like that.  Is it easy or hard.  Can they go in to Sunday School like it’s no big deal, or not really.  
 

At what point is a child not participating well in public school, and at what point is it effecting many parts of life, and many parts of life that are integral to development, happiness, not becoming isolated, not missing out on childhood experiences that have value — not to say any specific thing is required or necessary, but just not to become someone who can’t really participate (or have a positive experience) in things that are totally reasonable and not too much or anything like that.  
 

Then there is also a question of what is actual personality and what is — something that is actually a detriment.  The exact same thing can be actual personality for one person, and a detriment to another.  Aka — does someone really not care about something or doing something…… or are they just saying they don’t care because of a barrier.  Would they really love something if the barrier were removed.  
 

I think these are all things to think about.

 

 

[Lecka]

I also think — hey, there’s a school vacation coming up.  How is she going to do?

Some things would be unusual — like, maybe she does poorly with holidays, that is not that meaningful for “how does she do out of school.”

 

But if she’s just at home, that may not be the whole picture, either.

 

Still, it does give a lot of information.  
 

The time is NOW to request an IEP, though.  Sending a written request starts a clock.  Just chatting with the teacher does not.  Some things are the parent’s role and need to be done by the parent, this is one.