Violent 10yo

[Simmer]

My son has been diagnosed on the spectrum since he was 5yo, initially PDD with ADHD. Doctors over the years have re-confirmed this, although now they're leaning towards Aspergers with ADHD.

Up to a couple of months ago he was mostly manageable, albeit serious meltdowns at least once per week where something would get broken or somebody would get hurt. In the last few weeks this has escalated to at least once daily. In the last week alone he has smashed two large windows, 3 lamps, a ceiling fan, slashed soft toys, broken a wine glass and threatened a house full of guests to the point where they locked themselves in their bedrooms, and he has expressed desire to kill others or kill himself.

A few days ago this got really bad so I called 911. Despite telling them he was threatening to kill himself, they deemed it low priority and didn't turn up until 90 minutes later. By that time he was asleep so all the officer did was talk to us and then leave.

Previously, when he knocked the wind out of my wife in another fit of rage, we took him to ER. It was a Saturday. There was one psych doctor covering 3 hospitals and he didn't get seen for SIX HOURS. Of course, by that time, he was calm especially as the nurses gave him a Playstation to use. When the doctor eventually turned up she asked a couple of questions, looked at him, and said "he's fine, go home". (We did get an apology from her manager for that stunt a few days later)

His regular psych doctor prescribes him 4 meds. He upped the dosages slightly which made him worse, so he lowered them back down. But he's still getting worse (so maybe the dose increase was a red herring).

He needs to be committed for proper evaluation. 5150 maybe. But nobody will take us seriously. A Regional Center is helping us but they have processes to go through before he can get help. The two avenues I know of, ER and 911, have failed us.

The slightest thing sends him over the edge so we're walking on eggshells with him. The simplest things are impossible now, like taking a shower, or doing his homework.

Please, can anybody suggest anything to get him the help he needs?

 

[kbb0]

It sounds like something bad is happening to him, either external (very bad bullying, abuse from an authority figure or peers) or internal (mental health issues such as Intermittent Explosive Disorder or Borderline Personality Disorder) or both. If he is more verbal I would recommend trying to find a therapist (preferably one who specializes in children with autism). A therapist would be able to help you find resources for hospitalization. When any child is threatening to kill themselves or others it means that something is wrong and autism is not "wrong". Either something is wrong in their brain chemistry or someone else is hurting them and they don't understand what is happening or why. Abuse and trauma can also alter brain chemistry. It is extremely confusing and painful and so they lash out because they don't know what else to do with it. Also, you may already know this, but avoid any information from "Autism Speaks" while looking for help. Maybe they get lucky sometimes but this is an organization that thinks autism is "wrong".

I have Borderline Personality Disorder and when I am unmedicated the people who live with me have described it as "walking on eggshells", I have extreme anger issues and any tiny perceived slight against me sends me into a downward spiral. He may not have the same thing, but it would be something to talk to a doctor/therapist about.

 

[BraidedPony]

Can you video one of his episodes on a phone or iPad? This would be something a professional could not dismiss lightly (like the ER doctor).
At 10 kids start getting physically strong. I don't blame you for being concerned.

 

[Major Tom]

I have a 5 year old that has some pretty severe behavior as well. I wish I had some advice, but I don't know what to say really. I do know however that my son at least goes in cycles sometimes he is fairly well behaved and others, he's in a nearly constant state of melting down. I've noticed that the bad behavior happens a lot with the changing of seasons and routines that come with it.

 

[WittyAspie]

Could explosive behavior be a side effect of any of his medications? I know from experience that something designed to help can end up causing more harm. Perhaps one of them, or the combination thereof, is interacting with his body differently as he ages? He’s a little young for puberty, but once that starts the chemical changes in the body could cause adverse reactions to something that used to not have any bad side effects.

 

[Lady Lucifer]

Could explosive behavior be a side effect of any of his medications? I know from experience that something designed to help can end up causing more harm. Perhaps one of them, or the combination thereof, is interacting with his body differently as he ages? He’s a little young for puberty, but once that starts the chemical changes in the body could cause adverse reactions to something that used to not have any bad side effects.

True, but at the same time, why would they give him meds for no reason then? They are trying to treat his destructive behavior. Then again, if he is on ADHD meds or antidepressants, espically at his age, could cause problems.

I've reread your post like five times...this dosen't sound like AS or ASD at all. You have mentioned nothing about speacil intrest, SPD, misreading social cues/lack of conversational skills. All you have mentioned is that he has explosive behavior. Yes, you mentioned PDD....but haven't provided me with much evidence, becuase it has similar symptoms to ASD.

Now, as someone who has actually been to a speacil needs school, with a lot of ASD students, I am aware that some ASD patients (espically males) have behavioral issues....but they are usually used as a "self defense" or "fight or flight" reaction. Its generally not meant to hurt others. At least not severely.

reviously, when he knocked the wind out of my wife in another fit of rage, we took him to ER. It was a Saturday. There was one psych doctor covering 3 hospitals and he didn't get seen for SIX HOURS. Of course, by that time, he was calm especially as the nurses gave him a Playstation to use. When the doctor eventually turned up she asked a couple of questions, looked at him, and said "he's fine, go home". (We did get an apology from her manager for that stunt a few days later)

What is your child's empathy like? After he beat your wife, did he show remorse? Guilt? Shame? Or Nothing? If he felt nothing or maybe even pride, I'd say your child is most likely a sociopath or psychopath. And this is not to be confused with psychosis, which is a totally diffenet disorder all together. Also what is your family history mental illness? This could also help the community (and real doctors, not psychology students such as myself) understand the genetic foundation.

Someone mentioned BPD, though I honestly don't know much about that disorder to be honest. It could also be conduct disorder. (more likely, since psychopathy is usually dignosed at 18 yrs)

As for treatment and what you need to do? This is gonna sound really depressing, but here are a few solutions to the problem:
1. If your in a situation where you see your son hurting or threatening to hurt someone, you need to call 911 in the moment, while its happening. That way the operator can hear the threats to themselves. Hear the screams of anguish/pain becuase you can't make this stuff up. No one calls 911 as a prank.

2. Install surveillance in certain areas of the house for more evidence. Not every room of the house, but areas that wouldn't be too invasive of one's own privacy, like the kitchen, living room and hallway. You have to do this discreetly.

3. If your child does get held for a 5150, (I'm not entirely sure how those work) and if the doctors sugguest that they put him in a pedatric psychatric ward for an extended period of time, leave him there until he is able to manage in society. This child sounds dangerous from what I have read. And without further extreme evalutation it will be a lot worse. I know, your a parent and this probably hurts reading this. But would you rather this than for him to go out killing people in his teens or adult life?

Now, I'm not a doctor. I'm just a person who studies psychology, with a speacil intrest in true crime and child development. However, I know what its like not having the knowledge and resources avaible. I was in a similar (though not as extreme) scenario. But the advice given is just my inner judgement. I could be wrong about a lot of things.

 

[Simmer]

Thank you for the replies. Last one first: I have not described all his symptoms as it would just make my OP even longer - I just concentrated on the worse ones. The only reason he wasn't diagnosed an Aspie before was the speech delay: the doctors did not explain what exactly that meant, so a couple of months behind was enough for us to tick "yes, delayed" whereas they actually meant a year or more. That answer ruled out Aspergers. Had we ticked no then the result would have been "strongly suspect Aspergers" by the doctors.

Empathy: very little. He might say sorry but not without prompting, and not heartfelt. Yes, he does snigger if he hurts people sometimes - not all the time.

The meds are risperadol, sertraline, oxycarbanol, and another I can't remember at the moment. He's been due for some sort of serum analysis to check whether the drugs are "compatible" with his system, though I don't know how reliable / FDA-approved this technique is. But it's worth a try - it's just insurance dragging their feet like they've been doing forever.

RE puberty - recently he got tested for it (testosterone and some other level) but no signs yet. Mentally he can be grown up one minute and acting like a petulant, argumentative 3yo the next. Academically he is 2 grades ahead on reading and mathematics and average or above average on every other subject. However, recently he has been scoring 25% kind of grades because he doesn't want to do it.

As for bullying, he is observed virtually all the time when awake. At school he has a 1:1 aide for the entire day, including dinnertime and recess. They even provide a school bus service door-to-door because our local school does not have SPED for his age.

Curious about Austism Speaks. We did one of their fundraising walks in Anaheim, CA a year or two ago. I was looking at their website yesterday but ultimately came here.

Thanks for the help. I'm self employed, working from home, and despite some respit from a Regional Center, my *ability* to work at home when he is here is all but gone. We're already struggling without me having to say no to work I know I cannot do due to the lack of hours! And our marriage. We're not there yet but I read somewhere that having an autistic child massively increases the chance of divorce. But then, of course, it's a vicious circle because the kids pick up on the tension and raise hell themselves, causing more tension...

Sorry for the rambling.

 

[DJones]

...
His regular psych doctor prescribes him 4 meds. He upped the dosages slightly which made him worse, so he lowered them back down. But he's still getting worse (so maybe the dose increase was a red herring).

...

The slightest thing sends him over the edge so we're walking on eggshells with him. The simplest things are impossible now, like taking a shower, or doing his homework.

Please, can anybody suggest anything to get him the help he needs?

The doctor upped the dosage(S)? As in changing more than one medication at the time? I can see it when one med is used to control EPS, for example, your child has a track record of tolerance (i.e., its not a new med)

@WittyAspie hit the nail right on the head. Each med, taken by themselves, with hypothetically no other meds being given concurrently, has the ability to affect brain chemistry, and the way the brain chemistry is affected (positively or negatively) won't really be known until therapeutic/maint dosage is hit. That's for EACH med. When psychotropic meds are combined the possibilities begin to multiply - two meds that would be tolerated well enough taken by themselves may react badly together. Now you add a third...now a fourth...

That's why it is critical that your PsyMD is experienced, knows the combinations really well, understands peculiarities of each med. If his doctor has been trying different things (and they should if warranted) he better have clinical expertise with cross-taper switching, etc. There's a lot more involved than they tell you.

Always get second opinions, regardless. Educate yourself. Start writing down a journal. Go back as far as you can remember and recall details, changes that you began to notice with your child's behaviours. Cross reference those with additions and changes in meds, go to your pharmacy and get a print out of the history if you need, whatever it takes.

You may see a pattern begin to emerge.

cheers

 

[Simmer]

Sorry, I miswrote about upping the dosages. It was a *plan* to up the dosages over time. All we did was increase one med and then return a month later for the next stage. But that month later, instead of upping the dosage of another med, we went back to where we were a month ago.

The doctors over the years (we've had a few unfortunately, due to insurance changes/coverages) have largely not altered the meds much so I assume they're in general agreement. None have ever changed more than one dose or med at a time.

We have a behavior diary going. A very brief summary but it's already a page long for this week.

However, finally we have progress! Our insurance co has finally given us phone numbers of two facilities who will take him, albeit only in an emergency (so crisis rather than respite). This is something we've been asking for for ages. Unfortunately both are an hour away in opposite directions but it is definitely good progress.

 

[Lady Lucifer]

Your not rambling, your simply explaining to other (trying to be helpful) users what is your situation.

First of all, this is kinda off topic, but since your new here, I'd thought I'd mention something. Because aspies are super sensitive, they generally don't like talking about "autism speaks" as they are searching for a "cure" to autism. Some aspies wanna be cured, others don't. But we don't often talk about it here without causing...trouble.

Second, still kinda off topic, but it pains me that your marriage is at stake because of your son's behavior and condition. Mostly because I'm still in emotionally debilitating relationship with my family because of my condition. I'm not saying you should do anything about this, nor am I unwilling to help. I'm just simply trying to say, your dealing with a child who isn't NT, not fitting the box of the "perfect" child. Even if your child wasn't destructive and/or violent, would he still be a burden onto your marriage?

Now on topic, I may have to do some digging on wether some other disorders can be diagnosed into one person or not. There are some points in your case where I see sociopath and others I see AS. They have similar symptoms, but generally for different reasons.

As for the meds, I'd recomend researching the drugs (and dosages) your child take before giving it to them. These are some heavy duty drugs that could screw up the development of a child. No child should be on that many drugs, not even in his condition.

Also for these meds, are these for his behavioral issues or something else? Because if they were perscribed as sedatives or ADHD stimulants, these could be the CAUSE of his behavioral problems.

You really didn't answer the question about bullying. Is he or is he not being bullied at school?

 

[Simmer]

"Even if your child wasn't destructive and/or violent, would he still be a burden onto your marriage?"

No. I mean, all kids take their toll on a marriage, but when both parents are exhausted and stressed from dealing with meltdowns, that definitely takes a more serious toll on the marriage. We have had counseling and will do it again. It's also why we qualify for respite care: to give us a break, date night, etc. We can't hire ordinary babysitters for him, nor leave him with neighbors/friends. This is not us being paranoid: we have had parents bring him home from a sleepover at 2am because they couldn't deal with him. Others just refuse (but will take his younger sister quite happily). That is a strain too.

"You really didn't answer the question about bullying. Is he or is he not being bullied at school?"

I said he is observed virtually all the time. By that I mean the chances for bullying are pretty slim when you have an adult closely watching a child. So no, I don't think he's being bullied. He mentions occasional altercations but it seems more of a sensitivity than bullying (she laughed when I tripped, kind of thing).

As for meds, even the doctors don't know how they all work. A Regional Center asked us yesterday for his meds so their people can independently review them. I don't know the intended function of all these meds: one in particular the doctor said was a delicate balance between being a soother to sending him nuts. Risperadol, Oxcarbazepine, Sertraline (depression), Vyvanse.

Further to the clinic admission, apparently we are to take him to a local ER (3 within 15 minutes) where he would be assessed and then dispatched safely to one of the two facilities an hour away. That is safer than driving an hour with a child in a meltdown state in the car. He had a few good days this week, though last night was terrible with broken glass involved again. So it seems we're finally making progress overall (gotta think positive!).

 

[DJones]

You really didn't answer the question about bullying. Is he or is he not being bullied at school?

The OP may not be cognizant of the role bullying can play with AS and its capacious effects on the deepest levels of the AS' psyche, relative to that on an NT's.

We weren't - that is until we saw the transformation of our child before our very eyes. He had been the victim of bullying (abuse, really) by one, notorious (notorious amonst children's psychologists, Pdocs in that area) Vice Principal and a few of her cronies at a school system in the American Mid-West.

AS can lie in a 'dormant' stage for a person's life until abuse/bullying brings it out. It can transform a HF, below level 1, person into a non-vocal, permanently damaged human wreck requiring a life-time of round the clock institutionalization.

The culture of bullying is so deeply ingrained into the fabric of the US school system, it would be virtually impossible to say that one's child escaped it with any certainty. Especially if the child has communication issues. You can see it even with neurotypical children.

Most people really don't know what goes on inside.

 

[Simmer]

I'm not saying that he is definitely not bullied. I do find it difficult, however, to believe that in a classroom of 3-4 aides plus a teacher that a child could be suffering from actual bullying. That's not to say a group could cover up abuse: it's just more difficult.

But there is actual bullying, and then there's perceived bullying which, for an autistic child, can feel like the same thing. For example, his screen time is controlled because it's a known factor in meltdowns (over stimulation) and he will tell anybody that will listen that we're mean, controlling parents (the WORST parents in the world!) who abuse him (yes, he uses the word "abuse") simply because he has to finish up his game/TV. Maybe not the best example.

 

[DJones]

Sorry - Simmer! Didn't see your reply until after I posted mine.

No. I mean, all kids take their toll on a marriage, but when both parents are exhausted and stressed from dealing with meltdowns, that definitely takes a more serious toll on the marriage. We have had counseling and will do it again. It's also why we qualify for respite care: to give us a break, date night, etc. We can't hire ordinary babysitters for him, nor leave him with neighbors/friends. This is not us being paranoid: we have had parents bring him home from a sleepover at 2am because they couldn't deal with him. Others just refuse (but will take his younger sister quite happily). That is a strain too.

That is normal and as long as you guys are both on the same page, are getting counseling/help and both want everything to work out, you'll be okay.

I said he is observed virtually all the time. By that I mean the chances for bullying are pretty slim when you have an adult closely watching a child. So no, I don't think he's being bullied. He mentions occasional altercations but it seems more of a sensitivity than bullying (she laughed when I tripped, kind of thing).

I know it must seem to you that we are determined that some sort of bullying has taken place, lol. If you trust the adult (gut instincts are usually correct with regards to this) then go with it. Usually marked deterioration in the mental state can be a big red flag - it was for us - that something is wrong - and it warn't observably apparent until we dug and started talking with psychological professionals who were aware of our child's "bully" but that's probably rare.

As for meds, even the doctors don't know how they all work. A Regional Center asked us yesterday for his meds so their people can independently review them. I don't know the intended function of all these meds: one in particular the doctor said was a delicate balance between being a soother to sending him nuts. Risperadol, Oxcarbazepine, Sertraline (depression), Vyvanse.

Actually, that's a standard mix of Antipsychotic (Risperadol), an anti-seizure med (Oxcarbazepine), an SSRI/Antidepressant - as you already know - and a stimulant. These 'cocktails' are used for everything from bipolar to full blown psychosis and everything in between.

Going on about them would require pages on another forum but they are highly idiosyncratic and they can make things worse in the process of making things better - if you follow.

Glad to hear "Think Positive" Yes. You can't say that enough.

Cheers,

 

[DJones]

For example, his screen time is controlled because it's a known factor in meltdowns (over stimulation) and he will tell anybody that will listen that we're mean, controlling parents (the WORST parents in the world!) who abuse him (yes, he uses the word "abuse") simply because he has to finish up his game/TV. Maybe not the best example.

Absolutely true. We see the negative emotional mental effects more on our "normal" child than we do with our AS. Too much screen is bad, period.

 

[Simmer]

By "even the doctors don't know how they all work" I mean that they know what they do for most people, but not necessarily how they actually work. Phrases like "the actual mechanism of action has not been determined" on drug labels. To be fair, that does apply to a whole bunch of drugs, a majority even. Over the years we've heard over and over again the concept of "trying" this particular combination of drugs to "see if it works". Never a good state to be in, but if we forget a dose then the chances of bad behavior later in the day are significantly increased. So *something* is working, to a degree, but ultimately yes, fewer drugs would likely be better.

 

[Lady Lucifer]

Risperadol, Oxcarbazepine, Sertraline (depression), Vyvanse.

I did some research on these meds. I'm leaning towards the medication is the main source to your sons outburst. ESPICALLY the Vysane and Risperdol. (WebMD can be your friend in these rare cases)

 

[WittyAspie]

I did some research on these meds. I'm leaning towards the medication is the main source to your sons outburst. ESPICALLY the Vysane and Risperdol. (WebMD can be your friend in these rare cases)

I have personal experience with risperdol/risperidone. It made me feel constantly on edge, like I would lose it any minute.

 

[Simmer]

We had his 5 year review at a Regional Center yesterday. A different psych and after 3 hours of questioning, playing, talking etc she came up with a preliminary diagnosis (yet to score the results) of ODD with aspects of Asperger's. This I agree with from my reading of the two in the past. She could not understand why he has had no ABA therapy for nearly 3 years now (blame health insurance for that). Her report will go back to our case manager (the one who arranged respite care and helped get Medi-Cal for him) who should then have enough ammo to hammer our insurance co into actually doing something. He's been "prescribed" ABA therapy within the last 3 years but that doesn't mean the insurance co have to follow through. This time I hope they do. Really hope so.

 

[oregano]

You're in California? I think there's a law that says that insurers have to cover autism treatment. Medi-Cal is worthless, it pays so little due to budget cuts that pretty much the only doctors who take it are the bottom of the bottom of the barrel, totally incompetent and worthless. All they do is listen for 3 min then give you a prescription and send you on your way.