My daughter just turned 8 last month. Since the start of the 2nd grade her ADHD has gotten worse. We are on our 4th non-stimulant (the first 3 had bad side effects). The Dr's first tried Ritalin but that gave her severe anxiety. beginning in the 2nd grade her emotional disregulation started going to another level. She started becoming physically violent towards me (only me) hitting, kicking, biting, scratching, spitting, and just recently breaking things. It is just her and I in the household. She tried PCIT for a bit but it just wans't working. Now she is doing TBS which I feel is also not working. Her Psychiatrist wants to put her on Concerta which is fine except now you cant get it. She completely manipulates the therapists telling them what they want to hear and then going home and refusing to do any of the coping skills. 75% of the time she is the most amazing loving king little girl but that other 25 she is disrespectful and then goes in to moments of rage that can last up to 2 hours. I don't feel like any of these Dr.'s are doing anything that can help. I just don't know what to do.
ADHD with Aggressive Physical Violence - CHADD's ADHD Pare...
ADHD with Aggressive Physical Violence
So sorry that she is suffering with such severe behavioural disregulation. Does it mean you tried stimulants first and then non stimulants?
I have read here some parents say that Methylpenidate didn’t work at all for their child but Vyvanse (or other Amphetamine based stimulant )worked better, especially when combined with another medication such as sedative antihistamine (Cyproheptadine etc) or just non stimulant. Which ones have you tried? Kapvay (Clonidine), Qelbree?
Maybe some antidepressants which are used off licence for ADHD?
Just don’t give up. In the US you have so much wider range of medication for ADHD than what we have available in the UK…
You will eventually find something that regulates her brain’s neurotransmitters imbalance…
It’s great that she has therapies.
Have you had her assessed by OT for sensory integration? Sensory techniques may calm people- I like weighted blanket 😄 and a body sock and a wobbly cushion to sit on (for my kids). She might be able to self regulate better if she would work out for herself what calms her down.
Thank you so much for the reply. Yes the first Dr. put her on Ritalin but it gave her really bad anxiety so they moved her to non-stimulants. She is currently on Clonidine because of the physical violence. She takes a really small does 4 times a day. It doesn't really help much and does nothing for her ADHD. They want to put her on Concerta but we cant get any here in the US because there is some national shortage of most ADHD stimulants. I am not giving up at all just really exhausted. I feel like every time I think I find something that will help either it does not help or a new problem arises. I had to fight for almost a year to get her an IEP same for getting her into the right kind of therapy. Just for me to find out that she is too smart for it and it wont work on her. Now the next fight will be to get her into DBT. I am hoping that will help. But I feel like I am the one telling the Dr's what to do instead of them just listening to the issues and getting her the right treatment. I am not a dr. so I am just guessing based of what I find on my own. I just hate seeing my child like this. I know this is not who she is, it is just a problem she has. The person that she is sweet and kind. Thank you so much for responding.
Maybe ask her doctor to try the newest non stimulant Qelbree if she hasn’t yet tried it? It is also antidepressant and what you say she might need ‘mood lifting’ as she is surely unhappy the way she is now? So it would potentially help her focus and make her happier at the same time. Stimulants won’t lift her mood.
My friend got this book recommended by her child’s developmental paediatrician. I’d say once your child’s medication is well adjusted then it is time to try behavioural etc strategies. I noticed from experience with my son- until we got his meds right there was no point doing any ‘behavioural strategies’ etc as nothing worked anyway.
Ross W Greene PhD
-The Explosive Child [Sixth Edition]: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children
Have you had her evaluated for anything other than ADHD? A mood disorder could present as emotional disregulation - so could autism. If she is hypersensitive, things like noise or light could be setting her off. What about a learning disorder or language processing? Keep looking for the root of the behavior. A therapist or social worker could easily miss most of the conditions I suggested - but if you go to a psychologist they might be able to help.
I have asked the psychiatrist/psychologist to evaluate her for other things a few times. The Psychiatrist keeps saying she wants to get her to baseline first. (um Dr. respectfully this is baseline). They psychologist doesn't really say anything but I have an appointment with her today and I am going to see what needs to be done. I personally feel like it is a mood disorder but they are trying to say it is PTSD from when she was in utero and for the 1st 9 weeks when her birth parents had her. Although I admit she was traumatized when I got her, she got over that with a couple months of being in a calm household and being loved. I don't agree that this is PTSD. And the Psychologist doesn't believe in ODD, even though she literally has every single symptom. Thanks for the info. I am going to ask about all of these later today.
have you ever talked to her Dr about oppositional defiant disorder (ODD) your daughters therapy could be adjusted to help with that
Yes her first dr. diagnosed her with that. The current facility that we are working with said that they don't believe in ODD because they feel it labels them as bad kids. I basically said that was stupid all diagnosis' label kids it doesn't matter as long as they get treatment. I had a really hard time finding her a therapist near our location that takes her insurance (Medi-Cal). Also trying not to conflict with school as much as possible because she severely struggles at school. Also I am a single mom and work full time so it is a lot to juggle. I spoke with the therapist yesterday and the she told me of a camp that they offer for a week where she can stay there and work on things with therapists. I feel like that is what she needs at this point for someone to see her full time to be able to assess her. God knows how long it will take for that to happen as everything seems to be a hurdle. Also pending hearing back about meds. I think that is the biggest obstical.
Sorry she is struggling so much. Here are a few thoughts..
Could you attend the therapy sessions to make them more useful?
When our son was younger, I attended all his sessions. I would bring up an issues and the therapist would advice us on ways to handle it.
In addition.. could you guys spend time figuring out what triggers her to meltdown?.. this may mean waiting until they are over and things calm down, then discuss what happened to see what makes her get aggressive. If she can't express it then try to "guess".
Here is an example: our son was asked to do his chores, he would really meltdown and throw a fit.
I had a discussion (believe me I know I am making it seem simple) and found out that his biggest complaint was that it took to long to do. So I said ok, let's set a timer to see how long it took him. I told him anything over 10min he didn't have to do.
He was blown away by it taking him less than 10min. Once he knew he was not wasting a lot of his time and when we talked about the consequence of not doing them. I explained when you don't do them you lose things he wanted to do ( like watch youtube).
These are just things that really helped us. Also, in the evening time when medication has worn off I ask for less.
Hope these suggestions help a little.
Hope you find what works best.
Thank you so much for your input. I do try the timing of things and sometimes counting. Like can you pick up 20 toys and then later ask for another 20. That works best with her. Her meltdowns seem to be when she is tired and over things like bathing and putting her pajamas on. She doesn't have any adhd meds in her system to wear off just yet, but I am hoping they will help.
I guess what I learned as a parent is to try to look at things from a different lens.. when our son was tired I changed the demand I had on him, same with being hungry, his meltdowns got worse. Having a different lens to view through really meant that if a Neurotypical kid is asked to do something for 15min, I request 5 min.
Could you join her on picking things up after the first 15 toys? Or could she only have 15 toys?
Often also asking our son what he would like to do so it is more of a team approach? Maybe she doesn't wear jammies to bed?..
Just some thoughts.. in the past when I would ask our son when he wanted to do a chore it was always say after he rested. So I said ok rest, but without his cell phone. He would jump right up amd do thr chore.
Their little bodies have so much more to deal with than ours so I always try to be patient.
One more thing.. this might be the hardest, even on our hardest days ( I mean holes on the wall, school suspension...etc) I always told our son we loved him, but didn't agree with the wrong decisions that day.. this is very hard but very necessary for them to hear.
Maturity helps a lot.
Best to you.
Thanks for the input. yes we do a lot of the things together and sometimes that does help. taking away the tablet or tv when she is resting would start an entire war with her. Also her meltdowns sometimes come out of no where. she could get ready for bed 20 times just fine then one day have a 2 hour meltdown physically attaching me and screaming then entire time. its like she is a different person during those meltdowns. I continue to tell her that I love her throughout though. even when she is biting and punching me and especially in the time when she is coming down and just still screaming but no longer attacking.
This is the kind of thing that Dialectial Behavioral Therapy can be really useful for -all about emotional self-regulation. Designed for kids who have intense feelings and difficulties managing those feelings. done in group settings that are very skills-based, and where parents and kids learn together. If you can find someone who does it w/ young kids (its mostly designed for teens) it could be a great fit!
I literally asked her therapist about it yesterday and she said she is too young. I disagree. My daughter is too smart for TBS. and like you said it literally checks all of the boxes as to her problems. I got some DBT books and workbooks. I am going to try to work it into my parenting to see if that helps. Meanwhile I think you are right I should find someone who will offer it to children. Thank you so much for responding.
Did you get her genetically tested to see what meds to avoid? If not, certain meds that should work for some people may inadvertently causing her rage. We took our daughter off stimulants which were exacerbating things, and sound a whole lot like what you are currently going through. Things are better now bit not great.
We are currently trying to modify our behavior to not add to the problem. I believe some of our/her issues are learned behavior on her part.
I actually just ordered the genetic testing kit for medications for her and myself. I have taken years to get my own mental health medications right (and they probably still are not right), I don't want her to go through that as I am pretty sure she will need to be on some kind of medication.
The aggression is so hard. I don’t know if you’ve considered supplements at all but low dose lithium (2mg / day) has done wonders for my 9 yr old son’s irritability and aggression. Before the lithium, it got so bad I had to pin him to the floor to get him to stop hitting me. Since starting lithium, along with Omega-3s, magnesium & zinc, he’s so much calmer and happier. He still gets angry sometimes but rarely hits or gets super explosive.
There’s a great book on supplements called Finally Focused by Dr. James Greenblatt. It’s been my guide in figuring out what my son needed.
what brands are they? I feel like there are so many choices
Kal supplements makes a liquid lithium orotate that we use (photo below). Amazon sells magnesium and zinc gummies. For Omega -3, we use Vegepa - it’s higher dose than you can usually find but the pills are small and easy to swallow.
Thank you so much. I just purchased them. I will let you know if they help. Now to get her to take them. lol.
Praying for her to get the right plan of care.
thank yo so much.
This sounds like my son. He has ADHD and ODD (oppositional defiant disorder) and when he was younger anxiety. He was about 7 when he was diagnosed. We took him to a autism specialist who diagnosed him with everything because at first we thought it was autism. It took many years of medication changes and many different therapists. The one that we found to help the most is a behavioral therapist. She helped us and him better understand his behavior and she gave us many different strategies to help when he would have one of his outbursts. He manipulated everyone as well. You just have to stick with a plan and not let her get her way. Even if leads to high pitch screams and fits of rage. The therapist taught us safe ways to restrain him when he would do self harm and just to ride out the storm until he tired himself out and calmed down. With ODD they have harder times with people of authority especially the mother. My son said some pretty mean and nasty things to me during fits of rage, but I just had to tell my self that's not really him speaking, its the ODD. You've got a long and bumpy road ahead of you. My son is now 14 and still has some fits of rage, but he knows how to control it and if he can't (he's broken many phones, computer monitors, his seeing glasses just to name a few) and breaks something, he knows that we will no longer replace it and that he has to pay for it or replace it on his own. This has defiantly helped as more of a responsibility aspect. I hope this helps. Good luck and your doing amazing!!
I would love for her to be getting that kind of therapy. I wish we didn't have to fight so hard to get mental health care for our children.
one more thing to consider: neurofeedback. Our son had problems with self regulation & a brain scan showed elevated brain waves in the bandwidth that governs mood control. He also had elevated brain waves in the bandwidth the governs sleep. Neurofeedback has been an amazing resource to help his brain function optimally. He is still on a non-stimulant to help with focus but is maturing in amazing ways. I am encouraged. He also takes Hardy’s micronutrients, which seem to help with sleep & are geared towards mood control.
that is something I have always wanted to do. My daughter's birth mom I know smoked marijuana and was in the same area where the birth father was smoking methamphetamines' I am not sure if the birth mother ever did any while pregnant. Also there was extreme physical domestic violence throughout the entire pregnancy and the first 9 weeks before I got her. So I feel like all of that had to harm her during the growth of her brain. Thank you for this information I am going to bring this up at her next appointment.
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