To try to make a long story short, my 6 year old son who is in kindergarten was diagnosed about 3 months ago. School was a nightmare before he was diagnosed. Would have great days and absolutely horrible (destroying the classroom, getting physical w staff etc). Post diagnoses we started him on meds and he got into a self contained class for emotional regulation impairment. We saw immediate and significant improvement. zero issues for almost 2 months. Now over the past few weeks he has started struggling again with getting physical or destructive when things don’t go his way. We’ve been in therapy for his adhd/odd and started OT a few weeks ago. The problem is when he gets set off, he is totally out of control, isn’t rational and can make very unsafe choices. I’m wondering if his meds need to be upped, if he needs to add another med and/or if there is something else going on mood wise. It feels more than the adhd that’s causing these extreme behaviors but then again at the beginning with the meds his physical behaviors almost completely stopped and especially the extreme ones. The two examples of recent where he kicked teachers/therapist were related to not winning or wanting to do something his way. When they tried talking to him about it he flipped a switch and became aggressive (kicking them, tearing things off the wall). Any thoughts, ideas, experiences?
really struggling w aggression - CHADD's ADHD Pare...
really struggling w aggression
Sorry your child is struggling. I strongly encourage you to have him see a Child Psychartisit. This specialist will really be there to support you when you need it. They know medication and can help you find the best medication, with the best dose and they know when the best time you give the medication. For our son a single dose stimulant was not enough, no matter how high a dose we tried. He needed both a stimulant and non stimulant. Both together have been life changing.
Kids grow and change so this is a relationship I have really needed when things changed again for him.
In addition she wrote a letter of support for us to use in school.
I also hope you have a IEP or 504 plan so steps are in place for him.
Hope this helps..
We are always here for you..
Big hugs for your struggles
Thanks for the reply. We are lucky to have a great child psychiatrist (next appointment is a couple weeks away- wish it were sooner and I may try for that). We also have an iep which has done wonders for him. He is in a new placement which is mostly in a self contained for emotional regulation impairment which his current elementary school has so we were lucky. They treat him (and me) as people that need help vs horrible people which has been very helpful. He loves school now and is no longer uncomfortable walking through the door. I am thinking a non stimulant in addition may be helpful. His psychiatrist brought that up before when I was having issues at night w him after the medication wore off but I said no at the time because he was totally manageable and doing so well otherwise
You are so close to being successful! Hang in there. The reason we added the non-stimulant was anger and mood.
The non-stimulant for our son is a 24 hour dose. He took one at night before bed.. we were successful for a while then we added an am dose. This was life changing. He could tell, even though he didn't talk about it, how much it made the difference for him.
Sounds like you have school dialed in and I hope if you can add the non- stimulant you could see a real difference.
We were told that 60% of negative behavior should be controlled by medication.
We are so very thankful to help our son with proper medication to give him the ability to control the symptoms of ADHD.
This group has given me a safe place to ask questions, learn and get the support I needed along this journey.
Please share how things go so others can learn from you.
Best to you in finding what he needs.
I'm sorry to hear that your child is facing difficulties. I strongly recommend seeking assistance from a Child Psychiatrist. They specialize in providing the necessary support and guidance during such challenging times. They possess expertise in medication management and can assist in determining the most suitable medication, dosage, and timing.
In our experience, a single dose stimulant wasn't sufficient for our son, regardless of the dosage attempted. He required both a stimulant and non-stimulant medication, which has truly transformed his life. It's crucial to maintain a relationship with the psychiatrist as children grow and circumstances evolve.
Additionally, the psychiatrist provided a supportive letter for us to utilize at school. It's also important to ensure that there's an Individualized Education Plan (IEP) or a 504 plan in place to address your child's needs effectively.
Hope it gets better for you. God bless!
We've tried low dose ( 2 mg) of abilify and that seems to help mine with widening that zone of tolerance. Good luck to you.
Perhaps research Persitent Demand for Autonomy, aka Pathological Demand Avoidance (PDA). It focuses in the sensitive fight, flight, freeze, fawn reflex when expectations or the environment are nonpreferred or overdemanding and related to autism and sensory integration issues. I've had success with right sizing sensory processing support and building trust and connection in low or no demand contexts then the tolerance can be built for frustration, etc. with other skill building and right sizing expectations based on where child is at for demands or tasks (e.g., revised via an IEP in school). Focus on building the connection without the stressors and identifying the stressors to improve regulation before expecting child to reduce his response to triggers. Also definitely consider changing medicine as it can be a cause of high irritability and aggression too.
Thanks for the reply. I have come to the realization that I can’t have him do certain things that may not end well. I’m struggling a bit with how extreme to go because I don’t want to isolate him but I do recognize some situations can easily be avoided and better for all involved. He was aggressive before the meds so I don’t think that’s it. We are doing pcit (parent child interaction therapy) which is similar to what you are suggesting in that building up positive relationships is needed before getting him to comply. That has been very helpful at home but new people coming down hard on him will set him off. Q
I wanted to add. I agree, I am sure many will not agree, but I agree and avoid any triggers, which worked best for me. So for example, he was playing games on IPad. I gave a time frame 10 min. In 5 min I had the next task ready to transition to and told him 5 min. When time 5 min was up I announced time up.. I walked away and then when he did not stop I said "time was up and since you did not stop" tomorrow there is no Ipad. I call.this punish forward.
I made sure to not discuss it and went and did something else. End of day, next day IPad put away. This way there is no struggle and anger. He he asked I explained why there was none.
I did this when I knew there was going to be a struggle. Slowly this helped when I punished with the same item.
Same when he eat things he was not supposed to. The next day he did not get them again.
Hope this makes sense.
He is now 17 years old and we do not have any of these struggles.
Thanks for your reply. Very helpful. So glad to hear your son is doing so well.
Also any suggestions on the pda diagnosis? No clinician he has ever worked with thinks he is autistic (pediatrician, developmental pediatrician, psychologist or psychiatrist). Where he went to preschool for 4 years didn’t think so. The only person who has is his former kindergarten teacher told us she sees signs. I’m not saying he isn’t, I don’t know which is why I’ve gone to all these doctors.
Perhaps try to find an occupational therapist (OT) who has a specialty in sensory integration and building tolerance (through exposure and habituation) for dealing with frustration and emotional regulation. The U.S. does not have a lot of practioners in PDA so it almost looks like treatment for PTSD or the central nervous system (CNS) being oversensitive to triggers. The diagnosis of autism/PDA may not be as critical as the approach you use, which is to take into consideration the stress and anxiety response that is unconscious and not likely subject to treatment as a behavioral issue but rather as neurological and CNS issues (i.e., neurodivergence).
Super helpful. We just started OT. Im not sure about this practitioners expertise in this area but they did assign me based on his needs so I’m hopeful. Assume it will take some time to start seeing if it will make a difference.
Our son (now 7) struggled with emotional regulation in addition to traditional hyperactivity and inattention. Stimulants provided temporary improvement but ultimately we found guanfacine ER and atomoxetine helped him with emotional regulation most, and over time the hyperactivity and inattention have improved somewhat. Might be worth asking your psychiatrist about non-stimulant options.
although it doesn’t seem like it with you, sometimes afhd meds can make people more aggressive when it wears off. Do you notice these outbursts more in the afternoon or morning? If the afternoon, it could be wearing off. He may need a booster mid day. It’s normal that kids need doses upped as they grow.
My partner got aggressive when he came off his last med, but after a gene sight test, we realized it was adverse effects. My stepkid also needed a lot of room clears when being unsafe. The behavior classrooms were amazing for him. He transitioned back to mainstream in middle school and still doing well in 9th grade. He was only on anxiety meds though.
Have you tried talking with your kid on what is setting him off and how his body feels in those moments? I know I get set off when I’m not on my anxiety meds due to major headache.
Thanks for the reply. He is definitely worse in the evenings (he does a booster dose around lunch) but recently these outbursts have been while meds are in effect. I’ve heard the gene test so will check that out. Sounds like it was helpful for you. Great to hear about how well your step son is doing. I’ve tried talking to him and can usually (not always) get to the trigger but it’s the reactions to the triggers where he can’t communicate. I’m hoping OT can help with it. Obviously reducing triggers is another thing and he doesn’t always react extremely when similar circumstances happen ie he can control himself from getting aggressive sometimes. I do wonder if anxiety is driving this. My husband has bad anxiety and outbursts himself though they are never physical.
I would ask if your hubby used to have physical ones as a kid.
The gene sight test has done wonders, but insurance is being a pain for me rn and is trying to charge me 5600. I’m also display covered and my doc did the pre approval.
He says not as does his mom but his mom also says he was perfect and never had a tantrum…..
I’ve been there before. I know how you feel. Is your son seeing a child psychiatrist? Maybe they need to increase the dose or even change the med or add an immediate release dose at noon during school hours? My son is 6 and he tried adderall and it made his aggressive behavior worse. We had to switch back to Ritalin.
His aggressive physical behavior stopped at school but would continue at home, especially towards his little sister. He was diagnosed with ADHD/ODD and DMDD , the doctor added guanfacine at night to deal with his DMDD. The med says it takes 4-6 weeks to work. So we will see, he just started it last week. Maybe your son needs CBT therapy? I’m not a doctor so check what his doctor says. Hang in there. I know how frustrating it is to be a parent of the kid who’s always getting in trouble.
Thanks for your reply. Yes he sees a child psychiatrist. We have a follow up in a couple weeks so will see what she says. I’ve been wondering about dmdd. Just based on reading about it I’m not sure since he’s generally happy. I’ll look into cbt. I hope the new meds go well for your son!!! You are right. It’s so tough. We had a two steps back kind of few weeks so am a bit down.
Guanfacine helped my son with aggression.
Thanks for replying. Helpful to hear.
Hi! First of all, I am so sorry! But know you’re not alone. We are in the exact same boat! My son is 6 and struggling with aggression too. For that reason, I don’t feel qualified to really provide any advice, but I will say that my son’s doctor recommended we test for epilepsy because there is a large crossover in ADHD and epilepsy. Some of the epileptic symptoms can mimic the behaviors of ADHD! When I first heard that, I kind of wrote it off because my son has never experienced a seizure but we tested anyway. Lo and behold, he has epilepsy! There are forms with seizures that are not visible and can lead to a disruption in brain activity and therefore cause random changes in mood. Anyway, it’s something to consider and look into. If he has epilepsy, you need to treat that in addition to his ADHD to get a handle on the behaviors. Or so I’ve been told! Like I said, we’re still working through it and it’s a work in progress. But I wish you the best of luck!
wow that’s super interesting and nothing I had heard of before. I’m so glad you found that out. Good luck with your son.
these are all such great responses! you are doing all the right things, especially PCIT! we struggled with this with my son. I would try adding guanfacine first. that in addition to all the therapies you are doing could be great! IF that does not work, you will want to remove both stimulant and non-stimulant, and treat mood first. You can try SSRI's, and if those don't work (my son got manic/suicidal which was scary but fine the day after we stopped the med), you will move on to a mood stabilizer like Abilify. I know it sounds scary, but the reality is that the meds are trial and error. I have severe med anxiety every time we switch or start a new one, but it's the only thing that has significantly helped my son!
I don't know what time do with my son anymore. 
Overwhelmed and at a loss
11yo school refusal when with mom, aggression 
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