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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5133
Experience:  Dr. Mark is a PhD in psychology in private practice
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What is the treatment for a thirteen year male who cannot be

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What is the treatment for a thirteen year male who cannot be controlled by his parents? He becomes angered, exhibiting destructive behavior such as throwing objects, punching holes in doors and swearing. He has dificulty communicating, stares into space, has no interest in school or school work and does not care about his grades. All he wants to do is play games on various toys. He has also been diagnosedwith ADHD. He refuses to continue to see therapists. He has also threatened to kill himself.
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! You know, to give you the best answer, I think I should ask you a few questions first that will help define the problem and the situation.

Let's first rule out any spectrum-type disorder, okay?

He has a hard time focusing, but has he been evaluated as being higher than average intelligence?

Does he make friends easy now and in the past? Does he play in age appropriate ways and have good social skills?

Does he tend to obsess on activities he likes and have a hard time stopping when it's time to do something different?

Does he have repetitive motions and movements? Does he also have certain habits he does over and over?

Does he bring his fingers to his mouth or make facial expressions when talking, when he's unhappy or angry?

Does he have a hard time relating to other people's feelings?

Okay. Next, what did the psychologist and the therapist say? Is he having ongoing therapy?

Any extra information that will help, feel free to share.

Let's go forward from the answers to these questions.

I see you are online at this time but I'm going to be going into session soon, so if I can't answer before that, would later today be okay for me to respond?

Dr. Mark

Customer: replied 3 years ago.
WE need some time to respond to your questions. So later today would be ok for you to respond.
Expert:  Dr. Mark replied 3 years ago.
I'll respond as soon as I can once you have posted your reply back to me. Okay? Dr. Mark
Customer: replied 3 years ago.

WE need some time to respond to your questions. So later today would be ok for you to respond.

 

In response to the questions. He is of average intelligence, but grades are poor, C,D, and E's since there is a lack of caring about school and completing homework. Home is never done or done poorly at the last minute. He also is very disorganized and has been since 1st grade.

 

Friends are made easily, he plays soccer and deck of which he is goalie of both and does a very good job.

 

Good social skills with friends but not with parents and younger sister. He is very mean to his sister.

 

Video games are an obsession. That's all he wants to do. Stays in his room to play. Destructive behavior begins when he is told to end the games and begin homework or other tasks.

 

He has a difficult time relating feellings to others, especially his parents. He shows no remorse after an outburst.

 

Therapy is not ongoing at this time as he refused to go back. Only three sessions were completed, although others were scheduled. A pychriatrist was seen twice after the therapy sessions. Medication was prescribed (Concerta) but he contends it makes him sick and refused to take it. Additional therapy was recommended.

 

In addition, he appears agitated or nervous when around extended family or other adults in social situations.

 

He does exhibit a strange behavior. The blinds in his bedroom have teeth marks on the slates. He denied doing this. New blinds were purchased and hung, the same marks again.

 

His bedroom furniture is destroyed with pencil/pen marks and dents.

 

The destructive behavior is not seen in school. He attends a private Catholic School.

 

During destructive outbursts, he claims he hates his parents and wishes them dead.

 

Destructive outbursts occur from once a month to twice a week if he does not get his way. Behavior began several years ago and has escalated as time goes on.

 

Any help or sugggestions would be greatly appreciated.

Expert:  Dr. Mark replied 3 years ago.
We haven't hit a strong match with Asperger's Syndrome, though there are some features. I want to first rule out attachment disorders. Here's a list of symptoms. Tell me how this matches:

•Intense control battles, very bossy and argumentative; defiance and anger
•Resists affection on parental terms
•Lack of eye contact, especially with parents - will look into your eyes when lying
•Manipulative - superficially charming and engaging
•Indiscriminately affectionate with strangers
•Poor peer relationships
•Steals
•Lies about the obvious
•Lack of conscience - shows no remorse
•Destructive to property, self and/or others
•Lack of impulse control
•Hypervigilant/Hyperactive
•Learning lags/delays
•Speech and language problems
•Incessant chatter and/or questions
•Inappropriately demanding and/or clingy
•Food issues - hordes, gorges, refuses to eat, eats strange things, hides food
•Fascinated with fire, blood, gore, weapons, evil
•Very concerned about tiny hurts but brushes off big hurts
•Parents appear hostile and angry

Okay, I'll wait for your reply on this set. Dr. Mark
Customer: replied 3 years ago.

Dr. Mark,

Only the following symptoms apply:

 

Intense control battles, argumentive, defiant and angry

 

Lack of eye contact, does lie

 

Lies about the obvious

 

Lack of conscience, shows no remorse

 

Destructive to property, not self or others

 

Lack of impulse control

 

Learning lags

 

Inappropriate demanding

Expert:  Dr. Mark replied 3 years ago.

Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.

First, let me say I can imagine how overwhelming this situation must be for you. We've ruled out autism spectrum and attachment disorders. We're left with severe ADHD. That's both good and bad news.

And this is actually the key to my answer to you that you need to consider and think about. The good part is that those other two possibilities are very difficult lifelong problems. But then, so is ADHD though it often is more manageable as the child ages. That's the good part. The bad part?

You are going to have to be very proactive. Because most schools expect you to medicate the kid and that's it. But you need more, much more. Because your son is exhibiting extremely severe symptoms.

I have had one case that this reminds me of almost exactly. That boy came to my office at 13 as well. You are going to need to be in charge of this and it is going to be time consuming. You have four parts to manage:

1. The school: you need to get an IEP (Individualized Education Plan or Program) created by the school district. They don't want to do this because it's expensive. However, they are mandated to do this. But you will have to force them. And if they can't provide the services your child needs, they have to pay for a private school that can. Expensive. So you have to fight for it.

2. Psychiatrist. Most psychiatrists don't want to stick with a kid this severe because it's work on their part. So you have to keep on them, being friendly, flattering, etc. And also getting them to keep trying different dosages, combinations of meds, etc. But he needs medication. So go back to the psychiatrist.

3. Psychologist. He needs to work with a child psychologist who is expert in ADHD. That means you have to push for a good referral. And check out who the top people are in your area. He needs therapy to help in managing this as he ages.

4. Your son. You need skills to work with him. Support groups are IMPORTANT. Finding them is not so easy so you have to ask the school people if they know of any, look online for your city, ask the psychologist, etc. This is not a step to skip! You need the support. And you need to read and become an expert in ADHD. Russell Barkley (he's a pessimist), XXXXX XXXXXowell (mid-ground), and Thom Hartmann (optimist) are the leading authors.

What can you expect for your child? A lot will be determined by how much effort you can put into this. Remember the case I mentioned above? After we got the steps above in place, I referred them to another psychologist who specializes only in ADHD. One of the two parents had to make this almost a full time job at first and then it eased up. But there's always staying on top of his symptoms and being proactive.

Okay, I've given you a lot here. But you're already experiencing a lot. Why did you have to have this challenge? I don't know. But somewhere within you is the ability to help your son if you take charge of this disorder.

I wish you the very best!

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5133
Experience: Dr. Mark is a PhD in psychology in private practice
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