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Bill
Bill, LCSW, Consultant, Expert Witness
Category: Mental Health
Satisfied Customers: 3705
Experience:  35 years treating individuals, couples, families with mental health and substance abuse prob's
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I am 70 year old male raising our soon to be 16 grandson. He

Customer Question

I am 70 year old male raising our soon to be 16 grandson. He has lived with us since he was 9 mos old. He has been undergoing treatment for anger and general depressive state for about five years now. The first doc gave him Depakote...we changed docs and the new doc up depakote to 500 mg 2 x day. I recently found out he has been diagnosed with Mood Disorder NOS. He has threatened to kill himself twice....the last time he wound up in a Phsy facility for about a week. Still no change in Depakote although he is some what improved. My question is Is there any HOPE? Nothing....and I do mean NOTHING changes. I am about ready to throw in the towel......at age 70 with prostate cancer....3 heart attacks...serious back trouble.....I don't know how much longer I can hold up. What we are doing is not working? What do I do? Where is the joy in life gone? and will it ever come back?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 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.

This is of great concern: the diagnosis is saying that they haven't found enough evidence to identify Bipolar Disorder specifically but enough bad behavior that may be cyclical to give it that diagnosis. You say he's had counseling. Has it been serious therapy?

Is he having counseling now? If not, when and for how long?

What does the therapist say about him? Or what did the therapist say about him?

How about in school, what do they say?


Has he ever been evaluated for Obsessive Compulsive Disorder (OCD)?

I need to be thorough, so let's make sure there are no developmental issues:

Has he been evaluated as being higher than average intelligence?

Does he make friends easy now and in the past? Did he always play in age appropriate ways and does he 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?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?

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


Dr. Mark

Customer: replied 2 years ago.
Dr. Mark, you have a lot to cover but i will try. I would say he has been in serious therapy. He has been in counseling for about 9 years. And has been in treatment for 4 years or so.Concerning the therapist.....he thought he was doing OK but after he cut back on visits he had the suicide threat. The counselor referred us to the therapist although he continues counseling. No behavorial problems in school. He does have higher than normal intellectual capacity although he struggles in math.....but he makes barely passing grades otherwise. He does not make friends easily in his age group but he can charm the birds out of the trees when dealing with adults. He was beginning to be obsessive with computer games until I took them away. He fussed a bit but no problem otherwise no repititive movements...no to certain habits. He is unusally sensitive to others....he is very caring to his animals. His daddy...our son...was an adopted child and we saw the same things in him. we know nothing about family history. I hope this helps
Expert:  Dr. Mark replied 2 years ago.

Thank you for the replies to the questions and the added information. It helps a lot in understanding what the situation is. I believe I can now be of help with this issue.

I can imagine how frustrating this situation must be for you. You are clearly a loving grandparent and he's very fortunate to have you there.

I think we can rule out developmental problems. I am most concerned at this point about Bipolar Disorder (BD). It often doesn't become diagnosable until late adolescence/early adulthood. Until then it is just bad behavior by a kid who's bright. It sounds as though the doctors are thinking the same way.

There are two recommendations I would like to make:

First, I'd like you to go to the counselor and ask for a referral for ADHD testing with a competent ADHD specialist, either a clinic that specializes in this disorder or a recognized specialist. If it is present, then Strattera may be a very helpful medication, either with a mood stabilizer or on its own.

Second, and this may be more to the counselor's liking though I hope the counselor will agree to the ADHD testing, he needs intensive therapy with a psychologist or psychotherapy who is very experienced with teens. You must interview the therapist first and make sure you think the therapist is smart (street smarts) as well as very approachable. Decide with the counselor whether a male might be more suitable to introduce a father figure. Or if a female therapist is more suitable to have a mother figure in his life.

Okay, I wish you the very best!

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. You are not charged anything more than the deposit you already made by pressing ACCEPT. Feel free to continue the discussion even after pressing ACCEPT as my goal is to get you the best answer possible. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark

Customer: replied 2 years ago.
This was a mistake. Nothing new here and it certainly gives me anything I did not already know.
Expert:  Dr. Mark replied 2 years ago.
I think I understand: you already have decided to have him tested for ADHD and to have intensive therapy, is that correct?


If so, please know: there are no miracle cures out there. Your grandson has not been picked up by the police yet, so you can't have him forcibly put into a locked psych ward. You can call the police if he threatens suicide and they will take him to the hospital for a 3 day hold for evaluation. But he will be released after those 3 days if he is smart enough to tell the docs what he will pick up he needs to say to get out. They can't force him to stay after about 5 days max. He may become angry at you for doing this.


You can try to get him to a boarding school for troubled kids but it is very expensive and I didn't get the sense you have that kind of money. So I can imagine how frustrated you are but I can only give you the practical advice that is possible.


I hope you will not be angry at me because your grandson is not so ill that the state has taken him into custody or so well that counseling and Depakote is enough. He's in that in between stage and you have to hope that these things I've recommended that you already know about will indeed help.


I wish you the very best!

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. You are not charged anything more than the deposit you already made by pressing ACCEPT. Feel free to continue the discussion even after pressing ACCEPT as my goal is to get you the best answer possible. Bonuses are always appreciated! If I can be of further help with any issue now or in the future, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, Dr. Mark

Customer: replied 2 years ago.

I am not angry. Thanks

Expert:  Dr. Mark replied 2 years ago.
You are welcome and I wish there were better alternatives.


If and when you feel there is no alternative but to try to find a facility for him, let me share with you a "secret" directory I use for nonprofit facilities that often will work with you if you can't pay. I don't know what's available in your state. Most of these facilities are state based but you can try nearby states to see if any will work with out of state kids:

http://www.therapeuticmilieu.org/directory.html


I have to warn you of government summer programs for troubled teens as they often include kids who are already in the juvenile criminal justice system and it can be a way to introduce your son to those exact influences you don't want him introduced to. So, be careful with that.

I don't know if you are religious and I am not trying to push religion on you. It is just that the religious communities are the most supportive and the ones who might be willing to take him on as theirs to help. There is a Christian national school called Abundant Life Academy. Here is their page on the low cost affordable programs they know of. Their warnings are important and their suggestions are important. Perhaps a local minister can speak for you to Abundant Life Academy. Or perhaps one of these low cost schools will actually be workable for you.

http://www.abundantlifeacademy.com/teen-resources/affordable-and-low-cost.html

I truly wish you the very best!

Please remember to click the green accept button because: even though you have made a deposit, I do not get paid for my time unless you press ACCEPT. Feel free to continue the discussion as my goal is to get you the best answer possible. You can continue the discussion even after pressing ACCEPT. 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, Dr. Mark


Expert:  Bill replied 2 years ago.
Hello- Thank you for asking the question. I have over 30 years of experience working with children, adolescents, couples and families & am happy to reply.

I have a second/third opinion for you.

After reading the history and associated " lack of progress" it is my experience that when you still have the leverage of working with local Child and Family Services Agencies it is best to let them help you define a longer term treatment alternative that is court ordered.

I do not know the county and state where you live but I am most likely quite certain that a child services agency has been involved with you and your grandson. This is a situation where advocacy and insistence that they act as required by law to have you grandson provided a safe and secure program where he can have the best possible outcome.

This is accomplished by them working with you and the community mental health center to get a Court Order to have your son committed to a program provided and financed by the state. This is not correctional program but one that should be therapeutic. I am sure that he has received and abundance of testing in addition to the counseling services. I am also inclined to believe that he has received a Psychiatric Diagnosis- all which will help in working with Children and Family Services to define a program that will best suit his complex needs.

I am interested to know if there has been consideration for this and if not, why not? This is a situation where you often have to push the system and force them to act as required under law.

If I can be of assistance in defining the resources in your county, please respond with the County and State in which you live and I will be happy to give you feedback on how to proceed.

Best regards, Bill

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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
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