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Hi! I'll be glad to be of help with this issue.
I can imagine how frustrating and distressing this situation must be for you. You are clearly a loving and caring parent. And despite what seems to be a lot of people putting in good effort to help your son succeed in the world, he's having a very tough time and not functioning well. I'm so sorry you're going through this.
It is truly very distressing that he's getting this much help and still the improvements are not happening in any satisfying pace. He has a psychiatrist who is trying pharmacological means as much as possible. The school has a counselor involved; there are special ed classes; there's even an assistant for him. There are a lot of accommodations and his ability to control his behavior has still not been stabilized.
I can sense the frustration that the psychiatrist must have here. The diagnosis is bipolar (BD) and I'm sure your son is getting more than one medication to try to address as many of the symptoms as possible. Don't be upset with this: it's hardly ever the meds that cause this type of problem of lack of control. It's usually not the right meds with the right behavioral approach. And aligning all of those can be very difficult.
So, my first thought is actually that the meds need to be still worked on. I don't know if that means adding an antipsychotic like Risperdal. Don't be scared by the word antipsychotic. It's used very frequently with BD and some of them like Risperdal are very useful with aggressive tendencies.
But the diagnosis may also need to be reopened. The behavior that you describe gives the sense of severe ADHD. I often hear parents come back with the statement that this was originally the diagnosis or that when younger, the child was diagnosed with ADHD but it was then seen as a BD issue. But talking it out again with the psychiatrist and with a psychologist who might get to know your son may be worthwhile.
Given how all this effort is still not bearing fruit, my other concern is that the discussion for Autism Spectrum Disorders may need to enter the diagnostic conversation. If it's a matter of your son not having the developmental capacity to "fit" into the world in ways that even with all this help he is being expected to fit in, then the aggressive behavior might be understandable within the developmental framework.
I know it sounds as though I'm sending you back to square one. It's so frustrating for parents. I've been there before. But your son is still at square one and we can't help him by just trying to tweak what's happening if it isn't working. We may need to reevaluate from the ground up.
Having a psychologist who gets to know your son may be the one part of the treatment team not yet in place to accomplish this. It would need to be a psychologist who is well experienced in, if not specializing in, childhood and adolescent disorders, especially Autism Spectrum and severe ADHD type disorders so that Asperger Syndrome or other Spectrum disorders can be ruled out or explored, okay?
Your son's difficulties are so severe and he's having such a hard time controlling his impulsive (if ADHD or BD manic type) reactions or his developmental frustrations (if that's the situation) that to try to share with you tips is going to be futile. I'm working right now with a 9th grader in my practice who the school is trying so hard to accommodate like your son's school seems to be. And this boy has no capacity to hold any gains we make in therapy for more than an hour or so really. But no one can afford for me to see him more than once a week at this time with insurance. So I know that to give you some self help tips is not going to do it. But finding the right mix of medications and behavioral tools may help. That's what we're trying with this boy I'm working with.
Okay, I wish you the very best!
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