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My 10-year-old grandson is going through some serious

emotional and behavior issues, his...
My 10-year-old grandson is going through some serious emotional and behavior issues, his mother is at her wit's end, and we can't seem to get help for him. We are near Edmonton, Alberta in Canada. Do you have an expert who can help direct us if I give more detail on his behavior and some background?
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Answered in 54 minutes by:
5/13/2013
Dr. Glick
Dr. Glick, Mental Health Professional
Category: Mental Health
Satisfied Customers: 25
Experience: Adolescent Development, at-risk youth, aggression and violence, emotionally and behaviorally disordered.
Verified
Dr. Glick :

Hi [USERNAME]: My name is***** and I am willing to work with you to help identify some solutions you may want to consider to resolve your issue

Dr. Glick :

HiCustomer It appears you are off line now. When you get back on line, and wish me to assist, please let me know. If I am not on line, I shall get back to you. In the mean time, please respond to the following for me: Did the your daughter have a normal pregnancy and delivery with this child? Has the child been placed on any Psychotropics? Is so what, dosage, and for how long? When did this behavior first occur. Has it increased in severity over time? Where is the child's father (is your daughter divorced, separated,)? Does the child have any brothers and/or sisters?

Customer:

I am back now; had to go to the school because he was not cooperating with the teacher and acting very "cocky". The pregnancy was fairly normal, delivery was long and dilation regressed rather than progressed, almost necessitating a C-section (same thing happened with her first baby). His head was (and is) abnormally large for the size of his body (e.g. at 6 months, his weight was in the 25th percentile, his length in the 10th percentile, and his head circumference in the 75th percentile. He is built just like his father. He has one older half-brother. The parents have been divorced for about 4 years and the child's father moved to Arizona after the split, where his only contact, aside from the occasional phone call or email, was through sending packages of toys. A couple of years ago when he lost that job, he moved back to Canada but chose to move to Victoria to be closer to his parents, rather than to Edmonton to be closer to the child/ren. He has seen them only once since and that was when we took them there for vacation and literally delivered them to him for a day. Since then, he initially phoned weekly and continued to send packages, emailed and texted. However, he has not been in touch for over a month (probably for two months now), did not phone the older boy for his birthday in April, and appears to have stopped all contact. The child feels "abandoned" by his father. The behavior problems started a little over a year ago and I think I already mentioned in the "What have you tried so far" section about his hospitalization and Rolandic epilepsy. He was also diagnosed as suffering from high anxiety. He is on an anti-anxiety drug (dosage just doubled) and an anti-seizure med., but I will have to get back to you with the names and dosages. The behavior issues have certainly increased, especially over the past several weeks when his father has neglected to call him. His older brother just turned 18 and loves his little brother very much. We, the maternal grandparents, are also close by and help out when we can. We have reassured him that we will all always love him, even if we don't like the way he is behaving. We have explained consequences and asked him to think things through and deep breathe before he takes his frustrations and anger out on other people and things. He promises to stop, apologizes, then in a few days starts up again. My daughter (his mother) is very upset because she smacked him last night when he wrecked his bedroom and she has never struck her kids before. I fear she is at the end of her rope and increasingly frustrated over trying to find help for him. I hope this information is enough for now and I will try to get back to you with the names of his meds and the dosages.

Customer:

PS: My daughter has the number for Children's Mental Health Services in Edmonton but lacks faith that they will tell her anything other than what she has already heard - you have to go through the process (although they did that last year). She also is too busy at work to call so has to hope to catch them after work. Today, his teaching assistant told me that for another child that was having problems, the parents called the police and they were able to bypass "the system" and get him immediate help, but my daughter feels that is a bit drastic.

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I have switched to the Q & A mode since we are not on line at the same time. I have appointments most of the day and so I will be on and off line throughout. You describe what appears to be a social/emotional reaction and learned behavior that has been reinforced over time. AT LEAST ON THE SURFACE. HOWEVER,,,, I think that this issue has some unresolved questions that must be explored.
First, has there been a comprehensive neurological and physical examination done to rule out any medical issues that may be underlying causes of behavior? If not, your grandson's pediatrician should seriously consider that before we rush to psychological/psychiatric interventions including the use of psychotropics.
Second, we need to have a comprehensive psychiatric and psychological examination done to further detail specific diagnosis. We can do better than ADD etc.... with the science we now have.
Third, there should be some assessment also completed with risk factors for anti social behaviors.
Please update me on these various issues I have raised and give me some of your thoughts, so I can formulate a plan of next steps for you.
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Customer reply replied 4 years ago

I will need to discuss these questions with my daughter before I can give you complete information. I know that he was examined last year by a neurologist, and that is when the Rolandic epilepsy was discovered. He also was assessed by a psychologist or psychiatrist before admission to a Children's Psychiatric Unit, where he was seen regularly by a psychiatrist. Otherwise, I will have to get back to you.

I should have noted also that his mother remarried in September last year and in the last day or two he has mentioned issues with his new step-father, although according to the family, he is exaggerating and outright lying in some cases. He has been lying quite frequently lately.

Sorry, I had an appointment this morning and have another at 2:30 (MDT) this afternoon, so will be on and offline as well. I am here now for approx. an hour.

Thank you for the response. The additional information you provided is very helpful, and I shall await the details of the medicines and dosages before I formulate some suggestions for you and your daughter to consider.
You seem to have a good understanding of your grandson's condition and the manifest behaviors as a result of his condition. Toward that end, some of the interventions and strategies you have used seem appropriate. However, as I stated before, this case is complicated and I shall detail some of my impressions once you provide the additional information requested.
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Customer reply replied 4 years ago

I just sent a more detailed response but it does not appear on this string. Did you receive a response from me in the last 5-10 minutes?

No. I did not receive the detailed response... please resend it.
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Customer reply replied 4 years ago

Darn! Bear with me as I try to remember (I'm old!).

Meds: Quetiapine 50 mg (just increased from 25 mg), Lamotrigine 25 mg, both @ hs.

He received comprehensive neurological and physical examinations while in hospital last year. He was in a Children's Psychiatric Unit and under the care of a psychiatrist for that 3 week period. He had a repeat EEG a couple of months ago. However, my daughter just found out, when she called the hospital unit seeking help, that he was also diagnosed with ODD (oppositional defiance disorder), although she was not informed of that at the time.

She reached Children's Mental Health Services and an appointment has been scheduled, but not until June 13. She is also planning to get a math tutor for him, as that is the subject he seems to be struggling with at school and one of the things that "sets him off".

I was wrong about when his father moved away - it was January 2008, so 5 years ago, not 4.

On the maternal side, there are no genetic mental illnesses such as schizophrenia or bipolar disorder, although there is some history of chronic depression. We know no details on the paternal side, although the child's father, in my opinion, is a pathological liar. However, I am not a psychologist or psychiatrist and naturally, have no idea if that sort of thing is genetic or learned behavior. The child has certainly been lying a lot lately.

Sorry, that is all I can recall at the moment. If I have missed an important question, please advise and I will get back to you ASAP. I should be available all evening.

Hi again:
Thank you for the additional information. I can understand your concern for your grandchild and your daughter. This is a complex problem because it does seem to involve a physical condition, Rolandic Epilepsy, although what you describe in seizure behavior is atypical of that diagnosis, since most of the seizures are nocturnal and mild. Both medications you identified are used as psychotropics and for seizure disorders. I assume that the physicians are keeping a close eye on physical reactions since they are potent and sometimes cause some serious side effects.
You describe some concerning pre-delinquent behaviors (lying, severe aggression, defiance of authority and destructive behavior towards, self, others and property) The diagnosis of "oppositional defiant disorder"is not surprising at all, and very frankly should have been considered much earlier.
You and your daughter are doing what you can to manage and control the child's behavior. You must provide structure for the child along with very specific consequences for anti-social behavior. While I do not advocate physical or corporal punishment, I do understand how your daughter may reach frustration levels where that may occur.
Do keep the appointment in June with the mental health clinic. The follow up is very important to establish progression of the mental health issues. Also if the behaviors increasingly become more violent or anti social, your daughter should seriously consider involving the the juvenile justice system to provide some structure and support.
In the mean while here are things that you and your daughter can consider with the boy. I assume that the boy is intelligent and understands instructions. At this juncture, I cannot presume or know whether his behaviors are impulsive due to mental disorder or manipulative due to anti-social disorders. None the less a regiment of structure is indicated. Toward that end:
1) Develop a short list of expectations that is concrete rules. For example, no hitting, yelling....the list needs to be specific to the behaviors that are unacceptable and some things your daughter would like your grandson to attend to more carefully.
2) Set a schedule to follow with times and tasks...eg: awake time, meal time, school, chores, recreations time etc.
3) Follow the schedule.
4) Set some consequences for unacceptable behaviors that are realistic and achievable. Such consequences may be removing something the boy enjoys or assigning tasks the boy dislikes. Both are negative reinforcements but not considered "punishment" as is spanking....
5) Hopefully your daughter or her husband are able to physically retrain the boy should his behavior become destructive to self, others, or property. It is better to intervene and stop the boy before the destruction occurs by holding the lad and calmly getting him to deescalate rather than allow him to hurt himself or others.
6) Try to catch the boy "being good". That is take every opportunity to praise the lad for doing the right thing. Positive reinforcement is the strongest kind of reinforcement to change behavior positively.
I hope this has been helpful for you. Please contact me with additional questions should you need. Remember to provide feedback for my services so I may be credited accordingly.
Dr. Glick
Dr. Glick, Mental Health Professional
Category: Mental Health
Satisfied Customers: 25
Experience: Adolescent Development, at-risk youth, aggression and violence, emotionally and behaviorally disordered.
Verified
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Customer reply replied 4 years ago

Thank you. Most of those measures have been undertaken already, as in taking away TV, computer games, etc. and explaining consequences. Setting a schedule and adhering to it may help and I will certainly pass that on. The atypical seizure reactions - daytime vs. nocturnal, hallucinations - were the reasons the hospital staff wanted to have him back after summer break for further assessment and treatment. Thanks again.

HiCustomer
I'm just following up with you to see how everything is going. Please contact me if there is anything else with which I can assist.
Let me know,
Dr. Glick
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Customer reply replied 4 years ago
My grandson has been good all week, but now my son (his uncle) is suicidal and his "caring" wife chose to kick him out of the house rather than to support him through his difficult time. He has a testosterone level of 3 (yes, three) at age 43 and an enlarged liver. The testosterone level is affecting his ability to concentrate/focus as well as contributing to the depression. We are just a screwed-up bunch, I guess. Thanks for the follow-up.
You are welcome.... Let me know if you require any further service by posing an additional question and request my services. Thank you.
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Dr. Glick
Dr. Glick
Dr. Glick, Mental Health Professional
Category: Mental Health
Satisfied Customers: 25
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Experience: Adolescent Development, at-risk youth, aggression and violence, emotionally and behaviorally disordered.

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