Mumsnet Talk

I need help and advice.

Bit of background. DS diagnosed with ASD and ODD at age 7 after years of fighting we got him into a specialist priory school where he has been since age 8. DS is now 11 and is on strattera (25mg) once a day.

In the last few months we have seen his behaviour change. DS has less meltdowns but the ones he does have are horrendous and very aggressive.
School are struggling to cope with him (specialist school, 25 pupils in while school) and are very concerned as DS is now threatening to kill himself and self harming on a daily basis. at home DS is not perfect but we dont have the huge behaviours we have more the trashing of his room and screaming obsenities.

The school are talking about the possibility of sending DS away to a residential mental CAHMS hospital to get his aggression and mood stabilised. The said he is a danger to himself and others. They have called social services in and have told the LEA that they cannot school him safely without 2:1 staffing and even then he is a huge risk.

I dont know what to do. Have emergency CAHMS appointment on wednesday morning but am terrified they are gonna take my baby away from me.

I suppose what im asking is that does testosterone and the onset of puberty affect aggression and ASD to this extent. Will anti depressents help/. BI POLAR has also been mentioned. I dont know what to do. He is only 11, he is my baby and YES sometimes he scare the hell out of me and i cannot cope with him especially when he pulls knives on me (only happened once thankfully) but he is my baby.

Xx

I think you should repost this on the SN childrens board Bonkerz, it gets loads more traffic and there are really helpfull peopl over there.

Good luck.

I think puberty and testosterone have a huge effect tbh in my case I was fortunate if you can call it that ds was hugely aggressive and constant meltdowns before puberty afterwards he was hugely quiet and withdrawn.
It does sound like he needs a medication review and the best place to do that is probably as an in patient.
Can you think of it as a means to an end? A short spell away from home for a longterm better outcome.
I know how you feel though ds is 16 and he's still my baby even if he is a foot taller than me

Sorry you are having a tough time and I hope the CAMHS appointment works out. You mentioned he was taking Straterra - were you aware that the patient information leaflet mentions 'suicidal thoughts' and 'aggression' as rare side effects? may be worth discussing this at the appointment in case there's any association.

Bonkerz you would never forgive yourself even more so if ds killed himself....he needs specialist input and for this needs assessment. No one is in more pain over ds than you so hard to see outside the box. He will be in good hands and hopefully come back a healthier and happier boy...but if you refuse their is nothing they can do. His hormones plays a big part and if Bi Polar may need different medication to stabilize these horrendous mood swings. I hope your ds gets the help he needs soon (((hugs)))

Thanks pip

We have emergency cahms appointment tomorrow. Hopefully they will tell me what the plan is regarding getting him stable. He has had a really good day today. One extreme to the other.

oh Bonkerz I do feel for you

Please though say how ds is generally not just a good day tomorrow.....they won't tread on your toes if you don't want ds to go away for assessment as you do havw the power...I am just worried your ds will take it further you can't ignore these pleas for help by your ds. If you really don't want ds to go to a adolesent unit miles away do they have day places somewhere close to home. Priory wont get funding without evidence and for that ds will need to settle somewhere day and night to be observed 24/7. Like OP says Stratta can make aggression worse....it is very common esp asd that anti D's make the person more depressed too. If ds has a secondary condition such as BiPolar if left not treated these behaviours get worse. Puberty often trigger secondary conditions.

Best to get it out of the way now, not let ds deterirate further and end of day if bi polar ds will get worse not better where ever he is. Medication - mood stabilasers are the main treatment...then the counselling or support on top will help. Proiry will have possibly seen this before? They want ds to be at the xchool as been their years....this is a biological illness that needs the correct medication...but to work out the correct illness besides blood tests to rule out infections/thyroid/infections 'observation is the main method used and our kids due to communication difficulties it takes longer to work out and understand. Specialist psychiatrists and psychologists will be their to establish the problems. Tell CAMHS you are worried he will act out his suicide ideas...he may not understand so much sucide means the end.....so more vulner than a NT teen...is someone fron Proiry going or have they done report?

I have a risk assessment from priory and also a report from head detailing all attempts and aggressive outbursts for last few months.
The doctor I'm seeing tomorrow though is the same one who insisted ds had ADHD and not autism back in 2007. He is useless but I have the name of a autism specialist in cahms who has agreed to take ds on.

It is unlikely he will change his original dx thoughts? So if tomorrow is down to this Dr you may not get any further? Is this 'autism specialist' a medic able to dx? Will this Dr tomorrow block any further CAHMS by saying ds has (AdHd etc) and that is that? I am glad you have Priory detailed reports of behaviours/incidents this will give a clearer picture.
Bonkerz what do you feel needs to happen now? Are you with Priory on this? What is the future if Priory get no more support 2:1 etc and say unable to manage ds outbursts/self harming anymore due to H&S of ds and others?

You need to think of
1. If this carries on and Priory says can't cope anymore...what is next?
2. Going with Priory suggestions/thoughts on ds plans and pushing for 'assessment' and possible new dx (so more help 2:1 or new placement if 'environment' is not right.

I would go with the school tbh! They know on daily basis ds is self harming and outbursts need more staff to contain ds. Yes this could be the start of pubitity but these behaviours could get worse if not managed now...if down to a condition the right medication is needed....for this a full assessment is needed and believe me Mental Health services do not take it lightly dx a serious mental illness in a child of this age and will want 110% to make sure they get it right! Sorry to be blunt Bonkerz but trying to show 'reality' of right/wrong decisions made tomorrow. You are the parent with the decision and although yes ds is your baby...he is growing strong and harder to manage esp if underlying condition is cause...the sooner a condition is managed the better long term for ds. It must be devestating your ds is self harming daily and this is urgent.

Good luck tomorrow, please let me know how you get on and my thoughts and prayers are with you in hope their is some plan decided tomorrow. xx

Thanks. Ds has a formal diagnosis of autism, OdD an severe anxiety. The doctor I'm seeing today is generally obstructiv and doesn't like me mainly because I refused his dx of ADHD and pushed for further assessment and proved him wrong. All involved a formal complaint and some bad feelings hence I'm worried today is gonna be a fight.

I spent yesterday doin alot of crying an discussing things with friends. I understand I need to do something now in the short term for the long term gain. As much as it kills me to think of ds away from me I do understand it may be important.

Ds needs to be stabilised. I get that. The school cannot guarantee his or others safety with him being so unpredictable and aggressive and I have to respect the schools experience in this.

9am is my appointment. Will update ASAP. Thanks again.

Hi. just an update. Appointment went quite well. Doctor increased straterra to 40mg ad also introduced risperidone 500mcg per day and also melatonin at night. All this isin the interim until referral appointment with new autism specific doctor. Also got referral to OT and for some psych therapy. Got to go back next week.

It will be down to new doctor to assess any underlying mental health issues and treat accordingly.

my sons on strattera and we are having horrendous problems with agression and depressive thoughts also.

Ahhh posted long reply and timed out so lost it!

Bonkerz cutting long story short now Doh!

This Dr is saying to himself 'I was right all along he does have ADHD!' Strattera is ADHD medication.
Look up Strattera side effects...aggression and suicidal thoughts 'rare' on my nelly aunt...very common! Should be stopped if v high risk of person acting on them...your ds is self harming daily...this a huge risk! The Dr up's the dose?

Your ds is being prescibed a drug possibly causing his behaviours and getting worse. If ds gets anymore worse before a week is up demand another appointment that day or present at A&E and ask for oncall duty psychiatrist and explain ds at great risk and getting worse.
Strattera if given to a person with BiPolar will induce a psychotic/mania state and this is why I am guessing Proiry are thing ds has BiPolar due to him getting worse on the drug?
Then because the Dr has prescribed Respiridone to zombify and melatonin to calm also...you wont get to see what is actually working....your ds needs to be in a safe place monitored drug free to assess what the real symptoms are.

Sheeep you are not alone....I would ask for appointment asap to have your ds reassessed as 'side effects' are more damgerous than possibly the reason your ds was put on Strattera in first place.

I did ask about the side effects and he said that as ds has been on for over 8 months with aggression and suicidal acts only in last 2 months it's unlikely the drug.

He has reluctantly referred on to new doctor so I'm hoping it moves fast. He basically gave me three choices. 1) do nothing till new doc takes over 2) the option I chose 3) stop all drugs and wait till
New doc takes over.

Ds can't be on nothing. I was ok with risperidone but he said that straterra needs to be weaned off but till new doc assesses he needs to be on full dose for weight which is 40mg.

So confused. Risperidone does calm ds and makes him quite emotional but thats preferable to being aggressive.

At least ds is on risperdone for now Bonkerz.....well it depends as ds was on small dose (well not for a child I guess) but over long term your ds mood has deteriorated! Yes the sucide thoughts usually occur around 2 month mark....not 6 month mark....but the mood disturbances could take longer. The swinging of mood from great to sucidal is telling any Dr...ok this aint working....I don't think he knows what to do....which is frightening really for a Dr that is ?Consultant level working with children!

Tbh Bonkerz the 'withdrwal' effects of coming off any of Lilly's drugs are damn dangerous...so wise to wait and possibly wean off in assessment unit if they can get ds a bed. You choose the right optioin though as risperdone will hold him for now. You are seeing ds 'calm' not so agitated by Stratterra and this is showing ds is possibly very low (other side to the mania/aggression wants to kill himself). Poor dab....as you can tell I aint a lover of medication....esp when it does this to people...but sometimes is life saving if the right one is used!

Can't believe a Dr knowing how withdrawal effects people would say an option of stopping meds and waiting for new Dr? It proves one thing though if your ds has ADHD like that Dr said.....funny how your ds is getting worse!

Hang on in their Bonkerz your ds will be ok with risperdone. Hope this new Dr has a clue what he is doing will come soon and help your ds.

If you go to NICE guidlines...they should have info on treating your ds....and how fast input should be in a crisis situation. Sometimes you have to present to A&E to jump the waiting list you have to nag to be seen sooner!

Hope it is soon! Keep strong xx