To think if we can't get help, who can?

I've just read all through your thread and it sounds so difficult. How are you/him doing now? (I've got no advice just support from the sidelines really - adhd/autistic kids so some understanding but we aren't facing anything as near complex or difficult. My heart goes out to you.)

"he needs competition in the basics - being first to say the answer, praise for coming up with a good description, that kind of thing. You have to make him forget it's hard work and think it's a game"

I do understand this but won't this either have been plan A at school and it's already failed, or if it wasn't Plan A there was a really good reason why not, eg his peers are not able to cope/do not thrive with this approach. In either case perhaps school are not going to be able to meet need.

I wonder if it might be possible to introduce this game element with a one to one teacher. I compete with my teen all the time, and adults can regulate their responses better than SEMH needs peers. If DS is motivated by being the "winner" among peers then that implies someone has to be the "loser" - and that he must take his fair turn at losing himself. Neither of which sounds very realistic or stable to me in a group of presumably quite reactive and high needs kids. I just wonder if a tutor could work and be more realistic than trying to get a whole peer group set up perfect for him. A tutor with the right classroom experience, who's understood and digested your most recent insights and can "buffer" the winning/losing, mop up enough of the losses while still maintaining their position, and gameify the learning.

My son's got a different profile but he has massively struggled to engage. A.N.Other tutor has not worked out but the right tutor should be able to provide the "Goldilocks lesson" - not too challenging, not too easy, just right to press DS's engagement buttons. You can't keep moving him from peer group to peer group until one fits, and school probably have no other groups he could slot into anyway, but you can try different tutors and they vary massively in skillset and how much they'd click with your son.

I know you want/need him to be in school and therefore you want/need school to provide the learning in the peer group. But it's a long game. We've divided it up. Engagement with amazing tutor first, and he's gone from outright school refusal to asking to see mainstream classrooms. Would it be worth maybe seeing if they could teach him one to one at school for a few weeks in one subject? Please don't bite my head off if you've covered this. I have read the thread but I can't claim to retain every single sentence you've written.

Some of those things you list do sound like things the school should be able to do.

But a few of those things sound unrealistic.

I think you need to bear in mind though that children, even those without SEND, can behave very differently in different settings. Your son had a series of enforced school moves so at this stage, a school setting is likely to automatically be a bit triggering for him.

Is there an option for the school to do a managed move to a PRU, or some other form of alternative provision? I appreciate that might be temporary but it might be better than nothing. Although he’d be at a secondary PRU when the one he was presumably at before was a primary one, so a PRU might not work as well for him now as it did before.

Not sure I have advice but I will add my experience:

This does happen.

Students who show violent behaviour need to be risk assessed. Schools have a duty of care to their staff under the health and safety at work act and in order to stick to that they do risk assessments.

https://www.nasuwt.org.uk/advice/health-safety/risk-assessment-of-violent-and-abusive-behaviour.html

The current Dfe guidance on behaviour emphasises that keeping students and staff safe is a high priority and that child to child abuse is a major problem.

https://assets.publishing.service.gov.uk/media/65ce3721e1bdec001a3221fe/Behaviourinnschools--adviceforrheadteachersanddschoolstafffFeb2024.pdf

In most schools now if a student is being violent then they will be left in the classroom and the rest of the class will be evacuated. Obviously the teacher will try re-escalation strategies first.

In some schools student violence is a major problem and on occasion the unions have got involved after staff have been injured and the whole staff body have refused to teach the child.

I have personal experience that if a child has been supported and triggers identified etc, and has been through the process of support being offered but it makes no difference then they can end up just in a room pretty much on their own with a TA for support.

One of the children in question was routinely violent to multiple mainstream school staff. He had multiple diagnoses. He tried out a unit in another school but was violent there as well. He wound up back with us because no-one would take him. But his triggers were demand focused - he was basically demand avoidant - so classrooms would never work for him.

They did try to get him to learn things but ultimately it came down to the physical safety of other students and staff is more important.

Staff in special schools and PRUs are generally better at dealing with violence as they get so much of it, but even they have limits and the academic curriculum there is generally not as good as mainstream

I was going to suggest this too. I work with similar children to your child.

Basically I agree completely with @cansu

Glad things have improved at home!

Re school: they’re right though, they can’t meet his needs. Part of those needs are academic, so you agree. The school can’t teach him as doesn’t engage and gets aggressive.

In terms of the school “rewarding aggression”, what do you think they could do instead?

They’re putting him in a different room to separate him from children he could hurt or property he could damage. They could traumatise him by putting him in complete isolation or something he hated and you’d have every right to complain about that.

It is obviously brilliant that things have improved so much for you at home and you may well be right that the line you took worked. Surely though you can see that the environment, peers and needs of other staff and pupils make the position at school very different? I can't see how a judicial review or any other legal action will be able to force his school to act in the way you think they should.

OK. I think though that you are being unrealistic. I also remember you having to call for help when he has been aggressive on numerous occasions. You also do not have other children with similar needs to consider. I also think we are prepared to cope with things from our own kids at home that we cannot expect school staff to cope with. Ignoring aggression is your choice. Why should school staff do this? What happens if they do and someone is seriously hurt?

1. How do you know that what he has told you is true?
2. Let's say it is true. If he is aggressive when asked to do something then the staff have no choice but to reduce demands and provide an alternative. Staff won't accept getting hurt in order to show your ds that this behaviour won't work.
3. If they had an incentive that worked they would be using it.

It all kind of adds up to the school not being suited to your ds needs which is what the school have said.

There may not be anything better out there. I know you have said this yourself on other threads and I think you may have already tried to get other independent specialists and non specialists to take him.

You could try home education with tutors or eotas with tutors but you will likely have the same issues and again wont easily find people who are prepared to stand their ground with someone being aggressive. Students who are challenging with their behaviour often end up doing much less academic work while schools work on meeting their emotional and behavioural needs. My dd is accessing an alternative bespoke education service where tutors work individually with students. However it would again be trying to meet your ds emotional needs and working on his interests so not a traditional exam focused learning approach.

I'm not sure why he would have CPTSD because, while not wishing to minimise the difficulty that being adopted caused he has no neglect, trauma or disrupted attachment.

One of My DD had in utero stress from birth mums lack of food, drug taking, alcohol and stress from her chaotic lifestyle, removal at birth would have been traumatic and a broken attachment, moving to foster care, being adopted in itself a traumatic attachment disruption. He is showing you he is very traumatised. Your denial of this is surprising.

School tried art therapy, he just draws the same cartoons he draws the rest of the time, he likes animals but walking around once a week with horses is not going to turn him into a calm child! Maybe it would be good for a calm anxious child but that isn't him. He will not talk to therapists.

That sounds like art therapy was going very well, that repetition was great and a good sign he was working through stuff in a rythmic way. Horses are highly attuned sensitive prey animals who communicate at a sophisticated level non verbally so perfect for children with trauma as they have a larger amygdala. Horse operate a lot from the amygdala and can be really in tune socially as they are herd animals. If you can communicate with ahorse that is a skill and hugely confidence building.

I can't find any controlled or systematic research showing any of the therapies that the ASF funds actually work, except CBT which is not suitable for a child that won't engage. DH was just recommended Therapeutic Parenting so I looked up controlled trials and systematic reviews like I always do and it doesn't work better than doing nothing. Why does the ASF waste money like this, honestly? There's so little to help and they are throwing money away.

A lot of parents have had huge success with therapeutic parenting and low demand parenting. Just because someone hasn't done a study it doesn't mean it doesn't work in practice. Children with damaged brains and nervous system and complex trauma cannot be parented in exactly the same way as NT children surely.

Just to add - I've had panic attacks myself, so I sympathise with your DH, and when I have both of mine have been upset and concerned. My teenager with AuDHD couldn't cope with it, but 'hilarious' was the opposite of how she found it. I appreciate that's only two children, but I really want to keep reiterating, as I have since I joined this thread many pages ago trying to help, that your son's issues are NOT just, or even mainly, due to ADHD.

I'm absolutely certain a year at home would be awful for everyone.
DH would get no respite and his mental health is on a knife edge. He's had panic attacks before and DS finds them hilarious and an excellent outcome to his behaviour.

Yes in that case @drspouse him being at home obviously won't work. It was a last resort suggestion anyway as he has had to leave several schools already, and this one is wanting to move him on, and you are confident that what you're doing is working for him and have said before you've taught him more than the school has. But parental mental health is key and you need your own boundaries and space.

It is troubling that your son finds your DH's panic attacks "hilarious". As I said before, I have ADHD and I have two children with ADHD, one of whom also has ASD, was thought at one time of having ODD, and has been violent. I advise families and school involving children with ADHD, mostly from a legal viewpoint and involving EHCPs. This particular behaviour is not a typical or even an atypical ADHD trait.

People with ADHD, including me, may laugh at serious things inappropriately as an impulsive reaction out of anxiety or not knowing how to react. This however sounds different: a lack of empathy, dissociation and extreme need for control.
It's indicative of something else other than (or at least in addition to) ADHD. There's one child I know of, also 12, who behaves similar, but he has suspected ADHD, suspected Autism (waiting for an assessment) and a family background of extreme trauma and essentially permanent rejection from one parent.

Even though using the strategy of ignoring negative behaviour - that can work with children with ADHD - may work here, it won't address the underlying fundamental issue. If it was me, I would be doing what I can to seek help to look at that, regardless of the research. And I would absolutely be starting from centring things around him being adopted rather than him having ADHD, especially since you and the professionals have ruled out autism.

@drspouse I am so sorry you are going though all this, but I really think your thread should be required reading for all teachers, social workers, therapists, medica, anyone and everyone working with difficult children, because you are so articulate, and so clearheaded, and describe the actual reality so clearly.

Sorry, I know it doesn't help you, but thank you for the thread, anyway

I totally understand where you’re coming from in terms of attachment but depending on how birth mum was in pregnancy he may be carrying a load from there. There’s evidence that points to pre-birth trauma impacting things like self regulation, interoception and proprioception which is why sensory and somatic activities/therapies are often recommended for children with developmental trauma. I wouldn’t dismiss adoption playing a part with him.

The limits with all the therapies you’re looking at is that they are all coming from a cognitive place, which makes sense given your focus on therapies that can be the subject of clinical/RCT type trials. Where trauma is pre-birth/pre-verbal you’re dealing with responses in him that are driven subconsciously by instinct which he is now wrapping a narrative round that points to him knowing exactly what he’s doing and which then points to a behavioural response.

In your shoes I’d be looking at therapies and activities that are more physical than cognitive, that help him make sense of what’s happening internally in a physical sense rather than necessarily focusing on his behaviour or external prompts.

For example using the ABC framework mentioned previously I’d be looking at how he physically felt before an incident - using as many ways to help him describe that eg clay, drawing, music, movement etc rather than using a cognitive description. Following that up with behaviour (eg what was happening physically when he was doing X, was that different to how he felt immediately before) and again looking at consequences eg how did he physically feel afterwards. Given his age it’s going to be harder to help him link his physical sensations to emotions to behaviour but it’s part of him integrating responses he’s developed since infancy.

I know the science part of you wants gold standard evidence of everything - but as you’re finding, a good RCT doesn’t mean a particular therapy will work with X child because people don’t work that way. I tend to steer clear of things that sound truly hokey but have seen huge benefits on working with intereoception and prioperception with my daughter particularly. It became clear she just didn’t have the same internal physical cues as other people to help her know she was becoming overwhelmed or tired or anxious until she was well beyond being able to regulate and then she would explode. We ended up building almost compulsory sensory breaks at school and home whether she felt she needed it or not. Things like dancing, singing, swimming also helped - screen time was the worst thing because it numbed her to internal sensations and cues which would then overwhelm her when she came off her screen resulting in a tsunami of sensation that she couldn’t handle.

The difficulty is that most relational therapies don’t lend themselves to RCTs because it’s impossible to standardise the therapy enough to make comparison or a control group effective. It’s one of the reasons CBT/DBT are favoured by the NHS. They’re not necessarily more effective, but they can be manualised and standardised. DDP has been excellent for my DD but she has known attachment difficulties and isn’t aggressive/no behavioural issues in the way you describe. I wouldn’t suggest it in the absence of attachment issues.

You seem very clear that all his difficulties relate to ADHD and not his adoption history - is there a reason for that?

In terms of CAMHS, I managed to argue my DD into their service on the basis of her trauma history (also adopted) and evidence of the benefits of early intervention which also happens to be part of the wider policy environment where I live. I have expertise in developmental trauma so could argue from a credible place though I did feel like I had effectively resat my Masters to get there.

CBT can work wonders with ADHD in children, but I think purely trying to address him from an ADHD framework is leaving out a big part of the picture. He may not have attachment difficulties but adoption comes with so much more than attachment stuff, some of which can present in a similar way to ASD which may be why so many people are pointing to ASD when your son doesn’t meet the screening criteria.

How does he understand his adoption and what do you know of his pre-birth experience?

I know it can be very difficult to remain calm when you’ve been physically hurt or are living in fear of being physically hurt. And I’d certainly have a reaction to being told I’m effectively his servant - you’re constantly fighting your own fight or flight response which is totally counterintuitive and keeps your own system out of kilter.

I don’t think it’s helpful to change everything to suit the “needs” of a child, it gives them far too much power that they can’t process and leads to ever spiralling behaviours because the child knows you’re scared of them. I also think that what’s considered therapeutic parenting isn’t great for children with a high drive for control or reaction but saying that in adoption circles is like blasphemy.

Having him home for a year, or homeschooling would be disastrous for you all. You all need some respite and it sounds like he needs the structure and routine of school even if he finds it tricky or tends to play them at their own game.