11 year old DS already suspended from secondary

[HistoryT]

DS has ADHD diagnosed about a year ago. He takes 15mg of meds but I'm really not convinced they help. It's difficult because he only takes them on school days and while I do think that in the beginning they helped him stick at a piece of work for longer, I think they may also make him feel more agressive. I'm completely torn over whether to continue with them or stop.

He was bullied in his primary school. He annoys other kids, is immature and tries to get a reaction or 'stimulation' from interactions with other kids. He can also be kind, sweet, full of love and very thoughtful.

Secondary school was good for the first few weeks and now he seems to have got a reputation for being annoying and a bit of a clown and other children are dismissing him, saying derogatory things, putting him down etc. And so his behaviour has deteriorated, I think because he feels bad inside and it comes out as ager. He's extremely reactive and picks fights, hurts other kids. He crossed the line this week by head locking a girl and received a serious sanction, then he went on to do the same thing again a couple of days later. I don't know how to help him and scared he will have to leave his school. Current appraoch is to wrap him up in support and show him we're on his side, here to support, but at the same time his actions are so entirely unacceptable. He can't seem to take responsbilty or stop himself but is remorseful - but then he'll say things that show he believes the only way for him to respond is by being physical and showing others he is stronger than them. For context, he's average to small and defintely one of the shorter ones in his year.

What do we do to help him? Tried counselling but he tells them everything is fine and says he doesn't want to talk to anyone (he opens up to us a little bit but is mostly a ball of frustration and anger). He doesn't behave violently at home.

My ds didn’t get on with meds, they made him feel low/flat and not himself. We’re still in and out of school and he’s year 13 now, so that’s probably not what you want to hear. What I wanted to say though was that he is now very good socially, with a group of close friends,and he’s very confident. He was a bit like your son in year 7, prone to being annoying and generally laughed at for being a ‘SEN’. He credits the change to two things - going to the gym and getting really strong (your ds is a bit young at the moment) and watching lots of videos on YouTube about how to talk to people and make friends.

I’ll be honest, I can’t wait for his school career to be over as kids with ADHD just don’t fit the mould, but at least he’s happy socially.

PS ds was suspended four times in years 9 and 10 😱 I know how stressful it is!

Who diagnosed your son? It doesn't sound like an NHS doctor, using the DSM?
Do you have a copy of his diagnostic report?

He sounds pretty useless to me. Was this the same person who is dealing with your sons medication?

Has he been formally assessed for autism
It's a long form filling process ,with appointments and years waiting time ,or has someone who sees him for ADHD ,just made a passing comment
You can't have mild autism..he will be peddling away under the surface masking so you perceive his autism as mild ,but it's not mild to him ,an awful lot of effort and stress will be his experience for how he masks for your benefit
It's like being pregnant,you either are or your not
If he hasn't been properly assessed for autism,he needs to be..

You can not base your DS medication on your own experience

You are different people

You need to give him 2 - 3 months on his new daily regimen to give him a chance as you would with any medication

You could try genetic testing privately? It’s quite expensive, but very effective at taking the guesswork out of which medication works best. Myogenes is a good company for this.

They do it as standard in the US. It’s super frustrating it’s not offered in the NHS.

I’m unfamiliar with autism medications, but not medications as a whole.
I’ve never heard of taking a med 5 days a week - is that a new therapy?
It seems logical that for any med to be effective, a therapeutic amount needs to be in your bloodstream 24/7, so you’d take it 7 days per week.
I think you’re smart to give it a try every day.
I take antidepressants - the problem with those is they take forever to work. And then they don’t, so you try another. And another. And another. It’s frustrating & tiresome.
I hope you have good luck with this one, @HistoryT.

You sound like a very caring, attentive parent, so that's good. You just have to keep advocating for him with his medical professionals. He needs more specific therapy based on his diagnosis. He might need another diagnosis too. His medication needs to be changed for sure. I'm sure he's not responding well to his adult support system because it's his peers he's trying to connect with. That's his world, adults are just peripherals. Keep asking for more help from his doctor and keep doing your own research too. It takes a lot of work sometimes just to get what seems like basic care, unfortunately. I'm drowning in it myself at the moment. I do hope it gets easier for your DS, it does sound like he's trying very hard and just doesn't know what to do. Poor dear! I hope it gets easier for you as well!🌷

It depends on the medication. With ADHD meds, some are meant to accumulate in your system over time (often non-stimulants) and some are metabolised quickly and clear your system (often stimulants).

This obviously depends on the person, their metabolism and the suitability of the medication for them. Some people have to work with their doctors to find the best dosage pattern for them, but that’s very difficult with children unfortunately

When my son was growing up he took ADHD medication. I once discovered a pile of discarded pills he’d been hiding when he was supposed to take them each morning. Make sure he’s actually taking them.

Have you considered that school may not be the right place for him? Have you thought about home educating?

Does he have a EHCP? Is it adequate for his needs?

This.

There are lots of different types of ADHD meds. Which can be given at different doses and sometimes in combination. Your DS is obviously really struggling. And his lack of control is going to get him in lots of trouble and possibly expelled if he is hurting people. So I wouldn't give up on the meds so easily. If your doctor is not supporting you in trialling the right meds then I would try to change the doctor.

Your DS really sounds like my DS has autism and ADHD. He put himself out there constantly but wasn't liked for all the reasons you have given about your DS. And was bullied because of that and because he would react when bullied so became a target. He was also generally struggling in school with all the planning and organisation. So was constantly getting in trouble for his emotional and sometimes violent reactions and for v planning and organisational fails. The stress he (and your son) was under was enormous so everything just kept escalating and spiralling. Imagine a workplace like that for one moment. We would all be off with stress!!! And obviously as he has ADHD he will less be able to cope and process all these negative and difficult emotions.

What helped was calming everything down. He has a time out card so he could leave a lesson at any point he wasn't coping. He could take 5 mins outside or just go to the SEN room which had a calm space. He could go there any time, so could also go in breaks/lunch if needed. He also had a TA (she was a specific ASC TA, we were v lucky but I suspect most schools don't have them), who supported him with his homework. She would make sure his teachers emailed her with his homework so she could keep a track with him and support him in knowing what he needed to do and when. He also had two "SEN periods" when he met with his TA and complete his homework in school (as that was a major stress for him out of school as couldn't understand why he had to do schoolwork out of school). These periods were another opportunity for a break from the overstimulation of school and the other children.

He has issues with his handwriting which is another barrier that he didn't need the stress of so he was given a keyboard to use in class.

He also attended social skills groups and counselling both in and out of school (just to say about the counselling - my DS found it very helpful as he lives to talk without filter, but he is very prone to forget things and be "in the moment" eg he used to come home from school saying he had a good day and everything was great and then 2 hours later he'd be in floods of tears about a horrible incident that happened at school - if that s applies to your DS reminding him
If things he might want to talk about might be helpful?). My DS found it so helpful to be able to talk through some of his difficult emotions around the bullying.

On top of that the school should be clamping down on any bullying. I would be pushing hard for that. At my DS's school there were lots of instances of my DS being antagonised and wound up until he blew at which point he would get into trouble. It's important to push to ensure that the ones doing the antagonising are also dealt with.

With all of that in place things quickly began to improve, and by year 9 he had a good group of friends and was doing well. He was happier and calmer. I think it's a case of lots of small things to calm things down overall. Each thing may only have a limited benefit but overall they have a bigger impact.

1. The medications are for ADHD, not autism. There's no medication for autism.
2. It's common here in Australia for kids to take ADHD medication just on school days. It depends on the specific medication but many of them half a very short half life in the body... by the next morning it literally does not matter if you took it yesterday or not. Lots of reasons not to on weekends but it's mostly about managing side effects. Important to realise that ADHD is not an illness... it's a different neurology that makes it hard to fit into systems designed for people without ADHD. Medication makes it easier to cope in that environment. But at home on the weekend, we don't have to conform.

What sanctions do you give him for twice putting a young girl in a headlock?

If he only behaves like this at school and not at home then the obvious answer is he shouldn't be in the school. It's unfair on the children he is being violent to to be subjected to him

My dd became aggressive on equasym, we took her off them in the end. She would say herself they made her feel angry.......he needs an urgent meds review, in the meantime I'd consider keeping himhome until he's on more of an even keel.......a fresh start elsewhere might be just what he needs.

You mentioned that you were reading books on the topic. Can I recommend the books by Georgia Ede and Chris Palmer, too. These go into how nutrition affects the brain, and mental health.
This is a good into to the topic.

How do you deal with his behaviour when he steps out of line? Is his phone confiscated, made to increase house duties, grounded etc?

Agree re meds review, see another GP.

And there’s no such thing as ‘some’ autism / he’s either autistic or not!

This ^^

This is a really good guide - especially to explaining why medication can be beneficial.

3 of us medicated for ADHD in this home - 2 on non-stimulant and 1 on stimulant meds.

the non stimulant has caused no side effects for my son. Has no on or off time - he's 'medicated' all the time. It's effects are subtle but long lasting and over time have really helped his behaviours and anxiety. IT's often preferred as a treatment for people with autism and ADHD. We're both on Atomoxetine.

And see another psychiatrist - one who's more sympathetic.

I totally understand. It’s really difficult to know what to do for the best.

My son went through 3 types before we found one that suited (Elvanse, sadly the most expensive one for the NHS to fund! The US now has a cheaper off brand version so hopefully we will get that soon).

My son is now 23 and is a fantastic young adult but the teenage years were super rough. He couldn’t cope with the transition to high school, spent year 8 at a medical PRU due to depression/anxiety and went into a small private mainstream school in year 9, because it was a tenth of the size of the old high school. He was impulsive and prone to taking dares which got him into minor trouble with the police. I did 6 months of Multisystemic Therapy (NHS funded) to pull him back from that brink.

Finally got an EHCP as he started 6th form 😬

Bit of a depressing story but it really does have a happy outcome, he’s now a pleasant and hardworking young man who is living in a shared house and attending uni, whilst working part time shelf stacking.

being neurodiverse in a neurotypical world is always challenging, but the transition to high school and the changes of puberty make it incredibly intense.

All we can do is help them weather the storm as best we can.

The best intervention we got was occupational therapy - they were invaluable for helping pinpoint particular flashpoints for sensory struggles and develop coping (or avoidance) strategies.

Might sound silly but removing all the red from our home (especially a red rug in my son’s room!) and switching all the lightbulbs to warm tone/lower light made massive improvements.
As did chewy jewellery and letting DS clatter about on his skateboard BEFORE homework, rather than expecting him to do homework first.

If you haven’t seen an OT, please do!

You need to find a way to stop the outbursts at school. I don't know what the answer is, but it sounds like something different is happening at home than school.

But, as the parent of a child who was put on a head lock and wrestled to the ground, it needs to stop. Both kids are failed in this suitation.

I know it is the ND as the cause, but noone deserves to be physically assaulted, so a system to stop it (figit toys, medication, time outs without question, different school..........) needs to be worked out, and quickly.

It sounds like a full assessment may be helpful, whether it results in an EHCP or not. Write requesting an EHC needs assessment, pointing out the diagnoses and the effects on your son, and the fact that he is in danger of exclusion.