Teenage son attempted suicide - need support

[3Blues]

So its going to be a long one... I just need to sense check I'm not going crazy and I'm doing the right things here.

Teenage son, 14, is the middle child (DS 15, DS 7) and has always been wild and unique. From age 6 I suspected some form of neurodivergence, but was fobbed off by school because he wasn't presenting or showing those signs in school, but at home. So, DH and I managed and worked our way through it to help with sudden anxiety in our DS, grounding techniques for when he got overwhelmed or overstimulated, and just learnt together what was best to help him. I must have gone to the GP 10-12 times by the time DS was 11, showing a diary of how he was escalating and showing riskier behaviours - self harm (across arms and chest), compulsiveness, lack of self-control (to the extreme), compulsive lying and so on. At the same time, increased anxiety.

They eventually referred him to CAMHS and he started sessions with them 6 months later when he first attempted suicide by taking 30 paracetamol. At the same time, I requested help from MIND councillors at the doctors (5 sessions) and put him on a waiting list for local mentoring. He was doing sports, he was very popular, and we continued to follow guidance and advice for setting boundaries, gentle parenting, and how to make sure our other sons were not adversely affected and left out.

Fast forward to 2024. DS behaviour rapidly getting more and more out of control. Running away, refusing to come home, abusive messages, abusive behaviour inside the home (holes in doors, walls, vandalism), many MANY calls to the police and missing persons reports, bunking from school, suspensions, one arrest, behavioural contract with the police... and the support and advice we get is to maintain boundaries. Gentle parenting. Keep calling the police. We'll refer him for an ADHD assessment, but that will take years. So we save for an ADHD assessment and get it booked in for next month (waiting list - even for private). We get him a mentor. We try to work with CAMHS but they want to discharge him and wait for assessment. We speak to the police. I even called Social Services and safeguarding organisations on myself - we need help. What can we do to help our son? How can we ensure our other two are not affected or traumatised by what is happening?

I get asked, multiple times - am I looking for benefits? Am I searching for carers allowance? No. I receive no benefits. I work full time from home so I can be available at the drop of a hat. DH also works full time. This is not about benefits - why are these questions more important than getting help for my son?

Fast forward to the last three days. Son has demanded a lift somewhere. Husband has said no - i am in bed seriously ill, DH is making dinner for our 7 year old DS - and it's late. Son hits the roof and sends 38 abusive voice notes - now threatening to stab my husband (his DF) in the neck, and more and more abuse. DH ignores the messages, not wanting to escalate things, and we call the police to report this. We also, report him missing by this stage because he is in the middle of a massive hyper cycle and this is when he gets more reckless with his own safety.

Next day - abusive messages continue. Threatens to sleep on the streets. Refuses to come home - despite gentle parenting. Go looking for him. Nothing. Call thenpolice, report missing, and they find him a friends house to stay at so we know he's safe.

Yesterday - DH collects DS from friends house and brings him home to talk to him calmly. Offer support. Hyper cycle is wearing down. DS walks straight back out of the door saying he wants to die. DH immediately goes to look for him, can't find him. I call Social Services and the Police. Social Services won't do anything. Police file missing persons report. Third time in three days. DH - in the middle of me making the report, receives a message from DS saying goodbye and a bridge. We are frantic. DH races in the car to stop him, im screaming at the police on the phone to help. He gets there in time because a couple walking sees DS in the bridge and stop him. Trying to talk him down.

Police come to the house, offer so much support. Help me make a plan for what our next steps should be. Give me a crime number so Social Services will start helping with safeguarding. Tell me to call 111 to get urgent mental health support for DS.

111 Book an appointment for DS to go the A&E and see Mental Health professionals. Very concerned. We go to A&E. DS is agitated, angry, and keeps saying he just wants to die. Nurses in A&E are amazing. We wait, in a room because he is starting to swear, punch walls and kick off that he doesn't want to be there. Mental Health workers come in, kick me out, so they can speak to him. Amazing. We're finally getting somewhere. Or so I thought. I go back into the room - they tell me we're being discharged, they're going to make a plan with CAMHS and I will hear from them in 7-10 days. Keep an eye on your son. They will inform GP and school. That's it.

If you got this far - thank you. But also - what the ever living hell?! Is that it? Your son is suicidal - wait 7-10 days and we'll have the ever useless CAMHS to support. Is that all there is?

Only one paragraph in and....<shouting at school>

"HE'S FUCKING WELL SHOWING SIGNS NOW!"
(Past experience of stupid people in schools who can't see what is right before their eyes, and he was showing signs before)

Really sorry. It's really difficult to deal with. Services just don't want to help. Some of the help is useless. "Don't let them accidentally kill themselves" Or blame the parents.

Yes caffeine helps calm ADHD. (Heard amoungst parents of ADHD kids)

So sorry. It's so difficult.

I’m so sorry OP. The social services are useless and so all of this is on you and your dh. Ask him what he wants. Consider pulling him out of school? Source black market adhd medication. Get rid of gentle parenting, it makes the parents fake to their own kids, it blocks real human responses and it makes the kids feel they don’t actually know their own parents. Show your real self and your love and your worry for him. Get support for yourself this is so hard.

Social services are NOT useless but they don't have a remit here. This is not a parenting issue. It is children's mental health services that are failing and that's not because they are 'useless' either but they are chronically underfunded.

We are real with him, and we try to keep things fair. So he misses curfew - we ground him. He walks out laughing in our faces. We don't raise voices because it just takes the situation out of control and overstimulates him. I had to go away with work for three days, he screamed at his dad and threatened to kick his teeth in - my husband lost it and shouted back - he was reported for being verbally abusive by the school to MASH (even though he wasn't abusive, he shouted sit down, eat your breakfast, go to school) and the school said i shouldn't leave for work trips anymore because DS feels unsafe at home and my husband has a horrible temper. It's impossible. So many posts on Facebook about out of control teens, where are their parents - but you can't say anything anymore without it being wrong. The world's gone mad.

Yes sorry both op and @InkHeart2024 , point taken. This is a mental health issue. What I was trying to say, but made a mess of it, was that the op cannot rely upon anyone else. They won’t step in ime. That’s very scary. But it also frees the OP to take some radical decisions.

If you requested an EHCNA and the LA refused to assess or refused to issue, have you appealed? If not, are you still within the appeal window?

I read stories like this on closed FB groups I am part of. These are groups for parents of ND kids, one is ' Not fine in school ' . There's a few online groups for parents and others who are Autistic/PDA for example and ADHD. I read these stories and I know people experiencing this.

Just dealing with the current school system and being ND I now realise can be so traumatic. ( Son is ND, ( AuDHD, we were forced to assess privately to confirm because NHS refused!)

Nothing whatsoever to do with your parenting OP.

He sounds like he has PDA traits. I'm on an FB group for this, PDA parents I think it's called.

Your story isn't uncommon. With a correct diagnosis you can at least go back to the school and explain the struggles and issues with conflict are very much because of this and sons overwhelm ( which of course triggers the family).

When someone's being like your son it's so hard because it's triggering and makes us really angry inside as parents. The most important things in this situation for PDA teens is feeling control and autonomy over their life but realistically that's not always possible.

School will be a huge part of this for him right now. The demands, the conformity.

Just let him have the caffeine. If he's ADHD he will be seeking dopamine. My son does it. He wants caffeine, sugar, energy drinks, stimulation. It's actually heartbreaking. I'm trying to encourage his dad to try ADHD medications. ( Diagnosis needed which I know you realise).

I believe the services available to us are useless - and I can see it's because of such significant lack of funding caused by Government. The sad thing is you'll be much better off sourcing all your support privately here. The NHS isn't fit for purpose.

Have you tried to book a private Psychiatrist op? Most could offer an immediate assessment, he needs to be medicated urgently. Medication is going to be the answer but yes his age is an issue.

Is he taking anti depressants now?

There is waitlist for a private clinical psychologist but you might have more luck with a private psychiatrist op. You can’t afford to wait for the NHS.

OP, you are a fantastic parent.

It sounds very much like your DS has bipolar disorder. Sounds like he needs to be on medication for it. In your situation, since CAHMS are useless, I would go through BUPA and seek a diagnosis and medication/psychiatrist privately.

Would be best to get him on meds and understanding his diagnosis while
he is still a teen, because once he is an adult you won’t have so much input over the situation.

I wish you the best of luck.

I have no advice but just wanted to send a message of sympathy, OP. It sounds like you really have his back and I hope things improve for you all soon.

In your place op you have one week to get through to be seen by cahms:

Speak to your employers, it is possible to take compassionate leave? A few days to take him out, to look after just him. Take him to the sea - book some lunch. Try to take the pressure out of the immediate situation.

Your GP can and should be offering some medication to help control his highs and lows for now until he has received a full assessment. I would insist that some medication is used in the interim. A fast acting drug that can help stabilise him whilst you wait.

Follow the recommended private psychiatrist and request an urgent appointment. The quicker you can do this the better.

Set up a rota to monitor your son 24h. Even if it means you are sleeping in his room.

In the longer term you will find this much easier to manage, for now you are in crisis and need to respond accordingly. You will get this under control eventually, I know it’s hard to imagine but you will come through this. Please look after yourself and ensure you have your own counselling (and your dh) this is very very tough as a parent, and you need to put your own oxygen mask on first. Line up a recommended, accredited counsellor once a week so you can process your own fears and emotions. You will be much better placed to support your ds from a position of strength.

Why do you say it sounds like he has bipolar disorder? Are you qualified to make such a statement? And if you are qualified then you must know that everything OP has described falls under the traits of ADHD and possibly autism/AuDHD? So why would you suggest bipolar before a ND assessment has been completed? And if you aren't qualified, why would you say that?

I would agree with looking into PDA.
The intense anxiety driven need for autonomy can result in aggressive reactions - verbal, physical and self harm. Typical strategies make things worse and even doing things of their own choice or pleasure result in dysregulation.
The dysregulation is cumulative not just over each day but over longer periods of time. It's really common for PDA dc or teens to have dramatic changes - not able to cope with things they've done before. Burn out is extremely common. It's an incredibly distressing profile of autism. And can coexist with ADHd and other neurodevelopmetal differences like sensory processessing difficulties, dyslexia etc.

The dysregulation means the individual is functioning from their primitive or survival brain. They experience everyday 'demands' as a threat to their very being. Constantly in fight flight freeze fawn and some add flop (shut down).

There's much more information out there about PDA. There was less so 12 years ago at the point I started looking. My dd is autistic/PDA. We have lived through much of what you describe. She still experiences high anxiety and dysregulation but by fully embracing a PDA parenting approach she has thrived! She is a young adult, living with her fiancee working part time.

I really empathise with you, whether or not it's PDA. You definitely sound like a fabulous mum.

OP on reflection I would pay for a private psychiatric diagnosis and push for antipsychotics.

ADHD is clearly not the only issue. I have a relative for whom it has made a substantial difference.

I could have written much of what you have myself OP. My middle son (15) has ADHD and GAD and we are awaiting ASD assessment from CAMHS. We have had a lengthy period of self harm, violence, mania, depression and suicide attempts. It's been the hardest period in our lives, watching our son hit the self destruct button, not just on his life but on the life of our family.

We are very much still in the thick of it, but I do think that the antidepressants that my son has been taking for the past few months have helped. It also helped me to re-frame his behavior in my head - he is essentially unwell, scared and feels out of control. We have tried to go right back to basics and parent as if he was a toddler again. Lot of small meals, enough rest, not too much stimulation and lots and lots of praise and encouragement when he gets things right - even the little things.

It's really, really hard OP and I would give you (and everyone else here who is living through this) a massive hug if I could.

As a psychiatrist, it absolutely doesn't at all!
I wouldn't make a diagnosis based on the information given but it is highly unlikely to be bipolar disorder!

Antipsychotics to treat what? It would frankly be unethical at this juncture to give the child antipsychotics. This family needs support, the son needs clarification of diagnosis and psychological input, perhaps a bit of melatonin if someone practical minded will prescribe.

The diagnosis he will get. Something in the bipolar family maybe, impulse control disorder maybe. Or something else entirely. But the symptoms and behaviour sound very familiar to me.

Antipsychotics can be lifesavers. I've seen them turn lives around. This is clearly not a case where non medical solutions alone have a chance of being successful. It's not about coping strategies, there are most likely biological factors that need addressing.

OP on reflection I would pay for a private psychiatric diagnosis and push for antipsychotics

Assessment is needed not a push for a specific medication like antipsychotics.

Lots of parents of ND dc will sadly have experienced much, if not all, that the OP is going through. Intense anxiety together with extreme emotional and sensory dysregulation have a profound impact on the individual!

It's helpful for the OP to be aware of potential underlying conditions but it's important not to get single channeled or they may end up on the wrong assessments pathway.

They do this. I call them they but I mean schools, CAMHS, whichever institution you want help from. I blame the significant resource crisis. But rest assured the gaslighting and deflection is I have no word but endemic.

Diagnosis ( of ND conditions impacting him) will help alot. It will shut down nonsensical points like this made by schools etc. It will shut down ' it's your parenting ' thoughts or hints. It will give context to why your husband might be losing it ( totally forgivable) and shouting or worse on occasion. Yes this can happen and I actually understand it.

Your son might feel slightly better knowing for sure what's going on for him. You can access ADHD meds if applicable to try.

I know you're pushing for all this. I know it won't magically cure everything but it will help give clarity to everything happening and allow you to continually come back to school with ' my son is disabled by these diagnosed conditions and can we therefore discuss adjustments based on his disabilities '. This behaviour is all part of being disabled I now see from watching my son. But it just looks like a horrible, argumentative out of control teenager on the outside.

Either you're a psychiatrist in which case you should be ashamed trying to diagnose a child over a mumsnet post, or you aren't and are talking out of your rear end. Which is it?

Yes antipsychotics are great in the right circumstances, I prescribe them frequently. However they are not a fix-all and come with significant morbidity.

If I was working in CAMHS with any resources taking a biopsychosocial approach to this child and family the plan would be:
Liaise with school around education, alternative provision, reasonable adjustments, ?educational psychology assessment
Systemic family therapy
Full developmental and psychiatric history and assessment including screening for ASD/ADHD + referral to formal diagnostic service if indicated
Consideration of melatonin/an SSRI depending on the assessment

Sticking children on antipsychotics without an extremely clear rationale (and frankly it would have to be a situation with no alternative) is just so unethical, and setting them up for a lifetime of poor physical health.

Just a person with experience who knows what being out of options feels like, and who had to do a lot of learning and reading to funnel a relative to the right care stream before they got help that really addressed the problems. Because CAHMS, SS, schools and even GPs seem to lack the basic knowledge all too often.

Why are you so keen to dismiss medical solutions?

So yes my post is speculative. It is though based on a lengthy description by the OP that does indicate challenges far beyond ADHD. I'd say anyone trying to.minimise the likely cause is irresponsible here.

OP please read up on bipolar, BPD and impulse control disorder, and see if either resonates. Write a detailed letter to the psychiatrist detailing your experiences of your DS's behaviour prior to assessment. Do include the example of him potentially tricking the school into a dyslexia diagnosis.

This will not form the basis of a diagnosis but will help them target questions to your son to form their own opinion.

For the record, I am adult psychiatrist and I see young adults under 25. I see a lot of misdiagnosed personality disorder which is actually neurodiversity. If they have screened as likely to have ASD/ADHD and I have referred for specialist assessment then they are effectively treated from that point on that they have a provisional diagnosis. I prescribe melatonin off license for these young people if indicated.