Camhs referral advice - violent rages 8year old

[lifetheuniverseandeverything42]

Hi, I went to the drs this week to discuss getting a camhs referral for my 8yr old daughter. She has extreme anger and rages. Most days she has some form of outburst and often violent rages (not daily but probably weekly). To the extent that I ended up with a fractured arm.

Whilst I feel fairly calm at the moment I am extremely worried about the impact it is having on the whole family and we know we need some outside help. Just wondering if anyone can tell me more about the referral process and how long it took to be seen. Just to try and understand the process so I can have some conversations with her in advance. Thanks

What support has she been receiving at school?

Has the GP confirmed that CAMHS would accept this referral? They wouldn't in our area.
Does she have any diagnosis of ASD, ADHD, or a learning disability? Or any other medical diagnosis?

With us it's been a very long road

DD was 8 and really struggling at school, hurting herself, threatening suicide, extreme meltdowns. All at home and school. Constantly attacking DS

CAHMs rejected her twice and said she wasnt suitable for their service. It's only after shes had several counselling courses with different people where we're finally getting somewhere. I went through the GP for a referal and through school.

I've recently received an appointment for a parent meeting with them, they dont want me to bring DD so I'll see what happens from there on out

Hopefully it will be an easier process for you,

Thanks everyone, this is helping me feel less alone. We haven't really talked about it much so far.

I honestly don't know whether she is bad enough to have the referral accepted by camhs, though clearly she can be a danger as she managed to fracture my elbow in one of her rages. We have only just started the process so it may be that she is not accepted but hopefully they can at least point us in the direction of where to get help even if we have to pay for it.

We have told school about the problems we are having and she is going to have some 1-1 interventions at school but they were absolutely shocked when we told them what is happening as she shows no signs of this behaviour at school. She is not struggling at school, she has friends, no mention of bullying but she is still a nightmare to get to school each day but we do get her in and once we've left the house she walks to school happily. She has never been late but it is getting worse.

We have no diagnosis of autism, ADHD etc but maybe she's been masking at school and things are coming to a head at home. I think she is lacking in empathy and is very stubborn and self-centred (also lovely and funny and quick witted).

We have been trying to use the guidance in 'the explosive child' and we will continue to work on our patience and try and grow a thicker skin. Feel more positive that we are at least starting the process.

Hate to ask this but could she be receiving any abuse or bullying? These are classic signs… Does she spend weekends at her dads/grandparents or anything like that? 😬

I don't really rate "the explosive child" because it highly relies on a child having insight which most younger or neurodiverse children won't, and it pushes you to allow your child to avoid almost everything they are anxious about, so they just get more anxious.
Do you think she might have ADHD, ASD or similar? How is she eating, sleeping?

I will remain onto the look out for signs of bullying or abuse. I had a chat with her last night about it and she just laughed and smiled at me and told me no and that she would tell me. It seemed a very genuine reaction so I really don't think either are happening. There is very little opportunity outside of school as basically I'm around all the time bar a few hours here and there with elderly grans. School have no worries about bullying but now they know about problems, they will keep closer eye.

I don't think she has ADHD or ASD, if she does she has been masking very well and definitely does not have classic signs.

I am more than open to things other than the explosive child. I think it is better than what we had been doing up to that point but I do have concerns as it feels like she gets away with everyday the moment with little consequence. She is quite bright so when we relax rules a bit in the expectation to gradually improve things in the future she uses it as free rein to try and drive standards down further. We try to discuss things with her and agree as much as possible with her input as I'm sure there is a large element of wanting more control. She is very young in the school year and very small for her age that may add to her frustrations.

I do wonder if there is something hormonal going on. We've only recently started to journal her behaviour so maybe that will give us further insight if there is a pattern. Some weeks are definitely worse than others.

Thanks again. It is really helpful to talk about and get help and feedback from others. We hadn't really been talking about it much with friends and family as I feel protective towards her and don't want people thinking badly of her.

My now 12 yrs old has been emotionally unstable forever and between 5 - 10 was at his most deregulated with self harm, smashing rooms etc and an emotional time bomb. We went to CAMHS via the school but maybe we were lucky as we live in Central London. My experience is that CAMHS helped him to have an emotional vocabulary so he could say more how he was feeling and also getting older has helped. He’s also being assessed for ADD but the GP was pointless . Good luck. It’s hard.

You are describing my now 13yr daughter between 3-10yrs. Meltdowns at home but perfect at school (academically fine, teacher pet, lots of friends), got a bit better during covid (when no school).

Age 11 school came to us and said actually her academic progress has dropped off a cliff and we think you should get her assessed for dyslexia. So we did (privately) and yes she definitely has that, lots of accommodations put in place, academic progress rocketed but started to have problems with friendships (aged 12ish) and still having behavioural problems at home.

Then new SENCO came to us and said I think she's autistic. We said rubbish, but as at end of tether with behaviour paid for private autism assessment. Result, she is definitely autistic.

If you can, go private. Cost us something in region of 3k for both diagnosis, worth every penny. We did go to GP last summer re:Autism and have not yet heard back.

That's for this. Really helpful. Dyslexia runs in the family so it wouldn't be a shock but school have not had concerns about this so far. She seems very bright and is meeting expectations at school but thinking about it she is performing much better at maths than English which was always the case with me. We are having closer dialogue with school because of the home issues so I might ask them their thoughts on it. I think because she is performing satisfactorily they might not have picked up on the disparity between subjects and it might be worth further consideration.

In terms of autism, do you think if your daughter had been assessed earlier that it would have helped? Or would it have been too early and not shown up on the assessment?

I really appreciate the input and your experience. Thank you.

We didn't have any inkling DD had dyslexia either, she does not have the 'classic' presentation (letters backwards etc) and hit all reading milestones. School had no issues until she tanked her Yr6 summer exams. According to the educational psychologist's report she struggles with working memory and processing speed a lot, which is also part of dyslexia.

"In terms of autism, do you think if your daughter had been assessed earlier that it would have helped? Or would it have been too early and not shown up on the assessment?"

I think it would have helped me as I just thought I was a really really shit parent and of course if I knew what I was dealing with, i.e ND, then I might have approached some parts of parenting differently.

The lady who did DDs ADOS assessment admitted when DD walked in she immediately thought this girl does not have autism. DD masks very very well when she has to (which leads to complete exhaustion and overwhelm at home = meltdown). It was only when going through the assessment that it became very apparent and the result wasn't even borderline.

This is all very new, the autism result was literally two weeks ago and we are still all processing it.

I'm afraid I was turned down by CAMHS again when dd was that age and just told to do parenting classes.
She's currently 15 and on a 2-3yr wait for another ASD assessment and our MP is chasing up CAMHS for us.
Brace yourself for very little help, even if you know what you're doing. It's really hard going .

I'm just reading your post - you mention you don't think she has asd / adhd but many of the experiences you mention have to come from somewhere and are often signs of these to be so disregulated. I would recommend reading more up on both of these. The control item could be a PDA profile of autism or anxiety off back of autism or adhd and needing to feel in control because of it.
To be so disregulated after school she sounds like she's holding it together all day at school.

CAMHS in our area is a nightmare to be referred to, my son was having regular meltdowns and anger issues both at home and school, Luckily school did anger management sessions it hasn't completely stopped his behaviour but certainly helped. Maybe talk to school see what they offer

@Libra19752 dyslexia does not present as letter reversals. Just as many typical readers write these. I'm guessing whoever told you that doesn't know much about dyslexia.

Hi @drspouse I am not medical and my understanding of dyslexia was based on what I knew from the 80s as a child myself, hence the letters backwards and problems reading.

I was trying to show the OP that, as non-medical people, we may think that our child does not have something because we have certain ideas of what conditions look like, and those ideas maybe wrong. In our situation I certainly didn't think my daughter had dyslexia (which is actually not a very useful umbrella term) or autism and yet she does. My daughters school had no concerns at all about her until Yr6 which was is 9/10 years old which is older than the OPs daughter.

Honestly if you can afford to get help privately anyway then do. CAMHS won't know any more than you about that.

Get her seen privately and/or get some private counselling or intervention for the meltdowns. Stay on CAMHS wait list and access any classes or therapies.

See if there are local neurodiverse groups. join. Some of them run their own classes and are really helpful

(My son is 17 now but had ADHD diagnosis at 8)

Thanks for this. Reading up on PDA now and it does feel like it rings true with her behaviour. Rewards/consequences have never worked. Even looking back to when she was very young
It didn't work. The fight/flight/fright response also feels true. I will read up more and discuss with her teachers next week.

@lifetheuniverseandeverything42 good luck with your journey.
Adhd has fight flight fright response too - it's basically when you're disregulated you can't access the controlled part of the brain.
There was an interesting article in the guardian this week too about AuDHD and how much crossover there is between the two.

Rewards work well in ADHD but not always the typical ones (forget sticker charts) as future thinking is very limited.
DS will do non preferred tasks if he then gets screen time but it has to be in the same segment of the day. He has a mixed response to praise but that's partly because he's not been used to getting it
I feel the answer to demand avoidance is not to remove demands but to get the child used to it
I also feel that some of the avoidance of bodily demands is perseverance (it's really hard to stop what you are doing and switch to something else even if the something else is a bodily need).

CAMHS in our area specifically excludes ‘anger management’, so hopefully the referral is worded skilfully enough to go through at least for an initial assessment.

Naomi fisher is someone good to follow if you want to read up more on low demand parenting for pda profiles.

Also, bare in mind I believe they say a neurotypical child's brain isn't fully developed until they're 24 and and adhd child develops later, in terms for tantrums / angry outbursts. Doesnt mean they'll be this challenging forever just they mature later. Also generally at the age of 7/8 there is a vast difference between kids maturity levels plus hormone start to add into the equation.

We had this at the same age. It was super extreme though only at home. Thing’s eventually calmed down - lockdown was mostly easy with a few moments over too-hard work. Since then she’s had some significant day-long ‘moods’ where nothing is right and we had a tricky 6 weeks last winter but on the whole things are much easier. I am sure some of it is hormones and some of it is stuff that bothers her (without the emotional regulation to cope). She’s on a CAMHMS list but I dread to think how long it will take to be seen. DS has ADHD and had a 3 year wait for the NHS. He had typical presentation though so we paid for a private diagnosis. Not sure about DD - it might well be ADHD (Lots of other indicators) but I’d like a comprehensive review. Both DS and DD have dyslexia.

I have never been able to get her to behave/ do things using rewards or consequences. But I do tell her ALL THE TIME when I see her doing something good. I just hope that some of that goes in.

Sending hugs though it is super hard but you’re not alone.

My DD used to have very extreme violent rages - and was eventually diagnosed with PANS/PANDAS, which looks a lot like PDA.

It was very perplexing. And CAMHS rejected our referral which was utterly ridiculous. Going private can help if you get nowhere with CAMHS.

Rewards and discipline will do nothing with a child like this.

We self-referred to CAMHS when DD1 was at a similar age and similarly explosive - they got back to us very quickly, but it was more luck as we happened to be at a school in a pilot for their earlier low-key intervention project... which was of limited use as the therapist couldn't get round DD's avoidance tactics to get to the bottom of how she was feeling.

Recently school tried to re-refer and as she's now on the waiting list for an ASD assessment - CAMHS bounced the referral.

I find with DD - humour helps to defuse her, and presenting a "problem" for her to help me solve can work as well ("ok, this needs doing - what do you think we should tackle first" as a way of wording things).... plus letting her go off and tell the guinea pigs how terrible her life is for 5 minutes while the storm blows over, but around age 9 was awful for us (was during the lockdowns as well which made it worse).