Tuesday, January 17, 2012

Trusting My Gut Instinct!

Well I did it.

I trusted my gut instinct and cancelled my Thursday appointment with the therapist that I wasn’t happy with. I called him today and asked if he had reviewed my son’s case yet and he said he was only half way through. About five minutes later he called me back ready for questions.

I asked him, “So what do you think is going on with my son?”

He said, “Well it looks like he’s dealing with some OCD, impulse issues and oppositional defiant disorder (ODD), possible ADHD and maybe bipolar disorder.”

I then explained that yes he does have a problem with impulses and being defiant, but this is not all the time, only when his moods are off. When he is stable he has self control and obeys us and wants to do well. As for the OCD, I don’t now how he determined that being that he has no OCD tendencies.

Then I asked him, what about him seeing monsters? (Information I provided in the documents he read.)

He said, “For some kids this occurs because they are scared of monsters or of the dark and think they see things. It’s pretty common.”

Then he mentioned that the voices were not typical and that they weren’t coming on gradually so he didn’t think it was schizophrenia. I told him that I agreed and explained that the monsters were not a result of him being scared of the dark.

I then went on to explain the episode that lasted over an hour where he started feeling deep despair followed by seeing monsters. He then experienced quick changing moods of laughter, to crying, to thinking his parents were dead and to him seeing a white bunny with a pink scarf under the bed with his bloody ears cut off, holding a knife and growling at him. After that, my son vomits (from all the adrenaline ) then takes a bath. Once done, he goes down to have dinner and acts as if nothing happened, almost no memory of the episode.

To further demonstrate that these were clear episodes, I then explained a similar thing happening when he left Legoland. While driving home, he sat up with eyes of terror and thought I was a monster in the car trying to kill him, this lasted for about 30 minutes, also occurring after a drastic mood shift into depression.

The therapist responded with, “Is it possible that he just wanted to stay at Legoland and was sad?”

I explained, “No, he was happy to leave, in fact he had a brand new lego in his hand that he couldn’t wait to open once he got back to the house.”

From there I knew he wasn’t getting it. All good questions, but after the materials I provided him, I didn’t think these type of questions would follow.

He then said, “well it’s possible these episodes are mania and in that case I’m leaning towards bipolar. If that’s the case, there’s no way to end the illness, so we can only address his oppositional behavior and impulses. He would need to learn that they aren’t acceptable.”

The fact that he was separating the symptoms had me concerned. Just addressing his oppositional behavior will only lead to him feeling like a bad kid. We need all of his wellness addressed. He needs to learn how to cope with his struggles. Not be punished every time he fails.

So after getting off the phone, I prayed about it, I talked with my husband and I imagined what it would be like if I called him during one of my son’s rages and my gut instinct told me that he wouldn’t be able to help us.

So I cancelled our future appointment.

In the meantime, I have calls out all over town, even our old therapist helped out by giving me names of doctors outside of his HMO that may know where to refer me. It may be a long process, but I’m willing to do the hard work. I’m also approaching this from a different angle, I’m treating this like a job interview, asking them the tough questions, making them explain their experience and theories of practice. I’m making them earn this very important job of helping my son!


18 comments:

  1. I think you made the right choice. But please do not discount the information you gained from this person. 1: He acknowledged your son seems to veer to the bipolar spectrum 2: He may have ODD and that will need to be figured into any treatment plan your son gets involved with 3: He may have ADHD/ADD. It took me longer to be diagnosed with ADD than Bipolar and once both were treated I had a much better outlook on life. The impulse issues are a key problem with me and my Bipolar problems. I wish you all the best and hope you find the right therapist. That is pivotal and I love how proactive you are being. Just remember to keep an open mind, good notes, and trust your gut but also ask what your son thinks about the analyst he just saw. After all it is he who will have to deal with these doctors' diagnosis for a lifetime. xoxo

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    1. I totally understand what you are saying, but I’m afraid that his input was based on an incomplete analysis, which makes it harder for me to trust.

      For example, I forgot to add to my post that he thought my son has OCD. This is absolutely not the case. He doesn't have any OCD tendencies.

      As for the ODD (opposition defiant disorder), because this is only present when his moods are off, not all the time, it is from the mood disorder, but sure, you can add the label to describe his symptoms, but the Mayo clinic describes ODD as being persistent. This doesn't fit my son’s pattern of behavior. Though I bet the same therapy can be helpful so I imagine we’ll look at this.

      He also didn't mention anything about anxiety or depression, which clearly has been part of his illness for at least 4 years.

      As for the ADHD/ADD, my son went through testing for this several years ago and had feedback from teachers, parents and his therapist and it was determined that he didn't have ADHD or ADD. Though I know it can be common with mood disorders.

      You mention the impulses so I thought I would look that up today. When I read about ADHD/ADD, impulses were described as blurting out answers, having difficulty waiting his turn, or interrupting or intruding others. This isn’t the kind if impulses I see, instead my son has impulses of acting out violently or running away because his moods are off, I think this is related to him trying to take control of his outside world when he feels out of control on the inside.

      Also, my son has strong organization skills, is never forgetful, can sit patiently in class, can focus for long periods of time, never fidgets, can easily play quietly, is detail oriented, never loses stuff, in fact he is the one to ask if you lose something, is not easily distracted and is never asked to clean his room because he loves to clean his room and keeps his stuff organized, I even pay him to organize other parts of our home ; ) . So because of this, I don't think he really has ADD or ADHD.

      What about you, I was curious, do your impulses match the typical ADD/ADHD impulses?

      I learn something new everyday thanks to people like you! : )

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    2. I forgot to mention, I completely agree with you on asking my son what he thought. When I asked him about it yesterday, he responded, “Yeah, cancel the appointment, I didn’t like that guy.”

      You make a good point about involving him in the process, it’s a good way for him to learn how to do this on his own someday. I’ll keep this in mind!

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    3. I wanted to clarify the impulses statement I made. My impulses are more Bipolar related which I bet is how your sons impulses are as well. The impulse one gets when they are hyperfocused and manic...like washing hands or researching a new topic that I get excited about. During election time I hyperfocus on the news to the point where I miss sleep and am late to work. It gets where someone may think I am OCD but really I am just manic. SO I do completely understand how doctors can throw some pretty silly diagnosis out there.

      At the same time I do have trouble sitting still for long periods of time. I do have impulses to blurt out my thoughts before I forget them. And in school I was notorious for answering teachers before they were even finished asking a question. (It gets kind of embarrassing lol) But your son seems to not have that at all. Besides, that man only had one 45 minute session with your son so how much can he really know? Geesh...I am writing a lot and this is your blog. You just bring up a lot of good points that get my mind going.

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    4. LOL! I love when you post here, please keep them coming, you always bring good discussion and things to consider. I also agree that 1 visit is too short to get through the whole list of stuff. That is one thing that concerned me, he kept talking about unrelated things when I had so much I needed to get through. I imagine that it can take months before a therapist really gets someone. If someone is asking us lots of questions and shows us that they are searching to discover, then it is worth going those months to get us all in sync. If they don't ask many questions and are ready to implement therapeutic steps in the next visit, it leaves me leery.

      As for the impulses you describe that is more when you are manic or hyper focused, that is what I see in my son, he goes through episodes of being very project oriented, all he can think about is the project he is building. We also see him talking to us a TON more during these episodes, I always wondered if it was hypomania. He seems to be very happy and productive during these times.

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  2. Mama Bear- I think you should listen to your instincts. You know your son the best and if you think this therapist doesn't have a clue now-don't wait. I made that mistake and it was not helpful to my daughter. It almost made her go backwards until we found someone who did "get it". Keep up the good work and don't stop until you find the right therapist for your son.

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    1. I agree with you, I think we waited to long with our first therapist, it brought on a lot of insecurity in myself, I felt blamed for my son’s behavior, if I had left sooner, I could have avoided that mess.

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  3. Good for you!!! You'll never regret not wasting one more minute with him. I'm praying you find a new therapist soon.
    Cathy

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    1. Thank you Cathy for all your prayers, they mean a lot to me!

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  4. Sounds like it's for the best. As for input on the diagnosis, for our family the psychiatrist is the one that makes the diagnosis and the therapist is the one that helps ease the daily ups and downs of life. Unless the therapist is a really experienced clinical PhD, they won't know near enough to make an accurate diagnosis.

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  5. Based on what you described, it sounds like you did the right thing! I completely understand your point about the ODD being related to your son's mood disorder, not a separate condition. Bug, too, can become very defiant when her moods are off. But when she's in a good place, that kind of behavior isn't usually an issue.

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  6. Thanks for sharing, I was wondering if Bug had the same experience. That's what makes this so hard on our kids, they really do want to be good and behave, if they can do better they do, it's all related to those changing moods.

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  7. My son too has "intermittent ODD." Sometimes he can comply with directions and sometimes (when he's down, frustrated, angry...) he can't.

    I wanted to point out one thing about the dichotomy between the way the emotional world works vs the business world. Yes it takes months for a therapist to know someone well enough to be therapeutic and have an accurate diagnosis, and yet in the insurance culture we live in, they have to provide some sort of diagnosis for the paperwork from that first visit. Just something to think about as you are interviewing them for the job. Is this person willing to put the psychiatrist's diagnosis on the paperwork-or are they wanting to reinvent the diagnosis (and fill in their own pet ones.) Therapists are people too, and subject to the same sort of brain tricks the rest of us are. Someone who is very interested in ADHD and OCD will see ADHD and OCD more often than someone who is interested in Autism spectrum, because their brains are primed to seek out those attributes.

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  8. to be honest with you i would love to have your son around my house ,as you describe him here i think he is just a little boy who is not coping well with his emotions ,my son is much worst than what you describe in your blog,i would suggest to try ABA therapy ,or behaviour modification ,and be patience with him it will take a long time for him to learn how to control his impulses ,rages ,emotions ,anxiety,sadness and happiness,but he will in the end .

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  9. Hi Mammabear,

    I do think you made a good decision for you and your son. I had the same problem with the ODD label. My son is typically ODD when he is spiraling into one of his bad moods. Also, I wouldn't be surprised if your son has a setback from this experience and the changes in doctors. He wants to trust that they (especially this therapist)will help him, and this transition time between therapists might confused or upset him because he isn't getting the help he wants/needs/craves. Just a thought, since you mentioned in a later post that he has been more angry lately.

    Michelle

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    1. You bring up an excellent point Michelle. I was wondering if our psychiatrist appointment, where a lot of his past was discussed, brought up some stress and bad feelings, leading to the rage the following day. When I have our next appointment with our new therapist, I will go alone to give the big download so he doesn't have to listen to all the negative stuff again.

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