Resources, family therapist, school for anxious, gifted, possibly suicidal ADD boy: HELP!

[Anonymous]

My son is falling apart in 6th grade.

I mean really falling apart - his psychiatrist just asked me to put him on Zoloft, but I'm afraid to do it because of the increased risk of suicide. I'm seeking a family therapist who relates well to boys and understands issues that come along with ADD, encropesis and control issues, and high intelligence. I think a family therapist would help my son feel less like there is something "wrong" with him and the family therapy should help my husband and I with better parenting strategies.

Can you recommend a family therapist in NW DC or close in MD burbs who also takes Blue Cross Blue Shield? I've found some good names in the threads, will follow-up with them but any quick recommendations with insurance too would be really appreciated.

Since last spring, my son has progressed from saying, "I hate myself" to "I want to kill myself" to, just after Christmas, "Here's my favorite Christmas gift. I want you to have it because I'm not going to be around much longer."

Now that said, I don't think he's at immediate risk for suicide (he's a bit of a drama queen which is part of the problem) but I am watching him closely and am finally going to get a full blown neuropsych evaluation, which we had been putting off because of cost.

He's also suffering from intermittent encopresis, which of course does a number on self-esteem. He's been withdrawing from after school activities and friends and avoiding overnight events. The encopresis had cleared up last spring but has recently reoccurred. He HATED when we checked up on him re the encopresis, as it seemed to have resolved, but now that it hasn't, we're having to go back to the very basic steps we took last year -- which he also hates.

The psychiatrist said we needed to give him something to have more control over...he was sitting there when she said that. He turned that into "more control means give me a Nintendo DS, let me eat sugary foods, etc" so we said no to that ...are are really watching our language with him, trying to be more encouraging (yes, I've taken PEP classes!) and still searching for what a good example of "giving him more control" would be. Yes, I'm following-up with the psychiatrist -- this all has happened just this week.

He's in a regular MoCo school, in all advanced classes and his grades are either A or Z, basically. With a few exceptions, he either does the work, takes the test/quiz and gets an A, or he forgets to turn in projects and gets Zeros or Es. I met with the teaching team at the beginning of the school year when he first started getting Cs due to organizational issues. I explained that he was being treated for ADD but we have no official 501 or anything. The teachers and counselors were very warm and responsive and have tried to help him binder checks, organizational checks, etc. That worked and he was back up to getting straight As but since December almost all of his grades are Cs, Zs, Es, with a few As thrown in. I haven't re-contacted the school counselor as yet, instead I've been emailing with his teachers, but the counselor is probably the next step. We didn't apply to GT/LD middle school. I called MoCo and they said if he's already in 6th grade, that ship has sailed.

I feel like I'm rambling here...maybe all I need is the counselor names, but honestly, there is so much great sharing on these boards, I just thought I would put this out there...Thanks in advance for reading and for any thoughts/insights on resources that might help or just your own stories would be greatly appreciated.

[Anonymous]

What's his daily after school routine?
Weekends?
You've got your hands full. Hugs.

[Anonymous]

So sorry; didn't have time to read your whole post; I know others will.

The concern about SSRI's and suicide is somewhat misplaced I think. It's mostly a problem when the drug is given by a GP to someone who's not connected to suitable, ongoing care by the professional and by the family. The suicidal behavior happens when the patient is activated by the drug, but still in the fog of depression and not thinking clearly.

These drugs are miraculous for those whom they help. Wish I'd had them when I was younger. Sounds like he needs it.

Best of luck - it's very hard, but it almost always does get better with appropriate help.

[Anonymous]

PS from 12.53: The better mental health people don't take insurance. Sad but true. You can often negotiate around the fee, though.

[Anonymous]

Anonymous wrote:So sorry; didn't have time to read your whole post; I know others will.

The concern about SSRI's and suicide is somewhat misplaced I think. It's mostly a problem when the drug is given by a GP to someone who's not connected to suitable, ongoing care by the professional and by the family. The suicidal behavior happens when the patient is activated by the drug, but still in the fog of depression and not thinking clearly.

These drugs are miraculous for those whom they help. Wish I'd had them when I was younger. Sounds like he needs it.

Best of luck - it's very hard, but it almost always does get better with appropriate help.

Don't you think FAMILY therapy is vital?

[Anonymous]

This is OP again -

Thanks for your posts - re after school routine, he dropped out of after school activities and basically gets his limited computer time on Minecraft and then fights with his little brother. He complains about myriad illnesses and injuries to explain why he can't possibly go outside. Tummy aches are recurrent which I think are connected to the encopresis.

12:53, thanks that makes sense as I've not heard back from psychiatrist as of yet. I told my DS that he would need to take the Rx, and that depression runs in the family. He knew this but for the first time I disclosed that his grandfather, beloved uncle and mother are all on anti-depressants and there are several other family members who should be on them! It just worries me that we'd be trying Zoloft when I know he's not getting exercise and outside time and other stuff that would help, but that said he's probably so depressed that he can't even motivate himself to go outside. (Been there myself).

Finally, I found a mention in an earlier post about how you should avoid neuropsych testers who also offer services. (See: http://www.dcurbanmom.com/jforum/posts/quote/45/4095475.page ) I've also seen lots of posts complaining about expensive testers who take advantage of parents. I can certainly see the potential for conflict with someone who tests and administers services, as well as with someone who specializes in a particular disorder. For example, my psychiatrist diagnosed him with ADD without a full blown work-up (largely based on the genetic disposition as I have a very severe case and because she had been observing him as he waited with me for my appointments. She periodically would have him come in to talk with her so she could determine if/when it was time to start medicating). ....Given the encopesis though, I'm wondering now if he might have slight Aspergers or autism too because of the tie-in with gastro-intestinal issues including encopesis, which I was unware of until just this week.

So...that long paragraph aside, any recommendations for neuropsych testers who DO not offer services? Or are the docs with Stixrud above reproach?

Thanks again!

[Anonymous]

OP: go to Children's for treatment. They have a therapist there who deals with children with encopresis and other anxiety issues. They also have a wonderful psychiatrist who works with the therapist. Look into it on their gastroenterology web page and you'll see there is a psychologist who works in the same office. He is phenomenal. I wish I could talk to you in person. I know what your going through.

[Anonymous]

Thanks PP, yes, we had him see Dr. Kerzner originally for encopesis and now I recall either his pediatrician or his psychiatrist talking about how he works with a therapist. I'll call his office now...

[Anonymous]

PP here. By the way, I feel like Zoloft has changed my kid's life and my family's for the better.

[Anonymous]

IMO, you don't need a therapist as much as you need a school plan. It is clear that whatever school plan has been developed is not sufficient. IME, the anxiety and the negative self-talk cannot be resolved by psychotherapy or meds alone as they are a clear symptom of an underlying problem -- the failed educational plan. (This is not to say that you don't ALSO need a psychotherapist.)

It is unclear to me from your post -- do you have an official 504 plan or are the "binder checks" etc. being done ad hoc without a plan in place?

If there is no 504 plan, you need to get that in place at a minimum, and perhaps an IEP instead depending on what is going on.

Re: applying to the GT/LD program -- who said "that ship has sailed"? My understanding is that only the GT Middle School Magnets are by application, and it is true that if your son is in 6th grade he has already missed the application process for that. BUT, as I understand it, in the GT/LD programs in middle school admissions are done as a product of the 504/IEP process --i.e. the school-based team (in which the parent is an equal participant) makes a recommendation for placement in these programs.

Please contact Marisa Stemple, who is the MCPS GT/LD county-wide instructional specialist. It is her job to speak with you and let you know about the GT/LD programs, and even to review your case, observe your child, and participate in your 504/IEP meeting if you ask. You might also want to hook up with the GT/LD network and get on their listserv and ask more questions there. You can find Stemple's email and phone contact info on the MCPS website and the GT/LD network has a website.

If you have had no full neuropsych evaluation, you need one. Who diagnosed the ADD -- the psychiatrist? Generally speaking, a pDoc is qualified to supervise the meds, but I am very uncomfortable that yours prescribed meds without a "full work up". Did he/she do even the most basic checklist evaluation completed by parents and teachers? Only the neuropsychologist or a psychologist is qualified to do the full educational evaluation that can provide the necessary data and ID potential other diagnoses on which a proper school plan can be devised. The neuropsychologist can do other testing objective testing on executive functioning and attention which can help with an ADD diagnosis.

Many ADD kids need IEPs, which provide instructional support that an ADD child needs in the areas of executive planning and organization. "Binder checks" are often not enough. Assistance writing homework assignments down in the planner, breaking up and monitoring the accomplishment of long term projects, understanding what is really desired by the teacher in the homework, checks on turning in homework (i.e. explicitly asking child for it), extra time on exams and limited homework may be necessary as well as the ability to move or have substitute physical motion, and redirection to task in the classroom. Some of this is available on a 504 but some of it needs an IEP.

If you write a letter to your school and ask them to do the educational testing, they will be obliged to do so free of charge (given the facts as you describe them). Say that your child has ADD, you think that the current educational supports put in place are not adequate due to his increasing anxiety and plummeting grades and you believe that he might need "specialized instruction" to help him cope with his ADD in the classroom, and that you are requesting a full educational testing workup by the school psychologist to see if there are any additional issues and that you want to schedule a meeting with an IEP team. (if he doesn't qualify for an IEP, the team will have to consider the alternative of a 504 plan.) There are pros and cons to public school testing vs. going private, of course.

BTW, you sound very suspicious about neuropsychs. Almost all neuropsychs offer some services. Would you go see a doctor who both identifies your diagnosis and prescribes treatment - of course. Yes, as everywhere in life, there are some people who take advantage of a parent's desperation to prescribe expensive and unnecessary therapies, but you can be on the watch for this and read up about which therapies have the best evidential support. A neuropsych typically does extensive testing (2 days usually) and uses testing instruments which have been normed, standardized and validated. You will see objective results for most test instruments that report your child's score against a bell curve.

We have used Stixrud. Lab School is also good. The Stixrud testing and report were good, and there was no effort to sell services to us. I think what the poster in the thread meant by testers who offer services is that if you go to Huntington Tutoring to get "tested," you will only get something that reinforces their services. Neuropsychs have a professional obligations that these types of tutoring services do not. That said, asking for a sample report and references (or asking around to see who has used someone they like) is always a good idea.

[Anonymous]

OP, you and I have the same child except that mine is now in high school (still with depression and periodic suicidal thoughts). I would rethink your position on the Zoloft. It sounds like his condition is worsening - I don't like myself to I'm not going to be around much longer. I watched the spiral down for my son and it breaks my heart. Some times when I get home at night I don't know what I'm going to find. Scares the hell out of me. I walk a tightrope knowing that I am responsible for the outcome of every single medical decision I make for my son, which is fine if I get it right.

I have not found therapy to be that helpful. My son isn't a reliable reporter and he's not very open to talking, so individual therapy doesn't work. Family therapy ends up with me doing all of the talking and telling the therapist how everyone is doing and everyone just nods. If it weren't for meds, I don't know what we'd do.

Another thing if you haven't thought about it is whether ADHD meds might be needed.

As far as accommodations in MS, I think you're getting about what you'd get with a 504 even though you don't have one. If there is something more you need from school, it sounds like you might be able to get it informally.

[Anonymous]

Anonymous wrote:IMO, you don't need a therapist as much as you need a school plan. It is clear that whatever school plan has been developed is not sufficient. IME, the anxiety and the negative self-talk cannot be resolved by psychotherapy or meds alone as they are a clear symptom of an underlying problem -- the failed educational plan. (This is not to say that you don't ALSO need a psychotherapist.)

It is unclear to me from your post -- do you have an official 504 plan or are the "binder checks" etc. being done ad hoc without a plan in place?

If there is no 504 plan, you need to get that in place at a minimum, and perhaps an IEP instead depending on what is going on.

Re: applying to the GT/LD program -- who said "that ship has sailed"? My understanding is that only the GT Middle School Magnets are by application, and it is true that if your son is in 6th grade he has already missed the application process for that. BUT, as I understand it, in the GT/LD programs in middle school admissions are done as a product of the 504/IEP process --i.e. the school-based team (in which the parent is an equal participant) makes a recommendation for placement in these programs.

Please contact Marisa Stemple, who is the MCPS GT/LD county-wide instructional specialist. It is her job to speak with you and let you know about the GT/LD programs, and even to review your case, observe your child, and participate in your 504/IEP meeting if you ask. You might also want to hook up with the GT/LD network and get on their listserv and ask more questions there. You can find Stemple's email and phone contact info on the MCPS website and the GT/LD network has a website.

If you have had no full neuropsych evaluation, you need one. Who diagnosed the ADD -- the psychiatrist? Generally speaking, a pDoc is qualified to supervise the meds, but I am very uncomfortable that yours prescribed meds without a "full work up". Did he/she do even the most basic checklist evaluation completed by parents and teachers? Only the neuropsychologist or a psychologist is qualified to do the full educational evaluation that can provide the necessary data and ID potential other diagnoses on which a proper school plan can be devised. The neuropsychologist can do other testing objective testing on executive functioning and attention which can help with an ADD diagnosis.

Many ADD kids need IEPs, which provide instructional support that an ADD child needs in the areas of executive planning and organization. "Binder checks" are often not enough. Assistance writing homework assignments down in the planner, breaking up and monitoring the accomplishment of long term projects, understanding what is really desired by the teacher in the homework, checks on turning in homework (i.e. explicitly asking child for it), extra time on exams and limited homework may be necessary as well as the ability to move or have substitute physical motion, and redirection to task in the classroom. Some of this is available on a 504 but some of it needs an IEP.

If you write a letter to your school and ask them to do the educational testing, they will be obliged to do so free of charge (given the facts as you describe them). Say that your child has ADD, you think that the current educational supports put in place are not adequate due to his increasing anxiety and plummeting grades and you believe that he might need "specialized instruction" to help him cope with his ADD in the classroom, and that you are requesting a full educational testing workup by the school psychologist to see if there are any additional issues and that you want to schedule a meeting with an IEP team. (if he doesn't qualify for an IEP, the team will have to consider the alternative of a 504 plan.) There are pros and cons to public school testing vs. going private, of course.

BTW, you sound very suspicious about neuropsychs. Almost all neuropsychs offer some services. Would you go see a doctor who both identifies your diagnosis and prescribes treatment - of course. Yes, as everywhere in life, there are some people who take advantage of a parent's desperation to prescribe expensive and unnecessary therapies, but you can be on the watch for this and read up about which therapies have the best evidential support. A neuropsych typically does extensive testing (2 days usually) and uses testing instruments which have been normed, standardized and validated. You will see objective results for most test instruments that report your child's score against a bell curve.

We have used Stixrud. Lab School is also good. The Stixrud testing and report were good, and there was no effort to sell services to us. I think what the poster in the thread meant by testers who offer services is that if you go to Huntington Tutoring to get "tested," you will only get something that reinforces their services. Neuropsychs have a professional obligations that these types of tutoring services do not. That said, asking for a sample report and references (or asking around to see who has used someone they like) is always a good idea.

Dear PP: This is OP, thank you for taking the time to write this very thoughtful message. I have replied to your questions below.

1. We do not have a 504 or IEP in place. My son was able to "keep it together" up until this point.

2. Re MoCo GT/LD - I called the number listed as the contact number and whomever answered or was listed as the contact person told me this (It was not Ms. Stemple, but I don't think it was a receptionist either, I think it was a professonal in the program).

3. Yes, the psychiatrist diagnosed this without a full work-up and this was mainly due to my extreme concern about finances, I believe. Also the psychiatrist (appears to be) very competent - has taught at Georgetown, etc. - and has been in practice a long time and knows me and my family issues well.

4. I did not know that all of the services that you listed are available as supports, thank you, I can see where these would be helpful.

5. Re the neuropsych testing - wouldn't it be too much for my son to do both neuropsych and school testing? He is worried that something is "wrong" with him, he's afraid I'm going to send him "to a special school" (though I've not talked about it). From the threads, I've definitely gotten the perception that private neuropsych work-ups give you more and better detailed information that is helpful in parenting and treating the child. His increasingly dark, suicidal rants are prompting me to do whatever I can at this point to get to the root of the issues. That said, when I approached the school counselor in the fall, she said she'd work to start him on a path to get the testing for an IEP...but after the minimal supports put in place (binder checks, etc) his grades picked up to straight As again. To complicate matters, he had a lot of absences in the fall (which I'm belatedly realizing were probably psychosomatic or psychogenic) and the teachers at the group meeting blamed his absences on his poor grades. When I brought up the ADD, at least one teacher murmured "They all have ADD." [meaning all the kids -- or parents -- complain of ADD]. I really did not want to "label" my kid and hoped he could make it through as I did, but now I see he needs some more supports. Long winded way of asking, should I put off the private neuropsych testing and get school-based testing with the school counselor's help because then at least the school issues may resolve? If I do school-based and it's not sufficient, can I do private too? My son is going to HATE all of this, so I really don't want to put him through anymore of this than absolutely necessary. He also HATES when the school counselor comes to talk to him, HATEs when the teachers ask him about organization and complains to me that he just wants to be "left alone." And he screams at me saying I'm too "overprotective."

6. Re "suspicious" re neuropsych -- my question about separating services from testing was based purely on what I've read on these boards, including the string I copied. I think right now I'd describe myself as "clueless" or "still learning." I don't know enough to be suspicious, I'm just doing my research! That said, you're right, if the earlier poster was describing something like Huntington, that would make sense.

Since I wrote this, I've also called and left a message for Kerzner and the school counselor.

Thanks again!

[Anonymous]

Anonymous wrote:OP, you and I have the same child except that mine is now in high school (still with depression and periodic suicidal thoughts). I would rethink your position on the Zoloft. It sounds like his condition is worsening - I don't like myself to I'm not going to be around much longer. I watched the spiral down for my son and it breaks my heart. Some times when I get home at night I don't know what I'm going to find. Scares the hell out of me. I walk a tightrope knowing that I am responsible for the outcome of every single medical decision I make for my son, which is fine if I get it right.

I have not found therapy to be that helpful. My son isn't a reliable reporter and he's not very open to talking, so individual therapy doesn't work. Family therapy ends up with me doing all of the talking and telling the therapist how everyone is doing and everyone just nods. If it weren't for meds, I don't know what we'd do.

Another thing if you haven't thought about it is whether ADHD meds might be needed.

As far as accommodations in MS, I think you're getting about what you'd get with a 504 even though you don't have one. If there is something more you need from school, it sounds like you might be able to get it informally.

This is OP, thank you for your reply and I'm sorry about the troubles with your son. I know it's hard to share; I appreciate you doing so.

I know what you mean - I am very nervous about this afternoon with my son as I called his teacher today and I suspect he's going to have a fit. I called because I emailed her twice and she didn't respond. I had emailed about a Z assignment that is tied into a longer term assignment. He had told me he was "hosed" because "the teacher lost" the first assignment that tied into the 2nd. Without the 2nd, he can't do the 1st. I told him he should do the 1st over again so he can do the 2nd. Instead, he's been avoiding it...not telling me - and I didn't see on Edline- that the 2nd big assignment was due TODAY. It culminates in a presentation to parents that my son is desparately trying to avoid participating in, so as my husband said this morning, he's probably going to come up with a new ailment as an excuse for why he can't participate in the event with the parents.

Why do you say that I'm getting about what I'd get with a 504? From what 13:37 posted, it sounds like there are many other school-based supports I could seek for him, including, as she posted, "Assistance writing homework assignments down in the planner, breaking up and monitoring the accomplishment of long term projects, understanding what is really desired by the teacher in the homework, checks on turning in homework (i.e. explicitly asking child for it), extra time on exams and limited homework may be necessary as well as the ability to move or have substitute physical motion, and redirection to task in the classroom. "

Yes, he is on ADD meds. He takes Adderall ER in the a.m. on school days. He's also prescribed Ritalin in the afternoon for when he needs it, but he refuses to take it.

[Anonymous]

OP again - great, just got a response from DS's teacher after waiting since Monday for a response.

In closing, she said, "[your DS] is a very intelligent and lovely youngster, but he needs to accept responsibility for his work and stay on top of due dates and deadline dates."

Yes, that's true, AND he's going to need reminders in order to do it until (hopefully) he can assimilate this and improve his executive functioning. (I didn't respond that way but I did call the counselor).

[Anonymous]

I'm very sorry for your struggles. I know how difficult all this is as we struggle with it. I know you have put off treatment/evaluations because of financial reasons. Have you thought about enrolling in an NIH study? We participate in several and have gotten fabulous evaluations for ADHD and depression. You might consider it. Here's a link you can go to enter some parameters http://clinicaltrials.gov/ct2/search/advanced

Here's a few

http://clinicaltrials.gov/ct2/show/NCT00018057?term=depression&recr=Open&state1=NA%3AUS%3AMD&age=0&rank=5

http://clinicaltrials.gov/ct2/show/NCT00104039?term=adhd&recr=Open&state1=NA%3AUS%3AMD&age=0&rank=6

http://clinicaltrials.gov/ct2/show/NCT01552915?term=adhd&recr=Open&state1=NA%3AUS%3AMD&age=0&rank=1