What type of therapy do we need for our ADHD/Anxiety child?

[Anonymous]

I'm at a loss. Referrals from our doctor, our psychiatrist, or the school never work out. Either the office doesn't have appointments we can make, isn't taking new clients, or is just the wrong type of place overall. The last therapist's approach was to spend half an hour having me rehash everything my kid had done wrong in the past week, while my kid played with toys, and then they would play a fun game together. He'd shut down when all his shortcomings were brought up again, and I never saw any benefit in the games. He knows all the right answers for what he should have done in any given situation, but in the heat of the moment, he can't apply coping skills. He does really well one on one, so the therapist before that just thought he was a wonderful and amusing kid. Perhaps if I had a better idea of what to ask for in therapy, I'd be able to find a practice that was a better match.

Child is a 10 year old boy with combined ADHD and anxiety, whose latest issues involve putting hands on other kids at camp and running away. When he does something wrong and realizes he needs to face the consequences, that's when things get bad -- meltdown, more aggression, bad/hurtful language, running away, crying, destroying things. Then initially deny responsibility after the fact. Lots of fun. We have some issues at home with non-compliance, but most of his problems are at school and camp. We have an IEP, he's medicated (the meds he is on may not be perfect, but they help a lot, and the psychiatrist won't up the dosages), I've read all the books, we've been in various types of therapy for 7 years. Nothing seems to work for more than a few months.

We both work, jobs don't offer a lot of flexibility, and my kid needs to be in school (cannot keep missing school for appointments, causing him to fall further behind). We are FCPS, so things in Maryland are not going to happen, and we are not rich so cannot afford $1000 a week camps or a special needs nanny.

If you have had a kid like this, is there any sort of approach that has worked for you? What should I be asking for as I call around to try to find a new therapist? For most places I've talked to in the past, who have openings, the process seems to be to talk to someone who does scheduling, then have a series of 3-4 appointments with and without the kid, after which they may advise on a path forward. But that's a lot of time to spend just to find out that their approach isn't any different than what hasn't worked in the past. I need to be better asking for the right stuff up front, but aside from saying "help us" I don't know what to ask.

[Anonymous]

You need a behavioral therapist. You can also look at Unstuck and on Target classes at the Ivymount School. The classes are designed for ASD but will also work on ADHD. Ivymount may also be able to recommend a behaviorist for you.

[Anonymous]

Taekwondo has helped my son a lot. or another type of martial arts. They learn discipline, self-control, they meditate. And they are motivated to get to the next level. It's not competitive in the sense that everyone goes at their own pace. A couple of therapists mentioned it to help my son and I couldn't believe how much it has helped. It has helped more than any therapy he has done. He leaves there feeling confident too.

I did a similar therapy as you where I talked about the latest incidences and then the therapist and my son played a game and i eventually quit this because it seemed like the biggest waste of time and money!

my son also did a social skills group that helped too. He had a very good therapist to lead the group and that can make all the difference. There were a couple kids who were painfully shy and some that were socially awkward and my son just talks too much and doesn't wait his turn and only wants to talk about his interest etc.. This therapist was amazing how she molded the strengths and weaknesses of each child to help them all. I was so impressed. parents were able to listen in.

try a new therapist. try some new things! You have to find the right fit. We recently moved so I have to start over now.

[Anonymous]

We had an extremely similar boy. Did play therapy and CBT through Weaver & Associates in McLean to help with self-esteem and self-control on top of meds for both ADHD and anxiety. It will take six months + to see a real difference though. Therapy isn't overnight. The therapists will meet with the school so the school knows of the best strategies to help when things break down.

[Anonymous]

PP 12:14, where was your social skills group/therapist?

[Anonymous]

My kid has this same profile. We live in MD so I can't recommend my therapist, but what worked for us was a lot of calling around and eventually finding someone. This is his second therapist. The first was sort of what you described. This new one does part therapy with the kid and then part that includes me or my husband. That part focuses on particular things that didn't go well during the week when we can all give our different perspectives. For some reason, this helps. My kid is older but no games are played - we do discuss thinking of things from other perspective or a bit of role playing.

Also, we have stayed with this guy almost a year - longer than anyone else and we agreed to use him even when it doesn't always work because over time it is working - not each session but over time there is improvement.

My son is older - he is allowed to email the therapist - I love that and think that helps give him an outlet that isn't me.

The main reason we picked him was he was available. And we try to focus on goals each week, but truthfully it doesn't usually happen so much.

[Anonymous]

OP here. Thank you all. It is both nice and sad to know we are not alone. Just wanted to add that we've been seeing the current therapist for over a year, and just haven't noticed any improvements as a result of the therapy. We did a 6 weeks social skills group this spring, and although it doesn't address problems related to his frustration and his behavior once he gets worked up, it was very good at helping him learn to better interact with his peers. We want him to keep doing those types of classes.

[Anonymous]

OP - Are your son's therapist and psychiatrist (medical doctor) in contact as that is key to see how medication and therapy are working? In school does he have a behavior plan in place - if not should a behavior analysis be done and a plan set up? During the summer, you may well find that there just are not the supports available in a camp situation to meet his needs. You are at an important juncture with middle school approaching, and you or DH may find that it may be necessary to use FMLA to get DS to the services or programs which might benefit him.

No child likes to hear all the negatives in his life, so any opportunity should also be taken when meeting with those seeking to help him to also point up his strengths and instances/activities where he has had positive outcomes, too.

[Anonymous]

All I can say is that we've BTDT and haven't yet found great therapy. We've tried 4 therapists. Two were pretty useless. Two we somewhat useful in that I believe that they provided a safe place and a safe person for DS to discuss things with, someone outside of the our family. But I don't think those two made much progress teaching CBT. Partly it's an age thing, I think. I'm not sure most kids are ready for that until early to mid-teens.

[Anonymous]

OTs can help with emotional regulation (they teach things like how to identify emotions and feelings, and change behavioral reactions). But I'm only familiar with this for younger kids. 10 is almost old enough for actual CBT to work, isn't it? I have done several rounds of therapy for myself for anxiety, and the only therapist who really work are the expensive ones in practices that focus exclusively on CBT. They never take insurance but you might get reimbursed. Maybe plan to put enough for 12 sessions in your FSA for next year and start then.

[Anonymous]

I'm not going to suggest a therapy or therapist. Rather, I will pass along that the most useful approach to understanding anxiety in children I've found comes from the work of Gordon Neufeld. You can find a number of his videos on YouTube, and his book HOLD ON TO YOUR KIDS is helpful, too. Basically, he talks about how anxiety upends the healthy parent-child hierarchy, as kids seek out occasions for control or melt down when they feel themselves at the mercy of adults. His work argues for a whole-family approach, where parents learn to coach their children through distressing experiences of shame or frustration, so that they can better tolerate those kinds of experiences.

[Anonymous]

12:06 here, who suggested a behavioral therapist. It helped with my kid who has a similar profile. You need to set up a behavioral plan with clear goals that your child understands, and rewards for good behavior and negative consequences for bad behavior (mostly losing a reward). If the behavior is mostly at school, the behaviorist can help set up the IEP to reinforce good behavior.

It isn't therapy in the usual sense, because most of the implementation is done by the parents and teachers. The behaviorist sets up the program and guides the work.

[Anonymous]

Anonymous wrote:You need a behavioral therapist. You can also look at Unstuck and on Target classes at the Ivymount School. The classes are designed for ASD but will also work on ADHD. Ivymount may also be able to recommend a behaviorist for you.

I second this. The parent class that they offer at the same time as the social skills class is really worth it.

[Anonymous]

Another option might be neurofeedback - works well on anxiety and some ADHD
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[Anonymous]

Hello. I can definitely sympathize with you. Behavioral issues can be so hard to deal with, and it's hard sometimes to know as parents what to do. I would encourage you to talk with your pediatrician about your son's adhd medicine. There might be one that is more effective, or maybe his medicine just needs a little adjustment. At the very least, the pediatrician can be a sounding board for you to discuss possible plans of action. Cognitive Behavioral Therapy might be another option to look into when you are looking for a new therapist. CBT and role playing can really help kids work through possible scenarios that can come up and techniques to implement good behavior during real life situations. CBT and role playing has really helped several of my sons. Lastly, if your son has a neurologist, you can also talk to them about the ADHD and anxiety issues. Neurologist can offer good insight into ADHD. Praying for you!