Anonymous wrote:I know you don’t want to hear this, but I think you need to try meds again. She will likely react differently to them now than she did when she was younger. Her reaction is an anxiety-based reaction, and she needs an anxiety med. I’d start with Zoloft or Prozac. If those are too sedating, then Pristiq. Also read The Explosive Child.

or mood stabilizers. And you can keep the dose low if side effects occur.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re texting her back intermittently then you are NOT ignoring her. Did you do an FA? If not, why the F not?

What is that?

A functional analysis. If your provider tells you to ignore the behavior without first determining the function of the behavior then I’d fire them immediately and find someone that knows what they’re doing.

Oh ok. If that is some kind of formal assessment or process, then we have not had it. We have talked extensively about the function of the behavior, and the parent coach and DBT individual work together and consult. I’m fairly certain they know what they’re doing.

I think what the PP doesn’t get is that other evidence based modalities do not center on finding a “function” for the behavior. DBT and SPACE see the behavior as an outgrowth of emotional dysregulation and avoiding anxious sensations, respectively. The ABA notion of determine a “function” is really more for kids more severely on the spectrum where it may be harder to determine what is going on - eg they want attention, they are in pain, they don’t like transitions. Or for a very young child maybe a learning disability that is causing behavioral issues because they don’t understand the school assignment.

For a normal IQ teen acting like this, you don’t need to look far to understand the function. She has strong emotions and reacts to them accordingly.

This is OP and I have to disagree with you about DBT, at least the DBT we have. It is not focused on emotional dysregulation or avoiding anxious feelings, but primarily on what behavior we are inadvertently reinforcing. My parent coach feels strongly that this is a learned behavior and how DD has gotten her needs met and gotten relief in the past. And individually DD needs to work on healthier ways to get her needs met. She’s also always reacted disproportionately to any inkling that her feeling that she’s somehow defective is valid. Her meltdowns are always triggered by an insult, perceived slight, or ignoring by a valued peer, her sister, or me. Or, her phone getting cut off. But that’s a whole other story and we nipped that in the bud a while ago thank goodness.

Anonymous wrote:I know you don’t want to hear this, but I think you need to try meds again. She will likely react differently to them now than she did when she was younger. Her reaction is an anxiety-based reaction, and she needs an anxiety med. I’d start with Zoloft or Prozac. If those are too sedating, then Pristiq. Also read The Explosive Child.

I agree she needs to look at meds again too. Zoloft made my anxiety/ADHD child so much more agitated and anxious. It was not a good med. Lexapro seems to be the best SSRI for anxiety but unfortunately for many teen girls, it increases appetite and sugar cravings and there is almost always weight gain, more than most SSRI's.

But OP already said most SSRI did not work. She didn't mention Clonidine but I would really consider that to start because there besides initial drowsiness (that improves after a week) there really isn't many side effects. And it's a good med to try to counter the heart racing/agitated affects of stimulants if down the road, you would try that again. But even on its own, Clonidine can be helpful for emotional dysregulation.

How Clonidine Impacts Emotional Regulation:

Reduces Arousal:
Clonidine acts on the locus coeruleus, a brain region involved in arousal and stress response, helping to dampen down overreactions and reduce impulsivity.

Improves Impulse Control:
By affecting the prefrontal cortex, clonidine can enhance attention and impulse control, which are often affected in ADHD.

May Improve Sleep:
Clonidine can improve sleep initiation, which can indirectly help with emotional regulation, as sleep deprivation can exacerbate emotional dysregulation.

Clonidine in ADHD:

ADHD Symptom Management:
Clonidine, especially in extended-release forms, can help reduce symptoms of hyperactivity, impulsivity, and inattention in children with ADHD.

Adjunct to Stimulants:
Clonidine can be used alongside stimulant medications to further address ADHD symptoms, including aggression and sleep problems.

Benefits for Some:
Clonidine may be a good option for individuals with ADHD who experience side effects from stimulant medications or who don't respond well to them.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

She doesn’t do it in public because she knows that she can’t get away with it. What measures can you take so she also restrains the behavior at home? I would tell her that if she’s violent, you will call the cops. Let her test her theories in real time.

Do not do this. My teen is similar and it escalated even more and cops were called and she was handcuffed and taken into the hospital. She calmed they didn’t admit her. This has happened three times over the coarse of a year. This isn’t a typical temper tantrum but it isn’t enough for impatient either. In those moments there is no control and hardly any memory. In those moments, the key is safety, not threats. Obviously if there is self harm or harming others, you call the police. But no threats.

Working to diminish them from starting is the ideal situation. DBT therapy, EMDR therapy, a social group for autistic teen girls are the best suggestions. And she sounds like she needs a non stimulant ADHD med, anti psychotic, or a mood stabilizer. If she doesn’t get at least 60min of exercise a day, start that too

I can accept that I’m wrong, but I would absolutely move towards her leaving the home if violent.

OP this is a very helpful article for kids her age:

https://pmc.ncbi.nlm.nih.gov/articles/PMC5575919/

I know you don’t want to hear this, but I think you need to try meds again. She will likely react differently to them now than she did when she was younger. Her reaction is an anxiety-based reaction, and she needs an anxiety med. I’d start with Zoloft or Prozac. If those are too sedating, then Pristiq. Also read The Explosive Child.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

You need to work more with your DBT therapist on validation skills. What she is saying is clearly wrong and not acceptable. You don’t have to validate or even listen to it. You do need to set out clear rules (no violence) and enforce them.

+1 DBT therapists will tell you to validate emotions, not bad behavior. Discussion about the inadequacies of the police, etc. is nothing but deflection on her part. She doesn't need to work on the police, she needs to work on her own emotional skills.

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

You need to work more with your DBT therapist on validation skills. What she is saying is clearly wrong and not acceptable. You don’t have to validate or even listen to it. You do need to set out clear rules (no violence) and enforce them.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re texting her back intermittently then you are NOT ignoring her. Did you do an FA? If not, why the F not?

What is that?

A functional analysis. If your provider tells you to ignore the behavior without first determining the function of the behavior then I’d fire them immediately and find someone that knows what they’re doing.

Oh ok. If that is some kind of formal assessment or process, then we have not had it. We have talked extensively about the function of the behavior, and the parent coach and DBT individual work together and consult. I’m fairly certain they know what they’re doing.

I think what the PP doesn’t get is that other evidence based modalities do not center on finding a “function” for the behavior. DBT and SPACE see the behavior as an outgrowth of emotional dysregulation and avoiding anxious sensations, respectively. The ABA notion of determine a “function” is really more for kids more severely on the spectrum where it may be harder to determine what is going on - eg they want attention, they are in pain, they don’t like transitions. Or for a very young child maybe a learning disability that is causing behavioral issues because they don’t understand the school assignment.

For a normal IQ teen acting like this, you don’t need to look far to understand the function. She has strong emotions and reacts to them accordingly.

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

OP DBT addresses all of this. I don't know of any that are in-network for insurance. Waits are long so I suggest you get on lists with multiple practices. A good DBT practice will have a hefty parent component.

Was wondering where local people are getting DBT. I found some places on this forum, but wouldn't mind some more recs.

The ones I found are all out of network, and are either online or have a longish drive.

(My DD has similar problems.)

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

She doesn’t do it in public because she knows that she can’t get away with it. What measures can you take so she also restrains the behavior at home? I would tell her that if she’s violent, you will call the cops. Let her test her theories in real time.

Do not do this. My teen is similar and it escalated even more and cops were called and she was handcuffed and taken into the hospital. She calmed they didn’t admit her. This has happened three times over the coarse of a year. This isn’t a typical temper tantrum but it isn’t enough for impatient either. In those moments there is no control and hardly any memory. In those moments, the key is safety, not threats. Obviously if there is self harm or harming others, you call the police. But no threats.

Working to diminish them from starting is the ideal situation. DBT therapy, EMDR therapy, a social group for autistic teen girls are the best suggestions. And she sounds like she needs a non stimulant ADHD med, anti psychotic, or a mood stabilizer. If she doesn’t get at least 60min of exercise a day, start that too

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

She doesn’t do it in public because she knows that she can’t get away with it. What measures can you take so she also restrains the behavior at home? I would tell her that if she’s violent, you will call the cops. Let her test her theories in real time.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re texting her back intermittently then you are NOT ignoring her. Did you do an FA? If not, why the F not?

What is that?

A functional analysis. If your provider tells you to ignore the behavior without first determining the function of the behavior then I’d fire them immediately and find someone that knows what they’re doing.

PP why are you talking this way? Just be nice - dang

I’m so tired of this board, if you want nice and sugar coated pay me for my services. I told the OP the truth. She either does it or not, but it’s 100% what is needed in this situation. I don’t particularly care if you like my delivery or not.

No, if you have a special needs child and you don’t care about delivery when talking to someone asking for help, you are a very uncaring and angry person.

Therapists and doctors and parents don’t curse and talk like that to give a suggestion. And just retort with “I don’t care if you don’t like my delivery.”

You can suggest something without “sugarcoating” it but also not come off like an inconsiderate witch.

💯

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re texting her back intermittently then you are NOT ignoring her. Did you do an FA? If not, why the F not?

What is that?

A functional analysis. If your provider tells you to ignore the behavior without first determining the function of the behavior then I’d fire them immediately and find someone that knows what they’re doing.

PP why are you talking this way? Just be nice - dang

I’m so tired of this board, if you want nice and sugar coated pay me for my services. I told the OP the truth. She either does it or not, but it’s 100% what is needed in this situation. I don’t particularly care if you like my delivery or not.

No, if you have a special needs child and you don’t care about delivery when talking to someone asking for help, you are a very uncaring and angry person.

Therapists and doctors and parents don’t curse and talk like that to give a suggestion. And just retort with “I don’t care if you don’t like my delivery.”

You can suggest something without “sugarcoating” it but also not come off like an inconsiderate witch.

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.