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My 8-year old son

spudeenspudeen Posts: 19Member Listener
Hi Will,
Sam sent me your link as I have been on forum since November seeking help/advice regarding my son. I managed to get him assessed at school in July '16 - he has auditory working memory difficulties. Visual memory excellent. Below Average for writing/spelling, slow reader. He is ok at school, not many friends but school have no issues with him at all. He has seen no professionals whatsoever except for assessment at school. Dr has written twice to CAMHS but they have refused to see him. We had to call an ambulance just before christmas as we could not control him. Unfortunately it took over 2 hrs before they could come and he had stopped about 15 minutes before. I managed to show them a short film I took of him on my phone. He did not go to hospital but the GP on duty (111) opened up a file and TAC will be involved. Unfortunately, my son's aggression at home is increasing daily. He says he has voices in his head that tell him to hurt us (family). He has these at school as well but he can't hurt his friends. He has these voices for all the teachers too. But he "can't do anything because everyone is watching him. It seems ok to do it at home though". He apologises after every event, crying, sobbing, saying how sorry he is, he loves us. He bites himself, strangles himself with his hands and punches his head fighting with the voices. He "flips" at the slightest thing - homework time (my nightmare), shower time, drawing that has gone wrong or a lego construction not workinng out how he wants. He is like Jeckyll and Hyde - playing with his sister (almost 14) one minute and lashing out at her the next. Same with us. He has always been stubborn, doing what he wants but he is also very generous, lovingand witty. He always interrupts when we are talking. He must say what he needs to say there and then. He fidgets constantly, has eye and/or finger ticks, Cannot get him to concentrate for homework. He refuses to go to bed now until he crashes out as he is frightened of what is in his head. His monsters are us - mum dad and sister. He has now started acting badly in front of others - at the airport, at his grandmother's and uncle/aunt's house at christmas (they live abroad), in the library yesterday but at school no. I will start a parenting course in February as School Nurses suggested getting help there and also CAMHS suggested we do a "robust parenting course". Always blame parents! We cannot cope with our son's aggression. He is exhausted afterwards, we are sore and bruised and it is killing us not knowing what to do to help him. How to calm him down or try to prevent the evet happenng. Please try to give us some advice as we are desperate to help him.

Replies

  • will22will22 Posts: 29Member, Community advisor Talkative

    Hi Spudeen,

    So the situation is that your 8 year old son is demonstrating outbursts of aggressive behaviour towards his family and self-injurious behaviour in the form of self-strangling and punching himself. These behaviours are confined to the family environment and he’s functioning ok at school although he has some difficulties with his memory/reading/writing.

    He reports that he experiences a voice in his head telling him to hurt you, and although you’ve accessed your GP CAMHS have not picked up on him.

    First up, the decision by CAMHS not to pick up on this baffles me. As has been mentioned in other posts here, this is not a forum for diagnosis but anyone reporting voices instructing them to hurt others may well be experiencing a metal health difficulty. This is not the only explanation, but regardless is a very worrying sign.

    I cannot say why this is happening with your son but clearly there is something going on that requires urgent attention. Given the features you describe it would not feel inappropriate to me to bypass the GP and CAMHS and access a mental health crisis team directly. The issue may not be one of mental health, but some form of support service needs to get involved to assess his needs and work out what is going on. You have said that TAC is involved, what’s their take on this? If CAMHS are not involved then who is? As you have done here, write up a document detailing (bullet points if necessary) what you are experiencing and what its impact on you is. Send it through to any relevant professional involved with you at this point, requesting urgent help.

    In the meantime you’re faced with the situation of a volatile young man showing aggressive behaviour towards you and self-injurious behaviour.

    Manging this is tricky, there’s a lot I’d want to know before putting a plan together with you. A lot depends on his insight into his behaviour, his communication ability etc.

    Were this a case I was working on one of the first  things I would do would be to begin drawing up a list of flashpoints or what we would call antecedents- situations or events that are likely to lead to an incident. Things to avoid where possible. This will help you plan out your day so that you can anticipate difficulties and structure your time to avoid them wherever possible. The truth of course is that there are many things you cannot avoid, but starting to draw together the situations where behaviour is likely will begin to show you common themes and start to put a picture together of the all-important question – why is this happening. If he has insight into his behaviour (i.e. you can talk about incidents with him and he can give you any clues as to why their happening) then this is something you can do with your son- if you feel it’s appropriate to do so.

    Next up you need to work out your plan when there is an incident based on a key principle – ending the incident as quickly as possible and keeping everybody safe. When your son is experiencing an outburst it is likely that he is not in a rational state of mind. When we get angry or upset our ability to think and reason clearly is impaired. Strategies that revolve around putting in boundaries or trying to argue with someone that their behaviour is wrong and needs to stop will most likely lead to an escalation or continuation of an incident. As difficult as it is given the huge emotional involvement here and the stress that an incident causes (which will overwhelm your common sense) you need to plan through how you manage an incident in a calm safe manner that is predictable for everyone involved.

    Specific examples are tricky here – I cannot advise you directly without assessing the situation so I will have to be broad in my guidance.

    If he is becoming aggressive towards you it may be beneficial to attempt to acknowledge that he is hearing a voice (if this is what is driving the behaviour) and to attempt to have him communicate what it is saying either verbally or by getting him to wrote it down or express it in some manner.

    It may be more beneficial depending on the level of distress he is in to shut off all communication – which he may find only ads to his stress – and leave the room. Give him space to vent his feelings on objects that don’t have feelings.

    When he is calm and open to discussion (if he is able to do so) then you can engage with him about the voices, what they say and whether he has to listen to them or follow their instruction. Devise a strategy with him for expressing what they say and out letting that in a calm manner to prevent the build-up of stress. In a perfect world he can be taught to recognize when his stress levels are building and take the best action. He could learn some calming techniques and learn to utilize them with you. I am currently working with a parent who experiences an explosion of agitation and anger from heir son when he returns home from school. We’re in the early stages of teaching him to engage in a mindfulness/relaxation exercise when he returns home with his mum to head off the stress he feels and holds onto from school.

    Ultimately however this cannot be resolved through good management. However well you avoid or manage the difficulties, whatever is driving them will not simply go away. The difficulty for me is that the information I have here is not sufficient to work out what is going on. Your son needs a comprehensive assessment to identify is this an issue with his mental health, is there an underlying difficulty of which the ‘voices’ are a manifestation?

    There are things you can do, working out a plan for avoiding and managing incidents will help to a degree and engaging with your son and trying to find a way for him to express this feelings could be beneficial. But ultimately you need to return to the school and the GP and demand some support. Do you have a social worker allocated?

    Document what you are experiencing. Forward this to the people involved including the school. Pressure on services is immense, don’t let yourself be drowned out.

    I hope that is of some help, I realise that it must be frustrating for you that I cannot say “Ah, this sounds like xx, so you should do this….” I will look for some supportive information for you and send it through.

    Will

  • spudeenspudeen Posts: 19Member Listener
    Dear Will, I cannot thank you enough for responding so quickly. My son has been having difficulties for over 2 years now but it is only recently he has become aggressive towards us, biting, strangoling and punching himelf and now hearing voices. He used to just scream, be angry, frustrated, throw stuff around. I thought we were to blame and partly his stubborn character. Now it seems as though he has grown confident enough to express his anger/frustration?? Anything can trigger it but we have noticed that demands nearly always cause problems, (shower time, bedtime, homework, shopping etc.). We have tried to talk to him but I feel he doesn't know how to explain it all. Often he appears frightened, at times far away closed within himself.  We try to avoid conflict wherever possible, giving in often. He is always bored and loses interest quickly even with his favourite toys. He's always complaining about things, always food, nothing is fun, he's bored, he's no good at drawing (which is not true as he is very good).  He is also stealing, which means we cannot leave him in a shop without being by his side at al times. This makes him angry but he knows why as we have told him why. Unfortunately, it isn't easy to write everything to help you understand the picture a little more as there is so much to say. 
    We have nobody involved at present - only senco at school with regards to his educational needs as the school have no issues. I have told them everything and suggested maybe to look out for ASD but senco blatently refused to accept that. The school nurse I only saw last week for the first time. She has been the only person who has asked any history of my son at all.  TAC have not contacted us yet so we are on our tod at the moment. Our GP cannot understand CAMHS rejection either. Only when the Collaborative Lincolnshire Behavioural Pathway has been followed, and he has been involved with TAC, community paediatrics and us- parenting courses, and ONLY if it is a mental health issue can a referral then  be made. I am seeing GP next week to seek paediatrics appointment. If you could suggest any other specialist we could seek immediate help from please advise. You mentioned mental health crisis team - where/how would I be able to contact them? It would be difficult for us to go private but we will if it is the only way to get him the help he needs now. We are willing to travel too. We are Lincolnshire if that helps. Many thanks again Will. 
  • will22will22 Posts: 29Member, Community advisor Talkative

    Hi Spuden, 

    These are very challenging times for services, so I’m going to steer clear of laying blame on anyone’s door for not responding quickly. Similarly it’d be easy to look at the info you’re giving and come to a set of vague conclusions ‘Probably Autism, why doesn’t the senco realise this?’ Etc. But in truth what you have here is a complicated picture where the behaviours and presentation you’re describing could have multiple explanations or a combination of explanations. Even if you detailed everything possible you can think of it still wouldn’t be enough to reach a conclusion- that can only be done through assessment which has lots of features such as observation.

    It does sound like services are involved and things will inch forward at their own pace. Don’t be discouraged and back off from accessing help, certainly don’t find a way to muddle through and just service. Your 8 year old will one day be 18 and these difficulties may still be occurring. Early intervention is essential.

    Document everything that is happening to you and the impact that it is having. Forward this to the school, to the GP to any professional involved. Don’t give up.

    Regarding the mental health crisis team. I want to stress again that reporting voices does not automatically mean a mental health problem. When working with people with autism and learning difficulties I have met you ng people who appear to report ‘voices’ but this can simply be a confusion about their own internal monologue. For example repeating bits of TV and film dialogue. It could be this young person’s means of expressing complicated thoughts and feelings.

    Having said that, hearing voices, particularly ones that talk about hurting people is not something that should be ignored. If this was presenting to someone known to me and it was having an immediate impact on those around them I may (in the process of engaging the appropriate teams and working to rule out possibilities) contact support teams for individuals experiencing acute mental health issues. A quick google of Lincolnshire mental health crisis team bring sup their contact details and how to refer. Now they may not view your situation as a crisis. Your son is functioning well at school form what you’ve said and (I do not wish to be dismissive here) an 8 year old poses much less of a ‘crisis’ than a 21 year old man experiencing a breakdown. But it is a crisis for your family and requires intervention. If CAMHS haven’t picked up on it through the GP route then possibly this could be a springboard for some intervention. If Not then as you say TAC haven’t become fully engaged yet, and when they do they may be able to steer you correctly. If nothing else then return to your GP, document everything and make clear the impact.

    Just to go back to the nature of the difficulties themselves, you say that school are having no issues – certainly not to the degree that you are at home. That is a really key thing. If these difficulties stem from a functional difficulty (you have not mentioned any diagnosed learning difficulty or other significant issue) then it would be expected that within reason the presentation of difficulties would be consistent across settings, certainly if demands are a factor as these should come up frequently in  school.

    What this suggests is that there are situational variables here – in some environments he is better able to function than others.

    One thing to consider, without getting out on a diagnostic limb, is that anxiety can be a factor in many behaviours. In school environments tend to be more structured and routine and this can be to the benefit of individuals who struggle to manage their time, regulate their emotions or understand what is happening. In a perfect world you could drop into school and see how your son responds in this environment. School may be up for that or they may not.

    Either way I’d consider trying to support a greater routine and consistency in the evenings. Making use of visual schedules/timetables to outline what is happening each evening. This may not be appropriate, but is possibly something to explore.

    The scenario where there are no issues at school but they erupt at home is quite common for me. There is a fundamental difference in relationships between family and ‘staff’ with all the emotional weight that comes with it. The phrase ‘it’s his mother who gets it’ is one I’ve heard pretty often over the years. It’s also a situation that I’ve seen change dramatically with the right understanding and the right intervention.

     

    Good luck. Keep me posted and if you have a specific scenario you’d lie me to advise on hen please let me know.

     

    Will

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