Rough first night home for me with difficult child 2

[sandman3]

So, last night was the first full night home for D. He had a good day at school and came home happy to play with his brothers. There was some tension with A, but I did see that D was able to compromise and work things out which is a major milestone!!

But, as dinner time came along, things went downhill. D started screaming for a snack (typical problem) while I'm literally putting the dinner on the plates, then changes to screaming about not wanting any chicken, only Mac n' cheese, then changed to screaming about eating at the table. The fists started flying! I refused to let myself get worked up and tried to calmly talk to him while I was serving dinner (and getting punched). He was punching, screaming, head-butting, you name it....all over some dang chicken, or so it seemed.

After about 15 minutes of the tantrum, he did calm down and come to the table...ate about 3 bites of the Mac n' cheese, stood up and said, "that's it, I've had enough of this"...stormed to his room for a blanket and laid on the couch with a movie on. At this point I decided to ignore him and just let him chill, he was passed out within 10 minutes. Slept for an hour, I dragged him up for a shower, he perked up a little, but then was back to sleep by 7:30.

Question?? For those of you who have experience with Clonodine...are loss of appetite and intense sleepiness normal side effects? He was sleepy in the hospital when they first gave it to him, which I expected, but it's been over a week now, shouldn't his body be used to it yet?? And, he lost his appetite while at the hospital, I kept mentioning it to the nurses and docs and they say it's not a known side effect....but the coincidence is pretty strong in my opinion.

I hope this weekend goes better. I'm a little bit nervous, but I do have a couple of fun projects for them to do. Plus I'm using the new picture schedules the hospital made for us, hoping the weekend one works. Hopefully D-ex won't decide he needs to visit...I might want to punch him out!!! Or didn't someone mention something before about a ball point pen?? LOL!

 

[smallworld]

What time are you giving him the Clonidine and his other medications? How much of each is he taking?

All three medications he's taking cause sleepiness, which could explain why he's experiencing intense fatigue. I'm wondering if he's just too tired to eat, not that he's lost his appetite. You might need to feed him earlier, then give him his medications. Another thought is that he's getting "over hungry." When this happens to my daughter, she gets a bad feeling in her stomach and can't eat in spite of hunger. The irritability that accompanies intense hunger could also explain why he melted down around dinnertime.

HTH.

 

[Star*]

I have experience with Clonodine but wanted to address the dinner situation.

First of all - this helped us with our very out of control child. He wasn't out of control at times - he was out of control ALL the time and had periods of rest - when he slept.

As far as the situation at dinner and believing you are ignoring him - I get where you are coming from. HOwever you are teaching him that it's okay to do, behave, however at dinner and still get couch and tv.

Does he have written rules - house rules - your rules? I ask this because he SURELY did in the Residential Treatment Center (RTC) - so, to transition home - you may try this too. Rules on one poster board, consequences on the other - rewards for attaining short term goals on yet another - everyone signs and it stays posted where all can see.

What i know now about dinner time is that we had three rules about dinner. 1. If you didn't like it you didn't have to eat it - but if you didn't eat it you got nothing else. Dinner was dinner - either eat or dont. I never made things that my son did NOT like - he just decided at dinner to control the table by saying today "I hate chicken and will only eat Maccaroni". Well - yesterday, last week and last year he loved chicken. So today if he doesn't want chicken - he can have maccaroni - but no more than he would if he had chicken too. In other words - he could have a normal serving of maccaroni and vegetables - if those all got eaten - that was it.

Rule 2. If your behavior isn't going to be what is expected of you at the table - you can opt to have your dinner alone after we eat OR if you are that outrageous you can go to your room without dinner.

Rule 3. If you can't behave at dinner -and you choose not to eat - there will be ABSOLUTELY NO snacking of any kind - at any time until breakfast.

We made it pretty simple - eat what is put in front of you or don't the choice is yours. if you choose NOT to eat - then you weren't going to go watch TV, or play any games or ride a bike, or talk with friends - you would go to your room, bathe, and then bed. Also if you chose not to eat at dinner time - (we tried to have dinner same time every night to help with a consistent schedule) There would be NO (not even a cracker) or have us even see you in the kitchen.

This stopped a TON of tantrums and I mean a TON. We were actually able to go out and eat for the first time after about a year of doing this. I still remember the dinner, the place, and what I ate.....I savored it all. Dude had nice manners, ate what he ordered, didn't run around the restaurant, didn't throw a fit at any time, never even got up out of his seat. he said thank you at home from then on for dinner and mostly for breakfast for the first few months. But we stuck to it - and it made a difference.

To this day - sometimes (even at 17) he will grab a plate and forget to have meat and go to double up on the starch (which =sugar, which =nasty later attitude) DF will say - You can have as much veggies as you want, but if you don't eat some meat you don't get double (potatos, macncheese etc) And we also limited him to 2 sodas a day. Period....and tooka lot of sugary snacks, cereal, and junk food out of the house. It made a HUGE difference lately.

Hope this helps somehow.
Oh and how did we get him to leave the table when he was acting out? We physically removed him or just stood and said nothing extended an arm and pointed saying GO....GO....GO....GO.....like a broken record.

It took a while - but now when DF says DINNER IS READY - we're all in the kitchen getting our plates - no cheating before dinner either - a snack after school - ok, but make it apples or oranges or granola or graham crackers without sugar - and if you don't eat - NO TV or fun stuff. Eating is important for good mental health.

Oh - we also NEVER forced Dude to eat anything he didn't like. If we tried something new and he thought it was gross - we gave him an alternative dinner -and the other rule we have for everyone - if WE put it on your plate - eat as much as you can. If YOU put it on your plate - YOU eat what you put on your plate. This helped with Dudes ENORMOUS serving problem.

Hugs
Star

OH and the Clonodine - IF I gave this to Dude at 8:00 - he was OUT cold and slept all night. Such deep sleep I used to go in his room with a mirror and hold it under his nose to make sure he was breathing - I shook him so violently to wake him a few times it scared him. Also they tried giving it to him in the morning and he fell asleep in school. So we tried 1/2 a tab in the AM and 11/2 a tab at night - and still had problems with groggy and sleeping in school.

He also wet the bed for a period of time - and that made him angry - so we eventually stopped clonodine. It did help him get a full night sleep - and maybe we could have monkied with the times of giving it at night more but when I started giving it to him at 5:00 so he would not be sleepy for school - he missed dinner - and you couldn't wake him. And he didn't do any better in school with a full nights sleep either. It was square one for us.

 

[sandman3]

8am: 250 mg depakote, .5 mg risperdal, .05mg clonodine
1pm: 125mg depakote, .5 mg risperdal, .025 mg clonodine
4pm: 250mg depakote, 1.0mg risperdal, .025 mg clonodine
.

He always gets a snack after school and I feed them right around 5-5:30.....maybe I should postpone the 3rd clonodine dose until dinnertime? I'll try that tonight and see if it makes a difference. He just had a healthy snack that should tide him over until dinner.

Thanks!

 

[sandman3]

Star,
Yes we have set dinner rules and he knows them. I never allow them to eat anything else if they forgo what is served for dinner, I put their plate in the microwave so when they ask for something to eat later, I heat it up and put it in front of them. You're right, I probably sent a bad message, but when I saw him pass out like that and then sleep the night away I got concerned about the new medication.

Honestly, I think I was just plain nervous the whole day! We haven't all been together for a month with the 2 difficult child's hospital stays overlapping each other. Pathetic! Man, I hate feeling like I have to walk on eggshells in my own house!

 

[smallworld]

No wonder he's so tired. He's getting lots of sedating medications in the daytime so I'm not surprised he's passing out so early in the evening. You might want to ask about spreading the medications out a bit -- say 8 am, 2 or 3 pm and right before bed (whatever time that is). That way you get the benefit of sedation at bedtime instead of mealtime.

Depakote is usually dosed twice a day, with either even doses am and pm or the larger dose in the evening to help with sleep. Not sure why the psychiatrist has that extra dose at 1 pm. Depakote does not work like a stimulant, where the impact is felt soon after the medication is taken. It works by reaching a steady blood level, which can be achieved with twice a day dosing. I'd ask the psychiatrist about changing that dosing as well.

Unfortunately, getting the medications right involves a lot of trial and error. Good luck.

 

[Star*]

Sand -

Dude was on that much Clonodine and Depakote at one time - almost the same dosages. The depakote made him heavy quick. Then they had him take Welbutrin and Clonodine for a time. Depakote seemed to make Dude aggitated and short tempered more so than usual. Welbutrin seemed to do nothing.

Almost ashamed to admit it - but we had him over the years on a mix of over 64 medications. The only thing he didn't get in the pharmacy was lithium and Geodone. And I'm not sure at one of the Residential Treatment Center (RTC)'s they didn't try Geodone too.

We stopped with the Clonodine after they had him on that and ....Adderal XR.

Basically - with Dude just keeping him running from dusk till dawn seemed to do as much good as medicines. Now we're trying Vitamin C and B complex and cutting out sugar - adding more citrus. Somethings working - I don't know if it's the vitamins in mass doeses or his maturity.

And I never meant to say you didn't know what you were doing - ACK - I absolutely KNOW you are doing everything you can -and yes I know about just letting a sleeping mad dog lay. BELIEVE YOU ME - I do.

Like Smallworld said - medications tweaks seem to be our life for so long. Oh - and you can ask - but our regular doctor said with some medications like Strattera - he can have Benadryl tabs (2 ) and it would knock him out. The psychiatric. ok'd it - so when he really was wound tight we gave him Benadryl. Not all the time - just those - it's either YOU take 2 benadryl or I'm going to dive into a bottle of some light colored Mexican liquor with a worm....and a snorkle

Hugs
Star

 

[susiestar]

I think it was a rough day. the first day home, so worried he would upset someone and be sent back, and he lost it.

With the punching, what happened in Residential Treatment Center (RTC) when he did that? If they won't tell you ask for ALL the records, every single scrap, and read through them. The behavior reports and the consequences should be there. Be prepared for War & Peace type stacks of paper though. After 4 months in psychiatric hospital, my son had over 800 pages of notes in his chart. I have copies of all, reading them was very helpful.

They will first send you a 1 page report, you have to call and say you want the whole chart. Have it sent to a supportive therapist so they won't charge you. Our therapist got them, went through them, and then gave them to me. She learned a LOT from them though.

Set rules, consequences, and then be a broken record when he ignores you, hits, etc... Say "go to your room" or whatever, and just repeat it.

The medications are so sedating I would wait until after dinner for them, and I would probably feed him dinner right after school and then a snack later if he is still awake.

It can take several WEEKS to adjust, not jsut a few days or a week.

Please don't let him get away with hitting you and then watching TV. It sets a really really scary precedent.

We have different food rules. Each of my boys has certain food that they just gag over. Not a choice, but a physical reaction. thank you also is allergic to a number of things.

If thank you doesn't eat dinner, he has a list of acceptable things HE can fix and clean up after. If he doesn't fix, he doesn't eat. Exception is made if I know that what is for dinner is something he just can't eat. Then I consult him and make a different simple thing for him.

If he doesn't clean, next time he doesn't get the option. I make sure next time is the next day, or dinner if it is lunch. Just the next meal he does not get the option. NOT carried over for days - food should not be about punishment.

He is very good about it. difficult child pushed more, but he also got these options and consequences. He got reasonable servings, and a smaller seconds if needed.

sometimes hunger is so strong that if you eat you get sick to your stomach. It can HURT. Be sure he is eating lunch at school. Ask the school to check on it quietly. IF he doesn't like the food, let him pack. Or if you pack, make sure he eats (our school will not let them pitch anything left over unless it is liquid or sticky AND opened. It all comes home in the bag or lunch box. This way we KNOW if they are eating at lunch.)

MAke sure he has enough protein. Check out the Zone Diet by Dr Sears. It uses a balanced amount of fat, protein and carbs. Preferably complex carbs. We found some major health benefits, and my difficult child and other kids are so much happier and less gfgish with it. At the very least we make sure they have a decent amount of protein with every meal, snack, etc.... No pigging on chips etc... They get a serving (see the bag for the size) and they get some meat, or milk, or something.

The Zone has lots of books. Many recipes, ways to alter recipes you make, etc... It really helps.

You all have to get used to each other again.

Start as you want to continue.

Hugs,

Susie

 

[wakeupcall]

medication this and medication that....it's sooo exhausting. My difficult child has been on so many, poor thing. We had good results with Risperdal for his aggression. The most he took in a day was .5mg X 2. It put lots of weight on him because he could never get full...of course, it was all carbs that he craved. Our psychiatrist was very concerned that it would cause him to have tics, so we eventually weaned off it, but he was on it for about two years. I'd guess that it's the Risperdal that's causing the sleepiness. Clonidine can cause it, too. difficult child is only taking .05 mg of Clonidine at dinner. It helps with aggression, too and helps him sleep. My difficult child is 12 and 95 lbs.

 

[sandman3]

At the hospital, if he hit or threw anything, he went immediately to the "time-out" room.....a lovely, unfurnished room where they cannot hurt anyone and can have time to scream until they're ready to cool down. OH HOW I WISH I HAD ONE OF THOSE AT HOME, LOL! I would create one if we had any space available.

He's been on the Depakote and Risperdal for 2 years. The clonodine is the only "new" medication right now. So it's either that one, or the effect of that one now mixed with the others that's making him so sleepy. I think for now I'll just tweak the time until it seems right. The reason for the times is that the hospital was watching to see when in the day he began to lose control and timed his medications based on that. I guess I can do the same thing!

Tonight has been better. I waited on all of his afternoon medications until 5:00 and had dinner on the table at 5:15. He ate some, not a bunch but enough. We had reading time and he got sleepy during that but I made him get up and moving and now he's playing like a maniac with his little partner's in crime!

Getting ready for "movie night", I'll see how much he gets thru before he's zonked!

You guys are so helpful! Thanks so much!

 

[Wiped Out]

My difficult child takes Clonidine at night for sleep. He takes lower dosages in the morning and at noon and sometimes he will take a nap but not always.

 

[jannie]

I definately agree the medication makes him completely exhausted. I know that when my kids are exhausted they fall apart. He's had quite a day. I hope for you that he gets good nights rest...and tomorrow is a better day...

I do think you should speak with the doctor about spreading out the times.