Tuesday, June 7, 2011

To Medicate or Not

To start, I want to make it clear that I am pro psychotropic drugs for any person, including children, that need them. GB has Bipolar I with psychotic features, as well as ASD and FASD. When she is stable on the right medication her joy is infectious. I know she will be on medication for the rest of her life and I am grateful that there are medications that work for her. My feeling about Hope and medication are different.

Hope is not Bipolar, ADHD, FASD, or ASD. Hope is RAD. Since all the other disorders were eliminated, one by one, by seeing various medical professionals, the goal has been to help Hope heal, and ultimately  have her medication free. When she came to us, the first thing we eliminated was clonodine. That left us with .75 mg of Risperidal a day. We have gradually reduce that over the last four months and now Hope is only getting .25 mg a day. Until she spoke to her first adoptive family (AKA, The Texas Parents), she was doing OK on the reduced dose of Risperdal. Since then, she is back to long rages again.

Last night, at  gymnastics, Hope raged in the waiting room. In the  almost an hour it took for The Dad to get to us from work, I manged to restrain her and keep her from hurting anybody but me. When The Dad showed up to take over, I was bloody, my arms were swollen, and I had bruises all over. I gave her .5 mg Risperidal last night and it still took her 1 1/2 hours to go to sleep. The Dad wants to go back to Hope getting .25 mg after school and .5 mg Risperidal at night.

I understand his feelings. I look beat up today and looked even worse last night. BUT, before that phone call, we could contain Hope on .25 mg of Risperdal and were contemplating eliminating it completely. And that is my dilemma. Hope's issued are caused by trauma- trauma she is not responsible for and should have never happened. GB will always be Bipolar I... Hope can heal and have healthy relationships. Medication is a given for GB. Medication for Hope appears to be about controlling her behavior.

I have never believed in using medication for the sole purpose of controlling a child's behavior. So now there is a decision; to medicate or not. What is in Hope's best interests?


Ian & Ruby said...

From my perspective (as a parent of a 21 year old diagnosed at 12 with Bipolar 1 and medicated) I know that she needs her medication, and without it her life quickly turns upside-down. I guess for me the question with Hope would be - can she control her current behaviours, or is that not possible at this stage. I know that behaviours unchecked can become habits; if Hope's behaviours could be 'controlled' with medication, would it not make for a happier Hope; a Hope with whom you could reason and dialogue until she can recognise why she does these things? I know how badly relationships can be affected when there is raging and uncontrolled tantrums. I wonder if having Hope medicated may not be in everyone's best interests at this point. I would hope that as she matures that she will be able to take control of her life again. But at this stage she is just a little girl who is hurting, badly, but also hurting those who love her. I do not know of the Risperdal is the right medication for her. This would need to be discussed with her medical providers. But my heart aches for the traumas that she is continuing to go through; for the hurt that she is inflicting on all of you. There are no easy answers; but I can tell how much you love both of your girls; and they both need you so much. I know that together you will be able to make the right decision for Hope. I pray for a peaceful and happy future for her, and for GB. Blessings on you all.

Kate said...

I agree with the previous comment and all it said. Sometimes you need the meds as a starting point to control the behaviors just enough so emotional developement can occur on its own....once that happens and she has self awareness you can take her off them.

Julie said...

I agree with the other ladies. If you get the behavior out of the way, there is a better possibility of healing to occur.

Amanda said...

This is a tough call.

I grew up with two so-called "difficult" siblings. (This must be a code-word for "undiagnosed".)

There were plenty of times when meds would have seemed a good idea, if the folks back then knew what we know now.

For example, my sister would rage so bad, there would be a trip to the ER because my mother thought she was having an epileptic fit.

My brother would chase people around with knives during a rage and set fires, among other things.

Sister is now on SSI, still has rages. Brother seems fine, is an army vet. Hard to say if the meds would have made a difference or not.

But...I do know there are cases where meds are absolutely necessary and have turned lives around. Trial and error.

"Lil Ol' Me" said...

I've not read what the other comments are.

However, my first thoughts on reading this are...

What about going back to the medication dose (whatever it was) to get her stable again. And then as healing begins, as the rages diminish (heaven can only help out here) and she gets to a point where things are stable all over again.....then decrease.

And if possible...no more phone contact. We leanred the hard way. VERY VERY hard way. Truthfully, was the beginning of the end for our child.

Jen said...

This hits close to home. Katie does have Autism, but her behavior gets violently out of control, so we did use meds to try and control it. Our hope was that as we went on with therapy we would be able to eliminate them. Right now we are taking her off, just b/c they aren't helping, but I fully believe in doing what you have to do. If you know the meds will help settle her again, I would do it for now. Does she have to talk to that family ever again!? Ugh...

Anonymous said...

I have bipolar II, so I don't know which of my thought patterns are caused by that vs trauma side-effects. What I do know is that some things, especially re-traumatizing ones, can get my brain spinning uncontrollably. I deteriorate through negative self-talk to harmful wishes to wanting to pound my head on hard objects maybe as punishment or maybe to get the feeling inside my head to go away. And the BEST drug I've found for that is an anti-psychotic, taken as-needed. I do not imagine that anyone would want to feel the way I do when I resort to that antipsychotic. In the end, does it matter if the abberant thought-processes started because of long-term depression or biploar II or as a side-effect of too much trauma in my life?

And current thinking is that the more you think in a particular way, the harder it is to stop thinking like that. The conecpt of depressive thoughts being like a well-worn road ... thoughts that get near there are sucked down into the path of least resistance ... so doing something to stop Hope's brain from cycling down into that chasm is a good thing for long-term healing.

I guess you know where my vote is.

Karen -AspergersMom said...

When behavior is violent and completely out of control how can you heal? At one point my son was so anxious...therapy was a disaster. Now that is is controlled, he can hear and absorb therapy better. If you've read the blog you know what I've been through with my 15 year old, some of his rage is controlled with medication...then their are behaviors that need work. But we can't work on behaviors when rage is out of control. It's not fair for you to be hurt physically. Do what you have to do to be able to get through to her.

Kristine said...

If she is out of control she can't learn. If she is out of control, she can't heal. If she is out of control the rest of you are at risk. If she is out of control, how can you be the therapeutic parent that she needs?

GB will need meds the rest of her life. Hope probably won't from what you have told me. I don't think that small of a dose of risperdal is unreasonable.

Have you tried Tenex with her? I wonder if that would.

Penelope said...

The older she gets, she will mature and learn appropriate behavior and have more self-control. However, even normal teens don't exhibit good self-control. If the meds can get her through the tough times, then adjust accordingly. My 19-year-old stepson doesn't take any meds and is doing great. He jushaste to graduate from the normal teen hell called high school first.