Out of control 13 yr old

[Tzu]

Hi ... some advice woud be much appreciated.

I have been fostering a 13 yr old girl now for 18 months. She is VERY challenging! Her symptoms are the following:

Self harms (cuts her arms with razor blades usually when she has lost her temper or is bored in the night when we are all asleep).
Pierces her own lips ears etc and puts in safety pins or studs.
Very verbally abusive to anyone who opposes her.
Swears a lot.
Her room constantly looks like a bomb has hit it .. and anywhere else she has been sitting (I'm constantly cleaning up after her).
Her sleeping pattern is so messed up. She will over sleep one morning then stay awake for the whole of that night and next day .. come following evening she is still awake and very hyped and annoying .. then will finally go to sleep and sleep for 18 odd hours then the pattern starts again of being awake for ages and hyper.
Likes to dress in predominantly black clothes with heavy black make up.
Talks a lot about suicide and writes depressing poetry even though most of the time she seems reasonably happy.
Now starting to experiment with drugs and alcohol.
Has runaway about 4 times.
Assaulted a police officer recently for which she has been charged.
Been arrested twice for theft.
Lately showing huge interest in eating disorders and trying to become anorexic .. but may have to revert to bulimia (which she has tried a couple of times) as she loves her food!
Overly affectionate .. seems to need a lot of reassurance she is loved .. and we give it.
Been permanently excluded from every school she has ever attended and is now on the verge of being excluded permanently from the latest school which is in fact a special school for kids with emotional difficulties.
Apparently she was diagnosed at age 6 with ADHD .. yet nothing has ever been done about it.
We are her 5th placement and we desperately want to succeed with her .. even though when she kicks off she aims her temper at us and our belongings.

The only suggestion so far by the authorities for her is to send her to a residential/theraputic home for kids like this. I think this is sad and she says she will kill herself if they move her there. I cannot understand why she has never been tried on some medication to help her settle at school and get on with her work. At the moment she is more out of school that in. She either gets temporary exclusions for bad bahaviour or she just refuses to go in as she says it's boring and they pick on her.

I am keen to see her tried on something like Concerta .. but how to get a professional to treat her is beyond me as she is not my own child (here in the UK they don't seem keen to use meds on kids).

She does not engage in therapy .. hates it and finds it boring. I could be wrong but I feel she has ADHD still that has been left to get right out of control. And I wonder if she has symptoms also of Bipolar?? ... But I'm no expert and really just looking for help/advice .. any comments?

[janewhite1]

Okay, three things:

1)Cheers for you and your commitment to helping this child!

2)It does sound like she could be ADHD, and might benefit from medication. Drug use, "trying" to get an eating disorder, even the cutting and erratic schedule could be forms of attempted self medication. She's old enough to recognize that her brain is out of control, and she's looking for something to make her feel like she's in control of herself.

3) It's tough to be a foster kid. It's hard to say how much of her difficulties are that and how much are brain related.

Trouble is, you need a professional who is willing to deal with both 2 and 3.

Who would need to consent for her to get medical treatment?

Take heart: I was a complete terror to myself and everyone else at age 13, too. So are most girls, really. And most of 'em do okay.

[flintrock]

Only my opinion...but she sounds like she may have bi-polar tendencies.....I would take her to psychologist and get that checked out............very serious issues it seems for her. So young to be doing these things.........wearing make up at 13...........I don't think so.

[Thunor]

I don't know how much this will help, but for what it's worth, here's my opinion.

It's difficult to say if she has ADHD or not, though sloppy impulse control is certainly one of the symptoms of ADHD, and many of the issues you list are clearly related to impulse control. The problem is, impulse control can also be the symptom of various other mental and emotional disorders as well. As a side note, I can attest to the fact that need for love and reassurance can be a symptom of ADD. Even as a 35 year old male I am extremely emotional and affectionate and need constant reassurance and validation (which often puts stress on my loved ones . . . my poor fiancee).

As has been pointed out already, your foster daughter may be attempting to self medicate (either consciously or subconsciously) through various behaviours such as drug and alcohol use, sleeping patterns and cutting/piercing (my understanding is that pain can cause the release of dopamine and other neurotransmitters related to pleasure or sense of self worth).

It looks as though you have a long road ahead. The important thing for your foster daughter is that it seems that she has found a home where she will be loved and cared for and parents that care enough to try to help her, many children with similar issues will never find those things. I think that counselling is really important for her, despite the fact she doesn't like it. In addition, I (and remember I am not a mental health professional, so take my advice as coming from a layman) feel that a stimulant medication such as Concerta may have a positive effect, at least on a temporary basis to allow her to get benefits from other treatments such as counselling. I was told recently by a psychologist that prior to the discovery of the latest class of anti-depressants, stimulants were used to treat depression as well as ADHD, so you may see positive effects even if her problems are not truly ADHD.

[Tzu]

Many thanks for your replies. U have given me some food for thought. I didn't see the self harm as a form of self medication but more as attention seeking behaviour. So that makes sense that she could be self medicating that way as with the drugs and alcohol. The community nurse suggested I take her to my doctor again and ask her to refer this child to a pediatrician to have her ADHD managed. That is how she said I must word it as the child was diagnosed at at 6. I did take her yesterday to one of the new partners at the surgery (mine is difficult to get an appointment with) and she said the child doesn't 'look' ADHD. I was a little annoyed as since when can u diagnose ADHD just by looking at a child for 2 minutes? Anyway she asked me to bring her back on Friday to see my regular GP for a referal as she felt she would know the child better. So now we wait for that appointment and hopefully I can get a referral. I have tried to get my doc in the past to treat this child .. but she just says because the local mental health clinic is involved it's not necessary. Thing is it's a psychologiust involved and he cannot prescribe drugs. All he wants to do is talk therapy ... and of course she will not attend. I also feel therapy is a waste of time as she is not interested. Anyway .. will see what the doc says on Friday and hold thumbs she gets a referral to a psychologuist. Thanks once again all of u for ur help