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    Old 07-20-2006, 10:48 AM   #1
    Sarahsmom
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    Adolescence and aggression

    Our daughter has seen a sharp increase in aggressive behavior with adolescence. She is fourteen, and has always had some instances of aggression, but not like this. These are real, violent attacks. They started with this level of intensity this year as she entered middle-school. At first we thought it was solely the environment, but she has been aggressive at home as well. Lately, she attacked her care-giver while she was driving. They could have all been killed if she were on the highway. I have tried risperadol and it was a nightmare. I am interested in any therapies/interventions used to combat this. Because of her extreme reaction to risperadol, I am very hesitant to go the drug route. Any advice would be appreciated.

     
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    Old 07-20-2006, 12:10 PM   #2
    elmhar
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    Re: Adolescence and aggression

    Hi Sarah's Mom,

    When there are serious safety concerns, it is reasonable to go with a treatment that has the greatest likelihood of being effective quickly. Generally that means some sort of drug intervention. It could be that Riperadol was the wrong drug for her, or that the dose was too high. There are other drugs in the same category that may work without the side effects, but the only way to know is to try.

    Biological interventions (diet, supplements, etc) are sometimes effective within days or weeks in very young children, but rarely in older kids & adolescents. With older kids, bio interventions can take longer to have effect, and they may not have as great a total effect as in a younger child, where the brain is less fully developed.

    It may be possible, however, once your DD is stabilized on meds, to find someone like a DAN! doc who will work with you on testing & nondrug treatments for your DD. As she improves the meds can be decreased. Any observations that you can make regarding the frequency of her aggressive behavior, esp. re: hormonal cycle, may be helpful to bio doc.

    I have seen a few case reports of CES -- cranial electro-stimulation, the use of microcurrent devices, having a positive effect on aggressive autistic kids. These devices (Alpha-Stim is one brand name) are FDA approved for certain conditions & can only be obtained through a licensed psychologist or MD. Something you might want to look into.

    The other thing you may wish to try, if your DD does not have clotting or bleeding problems, is EPA concentrate fish oil. I recommend Omega Joy, Nordic Naturals, and Carlson's brands. Sometimes EPA helps mellow the kids out. EPA enhances membrane flexibility throughout the body, incl. the brain. It has been shown to be helpful in bipolar mania, depression, and anxiety. I am not aware of any studies on autism, but it is nevertheless used by many in the autistic community who are of the bio-intervention persuasion.

    Best wishes, and please let us know how things work out.

     
    Old 07-20-2006, 12:26 PM   #3
    Sarahsmom
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    Re: Adolescence and aggression

    Quote:
    Originally Posted by elmhar
    Hi Sarah's Mom,

    When there are serious safety concerns, it is reasonable to go with a treatment that has the greatest likelihood of being effective quickly. Generally that means some sort of drug intervention. It could be that Riperadol was the wrong drug for her, or that the dose was too high. There are other drugs in the same category that may work without the side effects, but the only way to know is to try.

    Biological interventions (diet, supplements, etc) are sometimes effective within days or weeks in very young children, but rarely in older kids & adolescents. With older kids, bio interventions can take longer to have effect, and they may not have as great a total effect as in a younger child, where the brain is less fully developed.

    It may be possible, however, once your DD is stabilized on meds, to find someone like a DAN! doc who will work with you on testing & nondrug treatments for your DD. As she improves the meds can be decreased. Any observations that you can make regarding the frequency of her aggressive behavior, esp. re: hormonal cycle, may be helpful to bio doc.

    I have seen a few case reports of CES -- cranial electro-stimulation, the use of microcurrent devices, having a positive effect on aggressive autistic kids. These devices (Alpha-Stim is one brand name) are FDA approved for certain conditions & can only be obtained through a licensed psychologist or MD. Something you might want to look into.

    The other thing you may wish to try, if your DD does not have clotting or bleeding problems, is EPA concentrate fish oil. I recommend Omega Joy, Nordic Naturals, and Carlson's brands. Sometimes EPA helps mellow the kids out. EPA enhances membrane flexibility throughout the body, incl. the brain. It has been shown to be helpful in bipolar mania, depression, and anxiety. I am not aware of any studies on autism, but it is nevertheless used by many in the autistic community who are of the bio-intervention persuasion.

    Best wishes, and please let us know how things work out.

    Thank you for your response. I am seeing a DAN doc on late august. The great plains laboratory is doing an outreach clinic, and I hope to have a ton of testing done. You are right about the age difference and effectiveness. I have had good luck with some biological interventions in the past, including GFCF diet. I do find, however, that the diet gets close to impossible as they get older. I don't follow the diet anymore, but I do supplement with enzymes. Sarah has always had digestive issues, but they have greatly improved. Still am curious about yeast and other culprits. There are so many supplements that can hellp, that it is hard to know where to begin and when you are just wasting your money. I hope with the testing to go about it more systematically. I have actually used an alpha-stim with Sarah when she was younger! Was very surprised to find so many references to it. The company actually let me borrow one (through my chiropractor) and take data, as they were then just testing with kids and autism. I gave them a couple of months of data. Sarah's initial response was very good, but after time, started to get aggitated with it and not very cooperative, and I didn't see any remarkable results so stopped using it. She did not have such high levels of aggression/anxiety at the time though -- worth pursuing again. I am also going to try cranio sacral (sp??). I had given sarah EPAs for a while, but have not lately. I will try them again, as they certainly can't do any harm, and necesssary for such a picky eater anyway! I should be taking them myself!

    I will reconsider the med route, but it is hard because I think she is just one of those kids who is very sensitive to medication, and the literature on positive results is not very promising. The most promising was the risperadol, and she was a mess! And, more importantly, did not stop the aggression. Never a dull moment as the parent of a ASD kid, thats for sure!

    Thank you for your response.

     
    Old 07-20-2006, 06:37 PM   #4
    elmhar
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    Re: Adolescence and aggression

    Sounds like you are very on top of things! Let us know what works for your DD.

     
    Old 07-20-2006, 07:03 PM   #5
    Liz Cook
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    Re: Adolescence and aggression

    your biggest problem may be puberty... if you dont mind me asking... is that a problem yet? horomal fluxuation are crap on us neurotypicals imagine what it would be like to be super sensitive to pms you might also try tracking her mood swings and severe outburts to see if they have a "cycle" to them if you note any increase during times when she should be having her menses then maybe she might need more down time then and she might also need some pain relief.

    i know this sounds silly but really i am serious. when i was working in adult care services for people with mental handicapps that was often one time of the month that was over looked until all of a sudden there was suddenly a light bulb come on that said oh yeah maybe i shouldnt be pushing this client to do so much work today because she is just not up to it. my mother worked at the same agency that i did but she worked with the more severely handicapped clients and she worked with one lady that would sit in her wheel chair and cry most of the day during her menses... they had to have a med nurse come in special during her time to give her her meds for her symptoms.

    i am not saying that this a an absolute answer to what is going on but puberty is rocky for neurotypical teens... my neice is turning 16 in september and we are just starting to get off of the emotional roller coaster with her!!

    is your daughter verbal? can she communicate her feelings and how she is feeling in general?

    my son is only just turning 5 and is already the aggressor! we do alot of body brushing and massage therapy with him... joint compressions and whatever else relaxes him. we have picked up alot from isaac's OT and if sarah (by the way, that's my nasty post puberty neice's name as well) is doing OT they may be able to give you some suggestions if you havent already got an arsenal of the them!

    anyhow, its just something else to consider good luck with finding an answer and until then... maybe consider having her ride in the passengers side rear seat of the car

     
    Old 07-20-2006, 07:26 PM   #6
    Liz Cook
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    Re: Adolescence and aggression

    also and i hate to suggest this but if the aggression does not subside... you might consider getting a course on mandt or pac or whatever you local restraining class is called in your area. i would atleast make sure that the service workers working with her know some sort of restraining procedure. its sounds worse than it actually is and there are laws and agencies have very strict policies on when it is ok to use the manuvers... which typically is when the worker or another person is in immediate danger or when the person being served is in immediate danger of injuring them self for example if a person was trying to run into busy street if they didnt immediately respond to a cue to stop then the provider with that person would do what would be called a "take down" and then there would be tons of paper work to be filled out when i worked in the agency i worked at it was standard procedure to be taught PAC (potentially aggressive client) manuevers but i actually never used any or saw any be used for the whole 5 years i worked there... and i worked with aggressive clients who came out of institutions where they were abused...ALOT... and could be very violent. but the thing is to remember that even though it sounds harsh its a last ditch effort to avoid injury not the first step to prevent it. in PAC we were taught not to even restrin someone for throwing objects and just to deflect them and get out of the way its not about keeping them calm at all times its about letting them have the opportunity to defuse the situations themselves and move on but also being prepared to protect them and others around them from severe injuries. we were taught how to get out of hair pulls and clothes grabs etc... without anything more than releasing each finger... and bites! very important around here by pushing into them which is opposite of what your instinct is i know but that prevents further damage and also if you back a person into a wall with your arm or what have you across their face so that you dont get hurt they are very likely to release quickly because then you are in their space. there is more than just restraining taught in a good class there is also behavior modification and tricks and what have you to prevent the use of restraints.

    anyhow... once again... something else to think about but if things get worse for sarah and not better it wouldnt be bad idea to look into getting providers with this training so that she can keep her services up and they service providers dont have the excuse that she is too violent to work with... because trust me if she is living at home in a supportive atmosphere then she isnt too violent to work with. the institutionalize clients i worked with had stories that would make anyone cry... the institution that was local here and not shut down until 1996 (i worked with a few clients from there) fed clients in troffs (spelling...) and there were sexually abused clients, and one i worked with had his hip broke... and one my mother worked with would have been high functioning except he entered the institute when he was 7 or 8 and his actually paperwork from there said that they "would break his will"... so when my mother worked with him he had flash backs and violent outbursts and would fling his feces and was generally in mental anguish all of the time. but he still received services and if i may say so my mom did a heck of a job at it. she was the only one in the building who could work with him and she never had to use PAC either

    and i am rambling but i get pretty heated up about abuse so i rant but there is no excuse to loose services if it becomes a more pronouced problem and this is something to keep in mind if they waffle on it. sarah will only get worse if it works to get out of stuff and she will get worse if there is something going on that is keeping her aggitated too... yep... ASD kids... ah yes this is the life...

     
    Old 07-21-2006, 08:37 AM   #7
    Sarahsmom
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    Re: Adolescence and aggression

    I am quite POSITIVE it is puberty!!!! You are 100% right -- it is hard enough on typical children/adults to deal with menses, but for her, it seems to put her in a complete hormonal tailspin. I have been a "behaviorist" since day one -- 6 years of ABA in the home/school and an ABA consultant every school year, so I am always looking for a pattern, simlar antecedent, common trigger. The vast majority of aggressive incidents happen just before or during her period. I put her on birth control in the hopes of controlling the hormone levels, and it also prepared me because I know when it is coming -- give her tylenol before, etc. But, the incidents are not soley happening around her period, but I am sure they are a big contributing factor. I am very encouraged to hear that it seems to level off around 16. Just hope I still have some hair left by then!! Her last incident was not around her period.

     
    Old 07-21-2006, 03:54 PM   #8
    GatsbyLuvr1920
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    Re: Adolescence and aggression

    Quote:
    Originally Posted by Sarahsmom
    But, the incidents are not soley happening around her period, but I am sure they are a big contributing factor. I am very encouraged to hear that it seems to level off around 16. Just hope I still have some hair left by then!! Her last incident was not around her period.
    I just had a mini-blowup today, and I'm almost 19, and it's nowhere near time for my menstrual cycle. For your daughter, it may be menstruation, but I don't get PMS. For me, it's more like CMS- Constant Moodiness Syndrome. I can't explain what sets me off sometimes, but it's nothing hormone-related. I've been moody and having tantrums since age four. It's better now that I'm on Lamictal, but it's my Asperger's, that I'm sure of...
    -GatsbyLuvr1920-
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