Tag Archives: guanfacine

New Order

The Captain has been varying in mood and irritability.  We can definitely say he is better than he was before the risperdal, but he still has his moments, and quite a few of them.

On Tuesday, we discovered that he has been blackmailing his brother for an undetermined time (a while).   Apparently he would hold any slipped swearing or other indiscretions against him, promising to tell me about it unless his brother lied to me about the fact that they were both playing with a certain neighborhood kid they weren’t supposed to be around.

Both of them lost the privilege of independence – the ability to go to the park or convenience store, etc., by themselves.  For the blackmailing portion, I said we would talk to the psychiatrist since we had an appointment the next day anyway.

The Doctor prescribed a new regimen for discipline.   No more punishments!   Really, it was just a re-wording of discipline.  He said that they have the clothes on their back and three square meals a day, and everything else is a privilege they need to work for.   Also, no video games/TV/etc. during the week – only on Saturday (not Sunday), and only if they’ve earned enough points, and even then, only for a limited time.  He suggested a half hour.

Also, he said to lock up food treats, so we got a lock for the fridge and for one cabinet door.

The Captain took this surprisingly well.  Amazingly well.  I think it must be because it was coming from a higher authority source in his mind – The Doctor.  His brother made a scowly face, but accepted it well, too.

The part about points was a little vague, so we stayed up late last night trying to determine what gets points, and how many points they are worth, and how many points are needed for the electronics privileges on Saturday.

The Doctor also recommend a two-week reward and a four-week reward if the previous time was judged to be good… I’m not sure how that fits in with the point system exactly yet.

What The Doctor doesn’t realize, because it’s never come up, or we’ve avoided bringing it up, is that these boys are oversaturated in video games and computers and movies.  Up until this point, they’ve largely been unschooled, due to the problems we’ve had with The Captain trying to implement a true curriculum.

Today, they begin with a more regimented schedule, with Spectrum workbooks for math, science, writing, vocabulary, and geography, as well as multiplication and division flash cards, and U.S. state flash cards.   We also got a game that teaches about human anatomy.   This is not the ideal curriculum – this is the cheap curriculum to get them used to structure.

For fear of them literally not having anything to do, and rebelling from the whole system out of boredom, we also got them new lego sets and some playing cards.

Last night, The Captain spent the night at Grandma’s, who has been apprised of the situation, while The Explorer stayed home.   Each will have their chores and schoolwork separately, and perhaps that will help ease them into this transition.

Meanwhile, The Doctor added guanfacine back into The Captain’s regimen, starting a 1mg for the first week, followed by 2mg the next, 3mg the next, and finally 4mg.     Thus, he is now on 3mg of risperdal + 1mg of guanfacine, and 5mg of melatonin at night.

I’m at work, but look forward to hearing how their days went.

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The New Doctor

After leaving the in-patient program, we had an introductory session with his new local therapist, followed by an appointment with the new psychiatrist the next day.  The new diagnosis left off the anxiety disorder bit and focused more on the moods and the pervasive development disorder, thus his current diagnosis is ADHD, bipolar, and high-functioning autism.

The Doctor reviewed what the hospital had prescribed (prozac, focaline, guanfacine, and desmopressin) and could not believe it.  Apparently some of these medications could interact with each other in dangerous ways, and some would not show improvement for a month.   He took him off everything, and switched him to just use Abilify.

Within days, he was back to “normal” and the chaos had returned.   At one point, he actually asked for his old medicine back.  The Doctor had said we should start low and move up, though, and that the mood and autism needed to be treated before the ADHD.

The In-Patient Program

The Captain’s hormones finally kicked in full force this spring, when his days and nights became a constant struggle, and his rages became completely uncontrollable.   Up until then, we had been able to “handle” him.  He has been homeschooled/unschooled and unmedicated since second grade.

The current state of the home is unbelievable.    We could no longer let his older brother, The Explorer, share a room with him, because all of The Explorer’s possessions would become destroyed just like The Captain’s.   We moved The Explorer and his stuff into our bedroom, and The Admiral and I out into the living room.   That’s right, we now sleep in the living room.   We are working on renovations to the rest of the house to allow us to be in another space, but until then, we are at the mercy of the living room and its lack of privacy.

Still, his behavior persisted and his rages over any little thing escalated, and his violence towards his brother exploded.   He punched, hit, and slammed The Explorer’s head into a desk.   We were at our wit’s end.

Finally, we made an appointment and took him to a local (but not close by) hospital’s adolescent behavior wing.  Security guards nearly had to drag him in.  After some hours of waiting and little feedback, we had to wait a few days until they decided to accept him into the in-patient program.

For three weeks, he spent his days at the in-patient day program and his nights at home.     He never displayed his rages or aggressive behavior while at the hospital, but based on our reports, the psychiatrist still diagnosed him as having a mood disorder, though he would not specify.   In the end, he was diagnosed as having ADHD, a mood disorder, an anxiety disorder, and pervasive development disorder.

Immediately, they started him on Prozac (for the anxiety) along with Desmopressin (for his enuresis).   His hyperactivity was still in high gear, and perhaps worsened, so they added Focaline to the mix.  Doses were changed, timings of medications were changed, but nothing seemed to help.   Nights at home were better some nights but chaotic on others.

In the last week, they added Tenex (guanfacine) to the mix, and at last, this seemed to normalize him.   He was able to attend homeschool group without throwing tantrums or attacking other kids.  He was able to focus and seemed genuinely happy.  He also learned a few “coping techniques” that he talked about (mostly things to do with his hands when fidgety).  He even stopped wetting the bed some nights (but not every night).

He was good enough to come home, they decided, and we were to meet with a new, local psychiatrist and therapist duo in a few weeks.