Dear Abby: Mom Is Desperate to Stop Teen's Violent Outbursts

[cereta]

DEAR ABBY: I'm a mother of two boys, 13 and 12. My oldest son has become very abusive, both physically and emotionally. He has been arrested for hitting me and hitting his little brother. He was recently kicked off the bus for hitting another student and has also been locked out of school.

I have tried therapy and medications for him, but he hasn't changed. I'm at my wits' end, ready to give up and hand him over to the court. He has both parents and a loving home. I don't know what to do anymore. I love my son, but can no longer do this. Please tell me how to help him! -- LOVING MOTHER IN TENNESSEE

DEAR LOVING MOTHER: Much information is missing from your letter. What triggers your son's violent episodes? Could he have a learning disability? Is he being teased or bullied, which might explain why he hit another student? Has he been ill, or could he have sensory integration difficulties?

At 13, it's too soon to throw up your hands and give up. Because therapy and medication haven't helped your son, I would have to ask what kind of therapist has been seeing him. When treatment doesn't work, a patient may need a more comprehensive assessment -- a second opinion or even a third. My suggestion would be to take him to a teaching hospital. And while you're there, please consider asking about some support for yourself because you have a lot on your shoulders.

Comments

[cereta]

This is one where I want to see others' reactions before I respond.

[the_rck]

I want a lot more information, but... There's a massive red flag on the 'arrested for hitting me and hitting his little brother' in terms of this being an active danger to the people living with the child. It implies potentially serious injuries, and may not be a thing that can safely be lived with while seeking help, especially not for the younger child. The same description of behavior from, say, a domestic partner would bring quite different advice.

I'm also puzzled by the combination of 'he has both parents' with zero mention of what the other parent is doing about the situation. The LW sounds like all the work of dealing with this and trying to get it treated (and authority for making decisions about it) rests on her.

I'm not sure that 'just keep trying and try harder' is adequate here. I suspect that the LW is understating the problem.

The LW also doesn't mention insurance/cost. Surrendering the boy to the court might mean the state paying for care/treatment but also often means a crapshoot about the quality of that care. A lot of insurers also won't pay for the sorts of testing that's needed here unless testing has already been done to show that there's a problem (one can run into this on other issues. "We only pay for testing vitamin D levels if you've had a previous test that showed low vitamin D levels. Otherwise, it's not medically necessary."). Insurers will also label such tests as 'experimental' and 'unproven.'

[cereta]

A lot of your first and last paragraph is what I was arguing on the Dear Abby site, especially the bit about the younger child. I don't know about anyone else, but I'm not sure I could restrain an average 13-year-old boy who was hitting his younger brother, not without one or the other of us getting seriously hurt. I would try just about anything before I took the step of surrendering the child to the court, but I can see how she'd get to the point of thinking about it.

[xenacryst]

Yeah, so much information that's missing from the letter (not to fault the LW - this, again, isn't something I'd go to an advice column for). Does he have any sense of what he's doing during these episodes, either at the time or after - or even before? Are these episodes a direct response to provocation, or are they disproportionate to any triggers? Does he harm himself? What kind of specialists have they seen? - and I'm really curious there, because ten minutes with Dr. Wikipedia M.D. suggests that the description fits very closely with Intermittent Explosive Disorder, and Dr. Mayo Clinic concurs, and the fact that this wasn't mentioned in the letter makes me suspicious about the treatment he's received already (not saying it is IED, but a sentence along the lines of "we thought it might be IED but that didn't turn out to be true" would at least suggest that they'd explored the possibility).

[cereta]

It's worth remember that the group that makes up "Dear Abby" edits the letters for brevity. I could see that being exactly the kind of detail they would omit, on the premise that most readers wouldn't know what IED was.

[xenacryst]

There is that, though I'd consider little details like that to be worth including - it signals the readers that the LW has some clue what they're talking about (even if the readers don't know), and, in this case, could help educate readers about what Dr. Google considers an under-diagnosed condition. I mean, the Mayo Clinic page on diagnosis and treatment of IED is good reading regardless of if this is actually IED. I don't want people to self-diagnose from an advice column, but knowing that there are real conditions and treatments can be helpful.

[minoanmiss]

As You Know, Bob, my household is dealing with a not-dissimilar situation. I really wish I could send this parent some suggestions and many hugs. There's so much detail that we can't know from a brief letter, but one thing is obvious: this family needs more and different help. And such help is out there. But/and it's taken us years to even begin to find it.

I actually don't think the teaching hospital idea is a bad one, not least since they will have connections to a great many other resources.

Also, there are ways to be trained in how to restrain an angry adolescent .... not quite *safely* but with less risk of serious injury. But this requires actual training from actual professionals.

I wish this parent and her family all the best. I know more than I want to about where they are.

[jadelennox]

A friend of mine has been having some terrible problems with her child of the same age, and MassHealth has been a wonder, paying for in-home care and inpatient treatments. But TennCare is notoriously one of the worst public options in the country, and I worry about the limited options available to the LW. I'd want the LW to have options like in-hope support and inpatient care before she gets to the more severe options.

If she's anywhere near middle Tennessee, Vanderbilt University Hospital has some fabulous support for low-income patients, but I don't know if that includes pediatric mental health.

I know so much about the intricacies of shitty insurance and adult or child mental health care that it's hard to treat this like a normal advice column letter. In fact, it shouldn't be a normal advice column letter. This is a job for a specialist in the legal and financial and medical options available in Tennessee, and the LW should call the Vandy children's hospital, which is top notch, and get advice about where to go for advice.

[minoanmiss]

Not for the first time I wonder if there's a way to give this kind of information to the columnist to pass on.

[shirou]

What an awful situation. I have nothing to add except that the mere fact LW wrote to Dear Abby shows she isn’t getting help from the right places.