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

[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.