school assistance

[bejs]

I have a teen son who has been diagnosed with emotional impairment. While quite smart, he has extremely limited insight, and is non-compliant with treatment efforts that have included 3 hospitalizations (non-voluntary, serious threats to hurt mother, deteriorated functioning, impaired thinking, non-compliance, social withdrawal and isolation, serious school failure with increasing attendance issues, episodes of catatonia), antidepressants with occasional antipsychotic med inclusion, various forms of out-pt counseling efforts (family, individual, in-home, father-son, mom-son). Generally, he projects all problems onto mom. He is considered to have mood disorder (depression with psychotic features), anxiety driven problems, R/O Asperger's (this was considered after meeting his father), R/O Schizophrenia (prodromal)

Our family is still recovering from father's leaving family, estrangement and alienation toward this child (youngest of 3), and his remarriage. Recently (summer and currently), father and this son have spent much more time together, while an older son has graduated college and moved back home. These structural changes have been helpful.

My current dilemma involves the school's request to meet with parents over a failing Chemistry class. There have been numerous school meetings, and I am out of new ideas. The school is requesting specific suggestions from me for handling my son, and I am asking that they be more clear about criteria for classes and eligibility because my son has signed up for as many advanced courses as possible. His reaction to the chemistry failure is to request additional honors courses before school in the morning. He tends to become grandiose and magical in his thinking (e.g. Chemistry is an intuitive subject that he already "knows", despite our best efforts to convince him this is a cumulative area of study - his brother majored in Chem in college), and is quite hostile when he does not get what he wants.
He has refused all assistance efforts on the school's part. The school does not know what to do next...

With persuasion, I have convinced his father to plan to attend this meeting. There is no hope of dropping this in Dad's lap, but I do support father's involvment. Their efforts to study together have not been productive academically, but have helped to create some relational glue. However, Dad, as a highly trained scientist (engineering, physics), seems to relate through academic achievement and also has limitations with insight and social skills.

This is a sad and draining situation (I am sad, drained and feeling frustrated and hopeless about helping him), I am looking for ideas to assist in my son's education, and must find a way to do so that places this situation back in my son's lap. He quickly becomes defiant, omnipotent, paranoid, and oppositional. He does not socialize outside of school and refuses to leave the house unless he has a specific need (i.e. I need to buy shoes now).
On the plus side, my son is bright and interested in learning (the trouble lies in organizing and homework) plays in the band, and has shown improvement through the increased connectivity with father and brother. He is socially relaxed with his brother and sister (she lives on her own, out of state). He can argue (well) and can present a paper or idea, will hold a position tenaciously (so if you get him to willingly do something, he tends to stay on it). He does not use drugs or alcohol, is not sexually active, has never "run" despite threats to emancipate himself, and has not committed any crime beyond assault threats toward me (he does make litigious threats to professionals, and tried to place me under citizen's arrest, however, and he does have an "open file" as a juvenile based on his behavior toward me, but no "record").

What has worked for others, I need ideas and help...

[bejs]

Because the post did not generate ideas from the forum, I thought I would share what happened.
After many deep breaths and a focus on hope:
I began an email chain with the school staff involved and worked to bring my son's father into the loop (he is generally very resistant). With some persuasion, he agreed to attend the meeting and we let him set the time and date, to encourage his follow-through and sense of control.
I sent the school staff three agendas to cover the focus of the meeting in the event that my son and/or his father failed to show. These were simple bulleted lists of priorities designed to increase my son's engagement. I sent these to the teacher involved (copies to support staff in guidance dept), who agreed to "run" the agenda. All staff were in agreement with these proposals.
My son failed to attend (left the school), we continued with "plan B" as outlined. With much encouragement, my son's father was pulled into the process so that he, teacher, and my son would manage/supervise assigned work together. Teacher and father will communicate by online structures used by the school, and school support staff and I will be sent copies of emails.
A contingency plan was organized (in-school tutoring, after school 3 days per week; escort to class by school staff if he skips class) if my son does not demonstrate improved functioning in the class.
Thus far, the plan increased the homework production by about 2/3 (still late, but better) , exposing a pattern of poor organization and minimizing, denying,blaming, or lying. The most significant factor in gaining my son's cooperation has been the involvement of his father, and his father's increased willingness.
I am relieved to be out of the crossfire, but am still informed. I will watch for any deterioration in general functioning, health issues, and see that he gets to/from school etc.
While my son said he would not cooperate and was angry at us for intruding on his school life, he seemed to also relax a bit and has been relatively cooperative. He did not decompensate, and seems to be in a more or less functional holding pattern (no meds at this time, so it is a situational and structural improvement).
I remain open to any ideas from Dr. Bradley and the forum, because this difficult situation will undoubtedly need all the help we can gather. I am especially interested in what parents and school can do to increase my teen son's engagement with helping modalities (we are growing a list of professionals who will no longer agree to work with him, so discouraging in a system that offers so little). Any and all your thoughts are welcomed.

[Mike Bradley]

Dear Parent,
I see two courses of action, the first of which you already handled beautifully. Working closely with your son's school is critical, and yes, despite his threats to the contrary, creating a reasonable demand structure around him (school supervision) will provide a calming effect. That's because even the "craziest" teens want to be successful and very much need limiters on their behavior.
The second course is to get him linked with a good helper. It upsets me that your son has apparently scared off some helpers with his threats of litigation and/or noncompliance. Folks who are adolescent experts are typically not terribly impressed with such threats or behaviors since we hear that stuff a lot (certainly a lot more than adult specialists). As exhausted as you might be, I'd urge you to keep searching until you find a helper who is better suited to a kid such as yours, or at least find someone who can coach you through this even if your son refuses to attend sessions. As overwhelming as your son appears to you, in the world of acting out teens he's not all that rare a specie.
Hang in there and please keep us posted.

[bejs]

Dear Dr. Bradley,
In your experience, what have been the most productive ways to seek ongoing help for a teenager who has serious emotional problems and is highly resistant to accepting help? He is hypersensitive and resistant to manipulative measures, does not tolerate affect-raising interventions. The school and we parents have come to consensus that an engagement model is the better approach with him. My son has a high anxiety component such that opposition, isolation, and disorganization are easily triggered, and there is a general reluctance by the school to use authoritarian measures.

It appears obvious that my son would prefer to do well, to have friends, and does try at times when there are school group projects that are assigned. His isolation and disorganization are serious, including in-home. He will not initiate interactions.

I realize the reluctance of helpers distresses you. I need approaches that work with providers as well as with my son. This is not just about getting my son to accept helpers, it is also about getting competent helpers to accept my son. I have interviewed extensively and sought supervision in selecting helpers, utilize help to assist in maintaining my own energy and perspective. I have consulted with university clinics, prodromal programs, and nonverbal learning diagnostics centers to look for compounding issues. These facilities all decline to work with him because of the travel required (a safety issue), his instability (compromises testing), and his involuntary status.
As someone said, I am in the stages of "flailing about looking for help". This will require a creative and intensive approach with someone really willing to roll up their sleeves. My experience is that others "care" to the extent that they feel effective, and my son uses that quite well to limit engagement. There has been a succession of psychiatrists, psychologists, and social workers. Some will no longer work with him, others will work with him if he becomes willing, some just take the money but do not provide a useful service. The county is willing to help if I can construct a meaningful program, but do not make recommendations beyond emergency hospitalization and in-home services (which was not effective and canceled him).
How can I best approach the helping profession, work with the system, to get ongoing help for my son? I do not have cash, but do have insurance (non-parity in our state).
Respectfully,
bejs

[Mike Bradley]

Dear Parent,
I have worked with some kids much like your son, and they are maddeningly great at defying all the best of attempts to help them. They provoke to a point just short of the line where treatment could be forced upon them, and they blow up every professional relationship you attempt to forge. If he crosses that line (with threats and/or unsafe behaviors) and you can get him into the juvenile justice system, a judge might mandate a treatment option that could help (a wilderness adventure program might be a thought). So if he threatens in any way, I'd immediately call the police.
Your second option is the mentoring concept. He might well benefit from a connection with a respected, older, male authority figure. That could be a relative, neighbor, teacher, minister, police officer, or therapist. Rack your brain to find someone who might make that type of connection with him to see if they can get your son to accept help.
Your third option is waiting, since time is on your side. As he ages, your son's brain will likely calm a bit and start worrying about that onrushing train headed straight at him, an irresistible locomotive called adulthood. As he gets closer to his age of majority he will be forced to deal with his lack of responsibility, a "privilege" that only works well for kids. He knows that as an adult no one will be obligated to care take him, and then he will have to confront his demons in order to feed himself. That's one message that he will not be able to threaten, argue, or "resist" away. Hunger and cold can be most therapeutic.
Good luck and please keep us posted.

[bejs]

Dear Dr. Bradley
You are reading our situation well, thank you. A couple of years ago I established a tiered approach with family,legal, school, and mental health providers. It was necessary to call the police several times (my son retaliated with citizen's arrest). This helped construct a minimum level of urgent intervention services. Due to assault against me, an "open file" was maintained until recently, and all adult parties regarded this as a mental health issue.
One useful strategy was to speak ahead of time with the local police and establish a relationship with one policeman who would become familiar attend each call, which helped limit further escalations during crisis.
Being new to the area and recently divorced, I also spoke to my neighbors (wives first) about requesting male assistance at times. One neighbor offered a mentoring relationship in areas of mutual interest, but my son refused him. However his presence was enough to help limit some rage. I have not gotten further with the mentoring concept (son is adamantly not willing).
In considering a wilderness program, I have looked at "therapeutic" camp and wilderness programs, motivational/social development programs, as well as regular camp programs. We have never been successful beyond day-camp (my other children eagerly attended various summer camps, and tried to encourage him). The specialized camps with services are hugely expensive. I have lost large deposits (made with hope months in advance) on these programs: kids like my son need to be stable and voluntary status. Additionally, the camps do not necessarily consider their programs to be generalizable.Wealthy families in the area apparently buy therapeutic mentorships with highly skilled therapists and schools, but I am not in that financial position. Sophisticated prepaid evaluative and treatment services are available around the country, but this is also way out of financial range - and they also want voluntary clients.
As you noted, time and some maturation (plus increased contact with father and brother) have provided a calming effect.
So, we seem to be in a waiting pattern, hoping that behaviors with consequences will eventually become sore teachers. I am fully aware that my son is not likely to be in a ready position to further his education, social ability, or work in the community, and it is scary that a prevention or restorative model is not available.
I am bewildered that I have been unable to find effective ongoing help for him, and discouraged that our family also was not assisted in managing. My son's circumstance has affected all of us, including those who no longer live at home. I am repeatedly told I must "find a way to talk him into seeing his needs..." as if there were actually words to do so. I was told by the 2nd treating psychiatrist that my son would "end up living under a bridge because he is just not committable". Yes, it is maddening, especially when it is 24/7, and it is heart-breaking. Thinking about his future is provocative, for sure.

[bejs]

Dear Dr. Bradley
You are reading our situation well, thank you. A couple of years ago I established a tiered approach with family,legal, school, and mental health providers. It was necessary to call the police several times (my son retaliated with citizen's arrest). This helped construct a minimum level of urgent intervention services. Due to assault against me, an "open file" was maintained until recently, and all adult parties regarded this as a mental health issue.
One useful strategy was to speak ahead of time with the local police and establish a relationship with one policeman who would become familiar attend each call, which helped limit further escalations during crisis.
Being new to the area and recently divorced, I also spoke to my neighbors (wives first) about requesting male assistance at times. One neighbor offered a mentoring relationship in areas of mutual interest, but my son refused him. His presence was enough to help limit some rage on one occasion. I have not gotten further with the mentoring concept (son is adamantly not willing).
In considering a wilderness program, I have looked at "therapeutic" camp and wilderness programs, motivational/social development programs, as well as regular camp programs. We have never been successful beyond day-camp (my other children eagerly attended various summer camps, and tried to encourage him). The specialized camps with services are hugely expensive. I have lost large deposits (made with hope months in advance) on these programs: kids like my son need to be stable and voluntary status. Additionally, the camps do not necessarily consider their programs to be generalizable.Wealthy families in the area apparently buy therapeutic mentorships with highly skilled therapists and schools, but I am not in that financial position. Sophisticated prepaid evaluative and treatment services are available around the country, but this is also way out of financial range - and they also want voluntary clients.
As you noted, time and some maturation (plus increased contact with father and brother) have provided a calming effect.
So, we seem to be in a waiting pattern, hoping that behaviors with consequences will eventually become sore teachers. I am fully aware that my son is not likely to be in a ready position to further his education, social ability, or work in the community, and it is scary that a prevention or restorative model is not available.
I am bewildered that I have been unable to find effective ongoing help for him, and discouraged that our family also was not assisted in managing. My son's circumstance has affected all of us, including those who no longer live at home. I am repeatedly told I must "find a way to talk him into seeing his needs..." as if there were actually words to do so. I was told by the 2nd treating psychiatrist that my son would "end up living under a bridge because he is just not committable". Yes, it is maddening, especially when it is 24/7, and it is heart-breaking. Thinking about his future is provocative, for sure.