My daughter has had multiple disgnoses for her behaviour problems, and keeps refusing her medication. Please help.

My 13 year old daughter was diagnosed with ADHD in 2007. She was prescribed Ritalin which, for purposes of concentrating, was helpful for her academics, however her outbursts of anger were off the charts. We took her to see a child psychiatrist who diagnosed her with an anxiety disorder and prescribed her Risperdal. In the summer of 2009 she decided that she wasn’t going to take her medication anymore (this due in part of being told really bad things about the medication). My daughter for the past year, has runaway, threatened suicide, continues to put herself down, hates herself, negative attention seeking etc. I have had in home intensive therapy, and various social programs through her school implemented as well as a very structured behaviour modification system at home. She has an Individual Education Plan at school and excellent support at home however her behaviour has gotten worse. I’ve had to take her to the mental health clinic in the hospital a few times where another psychiatrist diagnosed her with depression and put her on Cipralex.

She took that for a couple of weeks and stopped. We were referred to another psychiatrist who diagnosed her with Tourettes and ODD (ADHD was historically diagnosed). Now my daughter is on Wellbutrin, Risperidal, and Vyvanse.  Her behaviours have not changed, the Wellbutrin has made her extremely ill so of course I have called the psychiatrist and waiting to hear back. My daughter’s eyes twitch really bad, and she continues to make these strange sounds. She won’t eat, and due to the Children Law Reform Act she has to volunteer for any outside help we want to get her with respect to a treatment plan because she is 13. I feel like my back is up against a wall and I don’t know what to do for her anymore…..please help us.

Thanks for your note. I can understand why you are frustrated and confused.

You and your daughter need to have a comprehensive assessment and treatment plan. It is absolutely necessary that your daughter be a full partner in the making of the plan. If she is not a partner, she will not cooperate and the plan will fail.

The key is to get someone to help you organize and carry out this plan. Specialized medication and combinations of medication are being used.  Consequently, an adolescent psychiatrist with special knowledge of drug therapy is the best. A clinical nurse specialist who works closely with the child psychiatrist or her family doctor working together would also work.

Each trial of medication needs to be carefully evaluated. It may take several adjustments of the doses of medication to find the right dose. Any positive effects of medication always needs to be balanced against negative effects. When 3 different types of medication are being used, it is particularly difficult to evaluate.

Non medical approaches also need to be used along with medication. Assistance from a psychologist or social worker may help your family and your daughter to work together. In addition, you may find that a patient group may help. Your daughter’s psychiatrist may help you connect with other families.

You are not giving up on this situation and your perseverance is critical in getting the best care for your daughter. Your love and support of your daughter will be the most important factors in her recovery.

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