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Forum Name: Psychiatric Topics

Question: child with behavior impulse problem


 jeriby3 - Tue Jan 20, 2009 9:03 pm

my daughter is 9 almost 10..we have been struggling since she was about 3 to get her help and figure out what going on with her. she has been labeled adhd and is currently taking vysavan(?) and zoloft...she is very impulsive and lies steal sneaks getting punished for bad behavior doesn't do anything.. she keep on doing the same things over and over again.. taking things away such as ideas,tv computer and hangin with friends does bother her..her mouth doesn't stop..she says i don't care, i'm stupid,if you don't i'll kill you..she will lie right to your face when asked if she didn't something wrong.. we are very frustrated.. we when threw a behavior clinic and did many test and they didn't come up with anything to help us.. they said cousling..but they never gave us a counseler that could handle such a diffecult problem...the relationship between her and us isn't really up and down.. i don't know what to do any more.. she gets so out of control with saying such mean hurtful things..and doesn't listen complains all the time and hates school and anytihing to so with having to do with school work.. we have read many different book and used diferent things in each and it seems something will work for a bit then she figures it out and we are back at square one... we have taking parenting classes and tried different ways us going about displining her but that didn't work either.. we are very consistent with what we do..even though it doesnt' seem to work.. please help us.. thanks
 Dr. E. Seigle - Thu Feb 05, 2009 4:33 pm

Hi Jeriby3,

In general, children such as yours with problems including lying, defiance, threats to harm herself or others, and impulsivity, are suffering from a combination of having experienced stresses in their lives which have been very difficult (often in infancy, toddlerhood, and later years) and the stresses can tend to be longstanding. ADHD (Attention Deficit Hyperactivity Disorder) is often diagnosed. In addition, children such as yours who can be very impulsive, after being disciplined, reprimanced, corrected, punished, yelled at, or simply experienced negative reactions from the adults in their lives often, tend to have low self-esteem, anger, and feelings of shame and worthlessness. They often feel "different" than other kids. The relationships between parents and children such as these can often become quite strained, even though their parents clearly love them very much, and the kids love their parents as well. The relationship interactions often become quite automatic, with both child and parent reacting to one another in very instantaneous and repetitive ways that trigger one another, and in which each feels misunderstood, frustrated, angry, and at wits end. Underneath their anger, children such as yours are usually desperate to succeed, to be praised, to be successful, and to feel loved and accepted (even though their parents do love them very much).They often become afraid to try to behave better or succeed however, and instead act negatively in order to establish a sense of safety; better to "fail" by choice, than to try to succeed and feel as if they've failed when trying their hardest. This captures the way some children such as yours can feel.

So, what to do about all of this? Firstly, if you haven't alreay done so, consider consulting with an experieced psychiatrist or psychologist who primarily specializes in working with children and their families. Ask for a thorough evaluation (see below). In general, both the parents as well as the children need to make changes, so most practitioners will work as often with family members as the will with your daughter. Be cautious of someone who just sees your daughter, or only prescribes medication as the only treatment. Medication for ADHD such as Vynase can work well for overactivity and short attention span, but more complicated behaviors such as lying or ingrained oppositionality don't change well with medications alone. The impact of SSRIs such as Zoloft for complex behavioral-emotional problems such as your daughter's can be quite limited, if they work at all.

Family oriented treatments are usually needed, and these might include parent guidance, individual therapy for parents, couples treatment, and family therapy. Treatment for your daughter might involve some individual sessions but also involve the practitioner being involved with the family, school and teachers.

Often, more than one provider is needed with a child such as yours, such as child psychologist, a family therapist and a psychiatrist.

To summarize, you might consider that your daughter have a thorough child psychiatric evaluation, which includes a family/parent assesment, as well as a psychological evaluation, that might include an IQ test, what is called projective testing, and if school performance is a problem, academic achievement testing.

After these evaluations, the providers should meet or talk together by phone, and optimally, talk with you about their findings from the perspectives of :

1. What family, social, life stress factors are contributing to your child's problems.
2. What genetic and biological problems might be contributing.
3. What psychological factors, such as your daughter's temperament, her personality, and her self-esteem, relationship skills with adults and peers, and her coping skills with which she handles stress and change, are related to the problems.

To find providers for your daughter, you could ask your pediatrician, school counselor, or local community mental health center.

Good luck, you clearly are working hard to help your daughter and are loving parents. Don't give up, problems such as these can be quite tough, but can improve.

-E. Seigle MD

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