Twelve-Year-Old Has Fits of Anger

The mother of a sixth-grader describes her son's out-of-control behavior and asks what steps to take next.
Our 12-year-old sixth-grader is falling through the cracks in the public school system. We've attended IEP meetings and he has had some special need programs with no results. He sees a psychiatrist every two months for medications and a private psychologist weekly for support. All these things are not helping him or our family.

His behavior is inappropriate for his age - he acts like he's seven years old! He's getting progressively worse and it's totally upsetting the dynamics of our family. He constantly wants to be in control and has daily fits of outrageous, uncontrollable anger where he becomes a completely different person. He has a hard time calming down during these fits and we're afraid that he will hurt himself or someone else. He's remorseful after the fact, but then he forgets what he did. At home, he repeats this behavior over and over.

What in-patient facility in our area will give him a neuropsychological evaluation and monitor him daily so that we can figure out what is going on?

Maybe only a modification in his medication is needed, since he's currently on 30 mg a day of Ritalin®. This is the only medication that has ever been prescribed.

We need advice from the professional community to see what's actually going on in his head.

Sounds like you have a lot of reasons to be concerned! I can't give you specific advice about what's available in your area, but I will give you some general advice that other parents in similar situations can also use. I would first ask all the professionals who are now involved with your son to meet to discuss their treatment of him, and to work together to create a better treatment plan. I would like to know if he's exhibiting the same patterns in school. If he's not, then find out what the school has been doing to help him have more self-control and fewer outbursts. It may be that structure and clear expectations are helping him during the day, but he may be falling apart at home.

If that's the case, you should ask the school or your health plan to send a behavioral specialist into your home to observe the interaction between you and your son, and give you practical advice and support to help you deal with this behavior. If your son is acting this way at school and at home, then he probably needs more help than he's getting. It may be that more frequent therapy is indicated. Since the behaviors have not improved, your son may indeed need to have his medication re-evaluated. Encourage the psychiatrist and the psychologist to communicate with each other and tell you what they think should be done.

If you have tried all the things I have suggested, then ask the psychologist, the psychiatrist, or the special education administrator to refer your son to a psychiatric hospital for a more thorough assessment of your son's emotional status. Some hospitals offer a short-term in-hospital assessment that will help you pull all the pieces together. This kind of in-depth assessment should also rule out any other medical problems that might be causing your son's dramatic outbursts. The assessment team can also help you assess your family's ability to deal with him at home and help you decide whether his needs would be better met through some intensive family therapy or perhaps a stay in a residential treatment center.

Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.

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