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Hi Spudeen,
So the situation is that your 8 year old son is demonstrating outbursts of aggressive behaviour towards his family and self-injurious behaviour in the form of self-strangling and punching himself. These behaviours are confined to the family environment and he’s functioning ok at school although he has some difficulties with his memory/reading/writing.
He reports that he experiences a voice in his head telling him to hurt you, and although you’ve accessed your GP CAMHS have not picked up on him.
First up, the decision by CAMHS not to pick up on this baffles me. As has been mentioned in other posts here, this is not a forum for diagnosis but anyone reporting voices instructing them to hurt others may well be experiencing a metal health difficulty. This is not the only explanation, but regardless is a very worrying sign.
I cannot say why this is happening with your son but clearly there is something going on that requires urgent attention. Given the features you describe it would not feel inappropriate to me to bypass the GP and CAMHS and access a mental health crisis team directly. The issue may not be one of mental health, but some form of support service needs to get involved to assess his needs and work out what is going on. You have said that TAC is involved, what’s their take on this? If CAMHS are not involved then who is? As you have done here, write up a document detailing (bullet points if necessary) what you are experiencing and what its impact on you is. Send it through to any relevant professional involved with you at this point, requesting urgent help.
In the meantime you’re faced with the situation of a volatile young man showing aggressive behaviour towards you and self-injurious behaviour.
Manging this is tricky, there’s a lot I’d want to know before putting a plan together with you. A lot depends on his insight into his behaviour, his communication ability etc.
Were this a case I was working on one of the first things I would do would be to begin drawing up a list of flashpoints or what we would call antecedents- situations or events that are likely to lead to an incident. Things to avoid where possible. This will help you plan out your day so that you can anticipate difficulties and structure your time to avoid them wherever possible. The truth of course is that there are many things you cannot avoid, but starting to draw together the situations where behaviour is likely will begin to show you common themes and start to put a picture together of the all-important question – why is this happening. If he has insight into his behaviour (i.e. you can talk about incidents with him and he can give you any clues as to why their happening) then this is something you can do with your son- if you feel it’s appropriate to do so.
Next up you need to work out your plan when there is an incident based on a key principle – ending the incident as quickly as possible and keeping everybody safe. When your son is experiencing an outburst it is likely that he is not in a rational state of mind. When we get angry or upset our ability to think and reason clearly is impaired. Strategies that revolve around putting in boundaries or trying to argue with someone that their behaviour is wrong and needs to stop will most likely lead to an escalation or continuation of an incident. As difficult as it is given the huge emotional involvement here and the stress that an incident causes (which will overwhelm your common sense) you need to plan through how you manage an incident in a calm safe manner that is predictable for everyone involved.
Specific examples are tricky here – I cannot advise you directly without assessing the situation so I will have to be broad in my guidance.
If he is becoming aggressive towards you it may be beneficial to attempt to acknowledge that he is hearing a voice (if this is what is driving the behaviour) and to attempt to have him communicate what it is saying either verbally or by getting him to wrote it down or express it in some manner.
It may be more beneficial depending on the level of distress he is in to shut off all communication – which he may find only ads to his stress – and leave the room. Give him space to vent his feelings on objects that don’t have feelings.
When he is calm and open to discussion (if he is able to do so) then you can engage with him about the voices, what they say and whether he has to listen to them or follow their instruction. Devise a strategy with him for expressing what they say and out letting that in a calm manner to prevent the build-up of stress. In a perfect world he can be taught to recognize when his stress levels are building and take the best action. He could learn some calming techniques and learn to utilize them with you. I am currently working with a parent who experiences an explosion of agitation and anger from heir son when he returns home from school. We’re in the early stages of teaching him to engage in a mindfulness/relaxation exercise when he returns home with his mum to head off the stress he feels and holds onto from school.
Ultimately however this cannot be resolved through good management. However well you avoid or manage the difficulties, whatever is driving them will not simply go away. The difficulty for me is that the information I have here is not sufficient to work out what is going on. Your son needs a comprehensive assessment to identify is this an issue with his mental health, is there an underlying difficulty of which the ‘voices’ are a manifestation?
There are things you can do, working out a plan for avoiding and managing incidents will help to a degree and engaging with your son and trying to find a way for him to express this feelings could be beneficial. But ultimately you need to return to the school and the GP and demand some support. Do you have a social worker allocated?
Document what you are experiencing. Forward this to the people involved including the school. Pressure on services is immense, don’t let yourself be drowned out.
I hope that is of some help, I realise that it must be frustrating for you that I cannot say “Ah, this sounds like xx, so you should do this….” I will look for some supportive information for you and send it through.
Will
Hi Spuden,
These are very challenging times for services, so I’m going to steer clear of laying blame on anyone’s door for not responding quickly. Similarly it’d be easy to look at the info you’re giving and come to a set of vague conclusions ‘Probably Autism, why doesn’t the senco realise this?’ Etc. But in truth what you have here is a complicated picture where the behaviours and presentation you’re describing could have multiple explanations or a combination of explanations. Even if you detailed everything possible you can think of it still wouldn’t be enough to reach a conclusion- that can only be done through assessment which has lots of features such as observation.
It does sound like services are involved and things will inch forward at their own pace. Don’t be discouraged and back off from accessing help, certainly don’t find a way to muddle through and just service. Your 8 year old will one day be 18 and these difficulties may still be occurring. Early intervention is essential.
Document everything that is happening to you and the impact that it is having. Forward this to the school, to the GP to any professional involved. Don’t give up.
Regarding the mental health crisis team. I want to stress again that reporting voices does not automatically mean a mental health problem. When working with people with autism and learning difficulties I have met you ng people who appear to report ‘voices’ but this can simply be a confusion about their own internal monologue. For example repeating bits of TV and film dialogue. It could be this young person’s means of expressing complicated thoughts and feelings.
Having said that, hearing voices, particularly ones that talk about hurting people is not something that should be ignored. If this was presenting to someone known to me and it was having an immediate impact on those around them I may (in the process of engaging the appropriate teams and working to rule out possibilities) contact support teams for individuals experiencing acute mental health issues. A quick google of Lincolnshire mental health crisis team bring sup their contact details and how to refer. Now they may not view your situation as a crisis. Your son is functioning well at school form what you’ve said and (I do not wish to be dismissive here) an 8 year old poses much less of a ‘crisis’ than a 21 year old man experiencing a breakdown. But it is a crisis for your family and requires intervention. If CAMHS haven’t picked up on it through the GP route then possibly this could be a springboard for some intervention. If Not then as you say TAC haven’t become fully engaged yet, and when they do they may be able to steer you correctly. If nothing else then return to your GP, document everything and make clear the impact.
Just to go back to the nature of the difficulties themselves, you say that school are having no issues – certainly not to the degree that you are at home. That is a really key thing. If these difficulties stem from a functional difficulty (you have not mentioned any diagnosed learning difficulty or other significant issue) then it would be expected that within reason the presentation of difficulties would be consistent across settings, certainly if demands are a factor as these should come up frequently in school.
What this suggests is that there are situational variables here – in some environments he is better able to function than others.
One thing to consider, without getting out on a diagnostic limb, is that anxiety can be a factor in many behaviours. In school environments tend to be more structured and routine and this can be to the benefit of individuals who struggle to manage their time, regulate their emotions or understand what is happening. In a perfect world you could drop into school and see how your son responds in this environment. School may be up for that or they may not.
Either way I’d consider trying to support a greater routine and consistency in the evenings. Making use of visual schedules/timetables to outline what is happening each evening. This may not be appropriate, but is possibly something to explore.
The scenario where there are no issues at school but they erupt at home is quite common for me. There is a fundamental difference in relationships between family and ‘staff’ with all the emotional weight that comes with it. The phrase ‘it’s his mother who gets it’ is one I’ve heard pretty often over the years. It’s also a situation that I’ve seen change dramatically with the right understanding and the right intervention.
Good luck. Keep me posted and if you have a specific scenario you’d lie me to advise on hen please let me know.
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