| Intermittent Explosive
Disorder
Question 1:
I have a 15 year old son in Boys Town, he apparently has an intermittent
explosive disorder. He is on medication which seems to help a lot but he
still refuses to do school work and gets into fights both physical and mental
and verbal. He is in danger of being expelled from Boys Town mainly
because he refuses to do his school work and continually disrupts the rest
of the class. There are only 6 children in the grade 8 class. He has been
a handfull most of his life and has been expelled from 7 schools and we
removed him from 5 others before it was too late. We are now at a dead end
again what to we do.
Reply:
Sometimes what appears as discipline problems
are symptoms of a pathology. Your son
has been experiencing these problems for a long time it seems.
What is the diagnosis and what medications is
he taking? Is he getting any therapy
to manage his anger? Not knowing
the complete history, the only suggestions I can make are that he
needs to be evaluated by a psychiatrist. Get a second or third opinion
if you are not seeing any change in your son's
behavior. Individual and family
counseling is also very necessary.
Do give me some more details.
Regards
Raafea Malik MD
Question
2:
Thank you for replying. (Name) is on 600mg Convulex and Zoloft. He has attended therapy for many years. He still gets therapy
at Boys Town. He doesn't stay at home at the moment, he lives at Boys
Town. We all went to therapy and we have a good home environment. The
therapist all gave up on him. The psychiatrist has tried many medications;
this one seems to be the best. He started on Ritalin when he was 4. He is
a loving child but can't control his impulsive behaviour.
Thanks again. Waiting for your reply.
Response
2:
Impulsivity and aggression are also
present in Oppositional Defiant Disorder, BiPolar Disorder,
Manic-depressive illness and ADHD. These
disorders need to be ruled out. Your
son’s psychiatrist should be able to do that with the history of the
disorder. Talk to the
psychiatrist and see if he/she has ruled out these disorders.
Mood stabilizers like Depakote or Lithium can control impulsivity
and aggression in most cases. If
a mood stabilizer has been tried in the past, and it did not improve the
condition, I would suggest trying an anti-psychotic medication.
It is always a good idea to get a second opinion if the treatment
is not satisfactory… meaning that you don’t see a change.
Regards
Raafea Malik MD
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