Question:

My 11 year old son is diagnosed as having bipolar disorder, ADHD, and Oppositional Defiance Disorder. He is currently in a Santa Barbara County special education class for emotional disturbed children. Last year he was hit by a car and had a traumatic head injury. He is failing miserably in school. The behavioral issues are really bad and he is suspended on an average 2-3 times a week. I am very concerned about his lack of getting an education and I understand there is only so much a school can do. I have had countless IEP meetings, behavioral contracts, counselors, etc. I really need help and what the next step is or what I can get from the county or state. My son is extremely bright but his behavior prevents him excelling. He goes one step forward and two back. He was hospitalized this past summer for trying to kill himself, now he said he was just kidding but it was very serious. He is always picking at scabs, and trying to hurt himself. He can be very sweet but he has a really mean side and I am afraid he is seriously going to hurt someone.

Could you please help me!!!

Sincerely,
Kim Anderson

Answer:

Dear Kim,

I have asked my colleague, Marji Stivers, Ph.D. who is a clinical and school psychologist, to address your question because it extends far beyond simply behavior. I would also suggest that you ask your district to refer your son to our sister-center, Diagnostic Center South in Los Angeles ( http://www.dcs-cde.ca.gov/) because he is the kind of complex student we see. Here’s Marji’s response:

It sounds as though you and your son are facing some incredibly difficult and painful challenges. From your letter, I’m not entirely clear about the nature of your son’s disabilities or the services he is receiving. You mentioned that he has an IEP, attends a special education class, and that you and he have encountered a variety of
counselors and behavior plans. I will do my best to describe the types of assessment, supports, and services that are appropriate for the situation you describe. If any of these evaluations and services has not been offered, you may call another IEP team meeting to request it.

1. Is your son receiving good mental health therapy and psychiatric services? These services should be available from your county mental health department through a referral from his school district. If you have private insurance and prefer to use the providers on your health plan, you have that option. If you are not happy with the services provided, do not hesitate to obtain second opinions or switch providers.
   
2. Is your son on any medications that target attention, mood, or behavioral control? Have the medications been fine-tuned (doctors use the term “titrated”) for maximum benefits and minimal side effects? Is a physician trained in child psychiatry monitoring his medications? Is the physician receiving feedback from you, your son, and school personnel about changes in targeted behaviors?
   
3. Has a neuropsychological assessment been conducted to determine the specific functions affected by your son’s traumatic brain injury (TBI)? Is he receiving rehabilitation services based on the assessment results? TBI can have a wide variety of effects on processes such as attention, memory, sensory-motor integration, and other abilities. A thorough assessment can help pinpoint the deficits. Based on results of the evaluation, a good treatment plan should be developed that includes teaching your son strategies to compensate for deficits, providing necessary accommodations, and exploring other ways to minimize the impact of deficits. It is important to examine the potential links between any cognitive deficits he is experiencing and his behavioral difficulties.
   
4. Are the behavior contracts that have been tried based on a functional analysis of your son’s behavior? This is a very extensive examination of the reasons for his behaviors -- the needs that are met by behaving the way he does. A functional analysis of behavior results in a plan that supports him in learning and using other strategies to meet his needs. It is important for the plan to take into account the results of the neuropsychological evaluation. Deficits in memory, attention, or processing information from his environment must be considered in developing the plan.
   
5. If counseling and other services have not helped met your family’s needs, your son may be a very good candidate for “wraparound” services. These intensive services are for families of children who have not been sufficiently helped by other mental health services and are in danger of residential placement because their schools or families cannot manage their behavior. Under the wraparound model, professionals and families collaborate in developing a family plan and the wraparound staff works with the child at school and in the home, whenever and wherever the need is greatest.

I wish you the best and hope that this information is helpful.