Q: My son is 10 years old. He had a problematic birth (had to be revived after an emergency C-section and his APGAR was low). Four years ago he was diagnosed ADD and has been on various medications (ritalin, adderol, etc.) ever since. He is also dyslexic and has exhibited low self-esteem stemming, we believe, from his difficulty in school (although he has matriculated through his academic years without failure).
Over the course of the last year he has begun exhibiting extreme emotional symptoms such as rage. He has what I call meltdowns which begin with childish behavior (whining, toddler-like temper tantrums), but which escalate into fits of “psychotic” rage.
Twice in the last week he has struck his mother (who is extraordinarily patient and loving with him) and expressed a desire to inflict bodily harm on me, not to mention telling us both he hates us and has no concern for our feelings. Invariably, he comes down from these spells, is very contrite, apologizes and seems genuinely disappointed in himself. A week of mostly good behavior during which he can be the sweetest, most loving boy (“you’re the best dad ever, pop!”) follows. But the meltdowns return, and they seem to be returning with a cyclical regularity.
I’m concerned that ADD was a misdiagnosis (the doctor who originally made the diagnosis shared anecdotes with my wife and me about his own ADD children and how drugs have helped them). I wonder if my son might be suffering from a more serious form of mental illness, and both my wife and I feel like he’s slipping down a black hole and we may never get him back if we don’t do something.
A: I agree. There is more going on here than ADD. That being said, I don’t have enough information to give you a clear answer. You need to see someone who can. I suggest that you get a complete physical workup on your son and that you get a referral to both a neurologist and a child psychologist. Since he had to be revived after birth, there is a possibility that there was some brain damage that is not yet understood. Often children with some organic brain damage seem to get “worse” as they get older. This is because the academic and social demands get progressively more intense. It’s as if they hold it together as long as they can, then get exhausted and pop. He can’t help himself. A clue that this may be the case is that he doesn’t like what he is doing either.
Another possibility is that there may be what are called “absence seizures.” These are seizures that can’t be readily observed but are nonetheless affecting his behavior.
If he is medically and neurologically fine, I would then take him to a child psychologist for some testing. The psychologist will probably ask you and your wife to keep some detailed charts of your son’s behavior, especially since you have an idea that there is a cyclical dimension to it. By keeping careful data of when the tantrums happen, what they look like, what happens before and after each one, and how long they last, you may see some patterns that will help pin down a diagnosis.
Please don’t wait any longer to get these evaluations done. At 10, your son still wants your approval. This is the time to intensify your efforts to get a good diagnosis and appropriate treatment so that your son can be at his best and so that you can all enjoy each other as a family.
I wish you all well.
Last reviewed: By John M. Grohol, Psy.D. on 6 Oct 2008
Hartwell-Walker, D. (2008). My son is slipping down a black hole. Psych Central. Retrieved on January 28, 2015, from http://psychcentral.com/ask-the-therapist/2008/10/06/my-son-is-slipping-down-a-black-hole/