You said, "he won't make the choice to stop." Just to let you know, that's probably not a choice he is capable of making at this time. Once our kids slip in to "Fight/ Flight/ Freeze" mode, the thinking part of their brain literally stops working. They react instinctually.
Fight/ Flight/ Freeze - A child who is dysregulated and/or in fight/ flight/ freeze mode is “thinking” with the reptilian part of the brain (survival!). Their behavior is a purely instinctual response to what the brain believes is a life or death situation. The rational part of the brain just isn't online. Their eyes frequently glaze over, they are out of control, and it is like the child isn't "home." Afterwards they do not remember what happened just before or during an episode. Holding a child responsible for what happens when in a true fight/ flight/ freeze is pointless- it’s better to just move on after it's over and try to figure out what triggered it so you can avoid it in the future.
A “meltdown” is different from being in Fight mode which usually looks more like a rage. During a meltdown, the child has some control over how far things go. It is still possible to "reach" the child and de-escalate the situation and calm him/her down.
Our bodies' nervous system is very basic - it doesn't know the difference between say, excitement and anxiety. Medications, calming techniques, and maturity can help the body stay calm and keep from sending "AiieeeAiieeeAiiee" signals to the brain stem. Bear tends to go into "Fight mode" when he's upset, worried, anxious, afraid... Whereas Kitty tends toward "flight" or "freeze" and she dissociates (distracts herself).
DOCUMENT, DOCUMENT, DOCUMENT -
Documentation helps protect us, get services for our children, and refreshes my memories of past issues so I can see progress and make sure chronic issues get addressed correctly. It can help you get a higher level of care (like RTC) or if you need proof that you're not a child abuser (most people with kids like ours will get accused of child abuse at least once), or even just so you don't have to repeat a treatment technique that didn't work.
When dealing with police, CPS, getting your child services and treatment, trying to get people to understand and believe what you're going through... it's amazing what they'll believe when it's in writing, versus hearing it from the parent - even if you're super calm and logical about it. For this reason, I always carry a one page summary of my child's current meds and diagnoses.
One of the main things to remember about documentation is to do it as SOON as possible after an incident. Adrenaline and time really alter memories quickly.
Our children are especially prone to false reporting for many reasons - one is an actual distortion of the events in their mind (they remember the feelings and often associate it with things that happen in the past) - their perception is off when they describes events that led up to a meltdown. My daughter will say "Daddy was yelling at me," when all he said was, "Who left the butter out?" in a totally normal voice. They don't remember anything when they're in "fight/ flight/ freeze mode."
To protect all involved, I recommend writing an "Incident Report" and keeping it in a log, sending it in an e-mail to the child's therapist or whomever might keep track of the info, and/ or on the child's timeline:
Antecedent - what was going on before the behavior or possible/probable triggers.
De-escalation - what we said/ did to try to prevent the event (if we had time) - calming techniques http://marythemom-mayhem.blogspot.com/.../books-and...
Behavior/ Event - with as much detail as possible
Intervention - what we we did during and immediately after the event - how we tried to calm the child, confrontation, redirection, distraction, sitting with them, time-ins, holding, rocking..,
Follow-up - how you processed what happened with the child. Injuries, damage, repairs needed/ made (emotionally and physically)... What consequences were given (if any). Agencies contacted. Reports filed.
Especially when dealing with bureaucracy (like insurance or school!), try to keep as much communication as possible in writing (e-mails, notes). If the person insists on phone calls and face to face meetings, take detailed notes and IMMEDIATELY type up a transcript afterwards with as MUCH detail as possible. Include names, titles, agencies and affiliations, DATES and TIMES! When you need documentation you can use these transcripts and they are MUCH more admissible then saying, "Well Ms. So and So said he was doing this a few weeks ago." Once again, people believe what they see in writing.
PROTECTING YOUR CHILD AND FAMILY
Our kids were big when they came to us, and our biokids were younger and smaller, so we had the same concerns about protecting the other children (and ourselves).
We put in place a lot of regrettably necessary rules, like:
- No physical touches between siblings - this included hugs, tickling, wrestling...
- If someone says, 'Stop.' then you HAVE to stop.
- You cannot be in the same room with your siblings without an adult present. This might mean that if I had to go to the bathroom, then they needed to be in their room. If I was cooking in the kitchen then they needed to hang out with me (I tried to make Shadowing seem like a reward).
Most important thing we did was try to de-escalate before things got to the point they were out of control - Calming/ De-escalation Techniques
When a child started getting dysregulated and threatening themselves or others, it was usually difficult if not impossible to get them to leave the room (plus we preferred "time in" versus "time out" techniques, so we usually used the 4 Foot Rule (also known as line of sight supervision).
My daughter knows this is what we do, so I think she initiates it deliberately sometimes so she feels safer. The "4 Foot Rule" means an adult must be within (approximately) 4 feet of the child at all times (usually just means line of sight). If I know she can't hurt herself (like if she's holding the door shut then she can't hurt herself without moving away from the door), I might sit outside the door.
A more ongoing (rather than crisis mode like the 4 Foot Rule) line of sight technique that we use is Shadowing – Have the child stay close to you and follow what you do or you stay close to them. It is not a punishment- it’s an opportunity to help the child regulate safely. To get compliance, it can even be presented to the child as a reward. “You can be my special helper and help me pass out snack.”
We've been known to send the other kids to another room (scary as all get out to them, but we've had them lock themselves in our bedroom to watch a movie on our TV). If one of your kids hurts another, YOU are legally liable for failure to protect. It's important to keep the other kids safe.
CALLING IN REINFORCEMENTS
For a 10yo who still cannot get himself under control, I would:
- Make a safety plan with the child's therapist. Look at worst case scenarios, make a decision about how to handle each of them. Reassure your child this is to keep the child and all the family safe. Mine were convinced that this was a precursor to being kicked out again (it always had been). Words were not totally convincing, but that combined with the fact that we ALWAYS took them back helped a lot.
- Have a serious talk with your psychiatrist about a PRN medication for calming the child - if there's a possibility the child will take it. Mine were pretty med compliant. Hopefully, you've been working with your psychiatrist on medications already. Definitely keep the pdoc posted on all changes and behaviors.
I found that it's a fine line with meds. Sometimes whatever triggered my child just overwhelms the meds. That's why I like to have a PRN, something they can take when the meds aren't enough, but don't need all the time. I have to admit, we never really found a good PRN. My kids needed massive doses of everything to even function on a daily basis.
Finding the right combination of meds is what finally stopped the rounds of hospitalizations for us. Once their brain was calmer and under control, their window of tolerance was bigger and they could handle things without becoming violent as a first option.
- Have a crisis counselor on speed dial (our local MHMR equivalent had one - 24/7 availability and they would come to us to do an assessment).
- Call the cops - In my county I'd ask for a Mental Health Deputy, but everywhere calls them different things. I have to have a regular officer come out first and then they'll call the MHD. I'd contact your local non-emergency police department, and give them a "heads up." Explain your situation and ask for their advice on what you should request next time. It will probably make that emergency call go smoother, because they know a little about you and your situation - they're less likely to get the "scared straight," "just smack the crap out of him," you're a "bad parent," "boys will be boys"... kind of stuff that cops who don't "get it" might do/ say.
- Psych hospitalization - it's tough, but if your child is suicidal, homicidal, or psychotic - take your child to the nearest ER (if you can safely transport), call the psych hospitals on your own asking about a bed, crisis counselor can make recommendations and even call ahead, call the cops and ask for transport...
- Residential Treatment - this is why you document, document, document. If your child cannot be in your home safely then they may need to go to residential treatment. This could be for a few weeks to find the right med combination. It could be a few months to try to learn some coping strategies (like DBT). It could be for years for a child who is not actually capable of living in a family environment safely.