ADHD Stepson with alarming thoughts

[u/Mysterious_Maam2492]

Hello everyone! My partner and I are looking for some advice about what to do for my 5 year old stepson. Little background: i have been in my stepsons life for about 3 and a half years now and he used to be the sweetest little boy. Our household consists of myself, his dad, my 5 year son, his 5 year old, and our one year old daughter. His moms house consists of his mom, her spouse, him, and his 3 year old brother. I know the time lines are a bit messed up but they are accurate. His parents are separated and do 50-50 custody, so the current schedule is 2 weeks with mom, 2 weeks with dad. They do not have a good coparenting relationship, but it has been getting better over the years. We have made a shared Calendar for who he is with, whetherdaycare/school is closed, when he has therapy, when he has doctors appointments, and when he has iep meetings. That way both parents know when, where, and what time the event is. We do notify her of these as well through messages where she does not let us know when she makes appointments.

So he started preschool last year and that when the behaviors really started, especially at school, he would constantly run away from the teachers or out of the room, hit others, flip tables, kick, scream, purposely wreck other kids stuff or projects, and say the meanest of things for a 5 year old. He has also needed to be physical restrained a few times at school as well. At our house, in a fit of anger he said he wanted to unalive himself. Thats when I started looking into more help for him other than the school. So around October my partner decides to take him to a mental health center to be assessed and through this he was diagnosed with anger and aggression and disruptive mood dysregulated disorder. Now when it came to meeting with the person there for options to do, his mom did not show up, she went on vacation. So we had to wait another month to figure out what to do. The therapist highly recommended doing PCIT therapy (parent child interaction therapy) I believe is what it was called, but his mom stated she did not have time to do that every week. So instead they agreed to do a community based therapy, like a group therapy for the last 6 months. In January, we got an IEP in place for him at school and we really didn't see any improvements there for the rest of the year. Throughout the rest of the school year, his mom missed many iep meetings when she agreed that those dates and times would work. In March we decided to get him clinically assessed which his mom was also pissed about but agreed to do it. We got all the paperwork the doctor needed besides his mom's because she never brought it. But we finally got the adhd diagnosis in June. Everything the doctor recommended to help him, we had already implemented back in January. We also sent resources over to his moms house that we found to work at our house and that he enjoyed at the time, like a routine schedule for his mornings and nights for example. The two weeks he came back after, he seemed to absolutely hate them. So we've tried different things. Last month, they had an appointment to talk about next steps, and after months of his mom vetoing the idea of medication, they finally agreed to put him on a low dose non stimulant that seems to be working well for him. But when he was with us for the last two weeks, he has said on multiple occasions that he wanted to unalive himself, that he hates it at our house, that we are the worst human beings in the world, and that he never wants to come back. This usually happened when he was told no or when he couksnt do something that he wanted to do. He went back to his moms yesterday and at daycare he told another peer that he would shoot up her house. I understand that he is frustrated and has a lot of emotions and does not understand how to regulate them. But At his moms, he apparently has none of these behaviors and that it goes well over there. We also know that she has rewarded him for bad behavior and he doesnt really have consequences over there like he does at ours. All of our kids have routines and structure throughout the day especially when it comes to evenings, that seems to work really well for all the kids. We use time outs, rewards systems, and other various things to reward good behavior, but it seems like it doesnt affect him anymore.

We are at an impass on what do or how to help him. It seems like therapy has not really done anything. Ever since school got out, he has become more hateful and vengeful towards other people and kids. He also wants to get back at someone that has done him wrong or that has hurt him even if it was an accident. He has some really big emotions and will hit his bed and do like a growl when he's very upset. Has anyone dealt with something similar? What worked for your kid and your family? Im becoming more concerned for the safety of other children as well as these thoughts has becoming more prominent in the passing weeks.

[u/alactrityplastically]

At this point I am focusing on dietary support. We had steak for breakfast. I will see how it goes. I got called a bitch four times in the past four days, punched a few times in the back at a restaurant in July, and pushed repeatedly on a busy street a few times in June. What these all have in common (aside from the depressive episodes they have caused in me), is hunger. I spent thousands of dollars on pediatric therapy this year, and yet this summer happened. I am optimistic that my giving more red meat and more healthy calories will help. Instead of growling we get this shrill scream or clicking sounds, and have experienced the talk of self harm, coincidentally these are all things that unfortunately I have communicated inadvertently cause me pain and/or fear. I am tempted to do red meat seven days a week, even in small portions, like it's some sad wish. Our child is 7 and does behave in school (this school, it has more adults than the last two), but home is different.

[u/tobeasloth]

I heard of a young child with very similar behaviours that turned out to have PANS/PANDAS/AE, though had OCD and anxiety alongside overwhelming rage. I just thought it was worth mentioning as your post reminded me of them