Expert: Joyce A. Anthony - 7/17/2008

Question
Our stepson is 11 years old, and we have had custody of him for the last 4 years.  His mom is not in the picture.  He has always been known to be very defiant, have very aggressive behaviors, and then no matter how destructible or aggressive he is, have no remorse or any connection at all really to what just happened.  Even though we have made great progress with him (through establishing more consistency in the home, therapy, psychiatry, etc) there are still so many things working against us.  He is bigger now, and stronger.  And we are now starting to deal with hormones.  His fits are more severe than ever.  he took Abilify for over a year but the side effects were just too much, and have since switched to Prozac.  Haven't been on it long enough to see anything from that.  

Anyway, its been really bad lately and the therapist/counselors have suggested an SED evaluation, but I can't seem to find any information on what that is.  Someone I know mentioned that it is somehow related to residential treatment.  That has been something that has came up before, but theres been no real push for it up to now.  It has merely been suggested.  I guess my question is do you know what this type of evaluation is, and when is it time to consider a residential facility?  I think to myself, do I feel unsafe in these fits, yes, do I worry that he'd hurt himself, sometimes.  My husband is convinced that a residential facility is "giving up" and I don't really know enough to have a response to it.  Just lately, I feel like he needs more than what we can give him.

Answer
Hello Hannah:

An SED evaluation is one in which the child is evaluated for a "serious emotional disorder".  Here are the things that prompt such an evaluation:
SED stands for Serious Emotional Disturbance.
Children younger than 19 years are considered to
have SED if:
• They have a mental disorder as defined in the
most recent edition of The Diagnostic and
Statistical Manual of Mental Disorders
(currently the DSM-IV)
• They do not have a primary drug or alcohol
substance abuse problem or developmental
disorder which results in behavior that is not
normal for their age.
• They have a problem in more than one of the
following areas:
√ Taking care of themselves
√ Doing well in school
√ Getting along in the family
√ Getting along with others in public
Children who see or hear things that aren’t there,
have very unusual behavior, or threaten or try to
hurt themselves or others should also be referred
for SED evaluation and treatment.
***
When is it time to consider a residential treatment program?  That is often a very personal decision.  You stated it well when you said he needed more help than you felt you could give.  That is one of the biggest times to consider such a placement.

Finding and placing a child into such a facility is not giving up on him.  It is often an indication of great love--you are admitting your child needs help you can't give at the moment and you are willing to sacrifice him being with you in order to enable him to get that help.

These programs offer great opportunities for families to stay involved with treatment.  Any emotional disorder is better gotten under control when the whole family is involved.  

I would allow the evaluation, to see what disorder your son is dealing with.  From there, you can decide the next course of action.  It may simply be a different medication.  What is most important is knowing what you are fighting.

                      Joyce A. Anthony