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“We had really given up. We were at a place where, we thought for sure, he was going to end up homeless and on the streets, and we wouldn't be able to do anything else.” ~ Randall & Kimberly~
Randall, Jr. (RJ)*, a 17-year-old male, was referred to Equinox Counseling and Wellness Center by his parents Randall, Sr., and Kimberly. RJ had recently transitioned home after multiple out of home placements including wilderness therapy and two residential programs. Prior to out of home placement, RJ was exhibiting severe emotional dysregulation, aggression, defiance, unsafe and threatening behaviors toward siblings and parents, social problems (no friends), and was home schooled by his mother. It appeared behaviors were often triggered by the success of his siblings in comparison to his significant challenges.
RJ’s therapist referred him to an educational consultant due to making a homemade weapon and the threatening behavior toward family members. He was placed in wilderness therapy, then therapeutic boarding school where he was unsuccessfully discharged after 30 days for defiant behavior and severe peer conflict. He was then placed at a youth treatment center from where he was successfully discharged home despite ongoing preoccupation with weapons and severe attachment issues. He was referred to Equinox due to ongoing risk and need for intensive support and containment. Randall and Kimberly were committed to RJ returning home which they knew required their participation in parent and family support.
“The options that were being laid out to us were either your son comes home, and you give it a go—and the odds aren't too good that it's going to work. Or we go from the out-of-state residential to more of an “in-state” at least day program. We really needed a lot of containers and supports.” ~ Randall, Sr. ~
“The trauma we discovered with the other kids was that they feared for our safety, their safety, and RJ’s safety.” ~ Randall, Sr., and Kimberly ~
RJ was adopted at birth by Randall and Kimberly, addicted to methadone. He has 2 younger siblings, 1 adopted brother and 1 sister. He was well attached to parents and engaged with other adults. While RJ reached milestones within standard limits, he had poor expressive communication, became fixated on certain interests, exhibited poor distress tolerance and extreme rigidity. He struggled to make or keep friends, did not progress beyond parallel play, and needed to be in control.
Prior to and following placement, it was clear that RJ’s attachment trauma and developmental history influenced his ability to trust caregivers and make healthy connections in his home. RJ was highly reactive to Kimberly and often required Randal, Sr. to intervene. He raised his voices, used profanity, destroyed property, and threatened his brother when dysregulated. Parents work to redirect, calm or accommodate RJ to reduce his upset to protect his siblings when possible. RJ showed little trust in relationships, becomes easily defensive of help or feedback by parents, and lashed out several times a day when there were limits, expectations or parent leadership.
The family has a strong faith, care deeply for one another, and have a strong support group of extended family and friends. In particular, RJ’s parents were exhibited from the beginning that they had high distress tolerance, a strong partnership, and the ability to own their responsibility in conflict or escalation. They never blamed RJ for family level problems.
By age 6, RJ was diagnosed with Sensory Integration Disorder by Children’s Hospital. Further educational testing revealed basic perceptual and verbal reasoning abilities were much higher than working memory and processing speed. In 4th grade, RJ was diagnosed with Attention Deficit Hyperactivity Disorder, (ADHD) due to significant problems with inattention, aggression, and impulsivity. He tried medication but refused to swallow pills or wear a patch, so it was discontinued.
**It was not until, 2018 that formal testing in placement revealed functioning and symptoms warranting the diagnosis of mild to moderate Autism Spectrum Disorder (ASD).
RJ started individual therapy, at age 10 for anxiety, depression and aggressive behavior at home. At age 15, he went back into individual and family therapy due to verbal abuse, physical threats, and anger outbursts. He scared kids at his youth group and public outbursts became more frequent. Prior to wilderness therapy, daily blow-ups were unpredictable, violent, and threatened family safety. Family members walked on eggshells. RJ’s younger brother a frequent target of RJ’s incessant bullying and anger.
Additionally, RJ struggled with depression, low self-esteem, and extreme anxiety. He was suicidal on two occasions and exhibited persistent negative self-talk and low confidence. RJ was rejected by peers and therefore saw the world as his enemy, blamed others, and was unable to take responsibility for his actions. He exhibited hyper-vigilance to his surroundings and was unable to sit calmly or settled in one place.
“We were seen as the helicopter parents; we were the issue . . . RJ stopped wanting to go to school, was withdrawn, questioned why he was so stupid, and became so angry at his teachers.”
RJ was disruptive, inattentive, struggled with fine motor tasks, and had difficulty picking up concepts taught in the classroom. He received IEP services for social/emotional and academic needs starting in 1st grade. His IQ was in the low average, with low processing and profound executive functioning deficits.
In elementary school, RJ was often teased and bullied by students and could be scapegoated for classroom problems due to his propensity to act out. He began refusing school, withdrawing, raged at teachers, and repeatedly called himself “stupid.”
He received occupational therapy, speech and language services, social skills support, and math/reading support through the school district. However, parents realized in 4th grade other accommodations were not being fulfilled by the school contributing to high levels of distress. They withdrew him for home schooling. By 9th grade, his motivation declined, he did not sustain effort, and was defiant with his mother. Because of the complexities of RJ’s learning challenges, he lacked distress tolerance and would become overwhelmed causing him to give-up. When RJ came to Equinox, home school would no longer an option due to the severity of behavioral issues and lack of effort. He was at risk of not completing high school.
“In order to make friends, he would be willing to do things that would put him in uncomfortable situations. He bullies others as much as he has been bullied himself.” ~ Randall, Sr., and Kimberly ~
RJ’s parents believe he always lacked awareness around his social challenges and deficits. He could not readily make connections between his dominant behavior or inability to negotiate peer interactions and friendship challenges. He was bullied by peers and missed social cues, including when he was mistreated. To make friends, RJ would be willing to do things that would put him in uncomfortable situations. He had one only one close friend in childhood who moved away. He has not had no other friendships other than peers met with online gaming. RJ intimidated others through language, body gestures, and his dominating presence. This presence, hypervigilance, and mistrust of others often overwhelmed or scared peers. This caused many to avoid him or lash out in defense. In residential, he was jumped by several boys which exacerbated his mistrust in others.
RJ was lonely and desperately wanted to make friends. He got involved with online gaming which could often dysregulate him and the home environment due to his profanity, anger, and inability to tolerate losing or unfair play. Parents had difficulty setting limits on gaming or technology use. He was exposed to violent content, would perseverate on researching weapons and would buy items without permission or by stealing money.
“EQ is a place that that gives you hope, that empowers you to help your kids. I think probably more profoundly, how to love your kids. It's hard to love them when they're that lost, and we've discovered how to really love them again, as well as help them, and it's exciting.” ~ Kimberly ~
RJ participated in daily programming at EQ which included milieu therapy, individual therapy, and therapeutic care to first stabilize his behaviors and emotional regulation. However, his impulsivity, anger outbursts, and inability to tolerate even any group interaction informed initial treatment to include only community, home and intensive 1:1 support. In time, RJ was able to return to the group environment in the office at Equinox, eventually tolerate group feedback, and engage in family and individual experiential-based therapy.
Even more impactful to RJ’s progress, was Kimberly and Randall, Sr. involvement in parent coaching and daily guidance from Equinox. They began using specifics scripts when parenting RJ, set clear limits and boundaries even in the face of his aggression, and RJ heard clearly the home was a place that would be “safe today, tomorrow and every other day.” RJ began to experience tight containment from all adults as well as consistent messages of care and concern. RJ began to internalize limits meant care from his parents because they wanted him to remain home. If there were not clear, consistent boundaries and RJ acted out, he would not be able remain at home. RJ wanted to be home and deeply loves his family-his disrupted attachment trauma created mistrust and fear of which he had to work to a place of trust and safety. This occurred over the course of treatment.
RJ re-entered school in a day treatment setting. He was aggressive, ran from campus and defied teachers. Equinox worked with the day treatment program and school district to re-evaluate his academic needs and advocated for 1:1 teaching at home due to his high-risk issues in a school environment. This was extremely successful, and RJ began to engage in his learning again. He then entered a welding program for teens with autism for additional credits. There was tight collaboration with Equinox to address social/emotional challenges with the teacher, while the teacher focused on building rapport and relationship with RJ. This was a successful combination. At age 20 years old, RJ complete his high school diploma with a welding certification. An Equinox member proudly came to celebrate his graduation and view his welding projects. RJ celebrated with over 60 family friends and family where he cooked the meal on his own welded smoker and tolerated the large celebration for hours before needing a break. This was momentous for RJ’s parents as well as RJ.
RJ volunteered for a year while with a group of Equinox peers as a chef. This improved his self-esteem, self-worth and gave him vocational training as an emerging young adult. He has since worked with vocational support services of which he is eligible with his autism diagnosis. He is currently looking into part-time employment with the assistance of a job coach.
There continues to be many challenges for RJ around social connection. However, he was able to join in person gaming (D&D, Magic) with success, responds to parent limits on technology and made a few friends with whom he occasionally saw away from the game store. The pandemic and the resulting isolation were extremely impactful to his social successes. What stopped his behavioral regression, was RJ’s ability to talk about his loneliness and isolation with his parent, stay in relationship with his family, and find connection with peers during self-regulated gaming. He does not act out his emotions on his family despite his struggles to reconnect with others post-Covid. RJ no longer perseverates on weapons or utilize knives in any threatening manner. He sees the benefits of tools and does not require any limits on what he has access to in his home or community.
Beverly and Randall have expressed that their “family was saved” by the comprehensive interventions Equinox offered that included experiential family therapy (this family could not tolerate process or talk therapy), parent coaching, sibling therapy, neurofeedback for RJ, and an experiential approach to his therapy. They generalized clinical models and interventions into their home to create confident parent leadership in a concrete and visual ways. This was extremely successful that ALL family member learned what RJ learned in treatment. It was brought from Equinox to the home which has allowed their healthy communication patterns and ability to connect to sustain even after treatment ended. Beverly and RJ continue with parent coaching support on an as needed basis.
Summary: RJ (17 year old), Kimberly and Randall
Behavioral Symptomology: Significant history of emotional dysregulation, aggression, bullying, unsafe and threatening behaviors in the home, destruction of personal/family property, social problems, and poor academic performance.
Therapeutic treatment environments prior to Equinox:
School placements prior to Equinox:
Equinox treatment outcomes:
“Our son received the individualized attention and help he needed to learn how to feel good about himself along with the strategies, techniques and therapy he needed to become successful in life.”