He's lying

[crazymama30]

That is what difficult child son was yelling at me as a very angry, wet (from the hot tub) came storming down the street. Then difficult child goes to a bush and throws something in it.

Apparently difficult child had a lighter and was trying to light the bushes in the mans yard on fire! That was after he ran through the man's front yard causing his dogs to bark incessantly.

The man in question is the dad of a boy that difficult child goes to school with. Really a pretty nice guy, but thoroughly enraged at difficult child (I cannot blame him). Nice, guess the increase in the abilify just did not quite cut it. Did help some, but definately not with the impulsivity. At 13 1/2 he should know better than to play with lighters. And now whole neighborhood heard everything. Just great.

And now, he will not quit yelling at me that the guy is lying and that he (difficult child son) only lies to dad not to me. Horse pucky, he has lied to me and gotten caught too. Now he is screaming at me that I am a brat and kicking things. Oh great. Hopefully he calms down soon.

He is now grounded, no friends and no computer, and willl have extra chores to do. I hate the chore thing as that is more of a chore for me than him, as I will have to enforce it, but he needs some definate consequences for his actions.

 

[HaoZi]

It'll take a bit more time for the extra Abilify to really get in his system properly. We're having better luck adjusting down on the Abilify since the other medications were added. Hopefully the adjustment will help soon, but there's also the basic impulsiveness of even a normal 13 year old boy.

 

[crazymama30]

Well as soon as his vyvsnse and abilify had a chance to kick in? He was much better. Still wound up.....pressured speech, still impulsive but better. Stuck or perseverating on certain subjects but better. Thank goodness.

 

[pepperidge]

just wondering if maybe abilify can be too high. I know it isn't an SSRI, but I am wondering if in higher doses it affects serotonin. We have only seen crazy stuff like you are describing when my kids trialed SSRIs....

just a long shot thought.

Sorry. sounds terrible on all accounts.

 

[susiestar]

I wonder if the vyvanse might be contributing to some of this. I know the adhd has to be addressed, but sometimes stims cause as many problems as they help. I notice mood disorder on his list of diagnosis. Do you think he has ever truly been stable mood-wise? Has he ever been without a stimulant?

I am sure you probably have read The Bipolar Child and have seen the medication protocol, but re-reading it might give you some helpful ideas. It is my understanding from the book and other books that some people have to have ALL of the medications taken out before they can be stabilized. The presence of ANY antidepressant, stimulant, decongestant, etc... can keep the mood stabilizers from being able to work. Hard as it is, and it seems almost totally impossible unless you can get him into a hospital or Residential Treatment Center (RTC) for an extended period, it can take six WEEKS after tapering all medications off to completely clear them from the system. Much as this may be ideal, I just don't know how anyone would be able to do it. I know that with Wiz we never did a medication wash. Not a full one. He was never manic but without medications was just too dangerously depressed.

I probably wouldn't even push for a full medication wash, but would think about the medications carefully. It may take TWO different mood stabilizers and an antipsychotic like abilify to fully stabilize his moods. Then other medications are slowly added in to treat any symptoms not cleared up by stabilizing the moods.

When I first joined this family there were a few members who told everyone about this protocol over and over. After a while some of the members here who have bipolar themselves gave it a try. I can think of at least 2 by name and 3 others by situation who pushed to change their medications to be on just the mood stabilizers and antipsychotics until those were right. Often it took a lot of work to get the psychiatrist to give it a try. They have all come back and said that it made a huge difference, bigger than they ever dreamed, better than they ever dreamed to change the medications to get the antidepressants (esp SSRI/SNRI medications) and stims out of their body, to find the right mood stabilizer or two and antipsychotic combination. Some of them didn't need other medications at all for quite a while. Of course over time things needed tweaking, but the change to the protocol made a giant difference.

When those members were able to get their children changed to the medication protocol they saw real differences though it did take time to find the right mix of the right medications. I know I push this protocol here quite a lot. It may seem odd because I don't have a relative with bipolar except my exsil, so why do I remember it and why do I push it so often? One of my mom's best friends has 2 children with bipolar. I have seen the devastation that they have all endured as a family, esp the grandson who is about Wiz thank you's age. It just breaks my heart because I went to school with the children and their difficult child of an older stepsis. They were truly easy child's, smart, funny, really sweet and loving people. Their bipolar hit after they were in college and the change was dramatic. I hate to think of so many people with the problem, esp the kids who have limited say in what medications they take, who are taking medication combinations that research has shown to make the disorder worse.

I hope you can get a handle on the fire-setting. Is there a chance it is more than impulsivity? Some cases of pyromania seem to be anxiety related, at least what I can remember right now. Could he be playing with fire more or feeling an urge to play with fire when anxiety is worse? Are the therapist and psychiatrist addressing anxiety in any way with him? I know your husband has addiction issues, would some therapy for children of addicts be useful for him now? Or do the docs think he is still too young?

I hope tomorrow is more peaceful.

 

[LittleDudesMom]

I was thinking along the same lines as Susie - the vyvanse could be a contributing factor if the mood is not stabilized first.

Sharon

 

[DammitJanet]

Ok, thinking about your son. I didnt respond to this post because I read it pretty late last night and I wanted to mull it over.

He is hitting puberty. When was his last medication check? Since you say something about increasing abilify I am assuming not long ago. What dose of lamictal is he on? I assume since he is on the vyvanse that he must have a fairly bad case of ADHD that simply must be medicated. Are we positive about that one? Have you tried raising his lamictal? If he isnt on 400 mgs of lamictal there is room to increase. Actually you can go to 600 but I wouldnt go to that until an adult. Im still waiting to go that far. Have you considered a secondary mood stabilizer? I would go with one of the second line ones in this case though. Just my opinion..lol. Has he ever tried any of the newer AP's other than abilify? There are two newer ones out now that are supposed to work even better. One is called Saphris I think. Cant remember the other one.

 

[crazymama30]

Has he ever been stable? Yes, I do believe he has been, but it is infrequent and not long enough, in my humble opinion.

As for the vyvanse? when he was first diagnosis'd he was put on a stimulant alone, several infact. And it was awful. His mood was so labile, would go from violent to tearful and was extremely Obsessive Compulsive Disorder (OCD). Very very bad. We then went to a mood stabilizer, and added the stimulant, and it was much better. I would love to get him off the stimulant, but in order to try that I need to be home to monitor him. No way could husband handle him without his stimulant, he is off the wall impulsive, hyper, angry, and a very very bad temper. I realize it would take awhile to get the medication out of his system, so I would want to be home for a month or so with him to be sure. As for the severity of the ADHD? I had one psychiatrist look at me one day and say duck tape? As he would not stop. At his first evaluation at age 8? He was sitting in the psychiatrist's office chair spinning it. I started to ask him to stop, and she said for me to let him go, she wanted to observe him. He proceeded to spin so hard that he knocked the chair over and it landed on top of him. He is still that hyper at this day without his stimulant. He cannot focus, stay on track, or carry on a conversation if he does not have the stimulant. I have wondered about the vyvanse making things worse many times, but it is so so so so much worse when he does not have it.

The Lamictal? He is at 275mg. I might push psychiatrist to take that higher and to split the dose into morning and evening doses. I know we just raised it a few months back. As for the 2 mood stablizers? That may be where we end up. I hate to add more medications, he is on so many to begin with but if he is not able to function? Then that is what we will do. His last medication check was a week ago. He was so irritable and rude, it even impressed his psychiatrist who is rather new to him (been with her a year or so) and she had not seen him like this before. When she asked him about having hallucinations? He said of course he did not have those, only freaks have those. Now, remember his father hallucinates and could have been doing so yesterday! difficult child was simply being antagonistic.

His abilify dose? We went from 12mg at night and 5mg in the morning to 12mg at night and 7mg in the morning. He has been on more than that before. Actually, with the increase in abilify I saw a dramatic decrease in his irritablity and rudeness/meanness. I don't like having him on that much of an ap, and the plan is to back him down. I have wondered about trying seroquel instead of the abilify. More things to bring up to psychiatrist.


I am concerned as I feel that his abilify dose is high for a 13yr old of his size. He weighs only 97lbs. His lamictal dose I feel the same about, 275mg seems high for a kid his age and weight.


I am going to call psychiatrist on Monday and express my concerns. I really would like to stop the stimulant, but just cannot do it this summer. I have 2 weeks off in August as my mom is getting a knee replacement, but my time is going to have to be concentrated on her, and once difficult child is off his stims he is a double time job.

 

[crazymama30]

Oh, forgot to add. He does see a therapist who is aware of husband's issues and has seen her for years. I will let her know what has been going on.

difficult child gets his neuropsychologist evaluation this tues and thurs. I am glad it is coming up this week, as I don't want to make any major medication changes untill after the evaluation. I want the evaluation to be as accurate as possible, and the np knows what medications he is on and is ok with him remaining on his medications.

 

[TerryJ2]

Arrgh! What a mess. I know what you mean about his chores being more of a chore for you. I'm about to do that in a few min, in fact.
Wish I had some advice about the medications.

 

[Marguerite]

the emotional lability on stimulant - we have seen this with our boys on ritalin but not on dexamphetamine. A friend of difficult child 3's has this problem on ritalin (and of course Concerta - it's the same drug, just delivered differently).

I hear about rebound problems on ritalin so often I'm wondering if it's commonplace. I do remember difficult child 1 apparently cycling, ping-ponging from calm and coping to violent and dangerous. This would happen with every dose during the day (before Concerta was available here, he had to take ritalin every 2 hours at school and if a dose was even a little late...). I defy the most stable adult to be able to cope with such drastic changes so many times in the day.

I'm thinking maybe investigating a totally different stimulant could be the way to go; you're piling in more medications which may be trying tyo help with other problems, but if all you are trying to do is compensate for the stimulant's side effects, you will get stuck in a vicious circle of piling on more medications to cope with the increasing side effects of the more medications... we just did this with difficult child 3 in the last year, with the anti-anxiety medications he was on. It totally messed up his ability to lay down memory (ie no chance of learning any schoolwork) and so the doctor increased his stims to help him concentrate better. All we had to do was stop the anti-anxiety medications, but of course this pushes his anxiety back up. So difficult child 3 has gotten inventive about how to manage his anxiety - he carries a teething ring and chews it in order to avoid chewing his lip or his clothes. Not the best option, but far better than we've had.

With the obsession with lighters etc - difficult child 1 did this. We kept finding cans of lighter fluid and lighters, in his bed. Or under the couch. We kept confiscating it all, stashed it in our own spot and for years I never ran out of anything I needed to light the barbecue. His best friends were doing similar things, I found out. One poured lighter fluid over his hand and set fire to it, to see what would happen. They did this ins the school yard... admittedly, he only ever did it once. They all learned that it was not a good idea!

Part of the consequences you can use, is to get your son to write a letter of apology to the man whose garden he tried to ignite. It is necessary to face the issue head on, but it will be something he does not want to do; they would rather pretend it never happened and hope it will all go away if they ignore it.

Marg

 

[crazymama30]

Yep, I am going to approach difficult child about writing a letter of apology. Once he calms down and can be rational, he is not in that place yet.

As for ritalin vs dexamphetine? vyvanse is a form of adderall which I believe is dexamphetamine? I do know that once the abilify and the vyvyanse kick in we see a dramatic improvement. I would like to see what he looks like with no stimulant, but I have to wait untill I can be home to run interference, as all hades could break lose.

 

[crazymama30]

Marg, we may investigate new medications including the stimulant after the neuropsychologist evaluation this week.

How long is dex effective for? I like the vyvanse (form of adderall) as it lasts 10 to 12hrs.

And you are right, throwing more medications at him is probably not the answer, but for now I don't know what else to do. I definately see him cycling, and have no doubt that he has bipolar. I am wondering about seroquel, and a few other medications.

 

[crazymama30]

Ooops, I did not think I posted the first reply. sorry to be repetitive.

 

[gcvmom]

We've had great success with Seroquel XR in helping with impulse control problems and even hyperactivity in difficult child 2. It really works like the stims used to for him. There are even times when difficult child 2 has to get an extra dose of it on days when he's bouncing off the walls as can happen for no apparent reason. We had to go to Seroquel after he developed dystonic reactions to Risperdal, Abilify and Zyprexa. And in all honesty, it's working much better than any of those ever did for him.

I hope you can find a better combination for difficult child because clearly the cocktail he takes now is not cutting it.

 

[Marguerite]

Rebound can happen with any stimulant. While our personal experience was with ritalin, a friend of ours had rebound on dex but not on ritalin.

Dexamphetamine is short-acting but we get it privately compounded into an all-day dose.

We tried Strattera with difficult child 3 but it was disastrous. Pressured speech, aggression, circular arguments, not making a lot of sense, all in the first three days.

Marg

 

[crazymama30]

I am thinking thinking that vyvanse is similiar to what you have compounded. Not sure, but I think so.


As for rebound? We don't have any problem with that, our problems are almost always before the medications kick in or after they wear off, but really are not a rebound.......we have seen that. The problems the other morning? Before the medications kicked in. The rest of the day was better, not good but better.

We have tried focalin (refined ritalin), adderall, stratterra, concerta, and daytrana patch and of course the vyvanse. The only ones that worked were when he was also on Lamictal, and they were Daytrana (ritalin based) but difficult child would not leave the patches alone, and the vyvanse. All the others? Either made things worse or did nothing, however all the others were before he was on Lamictal.


G....how hyper was your difficult child before the seroquel? Does it sedate him? Does it last throughout the day?

 

[gcvmom]

On a visit for a second op. at another psychiatrist, before he had started any of his BiPolar (BP) medications and was only on a stimulant and risperdal, he was very much like what you describe your difficult child doing in that counselor's office. Spinning in circles, climbing on everything, talking non-stop, falling out of a chair while simply sitting in it, pacing around the room, you get the picture. That psychiatrist said he'd never seen a kid THAT hyper before (gee, thanks for that expert opinion). We ended up going back to our regular psychiatrist and finally concluded it was BiPolar (BP) we were seeing more so than ADHD (although that component is there, just not what was driving the level of hyperactivity and impulse control problems we were seeing).

He did better on Seroquel XR than regular Seroquel. The lower doses of regular Seroquel were VERY sedating. Once we got above (if I'm remembering right) 300mg, the sedation got better. The XR is still sedating, but not enough to outweigh the benefits for him at this point. Unfortunately, my difficult child takes a high dose and has to take it twice a day to maintain therapeutic benefit -- but our psychiatrist says he has to go by response and not always what the literature tells him. Of course, everyone is different.

But as it stands now, he absolutely cannot tolerate stims of any type. He acts like he's on crack.

 

[pepperidge]

CM what you describe doesn't sound at all like rebound to me....been there, still doing that. It sounds like some better mood stabilizers might be in order. Wounder if he needs something that addresses more the manic highs? Lamictal is great, but does it do that?

Good luck . You've got a tough one.

 

[DammitJanet]

Im with those who say it sounds like he needs a mood stabilizer to address the highs too. I have the same issues. I have to address both. Thats why Im on both topamax and lamictal. Topamax works on my highs and lamictal evens out my lows. Though oddly enough, if I climb manic enough, we increase my lamictal first and then the topamax.

I have such worries with seroquel because of the cholesterol issues. I was on a relatively low dose and it almost doubled my cholesterol in 2 years. This new saphris is supposed to not do that because it doesnt go through the liver. I was on it but we decided to take me off it because we were using it for anxiety on me and some delusional thinking after the meningitis. That has become better so we went off it and increased my anxiety medications. There is also another new one that came out just this past February but I dont know the name and it is supposed to be very good too.