How to distinguish adhd in autism from mania or even mania from anxiety...any tips?

[whatamess]

Here's the scene:
My older difficult child is home from school because of an intense school day the day before (and I felt staff needed a break). A teacher is coming to the house to speak with me about younger difficult child's school issues. Teacher arrives and difficult child is in a leaf pile, difficult child gets out of the leaf pile and grabs an armful of leaves, he approaches the teacher's car and I'm not sure if he is going to throw them into her car as she gets out or throw them at her. I block him (he's smiling/giddy). He gallops for the front door and I run closely behind him in case he thinks it's a funny idea to lock us out of the house. Teacher (reluctantly) enters the house after us. difficult child sits on couch, teacher comments on his t-shirt, difficult child takes off shirt. I tell difficult child to go upstairs or put his shirt back on. difficult child covers himself with a blanket, stands up with his head covered and starts walking-hands outstretched in teacher's direction. In the span of a little less than two hours difficult child: eats four cookies and asks for more, then tries to steal more from off the plate in front of me. Asks for sugar and proceeds to go into the cupboard and take a spoonful of sugar from the sugar bowl and down it, goes into the pantry and tries to take the bag of sugar and pour it into his mouth, goes to the electric piano and plays really loud annoying noises (like screams, car revving and fireworks), goes to the bathroom without shutting the door, repeatedly asks for a donut I bought and promised him earlier (I hadn't anticipated him eating the cookies meant for the guest), takes my little difficult child's plastic grocery cart and zooms it around the house making sure to bump the chair of the teacher on each pass through the kitchen as well as crashing into little difficult child's play table that has very 'clinky' ceramic dishes, throws a jack onto the chair of teacher (what he thinks is a funny joke if someone sits on it) except he laughs while he does it and we both see him do it (not subtle at all- a good thing for us), goes to his room to clean it, but I go up to find him repeatedly covering the vacuum suctiony thingy with a playing card to hear the noises it makes, sits on the couch and rips apart pieces of paper toweling with his teeth. Get the idea?!

 

[TiredSoul]

This is how my difficult child acts when he is not being angry/aggressive. What is it? What is the diagnosis for your difficult child - Pervasive Developmental Disorder (PDD) only?

 

[whatamess]

diagnosis and diagnosis suggestions have been: Pervasive Developmental Disorder (PDD)-not otherwise specified, autism, bipolar, adhd, odd, tic/tourette's, anxiety, adhd...

 

[TiredSoul]

diagnosis and diagnosis suggestions have been: Pervasive Developmental Disorder (PDD)-not otherwise specified, autism, bipolar, adhd, odd, tic/tourette's, anxiety, adhd...

So what do you think about the behavior you described in this thread? Do you think it is mania from anxiety, or something else? I am curious because like I said it seems my difficult child is either like you wrote above or angry/aggressive. Right now he is watching cartoons quietly - but he keeps asking me to get on the computer and I keep telling him not yet. If he doesn't get his way soon, his behavior will escalate. I have just been reading about "mania" because I never considered that before, but it seems it might be the case with my difficult child. He gets into these moods where he is thinking really intensely and drawing up plans on paper to build a fort - but then he starts demanding supplies to build it and when he doesn't get it he blows up. I just don't know what it is.

Which diagnosis do you think fits your difficult child?

 

[Jena]

hi.

i've read so many books, gone to library about my own kid. and just spent fiteen min. with a doctor and learned some more. he said difficult child's kids like ours crave control at all times. he said their will can be something that is astounding. he said they can also be the most intelligent and creative minds we have.

he said it's all in breaking them of those behaviors. whatever the diagnosis. not tolerating them and not giving any options completely drawing a line in the sand. he said these kids will do whatever it takes to manipulate and control their environment.

I don't know if that helps, probably not.

 

[TiredSoul]

he said it's all in breaking them of those behaviors. whatever the diagnosis. not tolerating them and not giving any options completely drawing a line in the sand. he said these kids will do whatever it takes to manipulate and control their environment.

I know what you are saying Jena, but it would be hard to draw a line in the sand when your difficult child is acting like whatamess described. With my own difficult child, there is absolutely no way to stop the behavior. We can choose how we handle it (ignore, not engage him, etc) but we cannot make it stop even if we say it will not be tolerated. The only way to stop it would be to put him in a straight jacket and tape his mouth shut. Know what I mean??

 

[gcvmom]

How is he when the routine is normal (ie no new visitors coming to the house)?

 

[smallworld]

Whatamess's difficult child sounds like Pervasive Developmental Disorder (PDD) to me, but a lot depends on early development. What was early development like?

It does not sound like a control issue. It sounds more like the child does not have a sense of what appropriate social interaction entails, which is a hallmark of a Pervasive Developmental Disorder (PDD) diagnosis.

 

[BusynMember]

I think autistic spectrum kids have far worse social problems then other kids and can not handle transitions. They just seem not to "get" people or life in general. It can look like defiance, but it's frustration and confusion. in my opinion the best way to see where your child leans is to take him to a neuropsychologist. You can find them in Children's and University hospitals. Schools are poor diagnosticians and NeuroPsychs do test for everything under the sun. Then I'd test again every two years as symptoms show up as they get older and it gets easier to figure out the main problem.

Pervasive Developmental Disorder (PDD) kids seem years younger socially than they are. And it is very hard to teach them how to "get it." My spectrum son is seventeen now and in some ways he's seventeen and in other ways (like his interests) he is maybe ten.

 

[Fran]

I agree with smallworld.

 

[whatamess]

Ok, I know he's on the spectrum, but I have a number of people telling me that his behavior seems to go beyond spectrum and into mental illness; like bipolar. I am trying to discern whether his behavior in that situation is 1) spectrum 2)spectrum + adhd 3) spectrum + mania. I have avoided neuropsychologist's because honestly he looks very autistic when he is put in a room with people he doesn't know- and what I mean by 'very autistic' is that he does not demonstrate his verbal ability at all, he stims and makes weird noises and just looks like a different person. I just don't think they'd be able to get a real assessment on all facets of who he is if one large part is hidden in their presence.

 

[BusynMember]

My son looks very autistic in a room of people he doesn't know too. Because he IS In some cases he won't even look at a stranger, even in a therapeutic situation. That's likely why your child seems autistic too...he is on the spectrum. My son also seems like an almost typical kid in our house and school where he is familiar with everyone. That's the baffling part of the spectrum, but I'm used to it.

I think Autism Spectrum Disorders (ASD) alone can make a child look and act so different that it can be mistaken for mental illness. My own son was mistaken for bipolar and put on many medications that he really didn't need. He has been medication free since he was 11 now and he's 17 and fine off the medications...just with the Autism Spectrum Disorders (ASD) quirks and issues.That doesn't minimize his disability, by the way. But it is due to a neurological disorder, not mental illness. Many Autism Spectrum Disorders (ASD) kids are plowed with medication. in my opinion that's psychiatrists misunderstanding what Autism Spectrum Disorders (ASD) is. Of course, some kids have more than one issue, however if you are hearing "it's more" from doctors that is one thing. If it's from friends, teachers, family or just regular therapists, I'd be skeptical. I do think a neuropsychologist would help you and you precious little one. Take care.

 

[Fran]

whatamess, my difficult child was pretty manic when he hit puberty. They called it atypical bipolar. Not sure what to call it. He hasn't had very manic behavior for quite a while. When we know more about AS I believe that it will be found that there is a mood component that is different than bipolar but a difficult child demonstrates mania. My difficult child never crashed. Seems he was on the hyper side his whole youth. He is on a mood stabilizer but hasn't had a changed dose in 6 or 7 yrs.
I'm hoping you can find a way to help him through this very unstable time of puberty and he starts to settle down. It was a long, hard road for us to not get swallowed up in fear for his ability to be in touch with reality. At no point did I believe he was manipulating me. He just isn't that calculating.

 

[smallworld]

whatamess, I have talked with a well-respected clinician at the National Institute of Health in Bethesda, Maryland, who believes that kids on the spectrum very often have mood dysregulation issues (similar to what Fran is talking about). I think your best bet is to find a doctor who works with the kids on the spectrum and is familiar with the medications that work best with this population. It might be a psychiatrist, a behavioral neurologist or a clinician in a autism clinic in a children's hospital. You might have to hunt around to find that person, but it will be well worth it. I recommend checking with your local chapter of the Autism Society of America (www.autism-society.org).

 

[Marguerite]

It does not sound like a control issue. It sounds more like the child does not have a sense of what appropriate social interaction entails, which is a hallmark of a Pervasive Developmental Disorder (PDD) diagnosis.

I remember years ago, husband & I were driving in the country to go visit my eldest sister and her kids. As we drove up, eldest nephew (aged about 8 at the time) recognised us. He and the other kids were in the driveway getting ready to wash the family car. In his excitement when he saw us, nephew picked up an empty bucket and put it over his head. I remember thinking at the time that it was odd, but nothing more. I put it down to an unusual way to express excitement and delight (we were very close). He did take the bucket off his head and give me a hug, but he was running around very excited, almost manic. His siblings were also excited but being younger, perhaps didn't know us so well. Nephew was always very much a easy child.

I would put a lot of the described behaviour down to immaturity (my nephew was about 8; autistic kids tend to behave like other kids, but at a different time in their life); to excitement (and the normal level of manic behaviour you can get at such times) plus the social inappropriateness you also get in autism. However, certainly make notes and share it with the doctor. But over time these behaviours should ease, if it's just immaturity/lack of social skills.

Watch and wait.

Marg

 

[whatamess]

I am just getting more pressure from people (Occupational Therapist (OT) who has known difficult child for 8 years, school consultant, etc) telling me that I should be looking at mood disorder (and I have looked, it just isn't falling neatly into bipolar). I have recently been told by a fabulous autism consultant, that this is not mania, it is emotional dysregulation due to autism (and sensory processing disorder (SPD) and anxiety which are part and parcel of autism).

 

[gcvmom]

I think you should listen to what your instincts tell you. If what the autism expert says is ringing truer than what others suggest about mood disorder, I would go with that theory until something happens to disprove it.

 

[smallworld]

whatamess, did the autism specialist tell you that the emotional dysregulation associated with autism is treated with medications or with interventions?

 

[Jena]

i have to say what's helped me thru the years is writing down and logging behaviors. it helps me to see if there is a pattern, or if there are behaviors that are present in certain situations. that's what clued me into bipolar to be honest. it was from just logging the behaviors the sleep patterns, etc. and soon there was a pattern, and i could see when the moods hit. sensory integration disorder which my daughter probably also has can have alot of symptoms as well.

i used to sit like a nut print up symptoms of each possible disorder and than sit with-a highlighter and highlight the ones that i saw in my kid. it was helpful somewhat. i agree with-small though also.

bipolar mania to me looks like:

for example my daugther at 2 a.m. has lipstick on, jewelry, necklaces, hair completely done and is raring to go singing songs and pretending to be a rock star in her room for hours on end. jumping and dancing around.

adhd to me outbursts and add ones to me look like: my stepson will randomly call things out and be highly inappropriate verbally when you least expect it total lack of impulse control at times with-him. and if you push hard enough regarding a behavior you want to correct he'll blow yet it's extremely short lived. unlike bipolar moods which a blow up can last FOREVER it seems.

my friends kid is asperger's which is on the autism spectrum. she will not give eye contact, is verbally amazing, highly intellectual for a kid her age, is not a big fan of sunlight, also has specific foods she'll eat, and some interesting sensory issues.


your going to figure it all out. our kids are like a maze never ending. it's like going on a hunt at times it feels to me. i started off with anxiety kid and as she grew i learned it was anxiety, bipolar, sensory issues, adhd, Obsessive Compulsive Disorder (OCD). its' like a never ending thing. yet i do have to say i find special needs children to be so fascinating and intelligent and such amazing kids when they aren't melting down.

 

[Wiped Out]

Wish I knew-my difficult child is not on the spectrum but the behavior you are describing is very much like my difficult child.