Midwest~ I also am concerned about the BiPolar (BP) medications since they don't seem like they are really working. A few of them definitly made him worse and I wondered if the classic "manic" signs were from the medications or really BiPolar (BP)?? I am constantly 2nd guessing myself and trying to think back to Jan. before we started the medications. Thanks for the insight and advice!! I am definitly looking into my options for an evaluation.
Language Issues
- Thread starter Mandy
- Start date
Marguerite
Active Member
How does anyone define "manic behaviour" especially in a really young child? From my own experience, when a Pervasive Developmental Disorder (PDD) kid gets excited about something he loves, what you can observe could be mistaken for mania.
Also with Pervasive Developmental Disorder (PDD), it can often overlap with ADHD and the hyperactivity component (if it's there) can again make a kid seem manic.
Younger kids often bouce off the walls when they're excited.
Pervasive Developmental Disorder (PDD) kids often get angry or depsressed because at some level, they feel different and find this upsetting especially when younger. Self-esteem is a problem you need to watch for.
My understanding of bipolar - mood swings form high to low FOR NO APPARENTLY VALID REASON. But you can get mood swings in ANYBODY, for valid reasons, at any time of life. But a Pervasive Developmental Disorder (PDD) kid - what is valid, is what is happening for them in their own minds.
Example (hypothetical) - a young Pervasive Developmental Disorder (PDD) kid who is obsessed with cars, especially matchbox cars. You are with that child and waiting at the doctor's surgery, the child finds a container of matchbox cars at the bottom of the waiting room toybox. The child spends the half hour wait lining up those cars and playing with rapt concentration, quietly. But that child's heart will be full of joy at the pleasure of being able to do his absolute favourite activity.
Then it's time to go into the surgery and the boy is made to leave the cars behind. No warning, no time to get himself used to the loss of the cars. He may be too young to understand that the cars are not his to keep. You will get the moter of all tantrums at this point, which is what the doctor sees. The doctor may have seen glimpses of the child sitting quietly and seemnig to be tranquil and calm; to the doctor (especially one who makes snap judgements) this will seem to fall into the bipolar category, especially if the parent reports similar findings at home - the child plays quietly but will suddenly rage spectacularly and without warning when the parents need the child to do something different. OK, the doctor has observed and there is also history... but Pervasive Developmental Disorder (PDD) will just as readily explain these observations. From the child's point of view, the mood swings have sound reasons.
A very young child is so difficult to diagnose unless you take a careful history and really work to get to know the child. We also tend to be geared towards a medication answer when it should never be more than a tool.
"OK, so what will we call it? If we call it ADHD, then we prescribe stims. OK, stimis caused a bad reacgtion, so let's try medications for bipolar." and so on.
There are no medications for Pervasive Developmental Disorder (PDD). However, my kids have responded well to ADHD medications for at least that aspect of their medical care. But it's very individual.
I know it's good to be able to use the (cheaper) school evaluations, but in my experience they are too superficial and perfunctory. A possible Pervasive Developmental Disorder (PDD) diagnosis (or BiPolar (BP) diagnosis) needs a really careful, meticulous assessment and frankly, schools aren't geared for this. However, any assessments done by the school an be used to kick-start a private assessment and maybe make the job a bit easier. It's never good to assess a kid too often because all that happens is, the kid gets good at doing IQ tests.
difficult child 3 a few years ago was part of a research project to develop more accurate methods of testing Pervasive Developmental Disorder (PDD) kids. They really are difficult to get a good measure of, they generally test below their true abilities. In that research project difficult child 3 was assessed as having an IQ in the mid-140s.
That's the other thing with IQ testing - above a certain score, or below a certain score (plus or minus 20) the accuracy goes out the window. I get annoyed with reports of "he has an IQ of 167" because it's a classic example of the difference between precision and accuracy. An IQ score of 167 is extremely precise, but the error bars are plus or minus 20 (or more) so technically, the score is meaningless. All you can say is, the person is brighter than most of the population at the time of testing.
That's why when I was at school and a teacher told us that all the kids in our class had IQ scores of over 120, that was as accurate as he could really say.
Outside certain score levels, IQ test score ranges are non-linear.
WHatever the diagnosis is, there can be a range of issues like an alphabet soup. Sensory Integration Disorder (SID), Obsessive Compulsive Disorder (OCD), ODD, ADHD etc. A lot of these will respond to individual therapy dealing specifically with that issue. These subissues can be part of a larger spectrum disorder. But you don't have to simply get a blanket diagnosis and then sit back and say, "My child has X Disorder, he is under treatment by Dr Y, so everything our son needs is being handled by Dr Y."
There is always more you can do, probably more you SHOULD do, for yourselves at home. You don't need to rely on experts to advise you (although good advice is always valuable) because YOU are the expert on your own child, regardless of whatever label the child is given.
Pervasive Developmental Disorder (PDD) kids, like a lot of difficult children, can have spectacular tantrums because teir level of frustration is very high plus their coping ability is often very low. They have a strong need to try to control their world and tihs can clash directly with a parent's need to direct and discpline their children. The more you try to assert your own control, the worse the ODD semblance becomes. Normal discipline methods (the ones which worked so brilliantly on your easy child kids) will often actively make these kids worse.
Different methods are called for, different thinking, different approach. But it comes down to what WE do as parents, to our own parental instincts.
Have faith in yourself as a parent. Your difficult child is not your fault. But you could be his salvation.
Marg
It's difficult to get a false high result, though. False low is much more likely and very possible.
Also with Pervasive Developmental Disorder (PDD), it can often overlap with ADHD and the hyperactivity component (if it's there) can again make a kid seem manic.
Younger kids often bouce off the walls when they're excited.
Pervasive Developmental Disorder (PDD) kids often get angry or depsressed because at some level, they feel different and find this upsetting especially when younger. Self-esteem is a problem you need to watch for.
My understanding of bipolar - mood swings form high to low FOR NO APPARENTLY VALID REASON. But you can get mood swings in ANYBODY, for valid reasons, at any time of life. But a Pervasive Developmental Disorder (PDD) kid - what is valid, is what is happening for them in their own minds.
Example (hypothetical) - a young Pervasive Developmental Disorder (PDD) kid who is obsessed with cars, especially matchbox cars. You are with that child and waiting at the doctor's surgery, the child finds a container of matchbox cars at the bottom of the waiting room toybox. The child spends the half hour wait lining up those cars and playing with rapt concentration, quietly. But that child's heart will be full of joy at the pleasure of being able to do his absolute favourite activity.
Then it's time to go into the surgery and the boy is made to leave the cars behind. No warning, no time to get himself used to the loss of the cars. He may be too young to understand that the cars are not his to keep. You will get the moter of all tantrums at this point, which is what the doctor sees. The doctor may have seen glimpses of the child sitting quietly and seemnig to be tranquil and calm; to the doctor (especially one who makes snap judgements) this will seem to fall into the bipolar category, especially if the parent reports similar findings at home - the child plays quietly but will suddenly rage spectacularly and without warning when the parents need the child to do something different. OK, the doctor has observed and there is also history... but Pervasive Developmental Disorder (PDD) will just as readily explain these observations. From the child's point of view, the mood swings have sound reasons.
A very young child is so difficult to diagnose unless you take a careful history and really work to get to know the child. We also tend to be geared towards a medication answer when it should never be more than a tool.
"OK, so what will we call it? If we call it ADHD, then we prescribe stims. OK, stimis caused a bad reacgtion, so let's try medications for bipolar." and so on.
There are no medications for Pervasive Developmental Disorder (PDD). However, my kids have responded well to ADHD medications for at least that aspect of their medical care. But it's very individual.
I know it's good to be able to use the (cheaper) school evaluations, but in my experience they are too superficial and perfunctory. A possible Pervasive Developmental Disorder (PDD) diagnosis (or BiPolar (BP) diagnosis) needs a really careful, meticulous assessment and frankly, schools aren't geared for this. However, any assessments done by the school an be used to kick-start a private assessment and maybe make the job a bit easier. It's never good to assess a kid too often because all that happens is, the kid gets good at doing IQ tests.
difficult child 3 a few years ago was part of a research project to develop more accurate methods of testing Pervasive Developmental Disorder (PDD) kids. They really are difficult to get a good measure of, they generally test below their true abilities. In that research project difficult child 3 was assessed as having an IQ in the mid-140s.
That's the other thing with IQ testing - above a certain score, or below a certain score (plus or minus 20) the accuracy goes out the window. I get annoyed with reports of "he has an IQ of 167" because it's a classic example of the difference between precision and accuracy. An IQ score of 167 is extremely precise, but the error bars are plus or minus 20 (or more) so technically, the score is meaningless. All you can say is, the person is brighter than most of the population at the time of testing.
That's why when I was at school and a teacher told us that all the kids in our class had IQ scores of over 120, that was as accurate as he could really say.
Outside certain score levels, IQ test score ranges are non-linear.
WHatever the diagnosis is, there can be a range of issues like an alphabet soup. Sensory Integration Disorder (SID), Obsessive Compulsive Disorder (OCD), ODD, ADHD etc. A lot of these will respond to individual therapy dealing specifically with that issue. These subissues can be part of a larger spectrum disorder. But you don't have to simply get a blanket diagnosis and then sit back and say, "My child has X Disorder, he is under treatment by Dr Y, so everything our son needs is being handled by Dr Y."
There is always more you can do, probably more you SHOULD do, for yourselves at home. You don't need to rely on experts to advise you (although good advice is always valuable) because YOU are the expert on your own child, regardless of whatever label the child is given.
Pervasive Developmental Disorder (PDD) kids, like a lot of difficult children, can have spectacular tantrums because teir level of frustration is very high plus their coping ability is often very low. They have a strong need to try to control their world and tihs can clash directly with a parent's need to direct and discpline their children. The more you try to assert your own control, the worse the ODD semblance becomes. Normal discipline methods (the ones which worked so brilliantly on your easy child kids) will often actively make these kids worse.
Different methods are called for, different thinking, different approach. But it comes down to what WE do as parents, to our own parental instincts.
Have faith in yourself as a parent. Your difficult child is not your fault. But you could be his salvation.
Marg
It's difficult to get a false high result, though. False low is much more likely and very possible.
Thanks Marg for the all the info! The only time he had very classic "manic" behavior was one week after switching his medication from Abilify to Tegretol. His hyper periods before that were minimal but he never wanted to sit long to do crafts etc. His main issues before medications were his LONG tantrums and aggressive behavior during his tantrums. That is why he was kicked out of so many daycares. He does display ODD behaviors and natural response to any request from us had always been NO. Since I have been home with him full time and really working with him A LOT of his ODD behaviors have definitly improved. He was also on a Gluten free diet before the medications and it seemed to help him a lot but because of the medications the Dr. asked us to go back on a normal diet. I still restrict his sugar, just like with my other children.
I am going to talk to his Dr. when we go on the 23rd to see if I can't get a referral to a developmental pedi from her. I just really want to make sure we are going in the right direction since he is on medications. If he has a Pervasive Developmental Disorder (PDD) diagnosis then I would want to try other therapy's with him instead of medications. I think that is why I am pushing to have some more testing or a 2nd opinion.
I am going to talk to his Dr. when we go on the 23rd to see if I can't get a referral to a developmental pedi from her. I just really want to make sure we are going in the right direction since he is on medications. If he has a Pervasive Developmental Disorder (PDD) diagnosis then I would want to try other therapy's with him instead of medications. I think that is why I am pushing to have some more testing or a 2nd opinion.
A few things to remember about IQ tests:
1. The tests are standardized on "typically developing" populations - which means the tests are not given to children and adults with known diagnoses which may impact the test results. Generally speaking, if a test is not standardized for a specific population (including socio-economic status or culture) the test results are inherently invalid from a statistical point of view. Therefore, a score of 107 Verbal IQ from a child with a known diagnosis such as auditory processing disorder would be invalid. It would, however, document what the child is doing, but not what his/her verbal IQ truely is.
2. The administrator of the test can significantly impact test results, especially for younger children, by the administrator's demeanor, body language, tone of voice, etc. The environment can also significantly impact how a child performs on a standardized assessment.
3. I personally think that any parent who agrees to have their child have a standardized assessment administered to them should learn about standardized testing and what the numbers and values mean. For example, one poster mentioned a spread between 110 and 107. Statistically, these numbers are well within the average range and there is no significant discrepancy between them. However, between 100-115 is one standard deviation which is more significant. The WrightsLaw websight has a great link on how to read and interpret standardized test scores:
http://www.wrightslaw.com/advoc/articles/tests_measurements.html#11
1. The tests are standardized on "typically developing" populations - which means the tests are not given to children and adults with known diagnoses which may impact the test results. Generally speaking, if a test is not standardized for a specific population (including socio-economic status or culture) the test results are inherently invalid from a statistical point of view. Therefore, a score of 107 Verbal IQ from a child with a known diagnosis such as auditory processing disorder would be invalid. It would, however, document what the child is doing, but not what his/her verbal IQ truely is.
2. The administrator of the test can significantly impact test results, especially for younger children, by the administrator's demeanor, body language, tone of voice, etc. The environment can also significantly impact how a child performs on a standardized assessment.
3. I personally think that any parent who agrees to have their child have a standardized assessment administered to them should learn about standardized testing and what the numbers and values mean. For example, one poster mentioned a spread between 110 and 107. Statistically, these numbers are well within the average range and there is no significant discrepancy between them. However, between 100-115 is one standard deviation which is more significant. The WrightsLaw websight has a great link on how to read and interpret standardized test scores:
http://www.wrightslaw.com/advoc/articles/tests_measurements.html#11
I think you are on the right track. The testing is NOT all standardized. It IS important to know what the scores mean and what the test does and does not test for.
There are neuropsychologists who do very short, useless tests and ones who do the very intensive testing MWM is describing. Same difference in developmental peds. We lucked out and our dev pediatrician actually had the policy that EVERY child the PRACTICE sees is given a full battery of tests (tailoring this to whatever tests the child needs, NOT doing every test for every child) and then the staff all sits down and discusses the results. It gives you a bigger knowledge base evaluating the scores and what the scores mean. We found it amazingly helpful, though others here have dev peds that don't do nearly that. If you can find that (it is called a multidisciplinary evaluation) at either the dev pediatrician, psychiatrist, neuropsychologist or even a Children's hospital, it is worth it to invest in the testing.
Even with that, make sure your "mommygut" isn't telling you to do something different. Stay informed, ask lots of questions, and trust that "mommygut" and your natural instincts. THe pros are experts in a field of study. Kids are not fields. Nor are they subjects you can learn in a classroom. Moms carry kids in their tummies (or adopt them in which case they are in mom's heart for far more than 40 weeks - they are there for YEARS while the mommy waits to get her baby!) and spend incredible amounts of time with the kids. MOMS are the experts in KIDS. Doctors are the experts in FIELDS. So if Mom's instincts say no, and docs say yes, NO is the best answer in most cases. And yes, I DO believe adopted moms have the same bonds with their children that birthmom's have. Same for step moms. Adopted moms and stepmoms are extra special because they KNEW they were in for some huge potential problems and they took that child into their heart anyway. That is some SERIOUS love, in my humble opinion.
There are neuropsychologists who do very short, useless tests and ones who do the very intensive testing MWM is describing. Same difference in developmental peds. We lucked out and our dev pediatrician actually had the policy that EVERY child the PRACTICE sees is given a full battery of tests (tailoring this to whatever tests the child needs, NOT doing every test for every child) and then the staff all sits down and discusses the results. It gives you a bigger knowledge base evaluating the scores and what the scores mean. We found it amazingly helpful, though others here have dev peds that don't do nearly that. If you can find that (it is called a multidisciplinary evaluation) at either the dev pediatrician, psychiatrist, neuropsychologist or even a Children's hospital, it is worth it to invest in the testing.
Even with that, make sure your "mommygut" isn't telling you to do something different. Stay informed, ask lots of questions, and trust that "mommygut" and your natural instincts. THe pros are experts in a field of study. Kids are not fields. Nor are they subjects you can learn in a classroom. Moms carry kids in their tummies (or adopt them in which case they are in mom's heart for far more than 40 weeks - they are there for YEARS while the mommy waits to get her baby!) and spend incredible amounts of time with the kids. MOMS are the experts in KIDS. Doctors are the experts in FIELDS. So if Mom's instincts say no, and docs say yes, NO is the best answer in most cases. And yes, I DO believe adopted moms have the same bonds with their children that birthmom's have. Same for step moms. Adopted moms and stepmoms are extra special because they KNEW they were in for some huge potential problems and they took that child into their heart anyway. That is some SERIOUS love, in my humble opinion.
Marguerite
Active Member
Thanks, Babbs. You said exactly what I was trying to say. It's so important to remember these things because too often many decisions are made, based on these test results. For example, when difficult child 1 did badly on his first IQ test (because he was simply unable to complete it due to being too stressed) the school counsellor nevertheless wanted to use the low score as justification to refuse him access to any extension work in areas where he was showing that he was able to do well. I was actually told that difficult child 1's good progress at school, despite scoring so low in IQ, was because I was bullying difficult child 1 to achieve beyond his capabilities.
The point was - difficult child 1 was only doing well because I was forcing him to over-achieve. But if difficult child 1's good results in school were due to my pushing him, it should also have shown up in a higher IQ score too.
IQ tests are too readily available to people (like difficult child 1's school counsellor) who haven't got the capability to understand the results. They can do a great deal of harm if we put too much credence into the results.
Marg
The point was - difficult child 1 was only doing well because I was forcing him to over-achieve. But if difficult child 1's good results in school were due to my pushing him, it should also have shown up in a higher IQ score too.
IQ tests are too readily available to people (like difficult child 1's school counsellor) who haven't got the capability to understand the results. They can do a great deal of harm if we put too much credence into the results.
Marg
