More ? re: Typicl vs. difficult child and ADHD vs. BiPolar (BP) vs. mood

Discussion in 'General Parenting' started by gcvmom, Feb 27, 2007.

  1. gcvmom

    gcvmom Here we go again!

    Not to steal the subject away here, but I've been reading the thread on "Typical vs. difficult child" and I see some of what's described here in my husband and difficult child 2. And I'm still trying to understand what's going on with them -- because we've been told it's ADHD, but the psychiatrist won't say it's BiPolar (BP), just that it's mood-related.

    husband and difficult child 2's problematic behaviors are mostly to the extent of an escalation of activity (often there is some kind of external stimulation going on, but it can also arise after too much time playing video games) to the point where someone gets hurt either physically or there is a perceived slight and then boom! There's an explosion of intense anger, something might get thrown, voices scream loudly etc. The look in their eyes is "out of control" -- pupils dilated and they almost look like they've "left the building". Once the storm passes, which may take a half-hour or more for either one to calm down and come back to almost-center, they act like nothing happened and don't understand why everyone around them is still upset!

    Lately, it happens with difficult child 2 when he's hungry or ADHD medications have worn off. How much of this is standard ADHD lack of impulse-control, how much of it is mood-related?

    I distincly remember a New Year's Eve in Vegas when husband got angry with me and suddenly started feeding the entire contents of his wallet into a slot machine -- $20 bill after $20 bill... It's like all the noise, and lights, and the stress of having his parents and sisters and their spouses around and then me saying something about money triggered the implosion. He had "that look" on his face, wild-eyed and just not himself and when confronted, was clearly paralyzed to do anything about it, even with me telling him to "STOP!". It took the better part of an hour, maybe a bit more for him to get out of this state and be able to talk to me about what he was feeling.

    Again, is it plain ol' ADHD or is it a mood disorder?
  2. Janna

    Janna New Member

    Maybe I don't understand what you're asking.

    Explosive behaviors have nothing to do with ADHD. Nowhere in the DSM criteria for ADHD does it say anything about raging/tantrums/meltdowns.

    We limit Playstation and computer time here because Dylan (diagnosis'ed Bipolar) cannot handle the game for any long period of time. He gets frustrated. He loses or can't beat a board. Things have gotten broken and he has lost his temper. He has slammed that stupid joystick on his head more times than I can count on two hands. When it gets to the point his voice is raising, it goes off. End of discussion.

    It sounds like the incident with your husband and the money, that sounds nothing like ADHD to me. You should use this navigation system to the right of the screen and read up on the other disorders. Read up on ADHD too. Those symptoms don't sound anything like ADHD (and I have an ADHD kid too, that does NOT explode, ever, and he's true ADHD, Combined Type).

  3. smallworld

    smallworld Moderator

    I've been thinking about your post today and wondering how to answer it because there are so many facets to this question.

    But first, I'll start with some questions: What kind of doctor diagnosed your difficult child with ADHD? Has your difficult child ever undergone any testing (for example, neuropsychological) to determine if he truly has ADHD? The reason I ask the latter question is that we've been operating under the impression that our difficult child 1 has ADHD for the last 4 years. We've even treated him with stimulants fairly successfully (ie, stimulants seem to help him get his work done). However, recent neuropsychological testing, which included a computerized IVA test of sustained attention, indicated that he doesn't have ADHD. His inattention, difficulty with attending to schoolwork and homework, forgetfulness and disorganization are all from a mood disorder, largely anxiety and depression. My point is that sometimes symptoms can look like ADHD when they are in fact due to another disorder entirely.

    I agree with Janna that explosive behaviors have nothing to do with ADHD. In fact, your husband's New Year's Eve episode sounds much more like mania associated with Bipolar Disorder than anything else. On the other hand, any hungry child, even without ADHD or a mood disorder, can experience low blood sugar and become irritable. And there is a common phenomenon called "rebound" that occurs when stimulants wear off in the afternoon. Children can become emotionally reactive or labile when stimulants leave their system. So that, too, has nothing to do with either ADHD or a mood disorder.

    The wild-eyed look you describe is more consistent with either epileptal seizures or BiPolar (BP) than ADHD. For this reason, I would recommend both a neurological and a neuropsychological evaluation. You really need to know what is what so you can put the proper interventions into place.

    Good luck.
  4. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I agree the new years eve episode sounds much more like a mania or hypomania than any sort of adhd episode.

    My ADHD son gets wound up and fidgety, talkative, loud, rambunctious. He is in constant motion. Something on him is constantly moving. His knee will be bobbing up and down, he will be tapping a pencil, glancing out the window, jumping up to check the windows, checking the cell phone for calls, looking in the fridge to see what we have to eat, seeing if the laundry is done...and on and on and on...all while talking incessantly. There is no explosions or rage, just movement. At the age mine is he can pay attention now.
  5. Hound dog

    Hound dog Nana's are Beautiful

    It also reminds me of mania or hypomania. N would always have the situation with video games. So I limited her use of them to keep meltdowns to a minimum.

    Situation with husband actually reminds me of myself. If I'm feeling super stressed, then say someone tells me not to do something, wham! Thankfully, I got a handle on this behavior during early adulthood. My best friend who also has bipolar still doesn't have control over this behavior.

    Now I was diagnosed ADHD as a kid. So was my brother. And from what everyone always told us, we had it pretty bad. But neither of us ever had rages or meltdowns. I don't recall any problems with impulse control either. Ours was more like Janet describes. (wish I had some of it now lol)
  6. Allan-Matlem

    Allan-Matlem Active Member

    I have to strongly disagree with the statement that explosive behavior has nothing to do with ADHD. Check any info on ADHD - emotional outbursts , anger control , easily frustrated , self control . Various diagnosis's share the same the symptons and of course there is also the caregivers role in the explosions.
    check out the handout on the thread - no 7.
    There are many pathways to explosiveness - executive function deficits, language processing deficits , social skills, emotional regulation skills, cognitive flexibility etc.

    By examining these pathways and also taking into account possible triggers we will gain better insight. Treatment should not only focus on medications , medications should as a goal not be a long term solution if possible.

  7. gcvmom

    gcvmom Here we go again!

    Thank you all for your thoughtful responses!

    I sometimes feel like I'm in a dark room I've never been in before, fumbling around to find a way out when it comes understanding what's going on with difficult child 2 and husband. They are clearly cut from the same cloth, because difficult child 1 does not have the same issues they do.

    Smallworld: difficult child 2 was diagnosis'd by a pediatrician/adolescent psychiatrist who got his degree from UCLA. He's in his late 40's or early 50's, so I would guess he's been in practice for about 20+ years. He's one of the few who handles peds in our county and comes highly recommended by many people I've come into contact with.

    We did go to UCLA for an ADHD genetics study a few years ago, and they subjected both my boys and husband to a battery of psychiatric and neuro tests (EEG as well). Nobody said anything about mood, and they even suggested husband did NOT have ADHD! Of course husband passed all their tests and attended well on everything -- BECAUSE IT WAS ALL NOVEL TO HIM and HE WANTED TO LOOK GOOD, is my assessment. I chalked it up to grad students doing the testing.

    difficult child 2 and husband both have the hyperactivity issues that go with ADHD -- but I suppose that it can also go hand-in-hand with mania, right?

    husband (who is unmedicated, but did rather well for a while on Adderall XR until he passed out on the highway while driving and then a cardiologist blamed it on the medications) fidgets with his hands or taps his fingers CONSTANTLY (his parents tried to channel that when he was younger and bought him a drum set, which he still has and plays in our garage from time to time, rather well, too). He cannot drive the car without sitting still, always adjusting something -- the mirror, his seat, the radio, the air temp, looking for something in the console compartment, and ALWAYS, ALWAYS eating sunflower seeds while driving. He cannot sit still to read a book (I've only known him to read two novels in the 19 years we've been together -- but comic books are another story...).

    husband cannot carry on a conversation without his eyes scanning the room or losing interest after about one minute. He interrupts (he used to say that if he didn't say what was on his mind right away then he'd forget) often.

    He's an impulsive spender. He has certain sexual predilections that border on compulsions in my view (nothing illegal or inherently immoral), and which also have a strange neurochemical effect on him, almost as if an addiction is being satisfied.

    When he was younger, he got into trouble with the police for threatening a group of kids -- who had beat him and followed him home -- with an empty shotgun. At least that's how the story goes.

    In college, he was put on probation for punching out an RA who he claimed pushed him in an argument about a girl.

    He's mellowed considerably, but his mouth can still get him into trouble when he feels threatened or if he feels that someone is not playing by the rules (he's a ref for our kids' soccer teams and gets into it with parents on the sidelines as well as other refs). I'm standing there telling him to shut up and let it go and he just keeps talking.

    husband is very bright, but can also be socially awkward and misses many nonverbal cues.

    difficult child 2 is looking/behaving more and more like him as time goes by.

    Stimulants help his attention and focus and he gets along with others, gets homework done easily and quickly, participates in class, and is productive at home when the medications are working.

    His biggest problem right now is that the stimulants aren't holding as long as they should. And when they're gone, he's done for the day and you'd better have a hefty supply of patience if you want to keep from losing your mind around him. He gets loud, he bugs his siblings and does things that annoy them (and he thinks this is funny when they scream at him to stop), he becomes very sloppy and careless, he wanders around stuck to his Gameboy (can't seem to put it down even if he needs to do something else with his hands), repetitively jumps up and down in one place (when he was little he would stand on his head), stands in front of the TV to watch when others are behind him trying to watch, and wants to snack, snack, snack. He doesn't stay in his seat for more than a minute at meal time either.

    I didn't mean for this to turn into the history of my world, parts 1-infinity!

    So maybe I should ask our psychiatrist about a neuropsychologist evaluation? Would he not be qualified to administer this?
  8. gcvmom

    gcvmom Here we go again!

    I realize these are complex issues, and no easy answers. I appreciate all the feedback!
  9. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Jamie isnt great with money either but he doesnt go on the spending sprees like a bipolar person would where he wracks up credit cards in a weekend. He might spend $200 on something for his buddies and then starve if he thought they needed it more. I have seen him give away his money to his friends because they were in trouble and him eat peanut butter and ramen noodles for two weeks. He has also sent money to his brother for the same reason before.

    He was never explosive. His impulsiveness did cause some damage at times but it was because he simply didnt think things through. For instance, he kicked a ball in the house once and never considered it might go through the window. Oops. It wasnt done on purpose but it did break the window. He was mortified. That was the major difference between him and his brother. When he did something wrong he almost punished himself because he had such a degree of remorse and guilt that what we had to do to him was almost secondary. Simply making him help fix the window was enough of a punishment. Cory on the other hand would rant and rave and claim it wasnt his fault and that the window shouldnt have been there and he wasnt going to help and on and on. Not to mention cory would have broken the window on purpose.
  10. smallworld

    smallworld Moderator

    Clearly, we're not doctors and can't diagnosis over the internet, but from what you describe, there are enough signs there that suggest there's more going on than ADHD in both your husband and your difficult child (and may not be ADHD at all). ADHD is not the only disorder that includes hyperactivity and fidgetiness as symptoms. Impulsive spending and sexual compulsions definitely make me think of mood disorder. Especially because you're giving your difficult child such high doses of stimulants, you really need to know whether you're dealing with ADHD or another disorder entirely. I would strongly encourage you to seek a neuropsychological evaluation for your difficult child. psychiatrists are not qualified to administer neuropsychologist testing; only neuropsychologists can do that. Many psychiatrists can refer to neuropsychs they know and respect. That's how we got to our neuropsychs over the years.

    We're here for you if you have any questions.
  11. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Put me in line that says it sounds like a lot more than ADHD. Your hub's compulsive spending when upset is consistent with mania. I have bipolar, not ADHD, and it sounds a lot like BiPolar (BP) to me (both hub and kid). I'd get another evaluation. My son was evaluated for twelve hours with a neuropsychologist and he did lots of testing. When he diagnosed he said the only truth that exists: "Since there are no blood tests, any diagnosis can be wrong. Mayo diagnoses people wrong all the time. It's just a guess." Complicating it further, ADHD medications make mood disorders worse, not better, although they make anyone focus better, even if you don't have ADHD. In our DSM rages and destruction is not part of ADHD. ADHD rages are short-lived and their destruction is due more to clumsiness or inattention (such as running into a table and knocking everything over). BiPolar (BP) rages are triggered by "no" and often just descend out of the clear blue. If you are iffy on a diagnosis, get another opinion. I recommend seeing a NeuroPsycologist and maybe a new Psychiatrist. We needed many professionals before my son was dxd. right and improved. I know the US has it's problems, but I truly believe that we are on the cutting edge for children's mental health (which is sad because we have so many deficits). Bipolar simply isn't acknowledged in many countries and Ritalin given for everything. Don't self-diagnose. Get the help. Hugs and good luck!
  12. gcvmom

    gcvmom Here we go again!

    Many, many thanks to all who have replied.

    I think I'll give the psychiatrist a call, update him on the meltdowns difficult child 2 had last weekend and ask about the neuropsychologist referral for an evaluation.

    Maybe if we can get difficult child 2 straightened out, husband will be more open to discussing his own issues and we can begin down that path.

    Again, my sincere thanks for sharing your experiences and opinions.