Need Help

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

  1. Kjs

    Kjs Guest

    I just cannot do this anymore. I am so tired. husband is no help, tries to justify difficult child's actions. I get the calls from school, I difficult child's calls. difficult child has no friends, trouble doing work in school. Mostly refuses to do it. Calls teachers names, gets kicked out recently on a daily basis. He is in S.E. Very bright, just does not do anything. Always other peoples fault. Talented at sports, until he gets beat, or misses a shot. Then he will end up crying and getting kicked out because of his mouth, and behavior at the officials. Told he had ODD ten years ago. Will it ever go away??? Marriage is falling apart, easy child doesn't want to come home anymore. difficult child has a way of making you feel sorry for him, even though it is his own actions that put him where he is. he has me in tears every morning that I take him to school. (I am working three mornings a week. He gets a ride). Recently switched jobs. He has always had issues with change. Even though I anticipated a few issues, I feel as if I just can't do it anymore. Will he ever get better?
  2. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Welcome KJS...

    I am sorry you are having such a hard time.

    It sounds like your son is being medicated for bipolar even though he is only carrying the ODD diagnosis. I say this because I am taking the lamictal/topamax combo too and I am bipolar.

    12 years old is a very hard age for kids. Personally I think they should allow us to ship them off at 12 and bring them back at 21! Can you tell Im not partial to teens? LOL. Anyway...all joking aside, things can get some better but it will be hard for awhile since he is going through puberty.

    You say he is in SE which I assume is Special Education. If they are kicking him out so often then they need to find something else that works better than that. Check in with the folks on our Special Education section for help there.

    Keep talking to us and tell us what problems you are having and we will try to give you suggestions. We are a great group of parents and what works for one of us may work for you and hey...something you have tried may work for one of us!
  3. smallworld

    smallworld Moderator

    KJS, welcome. I'm glad you found us.

    When things aren't working, I strongly believe a new evaluation is in order. What kind of doctor originally gave your difficult child the ODD diagnosis? What kind of doctor is treating him now? I would highly recommend seeking out a neuropsychologist, found at children's and university hospitals, to do extensive testing on your difficult child. You need to know what is what. Things can get better with an accurate diagnosis and the proper interventions put into place.

    While ODD can be a stand-alone diagnosis (rarely), we find on this board that many of the kids coming through actually have an underlying disorder that fuels oppositional behavior. Once the underlying disorder is treated, the oppositional behaviors subside. Janet is right that the medications your difficult child is taking are for Bipolar Disorder. The medications may not be working for two reasons: 1) he's being treated for Bipolar Disorder that he doesn't have; OR 2) he has Bipolar Disorder, but the doctor hasn't hit on the right medication combo (which from my own experience can take quite a while). This is why you really need to figure out what's going on with your difficult child.

    Again, welcome and good luck.
  4. Wiped Out

    Wiped Out Well-Known Member Staff Member

    Welcome to a fellow Wisconsinite. I'm sorry you are struggling so. It's hard when it seems everything is falling apart. I agree it sounds like a new evaluation is needed. Do they have a Behavior Intervention Plan at school so they can recognize triggers and hopefully avoid some of his blowups and when he does so they know how to handle him?

    I'm sure it's hard to find time but you need to be sure to take care of you too.

    I'm glad you found us as you will find much support-this place has been a life saver for me.Hugs.
  5. Kjs

    Kjs Guest

    when difficult child was 2 he saw a psychologist. he did some testing and we were told ODD. He fits ALL the symptoms. We were told there is no medication. Does not have ADD. Had a traumatic experience at Day Care between 18 months and 2. Took him eight years to let us know what really happened.
    He gets frequent migraines. Sees a pediatric neurologist from Children's Hospital. He put him on the Topamax as a preventative medication for the headaches. As for other doctors, just pediatrician and a psychiatrist who put him on Lamictal. He was doing much better, as of last visit 6 months ago the plan was to begin taking him off this summer.
    He has been very angry, forever!!! School tells us that all the time. When he becomes frustrated, overwhelmed, or doesn't understand something he reacts immediately without thinking. He has the option at school to leave class if he feels an outburst coming on, and going to another room to talk or be alone. He has chosen to stay and be very verbal instead of leaving. Sometimes I wish I had the option to leave.
  6. smallworld

    smallworld Moderator

    KJS, we're not doctors, but we can try to point you in the right direction. Your difficult child could have Post-Traumatic Stress Disorder, which is a form of anxiety, from the trauma he endured at such a young age. The anger, frustration and feelings of overwhelm may be your difficult child's maladaptive way of coping with his anxiety. This disorder needs the right kind of treatment. He hasn't been evaluated since he was 2. A lot has changed since then. Again, I strongly encourage a new evaluation.
  7. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    Good Morning KJS,

    I'd like to welcome here to our corner of the cyber world!

    I think I have to agree with most of the other posters. I think it's time for a new evaluation for your son. It could be PTSS, could be BiPolar (BP), could be depression, could be a great many things. One thing is for sure, something needs to be done for both of you. Neither of you are happy. It's best not to second guess or jump on a diagnosis bandwagaon - it's best to let the professionals test your son and follow through with a treatement plan.

    Take a deep breath........puberty (from what I understand - we are heading there ourselves) is a really tough time for our difficult children, especially the boys.

    Keep us posted, we are always open!

  8. Kjs

    Kjs Guest

    I don't know where to go anymore. Thought I went to all the right places. Where do I go, what do I ask? Our world is falling apart. I have threated divorce, leaving and never coming back (which I have been told is only adding to his issues)I just don't know who to talk to.
    Sports or no Sports??? he is talented in sports, but just can't accept the fact that he will lose, and he will miss. When this happens we never seem to get past it. Other parents have made comments and we just don't know how to respond. Other than pulling him out and hiding out in our house. He wants to play, he wants friends...his behavior just is not cooperating with what he wants. Our lives have revolved around him, walking on egg shells afraid that in the next second he will explode. I work midnight to noon (new job) so I can be home three days / four days. Thought that would help. Only has been three weeks, but things seem to be getting worse. Went through some real financial troubles a few years ago. Both lost our jobs. Just starting to get back on our feet financially. He does have a tremendous amount of anxioty. Am I just doing everything wrong??
  9. smallworld

    smallworld Moderator

    You need to ask for either a multidisciplinary or neuropsychological evaluation. Both can be found at a university or children's hospital.

    You're not doing everything wrong. Your son's disorder hasn't been fully explored and defined (by the professionals), and as a result, the proper interventions haven't been put into place.
  10. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Like smallmom said, we're not doctors, but most of us have experience. My son was misdiagnosed twice, which was enough to give ME PTSD. I strongly recommend getting another opinion from another Child Psychiatrist not associated with that hospital (for a fresh perspective). Even the best of them can make serious diagnostic mistakes and ODD *rarely* stands alone. Most kids here have ODD symptoms, but they are caused by a bigger disorder. My guess is they are thinking mood disorder anyways due to the Lamictal. That is pretty much a mood stabilizer. He may need more than just Lamictil. Although Topomax is a second level mood stabilizser too, lots of kids have problems with it. My son did. I also live in Wisconsin. I'm up in Mid-Wisconsin. I don't know how far you are from Madison but that's top notch for both psychiatric and neuropsychologist. I hope you do investigate his diagnosis. further, and that things become easier for you and your child. Hugs to you. I hope you get the help you need soon. If one doctor isn't helping, my theory is to move on. I would really question ANY doctor who puts a chld on Lamictal, which is mostly used for bipolar, and wants to wean him off. If he has bipolar, he needs medications for life. Before you freak, I have it and, on medications, my life is great. It always carries a co-diagnosis. of ODD.

    Symptoms of bipolar disorder can emerge as early as infancy. Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word "no" often triggered these rages.

    Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children.

    What are the symptoms of bipolar disorder in adolescents?

    In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness.

    Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.

    Symptoms of mania include:

    * elevated, expansive or irritable mood
    * decreased need for sleep
    * racing speech and pressure to keep talking
    * grandiose delusions
    * excessive involvement in pleasurable but risky activities
    * increased physical and mental activity
    * poor judgment
    * in severe cases, hallucinations

    Symptoms of depression include:

    * pervasive sadness and crying spells
    * sleeping too much or inability to sleep
    * agitation and irritability
    * withdrawal from activities formerly enjoyed
    * drop in grades and inability to concentrate
    * thoughts of death and suicide
    * low energy
    * significant change in appetite

    Periods of relative or complete wellness occur between the episodes.

    * Bipolar II. In this form of the disorder, the adolescent experiences episodes of hypomania between recurrent periods of depression. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity.
    * Cyclothymia. Adolescents with this form of the disorder experience periods of less severe, but definite, mood swings.
    * Bipolar Disorder not otherwise specified (Not Otherwise Specified). Doctors make this diagnosis when it is not clear which type of bipolar disorder is emerging.

    For some adolescents, a loss or other traumatic event may trigger a first episode of depression or mania. Later episodes may occur independently of any obvious stresses, or may worsen with stress. Puberty is a time of risk. In girls, the onset of menses may trigger the illness, and symptoms often vary in severity with the monthly cycle.

    Once the illness starts, episodes tend to recur and worsen without treatment. Studies show that after symptoms first appear, typically there is a 10-year lag until treatment begins. CABF encourages parents to take their adolescent for an evaluation if four or more of the above symptoms persist for more than two weeks. Early intervention and treatment can make all the difference in the world during this critical time of development.

    Is substance abuse and addiction related to bipolar disorder?

    A majority of teens with untreated bipolar disorder abuse alcohol and drugs. Any child or adolescent who abuses substances should be evaluated for a mood disorder.

    Adolescents who seemed normal until puberty and experience a comparatively sudden onset of symptoms are thought to be especially vulnerable to developing addiction to drugs or alcohol. Substances may be readily available among their peers and teens may use them to attempt to control their mood swings and insomnia. If addiction develops, it is essential to treat both the bipolar disorder and the substance abuse at the same time.

    What role does genetics or family history play in bipolar disorder?

    The illness tends to be highly genetic, but there are clearly environmental factors that influence whether the illness will occur in a particular child. Bipolar disorder can skip generations and take different forms in different individuals.

    The small group of studies that have been done vary in the estimate of risk to a given individual:

    * For the general population, a conservative estimate of an individual's risk of having full-blown bipolar disorder is 1 percent. Disorders in the bipolar spectrum may affect 4-6%.
    * When one parent has bipolar disorder, the risk to each child is l5-30%.
    * When both parents have bipolar disorder, the risk increases to 50-75%.
    * The risk in siblings and fraternal twins is 15-25%.
    * The risk in identical twins is approximately 70%.

    In every generation since World War II, there is a higher incidence and an earlier age of onset of bipolar disorder and depression. On average, children with bipolar disorder experience their first episode of illness 10 years earlier than their parents' generation did. The reason for this is unknown.

    The family trees of many children who develop early-onset bipolar disorder include individuals who suffered from substance abuse and/or mood disorders (often undiagnosed). Also among their relatives are found highly-accomplished, creative, and extremely successful individuals in business, politics, and the arts.

    Historical Perspective

    Bipolar disorder has left its mark on history. Many famous and accomplished people had symptoms of the illness, including:

    * Abraham Lincoln
    * Winston Churchill
    * Theodore Roosevelt
    * Goethe
    * Balzac
    * Handel
    * Schumann
    * Berlioz
    * Tolstoy
    * Virginia Woolf
    * Hemingway
    * Robert Lowell
    * Anne Sexton

    The biographies of Beethoven, Newton, and Dickens, in particular, reveal severe and debilitating recurrent mood swings beginning in childhood.

    * Timeline

    Diagnosing Bipolar Disorder in Children

    Healthy children often have moments when they have difficulty staying still, controlling their impulses, or dealing with frustration. The Diagnostic and Statistical Manual IV (DSM-IV) still requires that, for a diagnosis of bipolar disorder, adult criteria must be met. There are as yet no separate criteria for diagnosing children.

    Some behaviors by a child, however, should raise a red flag:

    * destructive rages that continue past the age of four
    * talk of wanting to die or kill themselves
    * trying to jump out of a moving car

    To illustrate how difficult it is to use the DSM-IV to diagnose children, the manual says that a hypomanic episode requires a "distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days." Yet upwards of 70 percent of children with the illness have mood and energy shifts several times a day.

    Since the DSM-IV is not scheduled for revision in the immediate future, experts often use some DSM-IV criteria as well as other measures. For example, a Washington University team of researchers uses a structured diagnostic interview called Wash U KIDDE-SADS, which is more sensitive to the rapid-cycling periods commonly observed in children with bipolar disorder.

    How does bipolar disorder differ from other conditions?

    Even when a child's behavior is unquestionably not normal, correct diagnosis remains challenging. Bipolar disorder is often accompanied by symptoms of other psychiatric disorders. In some children, proper treatment for the bipolar disorder clears up the troublesome symptoms thought to indicate another diagnosis. In other children, bipolar disorder may explain only part of a more complicated case that includes neurological, developmental, and other components.

    Diagnoses that mask or sometimes occur along with bipolar disorder include:

    * depression
    * conduct disorder (CD)
    * oppositional-defiant disorder (ODD)
    * attention-deficit disorder with hyperactivity (ADHD)
    * panic disorder
    * generalized anxiety disorder (Generalized Anxiety Disorder (GAD))
    * obsessive-compulsive disorder (Obsessive Compulsive Disorder (OCD))
    * Tourette's syndrome (Tourette's Syndrome)
    * intermittent explosive disorder
    * reactive attachment disorder (Reactive Attachment Disorder (RAD))

    In adolescents, bipolar disorder is often misdiagnosed as:

    * borderline personality disorder
    * post-traumatic stress disorder (PTSD)
    * schizophrenia

    The need for prompt and proper diagnosis

    Tragically, after symptoms first appear in children, years often pass before treatment begins, if ever. Meanwhile, the disorder worsens and the child's functioning at home, school, and in the community is progressively more impaired.

    The importance of proper diagnosis cannot be overstated. The results of untreated or improperly treated bipolar disorder can include:

    * an unnecessary increase in symptomatic behaviors leading to removal from school, placement in a residential treatment center, hospitalization in a psychiatric hospital, or incarceration in the juvenile justice system
    * the development of personality disorders such as narcissistic, antisocial, and borderline personality
    * a worsening of the disorder due to incorrect medications
    * drug abuse, accidents, and suicide.

    It is important to remember that a diagnosis is not a scientific fact. It is a considered opinion based upon the behavior of the child over time, what is known of the child's family history, the child's response to medications, his or her developmental stage, the current state of scientific knowledge and the training and experience of the doctor making the diagnosis. These factors (and the diagnosis) can change as more information becomes available. Competent professionals can disagree on which diagnosis fits an individual best. Diagnosis is important, however, because it guides treatment decisions and allows the family to put a name to the condition that affects their child. Diagnosis can provide answers to some questions but raises others that are unanswerable given the current state of scientific knowledge.

    How can I help my child?

    Parents concerned about their child's behavior, especially suicidal talk and gestures, should have the child immediately evaluated by a professional familiar with the symptoms and treatment of early-onset bipolar disorder.

    There is no a blood test or brain scan, as yet, that can establish a diagnosis of bipolar disorder.

    Parents who suspect that their child has bipolar disorder (or any psychiatric illness) should take daily notes of their child's mood, behavior, sleep patterns, unusual events, and statements by the child of concern to the parents. Share these notes with the doctor making the evaluation and with the doctor who eventually treats your child. Some parents fax or e-mail a copy of their notes to the doctor before each appointment.

    Because children with bipolar disorder can be charming and charismatic during an appointment, they initially may appear to a professional to be functioning well. Therefore, a good evaluation takes at least two appointments and includes a detailed family history.

    Finding the right doctor

    If possible, have a board-certified child psychiatrist diagnose and treat your child. A child psychiatrist is a medical doctor who has completed two to three years of an adult psychiatric residency and two additional years of a child psychiatry fellowship program. Unfortunately, there is a severe shortage of child psychiatrists, and few have extensive experience treating early-onset bipolar disorder.

    Teaching hospitals affiliated with reputable medical schools are often a good place to start looking for an experienced child psychiatrist. You can also ask your child's pediatrician for a referral. Check the CABF Directory of Professional Members to see the names of doctors who practice in your area.

    If your community does not have a child psychiatrist with expertise in mood disorders, then look for an adult psychiatrist who has 1) a broad background in mood disorders, and 2) experience in treating children and adolescents.

    Other specialists who may be able to help, at least with an initial evaluation, include pediatric neurologists. Neurologists have experience with the anti-convulsant medications often used for treating juvenile bipolar disorders. Pediatricians who consult with a psychopharmacologist can also provide competent care if a child psychiatrist is not available.

    Some families take their child to nationally-known doctors at teaching hospitals for diagnosis and stabilization. They then turn to local professionals for medical management of their child's treatment and psychotherapy. The local professionals consult with the expert as needed.

    Experienced parents recommend that you look for a doctor who:

    * is knowledgeable about mood disorders, has a strong background in psychopharmacology, and stays up-to-date on the latest research in the field
    * knows he or she does not have all the answers and welcomes information discovered by the parents
    * explains medical matters clearly, listens well, and returns phone calls promptly
    * offers to work closely with parents and values their input
    * has a good rapport with the child
    * understands how traumatic a hospitalization is for both child and parents, and keeps in touch with the family during this period
    * advocates for the child with managed care companies when necessary
    * advocates for the child with the school to make sure the child receives services appropriate to the child's educational needs.


    Although there is no cure for bipolar disorder, in most cases treatment can stabilize mood and allow for management and control of symptoms.

    A good treatment plan includes medication, close monitoring of symptoms, education about the illness, counseling or psychotherapy for the individual and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support.

    The response to medications and treatment varies. Factors that contribute to a better outcome are:

    * access to competent medical care
    * early diagnosis and treatment
    * adherence to medication and treatment plan
    * a flexible, low-stress home and school environment
    * a supportive network of family and friends

    Factors that complicate treatment are:

    * lack of access to competent medical care
    * time lag between onset of illness and treatment
    * not taking prescribed medications
    * stressful and inflexible home and school environment
    * the co-occurrence of other diagnoses
    * use of substances such as illegal drugs and alcohol

    The good news is that with appropriate treatment and support at home and at school, many children with bipolar disorder achieve a marked reduction in the severity, frequency and duration of episodes of illness. With education about their illness (as is provided to children with epilepsy, diabetes, and other chronic conditions) they learn how to manage and monitor their symptoms as they grow older.

    The parent's role in treatment

    As with other chronic medical conditions such as diabetes, epilepsy, and asthma, children and adolescents with bipolar disorder and their families need to work closely with their doctor and other treatment professionals. Having the entire family involved in the child's treatment plan can usually reduce the frequency, duration, and severity of episodes. It can also help improve the child's ability to function successfully at home, in school, and in the community.

    Parents: Learn all you can about bipolar disorder. Read, join support groups, and network with other parents. There are many questions still unanswered about early onset bipolar disorder, but early intervention and treatment can often stabilize mood and restore wellness. You can best manage relapses by prompt intervention at the first re-occurrence of symptoms.


    Few controlled studies have been done on the use of psychiatric medications in children. The U.S. Food and Drug Administration (FDA) has approved only a handful for pediatric use. Psychiatrists must adapt what they know about treating adults to children and adolescents.

    Medications used to treat adults are often helpful in stabilizing mood in children. Most doctors start medication immediately upon diagnosis if both parents agree. If one parent disagrees, a short period of watchful waiting and charting of symptoms can be helpful. Treatment should not be postponed for long, however, because of the risk of suicide and school failure.

    A symptomatic child should never be left unsupervised. If parental disagreement makes treatment impossible, as may happen in families undergoing divorce, a court order regarding treatment may be necessary.

    Other treatments, such as psychotherapy, may not be effective until mood stabilization occurs. In fact, stimulants and antidepressants given without a mood stabilizer (often the result of misdiagnosis) can cause havoc in bipolar children, potentially inducing mania, more frequent cycling, and increases in aggressive outbursts.

    No one medication works in all children. The family should expect a trial-and-error process lasting weeks, months, or longer as doctors try several medications alone and in combination before they find the best treatment for your child. It is important not to become discouraged during the initial treatment phase. Two or more mood stabilizers, plus additional medications for symptoms that remain, are often necessary to achieve and maintain stability.

    Parents often find it hard to accept that their child has a chronic condition that may require treatment with several medications. It is important to remember that bipolar disorder has a high rate of suicide. Estimates vary, but mortality rates of 5-10% from suicide are reported by various studies, rates equal to or greater than the mortality rates for many serious physical illnesses. The untreated disorder carries the risk of drug and alcohol addiction, damaged relationships, school failure, and difficulty finding and holding jobs. The risks of not treating are substantial and must be measured against the unknown risks of using medications whose safety and efficacy have been established in adults, but not yet in children.

    A Cautionary Note on Antidepressants and Stimulants from the National Institute of Mental Health

    Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat attention deficit hyperactivity disorder (ADHD) or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.

    Child and Adolescent Bipolar Disorder:[NL]An Update from the National Institute of Mental Health


    In addition to seeing a child psychiatrist, the treatment plan for a child with bipolar disorder usually includes regular therapy sessions with a licensed clinical social worker, a licensed psychologist, or a psychiatrist who provides psychotherapy. Cognitive behavioral therapy, interpersonal therapy, and multi-family support groups are an essential part of treatment for children and adolescents with bipolar disorder. A support group for the child or adolescent with the disorder can also be beneficial, although few exist.

    Therapeutic ParentingTM

    Parents of children with bipolar disorder have discovered numerous techniques that the CABF refers to as therapeutic parenting. These techniques help calm their children when they are symptomatic and can help prevent and contain relapses. Such techniques include:

    * practicing and teaching their child relaxation techniques
    * using firm restraint holds to contain rages
    * prioritizing battles and letting go of less important matters
    * reducing stress in the home, including learning and using good listening and communication skills
    * using music and sound, lighting, water, and massage to assist the child with waking, falling asleep, and relaxation
    * becoming an advocate for stress reduction and other accommodations at school
    * helping the child anticipate and avoid, or prepare for stressful situations by developing coping strategies beforehand
    * engaging the child's creativity through activities that express and channel their gifts and strengths
    * providing routine structure and a great deal of freedom within limits
    * removing objects from the home (or locking them in a safe place) that could be used to harm self or others during a rage, especially guns; keeping medications in a locked cabinet or box.

    What are the educational needs of a child with bipolar disorder?

    A diagnosis of bipolar disorder means the child has a significant health impairment (such as diabetes, epilepsy, or leukemia) that requires ongoing medical management. The child needs and is entitled to accommodations in school to benefit from his or her education. Bipolar disorder and the medications used to treat it can affect a child's school attendance, alertness and concentration, sensitivity to light, noise and stress, motivation, and energy available for learning. The child's functioning can vary greatly at different times throughout the day, season, and school year.

    The special education staff, parents and professionals should meet as a team to determine the child's educational needs. An evaluation including psychoeducational testing will be done by the school (some families arrange for more extensive private testing). The educational needs of a particular child with bipolar disorder vary depending on the frequency, severity and duration of episodes of illness. These factors are difficult to predict in an individual case. Transitions to new teachers and new schools, return to school from vacations and absences, and changing to new medications are common times of increased symptoms for children with bipolar disorder. Medication side effects that can be troublesome at school include increased thirst and urination, excessive sleepiness or agitation, and interference with concentration. Weight gain, fatigue, and a tendency to become easily overheated and dehydrated impact a child's participation in gym and regular classes.

    These factors and any others that affect the child's education must be identified. A plan (called an IEP) will be written to accommodate the child's needs. The IEP should include accommodations for periods when the child is relatively well (when a less intense level of services may suffice), and accommodations available to the child in the event of relapse. Specific accommodations should be backed up by a letter or phone call from the child's doctor to the director of special education in the school district. Some parents find it necessary to hire a lawyer to obtain the accommodations and services that federal law requires public schools to provide for children with similar health impairments.

    Examples of accommodations helpful to children and adolescents with bipolar disorder include:

    * preschool special education testing and services
    * small class size (with children of similar intelligence) or self-contained classroom with other emotionally fragile (not "behavior disorder") children for part or all of the day
    * one-on-one or shared special education aide to assist child in class
    * back-and-forth notebook between home and school to assist communication
    * homework reduced or excused and deadlines extended when energy is low
    * late start to school day if fatigued in morning
    * recorded books as alternative to self-reading when concentration is low
    * designation of a "safe place" at school where child can retreat when overwhelmed
    * designation of a staff member to whom the child can go as needed
    * unlimited access to bathroom
    * unlimited access to drinking water
    * art therapy and music therapy
    * extended time on tests
    * use of calculator for math
    * extra set of books at home
    * use of keyboard or dictation for writing assignments
    * regular sessions with a social worker or school psychologist
    * social skills groups and peer support groups
    * annual in-service training for teachers by child's treatment professionals (sponsored by school)
    * enriched art, music, or other areas of particular strength
    * curriculum that engages creativity and reduces boredom (for highly creative children)
    * tutoring during extended absences
    * goals set each week with rewards for achievement
    * summer services such as day camps and special education summer school
    * placement in a day hospital treatment program for periods of acute illness that can be managed without inpatient hospitalization
    * placement in a therapeutic day school during extended relapses or to provide a period of extra support after hospitalization and before returning to regular school
    * placement in a residential treatment center during extended periods of illness if a therapeutic day school near the family's home is not available or is unable to meet the child's needs

    A Turning Point

    Learning that one's child has bipolar disorder can be traumatic. Diagnosis usually follows months or years of the child's mood instability, school difficulties, and damaged relationships with family and friends. However, diagnosis can and should be a turning point for everyone concerned. Once the illness is identified, energies can be directed towards treatment, education, and developing coping strategies.
  11. LittleDudesMom

    LittleDudesMom Well-Known Member Staff Member

    I agree with small, a multidisciplinary or neuropsyc evaluation is what you need to be looking into. Do you have a local teaching hospital/university where you live? Is there a local children's hospital? That's where you can start. Make the call today. But, it could take several weeks before you can get in for an appointment.

    In the meantime, work on a parent's report (there is a link here to an example/proforma).

    I think we can all understand the "walking on egg shells" behavior - I know that I can! difficult children can be really hard on relatioinships and jobs. Marriages end and employers fire. Many here have had that experience.

    Know that you are not alone. Many, many parents are going through the same thing. Is your son aware of his "limitations"? If so, can you sit him down for a reality check - let him know how his behaviors are affecting you? Let him know that you are working to get him help - you don't want to see him sad, mad, and suffering.

    In regards to the school, does your son have BIP (behavior intervention plan)? Sounds as though he does since he is supposed to leave the classroom if he is getting frustrated (same for my difficult child). Sometimes we have to step in to make sure it is being enforced. Is there someone at the school that has a comforting effect on difficult child? Is there some task that he particularly enjoys or is calming that they can assign him when he is getting frustrated?

    In regards to sports, you may have to get tough and draw the line here. It is not worth the meltdowns, socially, at these sporting events. Other kids (and their parents) are going to judge your son on his behaviors - that's reality. You may need to tell your son that if he cannot handle the rules of good sportsmanship, he'll be benched at home until he can.

    Hugs to you.

  12. Kjs

    Kjs Guest

    difficult child just called me(I am at work). He hates school, nothing good about it. Has no friends, then he cried because he is so sad and gets mad at everything. I asked him if he wanted me to call the doctor, but he said he won't go. When we do have an appointment he is fine until we get there, then he says things that aren't true, and is awful. I am scared. He is really, really sad and angry.
  13. timer lady

    timer lady Queen of Hearts

    Just popped in to welcome you. You've been given a lot of information to digest here.

    Take some deep breaths & please don't make any major life decision under this level of stress.

    Prioritize the issues & take them down one by one.

    In the meantime, please please please start the process by getting yourself some help; find some time for "you".

    "If you're walking through hell....keep walking" Churchill
  14. jodyice

    jodyice New Member

    welcome kjs, sorry you had to find us, glad you did. I have no words to offer other than what's been said, but wanted to welcome you to our place in this big world.