New bipolar diagnosis--will lithium improve conduct disorder?

Discussion in 'General Parenting' started by sheepdoglover, Jul 27, 2011.

  1. Hi there,

    My difficult child is presently inpatient and is being diagnosed with a mood disorder that has a clear bipolar component and they are starting him on lithium. I don't know exactly what they will call it since does not fit any of the classic profiles. There is a strong family history (including myself with bipolar II). by the way, have known for YEARS that he was on the Borderline Personality Disorder (BPD) spectum and couldn't get psychiatrists to listen and medicate him appropriately GRRR . . What finally occurred was that age age 14, he became more clearly hypomanic and exhibited grandiosity. Unfortunately this took the form of anti-social types of conduct.

    So, over the last several months, he began to use marijuana regularly, "deal" by pooling money from his fellow 8th graders and purchasing from older high school kids. He got suspended twice for defiant behavior--just leaving school. Some violence, but not to us and in retaliation to someone who was violent towards him. And recently, he developed odd/paranoid thinking (these people are out to get me and can't be trusted types of thoughts). No problems with the law.

    My big concern is that I have read that he has plans with other boys to start a drug dealing business, and to rob other kids to get $ for said business . . . you get the picture. This is really unacceptable. I have told him I will help him get an accurate diagnosis for his mental illness, and help treat his mental illness. I will also help him with substance use if he needs that help. But I will not tolerate criminal behavior that has a victim for one single minute and I will turn him and his associates into the police.

    So, the doctors feel that these "plans" to have a drug business are in part due to this grandiosity he has been experiencing. But he nevertheless seems drawn to this criminal element which worries me greatly.

    In your experience, has stabilizing the mood, and removing the substances from the picture, improved the anti-social conduct? I guess I'm hung up on that because as I said, this is where I draw the line. I will not enable anyone, including my son, to hurt another person. I don't think I would even allow him to live in my home--I would send him to a therapeutic boarding school of some sort.

    Thank you in advance
  2. flutterby

    flutterby Fly away!

    Often getting the right medications in place, along with therapy, makes a huge difference in "stinkin' thinkin'". I see our kids' behavior as a symptom, not the cause. As I'm sure you're aware, though, it can take a lot of trial and error to get the right medications.

    Welcome to the board. It's typically kinda slow during the day in the summer, but more will be along later.
  3. Thanks. I appreciate that insight. I need some hope that the behavior will improve. I really don't want to have to send him away and the psychiatrist yesterday suggested that would be necessary if they couldn't control the mood and substance piece and he continued with the negative behaviors.
  4. Fran

    Fran Former Site Owner

    Hopefully, the medications will help him understand consequences.
    If you make a statement of consequence be prepared to follow through or he will never take you seriously.
    Have a plan of who to call and when. Make sure husband is on board. Have phone numbers and agencies at the phone.
    I don't know if medications will make him a "good" person since that is a choice but hopefully it will dial down his idea that he is capable of
    anything he wants to do. The rules don't apply to him.
    Therapy in addition to medications is a first step. Taking him away from the situation of all his "buddies" may not be a bad alternative to negative influences.
    If he is showing physical violence, then you need to have a plan to protect yourself also.
    It's scary. Sending good thoughts that the medications work.
  5. TeDo

    TeDo Guest

    The lithium may help level things out. As for the "plan", I am glad you have drawn your line in the sand so to speak. It sounds like these "friends" are not the type I would allow my son to hang around with. As flutterby said, there could be a lot of trial and error in finding the right medications and the right dosages. Hang in there. I am glad he is inpatient so he is away from the drugs and friends and can have his symptoms monitored. Hopefully they are doing some therapy as well.
  6. You guys raise an interesting point about friends. Presently, he has a good group of friends (some of whom have been distancing themselves from him due to the drugs), and a dangerous/druggie/anti-social group. I don't think the latter group is cohesive--in other words, he seems to know bad influences from various places. I think I know who they are from reading texts and monitoring FB. But how in the world do you actually control who your child hangs out with? If he goes out, I can follow him on the phone GPS, but I don't know who he is with. He could easily lie to me. Would your recommendation be to say these people who I know are bad influences are off-limits to you? Just be very clear about it? And then there are 1 or 2 who are kind of in the middle of the road. Good kids with good grades who happen to smoke a lot of pot. They are able to do substances and have a successful life. Do I restrict him from them too? He will fight that hard.
  7. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Hi, welcome to the board. I see your son is 14. That is a very difficult age with boys. It is when my son really took his nosedive into the teen years from hell. Starting him on lithium seems a good choice since he seems to be exhibiting some manic behavior but have they considered any sort of anti-psychotic to help with the distorted thinking?

    If your son is or has started with some sort of drug use or selling or passing around pot, well, he and his friends are distributing and he can be arrested for a felony. Even if all they do is pool their money to buy a larger bag and then split the proceeds, its distributing. If he is planning on robbing someone to start a larger drug have bigger issues. It does sound like he is bordering on the conduct disorder diagnosis along with a mood disorder. Whether or not dealing with the mood component will help with the conduct problems is yet to be seen.

    If I had a 14 year old boy who was suspected of having a mood disorder and/or a conduct disorder and was smoking pot AND he was hanging around kids who also smoked pot... I would ban him from those friends. I know this is difficult. I have been there. I had a son in those very same circumstances. We had to keep him attached to our hips constantly. He went nowhere alone. He was always with one of his parents. At one point his father quit his job so he could be home with him. We simply couldnt trust him out of our sight. We did send him to several group homes, psychiatric hospitals and finally a Residential Treatment Center (RTC).
  8. Mattsmom277

    Mattsmom277 Active Member

    I wanted to say welcome to the board, even though I don't really have any words of wisdom on the exact questions you are asking. It is a good step for your son to be properly diagnosis'ed now and to have medication in place. I hope this medication works out but do not give up if it isn't the correct one, it can take several tries to find the right mix for a particular individual.

    I want to say I admire that you are firm already in the line you will draw in the sand. If you and your spouse are both on the same page and prepared to have consequences for behaviors that are unacceptable, it can only serve your son well to see you both follow through when he needs to be disciplined for being out of line.

    It is such a touchy thing to try to bar any kid, let alone a difficult child, from certain friends or acquaintances. I can certainly understand your concerns and I wish I had something to contribute in that area. All I can do is judge from my own experiences and say that with my difficult child I allowed much more freedom at home, in attempts to keep him AT home with his friends rather than the "unknown" factor when he was out and about. It only worked because I had a basement I transformed into his personal space and I knew the kids he'd have over and approved of them. I don't know how I'd have handled the kids I didn't want him around, but I'm tempted to think I may have allowed it under my own supervision but that is theory, in practice I may not have at all. When my difficult child would have friends in, he was given free reign downstairs so long as the noise wasn't crazy and no alcohol, drugs, smoking. He would at times have several boys over hanging out and although I would have loved to see him being out of the house more, for me it was a solution to my particular problem with not knowing what he'd get up to if outside of the house. His friends came to respect me and the rules of the house and it worked out. But then again, he hadn't been smoking pot (that came later after I had him move out for a while to see the grass wasn't greener). When he did return home to live, I made a ZERO pot rule, as in NONE. I caught him ONE time after he moved home, he didn't bring it home but he did have a adult neighbor (grr) share pot with him and came in high. He lost his computer, xbox, cell phone priveledges for a month. He was working towards earning some pricey shoes he wanted, that money earned was put away and the shoes put on hold until his month of restriction was up. He was to add an extra day for each time in that month he was smart towards me in conversation or put up a fight at chore time etc. I have to say that I don't think this was the reason he stopped with the pot, I think he stopped because he saw that I had removed him from our home and by the time I caught the incident with the pot smoking, he was right scared I'd remove him again and he'd had time away to realize how much "home" really meant to him. He has gone on to be very typical teen-ish.

    I have no idea what will be right for your son but it sounds like you are on the right path with treatment, medication and having firm boundaries. Perhaps before he returns home your husband and yourself might want to make a list of behaviors that are unacceptable and the consequences for engaging in them. If you are both prepared to follow through and know ahead of time what your consequence will be, there is less room to act in anger of the heat of the moment and choose another approach or something that will cause your son to think he's pulling one over on you both.

    I applaud your decision to turn him and his friends in if they make good on their 'ideas' for this new "venture". I think sometimes with difficult children particularly, the tough love approach can be a difference maker. You'll know soon enough if it doesn't work with your own difficult child and you can contemplate then what to try next.

    Welcome to the board, there are so many wonderful people here, many with similar experiences to yours. Hopefully they will have some wisdom for you as I don't know that I have much to offer on this topic. Please be sure to update us on how the lithium is working out
  9. TeDo

    TeDo Guest

    Absolutely put those friends on the "not happening" list. You are the parent and you control his life whether he likes it or not. Before you do that, make sure you have consequences already figured out and lay them out to him. Then you will need to follow through each and every time.

    This may sound crazy to some but it has worked with my kids for years. When they were old enough to go alone to play with friends, they had to tell me who they would be with and where they were going. If they change their minds about where they are going, they need to let me know BEFORE they change locations. After about an hour, I drive by or go to where they said they were going to be. If they're not there, I go looking for them and drag them home once I find them. If I see they are with friends I disapprove of, I drag them home. Once we get home, I remind them of my rules and issue the consequences. Because I started this pretty young, it has not really been an issue in our house. I know it sounds drastic but in today's society you can never be too cautious and it also shows my kids I'm dead serious.
  10. seriously

    seriously New Member

    Have you had any contact with parents of these other kids? Do they know that their kids are doing pot or are selling?

    Have you reported this to the school?

    You have hit the nail on the head in terms of dealing with substance abuse issues. Distancing from the "friends" who did those things with him is absolutely necessary to reach and sustain sobriety for 99% of the people who try to get off drugs/alcohol.

    This is particularly hard to do with teens who have to go to school every day and see these same kids all the time. Unless they change schools there is constant contact or opportunity for contact.

    Even changing from one public school to another may not help because of "associations" that cross school boundaries.

    This may be why the psychologist said that sending him to an inpatient or residential treatment facility may be necessary.

    And it is no guarantee of course.

    It's very promising that the mood disorder piece has finally been identified. sorting this out with kids and teens is really difficult but given the family history I would have thought the psychiatrist would have been inclined to treat him more aggressively sooner. But most of the BiPolar (BP) medications carry a significant risk of metabolic or systemic side effects that can sometimes be dangerous. Until they feel the sx and signs are pretty clear they are reluctant to use these medications since they do not want to medicate someone who doesn't need it.

    Has he only shown hypomanic behaviors or have you also seen/he has reported sx of depression?

    Lithium is usually very effective in treating mania but doesn't seem to have much punch when it comes to treating the depression that goes with BiPolar (BP) II. If he's only had hypomanic sx then that would be the correct diagnosis - or BiPolar (BP) not otherwise specified.

    Do you see any kind of pattern to his mood shifts? Does he have periods where he seems "normal" or not?

    Unfortunately the marijuana (and any other illegal drugs) make everything a lot more complicated in terms of both diagnosis and treatment. So it's going to be trial-and-error with medications and settings, perhaps for a year or more.

    If you have the financial resources to send him to a therapeutic boarding school, my frank advice would be to do it straight out of the treatment facility he's in now.
  11. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hey, you DID get responses! :)
  12. HaoZi

    HaoZi Guest

    Dropping in to say welcome to the board. I don't have any answers for you, either. I would see about separating him from the "friends" that are encouraging this behavior in any way. If the lithium doesn't work there are many other medications out there that might prove helpful if needed for bi-polar, so don't give up. Everyone is different and the right medication mix (or wrong one!) can make a world of difference in how well he takes and puts to use talk therapy and other help.
  13. Wiped Out

    Wiped Out Well-Known Member Staff Member

    Just adding in another welcome (I answered on your other thread too). Nothing new to add to what others have already said. Sorry you needed us but glad you found us! Hugs.