Newbie

[Over]

Hi everyone! I'm a newbie and my signature says most everything, but I wanted to add that Alexis has been off of her Risperdal since the beginning of this Summer due to the psychiatrist's concern about possible side effects. She seems to be doing pretty well as far as the bipolar goes with only some manic episodes, but nothing huge.

The problem we're having is the ODD. I swear I could tell the child the sky is blue, and she'd argue with me and say it was purple just to argue. I'm feeling very run down, and overwhelmed with her, and I am at the point where nothing seems to help. We've punished, we've fussed, we've taken away privileges, we've promised and given positive rewards. She just seems not to care and my stress level is climbing unbelievably. Mostly because the majority of the behavior is directed at me.

I'm wondering if it's common for a child with ODD to direct most of the anger onto one parent? I'm at the point where I don't know whether to laugh, cry, or hide.

 

[BusynMember]

Welcome to the board .

It is common for bipolar kids to exhibit lots of ODD behavior. I would feel queasy about having her off medications. It's not good for kids to have manic episodes...they can ingrained on the brain. I have a mood disorder and without medication the moodswings worsen. I would personally want my child on a mood stabilizer rather than just an antipsychotic. Mood stabilizers are Lithium, Lamictal, Trileptal, Tegretal, and Depakote. They work better for the long term.

Also, yes, it is very common for kids with all disorders to take it out on mom more than dad. Dad's, maybe due to their tallness and loud voices and not being around as much, tend to see them at their best and to get a better response in the area of discipline. Sometimes Dad doesn't believe Mom or thinks Mom is just a poor disciplinarian, but that's not it. In my house, even the dogs listen to Dad more than Mom. I swear, it's the deep voice!!!

 

[gcvmom]

I think sometimes you have to detach from that argumentativeness and try to let some of the things go by without taking the "bait". It's hard to do.

You may need to learn some different approaches for dealing with the ODD behaviors. Have you read much from Dr. Ross Greene? Here's a link to his website on Collaborative Problem Solving:

http://www.ccps.info/

Many of these techniques help solve the power struggle issues we can get into with our "special" kids.

Like MWM said, I'd also be nervous about not having something in place to control the manic symptoms better. The way our psychiatrist described bipolar is that if left untreated, the symptoms act like kindling in the brain and can eventually result in a full-blown, and more severe presentation of the disorder from which it is much, much harder to recover.

Welcome to the board!

 

[Wiped Out]

Welcome. You are so not alone. My difficult child directs much of his anger on me; everyone gets it but I receive the most of it! I agree I would be worried about her being off of all medications. I know with my difficult child's bipolar it can get bad if we are late with even one dose. Hugs.

 

[susiestar]

Welcome! You will not find a better place for help and support with your child and your life. Not anywhere.

While the psychiatrist is concerned about side effects, and it is important to weigh those, he is playing a very dangerous game with your child's very life.

Bipolar disorder, untreated, has a 30% mortality rate. That means that 30 out of 100 people with bipolar will commit suicide or cause their deaths in some manner. This is out of the Bipolar Child. I have seen it substantiated elsewhere.

Even if that number is artificially high, there is still too much risk to leave a child unmedicated. The present theory is that bipolar is caused by seizures in the brain. Not necessarily ones that can be found on an eeg, but still seizures. It explains why many of the first line mood stabilizers are anti seizure medications.

Each mood swing creates a pathway. Over time these pathways, which cause and contribute to the mania and depression and mixed states, get stronger and stronger. They start as a thin path through the trees. The more you travel that path the more obvious and wider the path becomes. Before long it is paved with concrete. Eventually it is a 6 lane expressway.

Early and consistent treatment can help keep it at the dirt trail stage. Or closer to it than not.
What you see as "ok but some mania" may be mixed states, stuck between the extremes but not at "normal'.

Please get another opinion. Do some research on the Child and Adolescent Bipolar Foundations website - cabf.org .

ODD is NOT a great diagnosis. Yes, it will tell you what she is doing. It doesn't even TRY to address the WHY she is doing it part. A good diagnosis points you in the direction of help. ODD doesn't.

Traditional parenting and sticker charts and chips and token economies just don't work with difficult children. No matter what you do it will not work long term if you stick to those things.

Check out the collaborative parenting sites recommended above. It seems like it is catering to the child, counterintuitive pretty much. But it can WORK. That is what is important. It can work LONG TERM.

ODD behaviors are usually caused by another untreated disorder. Or one that is poorly treated. If she is off medications and is bipolar she CAN NOT BEHAVE THE WAY YOU WANT HER TOO. CAN not, not WILL not. No matter what she tries she will get it wrong. It is teh disease that you have chosen not to treat for a while.

Once you truly accept that you will be able to help by finding a medication combo that works. Otherwise this is just going to spread (the odd behavior). LOTS of us have found that with proper treatment, medications and therapy, the odd disappears. It isn't magical, and they still mess up and are difficult children, but they are not as tough to live with.

Did the psychiatrist (shrink) tell you that MOST medications for bipolar take MONTHS to get to the therapeutic level? And the patient needs to be at that level for 6-8 weeks for it to work??? I am betting he did not. My daughter takes Keppra for seizures. It is starting to be used as a mood stabilizer according to one of our doctors. It took us a full YEAR to get her up to the therapeutic level. Every medication increase takes 2-3 MONTHS to get to the level and 6 more weeks to have the full effects.

Every time you stop medications it should be done over a period of weeks to months. medications must be titrated down very slowly or really bad things can happen. Even a person with no history of seizures will have seizures if you stop the medication cold turkey. Antidepressants, which are NOT good for bipolar no matter WHAT the psychiatrist says, have nasty nasty withdrawal symptoms. Google lexapro withdrawal or effexor withdrawal and it will make your hair stand on end.

antidepressants (AD's) are rx'd for bipolar by many many psychiatrists and other docs. Sadly, the approved medication protocol by the Academy of Child and Adolescent Psychiatrists AND the Academy of Psychiatrists both say that AD's should NOT be given until the patient has been stable on mood stabilizers for a period of time.

Mood stabilizers and atypical antipsychotics are the first two types of medications used. It often takes 2 mood stabilizers and an antipsychotic to stabilize a patient. AD's will send a bipolar patient into major mood cycling. Ask a couple of the moms who have bipolar what an AD does. MidwestMom would share her experiences I am sure.

Please think about what I ahve said. research it yourself. We are here to give support any way we can.

Oh, and many kids pick one parent, usually the mom, to direct the problem behaviors to. They pick the parent they feel truly loves them unconditionally. They relax and let it all out with us because they feel we will love them no matter what. Kind of a mean backhanded compliment, if you ask me. But it is what it is.

Hugs and welcome!

Susie

 

[graceupongrace]

Oh, and many kids pick one parent, usually the mom, to direct the problem behaviors to. They pick the parent they feel truly loves them unconditionally. They relax and let it all out with us because they feel we will love them no matter what. Kind of a mean backhanded compliment, if you ask me. But it is what it is.

Susiestar is absolutely right. Our difficult children will hold it together around friends, teachers, even the other parent, but they unleash on us because they understand that nothing will make us stop loving them, as much as we detest their behavior. I know this because I constantly feel I have a big target painted on my back.

I tried all sorts of creative rewards, point systems, etc. and none of them ever worked. Ever. psychiatrist finally explained that difficult child is just not wired that way; things that motivate other kids will not affect him. It's a function of brain chemistry, not poor parenting.

The medications will not solve the problems, but they may enable you to work with difficult child to solve them. My understanding is that bipolar (which eventually was ruled out in my son's case) is treatable and manageable, but very, very rarely without medications. Risperdal is not the only alternative.

Sending hugs your way!

 

[flutterby]

I always felt, with my difficult child at least, that she held it together all day, and it took so much out of her, that by the time she was home in a safe environment she was physically unable to hold it together anymore. And everything that she had been holding in came pouring out - all. night. long.

IOW, I feel your pain.

Welcome to the board.

 

[TerryJ2]

Yes, it is more common. The worst behaviors will be exhibited against the parent who spends the most time with-them. Usually, that's the mom.
I learned that the hard way.
You've got to share as much parenting as possible with-your husband. Let him share the load. Give him entire days (weekends, if he works FT and you're home) and it can't be all fun stuff. It has to include chores and homework. That's where these kids really get uptight.
I agree with-others here, you have got to learn to detach. Some days it's easier than others. Sometimes you have to take medications yourself. Whatever it takes, do it for your own peace of mind. We don't all need to end up with-heart conditions.

I wasn't aware that ODD behaviors were exclusive to bipolar; my son is Aspie-lite and he's ODD, although he has improved with-yrs of therapy, Adderall, and Imiprimene. It's possible he's got a mood disorder as well, but anyway, that just caught my attention.

 

[susiestar]

ODD is in NO WAY exclusive to bipolar. My Aspie could have written the book on ODD. So could many of our difficult children with as many diagnosis's as their are toes on all of their feet! THAT is exactly why ODD is a garbage can diagnosis. It just tosses a lot of behaviors into the ODD bin with no clue as to what causes them.

Risperdal is an atypical antipsychotic. It is great for use with aggressive kids. It will not CAUSE mood cycling as far as anyone knows. But it is NOT real treatment for the true problems of bipolar. For that you need mood stabilizers, often a combo of two of them. Others can tell you more about them. Or you can google them. Just don't get too caught up in the side effects. While they ARE important, every single medication has a very long list of awful side effects. The trick is to get the help with the fewest side effects.

 

[Over]

Midwest Mom,

I am very uneasy about her being off of the bipolar medications. The psychiatrist insisted it was for the best, and I recently found out that he removed her bipolar diagnosis from her diagnosis list on her chart when I asked for a paper with the diagnosis' in order to request and IEP at school. He did this without saying anything to me. There is no doubt in my mind that she is bipolar, and he diagnosed her 2 years ago with it.

GCVMom,

I definitely try to choose my battles. I have to, otherwise I'd be fussing at her constantly! Thank you for the link, I'm definitely going to check it out.

Wiped Out,

Thanks for the welcome!

Susie Star,

I can already tell that this board is going to be wonderful. I've felt like I'm the only one dealing with this, but now I see I'm not! Thank you so much for your wisdom. I've written several things down to talk to her doctor about! She was on Risperdal for 2 years. He took her off the summer of 2007 and she had hallucinations and horrible problems and almost ended up inpatient. He put her back on it, and then took her off again at the beginning of this Summer. His excuse, "We have to see how she does without it in case she can go off of it. The side effects are so bad that we need to." As a result our home life is horrible. No hallucinations this time around, but the ODD is really bad like I said. I feel like I walk on eggshells which is not good for me because I have PTSD. I did know about the antidepressants and have refused to have her put on them.

GraceUponGrace,

I feel the same, that there's a huge target on my back. *Sigh*

Heather,

Thank you for the welcome!! I never thought about it that way, but it makes sense!

Terry,

Thank goodness my husband is willing to share those responsibilities on the weekend. He is gone for 12 hours a day right now between commute and work. He gets home at 6 and we eat, bathe, and put the kids to bed. On the weekends I do get help with her. He gets a lot better response from her which frustrates and relieves me all at the same time. I've been considering seeing a doctor myself about the stress and upset that being difficult child's Mom has entailed.

 

[totoro]

Welcome!

Why did he remove the diagnosis?
I would want a concrete reason for the removal. You should have a say in what you think is going on, the psychiatrist should listen you and take what you see and feel in regards to the diagnosis.
You should also always have a say in the medications and the choices.
Have you had Neuro-psychiatric evaluation done for her? Sometimes this really helps as far as seeing every thing that is going on and you can take this to the psychiatrist and show him what is truly going.
Sorry you are seeing the ODD symptoms so much.
And yes our kids let lose on us.
But, when they are stable the ODD symptoms tend to go away. Which is why my psychiatrist will not use ODD as an actual diagnosis, she considers ODD as a symptom of K's BiPolar (BP).
Or it would be a symptom of her ADHD, or some-ones Autism etc.

Good luck! And Welcome

 

[Over]

I found out after we left the office, so I haven't gotten the chance to confront him with it and ask why. Her next appointment is in October, but since her behavior is so awful right now, we'll probably end up asking for a closer one, and I'll ask him then. I'm going to tell him that I do not agree at all and I just think it's really shady how he did it without mentioning anything.

No I haven't had a Neuro-psychiatric evaluation done. I don't even know where I would start to do that? Thanks for your reply!

Heather

 

[TerryJ2]

I would be VERY upset that the bipolar diagnosis was removed with-o my knowledge. That is very strange.
It could have been something to assist you with-paperwork. Some diagnosis's get better interventions than others. Then again, maybe he's looking out for his own #$$.
I would call, not wait until the next appointment.

And definitely do a neuro-psychiatric evaluation. Get a phonebook and start calling. My pediatrician didn't know I was even getting one, but when I got it, and told I him the results (which were abysmal--within 30 sec the psychiatric pronounced difficult child ADHD and NOT Aspie and demanded to know why I even thought so), the pediatrician said something about how you can say whatever you want when you're the only game in town. So I found a diff doctor in another city and went through lots of testing. It was much more thorough and revealing.

 

[Over]

I hope it's because some diagnosis' get better intervention than others, but I have a sneaking suspicion that it's something else which is why I want to confront him face to face. I have to have the IEP in place before next year's testing starts so I have a little more time. I've been doing research and getting my ducks in a row as far as what I want for her. (Thankfully, I know what to expect because we've done IEP meetings with my younger daughter with CP.)

What type of Dr. does the Neuro-psychiatric evaluation? Is it covered by insurance at all? I'm definitely looking into it.

 

[TerryJ2]

It should be covered by insurance, although oftentimes, psychoeducational testing is not covered, since it's "educational" more than "psycho" aka "medical."
On the board, we call these docs neuropsychs, which means they have a degree in neurology with-an interest in psychiatry, but sometimes it's the other way around.

I just did a quick online search and can't find the dr we used under neurology, so I think he was a psychiatrist with-an interest in neurology. I was not happy with-his diagnosis, as I said earlier, nor the amt of time he spent with-us (mostly, the lack of time). No testing.

Talk to the staff when you call around. They can be pretty honest. I was forewarned with-our visit when the nurse said, "I think you'll be disappointed."

I had to hunt on my own but it was worth it.

 

[susiestar]

Actually the docs who do the testing are usually neuropsychologists, NOT neuropsychiatrists. They have special training in how the brain affects behavior, and how different parts of the brain result in different behaviors.

get a new psychiatrist. Start calling today. Make sure it is a child and adolescent psychiatrist. This one is nuts, in my opinion. Changing the diagnosis with-o telling you is dirty pool. Esp since he hasn't even TRIED mood stabilizers. He is doing you and your child no favors. NO psychiatrist should just ignore horrible home life.

Don't notify him you are firing him. Don't cancel appts. Wait until you have seen the new doctor and then fire him.

I am sorry he is being unprofessional.

 

[Over]

He actually is a child psychiatrist, just not a very good one in my opinion. Unfortunately he's the only one in our area as far as I know. I've been searching but all I can find are psychiatrists for adults. I'm definitely looking into what you've all said!

 

[TerryJ2]

Good luck! You may have to drive to another city. I drove to another city for the tests we finally got, and it was worth it. (Of course, difficult child's main concern was whether there was a McDonald's next to it, LOL! There was.)