4-y-o with ODD and possibly BiPolar (BP)

Discussion in 'General Parenting' started by aimeefitz, Dec 8, 2008.

  1. aimeefitz

    aimeefitz New Member

    Hi all - Just found this place today, and still reading through a lot of past posts etc.

    Here's my story. My son is 4, will be 5 at the end of the month. He started displaying severe behavior issues at 3 - he has been expelled from 3 preschools and 1 in-home day care in the last 18 months. We finally took him to a psychologist who gave us a diagnosis of ODD and suggested we see a psychiatrist for medication. The psychiatrist gave us a prescription for respiradol, and we have not started it. I feel horrible giving my son drugs. I think husband and I are in denial about how much help he needs.

    Anyway, we contacted the school district about Special Education - with a diagnosis of ODD, I assumed that there would be some help. The psychologist said that there were possibly day treatment facilities or something. Anyway, we went through the whole process, and while the school psychologist was very sympathetic, she said he didn't qualify since it's a behavior issue. Cognitively, he's well past his age - he writes his name, counts, does all he should. He can't start kindergarten until next summer though.

    The original psychologist also suggested a preliminary diagnosis of bipolar, but said that it wouldn't hold up since that can't be diagnosis'd until he's at least 7.

    So, I feel like a horrible mother. I lose my temper with him, and just this morning, it was like a mad house in here. He's super smart, and that's part of the problem. The withholding of privileges doesn't work, the taking away of toys doesn't work. Locking him in his room for timeout just results in destruction of his room and his toys. He doesn't learn from any of this. (I was reading the article on ODD in the other forum and thought wow! that's my kid!)

    Today, we sent him into the bathroom to brush his teeth and wash his face after breakfast. After ten minutes, he had done nothing. He was just wet - he had been playing in the sink. He likes to wash his hands with toothpaste because he likes the smell (it's bubblegum flavor - I'm not buying that again!) If we stand in the doorway and watch him, he gets upset and screams and cries and threatens us. So, for the most part we let him go by himself and take care of it. About 50% of the time, he does it okay. The other half.. well sometimes we can prod him, or remind him, and he can get himself going. Today, everything fell apart. He went to daycare this morning unwashed, unbrushed, and very nearly naked. (He finally agreed to put his clothes on just as husband was taking my daughter to school.)

    This is deeply affecting me. I don't want to see him, I dread the minute he comes home, I hate getting up in the morning, and I find myself fantasizing about sending him to boarding school! I hate myself for feeling this way - I was abused as a child, and the only thing I want for my children is to feel loved, cared for and never, ever hurt or abandoned.

    We just don't know what to do. To top it off, my husband was laid off 6 months ago, and we're down to cashing out retirement accounts to keep the house afloat. The school psychologist recommended a treatment place that has training programs for parents of children with ODD, but I haven't called because I don't think we can afford it. It's not covered by insurance. (Which we're paying $1,000 per month for that we can't afford anyway, since we have to keep COBRA, but god forbid something major should happen to our kids without insurance!)

    So, we're stressed out about money, about our kids' behavior (my daughter is 6 and has mild AHDH, unmedicated since her teacher is managing it and her grades are phenonmenal), about everything.

    Thanks for reading and letting me vent. I think this board will be very helpful to us in the future.

    Aimee :)
  2. SRL

    SRL Active Member

    Hi and welcome to our forum. I think you'll find good support and information here.

    Could you tell us how long the psychologist spent with you as parents, how long with your son, and if any diagnostic tests were administered? Also, what kind of psychologist was that (ie what were the credentials or letters after the name)? Some specialties overall do a better job with the younger ones and we want to make sure you have had a thorough enough evaluation.

    Before you look to treatment programs or boarding schools, I think we can give you some help in handling behaviors. Pick up a copy of the book The Explosive Child by Ross Greene and read the thread about it at the top of this board. It's not a cure by any means, but many parents here have found these strategies to be very helpful.

    Your school psychologist is misleading you in that behavioral problems can't qualify a child for early intervention. In fact there is a category under special education law specifically for those with behavioral and emotional challenges. The catch is that it has to be impacting his ability to function in the educational setting and I would say getting kicked out of 3 preschools and one day care in a year and a half definitely is a red flag for that.

    What I suggest doing is writing a letter to the school district's director of special education requesting a full and complete evaluation. They don't need to have a lot of details--just write in that he had a diagnosis of ODD and has been expelled from 3 preschools. Send the letter through certified mail so you will have a receipt of it being sent. Follow these steps exactly and they will have a timeline in which to complete an evaluation. There are a few loopholes on their end but most of the time if you let them know in this way that you know what your son's rights are they will follow through and do the assessment.

    Can you tell us a little more:
    1) What's the family mental health history like--any bipolar, anxiety, Obsessive Compulsive Disorder (OCD), etc?
    2) Developmentally has he been on target in every area? What's his speech like? How about motor skills?
    3) Any unusual interests or obsessions?
    4) Does he have any unusual sensitivities to sensory stimuli--ie extremely picky eater, super fussy about the clothes he wears, aversion to things like tags, socks, bright lights, sounds, etc?
  3. judytor

    judytor New Member

    Hi Aimee! Welcome! (I'm in So Cal too...feel free to PM me if you want to chat).
    In the meantime, I can sympathize with A LOT of what you said. My ds4 is very similar. He was diagnosis'd with Autism, fetal alcohol effects, ADHD, mood disorder-not otherwise specified, anxiety disorder, and a few other things like Disruptive behavior disorder and sensory processing disorder (SPD) oh and my favorite conduct disorder (which I DO NOT believe he has).
    Anyway....you're not alone! I went through the SAME thing with our school district! They told me the exact same thing. (I wonder if we're in the same district).
    I think SRL gave you some great advice! I definitely suggest The Explosive Child! I think it will give you LOTS of insight into your son's behavior!
    Anyway...good luck and stick around. This place is very supportive :)
  4. aimeefitz

    aimeefitz New Member

    Hmmm. No diagnostic "tests" per se were administered. We had 2 two-hour sessions, about 4 months apart, initiated both by me. Basically the private psychologist was "just" a PhD who specializes in children. He was in our insurance network. His office clearly indicated he worked with children, but to what degree or in what exact capacity, I don't know.

    Basically he asked us as bunch of questions about my son's behavior, situations, etc. Talked about our parenting, and reassured me that our parenting was fine - that the issue was with our son. The second time we went, it was like he was frustrated with us because I expected him to "do" something - he's like, look you can medicate and mainstream him, or try to put him in a Special Education program. There's nothing that I can do to really help you at this point. Which was disappointing to me. I expected some sort of therapy sessions - but he said my son doesn't need therapy.

    The child psychiatrist was pretty much the same - the only pediatric psychiatrist in the network, and we spent about an hour talking about behaviors, and she agreed with the psychologist's diagnosis of ODD and prescribed the respridol. She was hesitant to go along with the BiPolar (BP) and said that it would "emerge" more clearly as he got older if it was true.

    I am so buying that book TODAY.

    We had a full assessment - this is exactly what I did, and the whole process was interesting, but not helpful. He had an audiology session, a vision screening, a speech/Occupational Therapist (OT) evaluation (actually, the assessor stopped half way and said, I'm just going to play with him for the rest of the session, since he clearly has no pathology.)

    What you said above is correct - but the school psychologist said, our programs are not appropriate for him because he exceeds the educational requirements for meeting kindergarten. He would run circles around the other children in the program, who are mostly Downs, autistic, blind/deaf etc. She thought that he would not be getting the appropriate education in the Special Education program because of this. Based on his academic performance alone, he is more than capable - and the only way she saw that he could get into any program was to define him as "severely emotionally disturbed" and she thought that was bit extreme considering he is, half of the time, perfectly happy and obedient.

    She assessed him by interviewing us, using the "Vineland-11 Adaptive Behavior Scales" according to her report and my IEP. My sons "results were within the average range across the three domains, including all subdomains."

    We completed the "Behavior Assessment System for Children" on him, and he was scored in the "clinically significant range" for externalizing problems, behavioral symptoms index, and adaptive skills. The psychologist said that "it is important to note that while [my son] is rated within the clinically significant range in several areas, the majority of these areas appear to be related to compliance and impulsivity issues rather than emotional disturbance."

    This is probably waaay more info than you need, but the school district does not see this as an emotional disturbance. When I asked about the bipolar diagnosis, she said that when that was confirmed, then he could be re-assessed, but that it was still possible to keep him in the mainstream if he was appropriately medicated.

    The outcome from the school district IEP was to meet with his kindergarten teacher before the school year (which doesn't start until July) and come up with a "plan" and that the Special Education department would arrange the meeting, and assist with the plan. If he was unable to stay in the regular setting, we could also have him re-evaluated, pending the advice of the kindergarten teacher. (And depending how many other children he bites, kicks, scratches or pinches - or his teachers or teachers' aides.)

    What I'm worried about is the period between now and then - he's at an in-home daycare that seems to be working, but I suspect that she is not being 100% truthful with us. I don't know why. We found out that another daycare was not being truthful with us, after 6 weeks we got a call just to come get him and never bring him back. We were shocked since we thought he was doing well. He had been having problems, but the teacher thought she could handle it, and that he would get better. And then the last straw was when he LOCKED her our of her house, stood there laughing at her and wouldn't let her in. Then, when she climbed in through a window, he kicked her, then bit her.

    So, while things seem calm for now, I'm seriously waiting for the other shoe to drop - and then, what will do until the school year starts?

    I do not have a history, except for depression - I was adopted. There is nothing on my husband's side except alcohol and drug abuse. I suspect things on his father's side but his dad moved out when he was 18 and never looked back.

    100% developmentally normal. Super, super bright. His speech is fantastic for his age, motor skills all on target. In fact, from the IEP report: his "mean length of utterance is 5.1. This is appropriate for [son's] chronological age. He spoke in four to seven word sentences and used expanded and complex sentences. His connected speech was intelligible and easy to understand."

    None that I have observed. He does get freaked out by plants, especially flowers. He is very fearful of unknown animals - we have raccoons in our neighborhood, and although he thinks they're cute, he's terrified one is going to come into his room. Same for coyotes. We took a walk yesterday and he wanted to know if the live oak trees on the path were going to eat him...

    He doesn't like loud sounds - he is terrified of the automatic flushing toilets. That was really hard for us to get around when he was being potty trained. We since have learned to hold our hands over the sensor until he is up and at the other end of the stall. He used to cover his ears and scream when the toilet flushed. They are, really, very loud.

    Sometimes, if I yell to him (like, come eat dinner), and I'm too close, he says, you scared me mommy! you're too loud!

    So I guess that counts!

    I appreciate any feedback - I know this was very long ,and probably waaay too much information, but I wanted you to know that we've been serious about doing this the right way!

    Aimee :)
  5. aimeefitz

    aimeefitz New Member

    Judy - thanks so much for the response. I read your thread, and it does seem like we both have our hands full.

    I'm out in XXXXXXX Where are you?

    Aimee :)
    Lasted edited by : Dec 8, 2008
  6. SRL

    SRL Active Member

    We suggest that posters not reveal their locations on this public board, as we've had some problems in the past. Feel free to use private messaging.
  7. aimeefitz

    aimeefitz New Member

    Oops sorry about that - I will send her a PM!
  8. SRL

    SRL Active Member

    No problem--we'd rather be safe than sorry sometime down the road!
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I'd actually test him again and see a neuropsychologist, although he's still young. To me there are red flags for high functioning autism. That would explain many of his issues. ODD rarely stands alone. The Autism Spectrum Disorders (ASD) spectrum in my opinion could be triggering his defiant behaviors. I would definitely take him for a private assessment. I have never had good luck with the school districts. It's like they don't really know or care. Our son's assessment was ten hours long in two hour increments and was VERY intensive. He was tested in every way possible.
  10. judytor

    judytor New Member

    ITA with the PP who said ODD rarely stands alone! It also sounds like he has some sensory issues.
    You mentioned you were adopted (do you know if your bio parents had any mental health issues?)

    There are many childhood conditions in which symptoms overlap so it's important to get a really thorough evaluation with someone who specializes in children like yours. (Easier said than done).

    I have an awesome psychiatrist up at UCLA (if you're interested). He was the one who actually saw the autism that no one else thought "fit" ds4's symptoms. PM me and I'll give you his info :)
  11. jal

    jal Member

    Welcome Aimee. Your difficult child sounds a lot like mine. He's been through 5 daycares and cost me a job of 9.5 yrs. No Learning Disability (LD)'s, but all behavioral and emotional. My difficult child too locked his daycare provider out of the church the group was housed in. I too, in the beginning got the standard he has no learning disabilities so therefore the school can't do anything (this was at 4 yrs of age). neuropsychologist testing is definately a way to go although he is young. My son is diagnosis'd BiPolar (BP) and ADHD, yet in his new school they are seeing more signs of high functioning autism. While persuing the neuropsychologist I would touch base with the school district periodically. We were lucky in the fact that ours worked well with us and they knew ahead of time that we were concerned for our difficult child's education. We in our hearts knew he would have trouble functioning in the classroom. At the beginning of the year (kindergarten) they agreed to give it a month and we would meet again. Well, he didn't make it a month. They saw first hand our concerns and we wrote an IEP and got a para for him. When he went back for first grade it was evident that they did not have the supports in place and he wasn't going to be able to function. We got out of district placement for a therapeutic school and he is thriving.

    Like your difficult child, mine is very smart, and was talking and counting in english, spanish and french from an early age, but he also disliked industrial toilets and loud noises, yet he is practically afraid of nothing. This is just a very short synopsis of my situation, but the main jist is to stay in contact with the school. Let them know your concerns about difficult child functioning in the classroom. Maybe you can get them to agree to evaluate his behavior the first month he is there and then to reconvene. The key, as was stated before, is does his behavior affect his ability to learn and/or the ability of others around him to learn? If so, then he would qualify got OHI (other health impairment) under the IEP.

    You may also want to check and see in your state has can offer you some in home services. We are currently working the the Voluntary Services which is affiliated with DCF. We asked for help with our difficult child and were accepted into the program free of charge. They offer intesive in home therapy and respite. They have been a pleasure to work with. It may help to get these services at no charge to you to help lessen the burden you are going through and you can stop it at anytime you want.

    Best of luck to you as I have traveled the first part of the road that you are on an do understand how hard this all is.
  12. Mandy

    Mandy Parent In Training

    I just wanted to say Welcome and it looks like you have already gotten some great advice. I am in the process of getting my son diagnosis, but he has also been kicked out of 3 daycare's and thankfully has a babysitter willing to deal with him right now. I totally understand the frustrations of having childcare problems and not being able to just QUIT work and stay home!! It is so stressful:anxious: I definitly would look further into your school system for help because your child can get help with severe emotional disturbences as it's called. Good Luck!
  13. aimeefitz

    aimeefitz New Member

    Okay, question: What's a neuropsychologist? How do I find one?

    I actually called the program that does the parent training for difficult kids (it's part of a federall funded 0-5 program) and found out it's free! I was shocked. Of course, there's a 2 month waiting list, but we are on it now.

    Also I wanted to explore the issue of "labeling" - we have been hesitant to label him with anything because, as smart as he is, he will pick up on it. We don't want to destroy any self-esteem he has - I'm already wondering what being expelled from all those schools has done to his little head. It was so sad - last year we had a birthday party for him a Chuck E. Cheese. At this time, he was at a large Montesorri program, and we invited 15 children. Only ONE child showed. He was heartbroken, and we tried to tell him that the other children didn't come because they were afraid he would hurt them.

    So, while putting the label of "severe emotional disturbance" on him might get us better services and help, we are afraid of the long term repurcussions of that kind of labeling to his sense of self worth, and if it would become a self-fulfilling prophesy.

    I suspect that he may last a month or two in kindergarten and then we will have to go down that road. Until then, I am reading the Exposive Child (when it gets here) and taking it day by day.

    I really appreciate all the comments! It's so nice NOT to hear things like "oh just sign him up for sports" which was the comment of a friend of mine.

    Aimee :)
  14. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    You can find NeuroPsychs at University and Children's hospitals. No neuropsychologist is going to use a label called "Emotional Disturbance." That is a school label only, and it's not useful. But there are labels that are less damaging and VERY useful as far as school and community supports. The two big disorders we hear tend to be a childhood mood disorder (developing) and high functioning autistic spectrum disorder. Sometimes we hear ADHD/ODD--often that is not the final diagnosis, but it's a start. All of these explain his behavior to you and to him and to the school and can be treated (although it can be a work in progress). And none are due to "emotional disturbance." That's a catch-all for schools so they can group difficult kids together. Don't allow it. Test him and see what is really wrong.

    in my opinion not labeling him won't help his self-esteem. If kids don't show up for his party and if he keeps getting expelled he already KNOWS something is wrong with him. If he's bright, there is no way he looks around and thinks "I"m just a normal kid." Many times people feel better knowing there is a reason for their struggles and a way for them to get help. Without the label, he isn't going to get the supports he needs and he will likely keep failing in school and socially. Early intervention is far more effective than waiting. Often untreated children grow up to be teenage drug addicts. Don't want to scare ya,b ut that's how it is. If you are "different" there is NO way to keep that hidden. Your son already knows this and probably wonders "what's wrong with me?" And if you say "You're just struggling a little" he probably doesn't believe it. It can quickly turn to, "I hate myself. I want to die." Please, please evaluate him and don't worry about the labeling. He has already labeled himself. He has labeled himself "bad" and "friendless." No labels are worse than the ones he is giving himself...good luck.
  15. SRL

    SRL Active Member

    The school psychogist is not telling you everything that you need to know. In cases where services are indicated, the districts are required to provide them whether they have a program in place or not. This could mean doing something like providing an aide at a private preschool, forming an early intervention class within the district for students whose issues are behavioral (often a mix of students), or sending him to a neighboring district that does have an appropriate program. Most parents don't know about these options, and that's what the district is counting on. Likely they just didn't want to deal with him until kindergarten because they didn't have an easy and less expensive option in place at the preschool level.

    However, with him being so close to starting kindergarten, and you having minimal experience with special education laws and/or funds to hire an advocate or attorney, I will say it's unlikely you could get any of those done in time to help him this year. But in the future don't take "We don't have a program in our district" as an excuse. It's the law. If he gets kicked out of another daycare, you may also want to push the district still this year.

    I wouldn't worry at all about the school educational label. There's no reason to share it with a young student. Most young kids don't care--it's the adults that do.
  16. Mandy

    Mandy Parent In Training

    I was trying to explain exactly what SRL said:D Unfortunatly to be covered under the school districts Special Education program you need to have one of the following "labels" ED(Emotional Disturbance), Learning Disability (LD) (Learning Disability), or (OHI) Other Health Impaired. They have to fall under one of these categories to be able to start an IEP (Individualized Education Program). Then if the school district finds they can not meet the needs of your child through the IEP due to severe behavioral problems you can be referred to an outside school that the school will then have to pay all or most of the funds for. Like I mentioned the Bi-polar child explains it probably better than I can.:D I have been researching it because I am afraid Cole with have these same issues in school. As soon as we have a diagnosis I am going to contact our school district and send a certified letter asking for a meeting regarding his enrollment. I am also going to check out advocate's in our area that can help set up the IEP. School districts can provide services for children requiring Special Education starting at Age 3. It is a pain in the butt process just to make sure your child is protected, but if they aren't then they can suspend or expel them for violent behavior.
  17. amandab192

    amandab192 New Member

    Hi, Aimee!
    I just joined the forum and wanted to say how similar your son sounds to mine. In fact, he's absolutely terrified of coyotes, also (we live in the city)! Logan is diagnosed Mood Disorder-not otherwise specified, but will be diagnosed Bipolar I once he's six--that's our own psychiatrists silly rule. Previously, we had the alphabet soup diagnoses like everyone else.

    What has helped us, his psychiatrist and therapist, is to chart his moods and behavior. You say that 50% of the time your son is compliant and happy. Is there a pattern to that? You can find some great pediatric mood charts online. Take a minute each day (or twice a day--noon and night), to record his overall mood (I use content, sad, hyper, anxious), sleep, and any noteworthy behaviors. This helped us see that our son does cycle and we can adjust our expectations based on where he is in his cycle (he cycles about every four weeks as well as seasonally). Young kids often cycle daily and are on the depressive end, so my son is the exception. Neither my husband nor I have bipolar, but alcohol and drug abuse, depression, and even psychosis are strong on my dad's side and these are common indications of bipolar. Also, our son has prominent hypersexuality without a history of abuse (HS is only seen in bipolar or abuse). As far as school help, it's a struggle. He had an IEP for a year, but "lost" it once he started to control himself during day care. I'm sure he'll need it again once he starts Kindergarten next year. He's in a day care now that is very receptive and he's been able to keep himself together while at school. In your case, you are absolutely within your legal rights to services. Every state is different as far as community services. Here in PA, we have Wrap services that would provide an aide, independent of what the school district might provide. I hope you find a sympathetic ear within the school.

    Risperdal has worked very well for us for the aggression (I'm not nearly as bruised as I was a few months ago), but Logan is in need of a mood stabilizer to help the major fluctuations--to help his sleep, mood, self-esteem, etc. become more consistent.

    This isn't to say that I think your son is Bipolar--there are so many overlapping characteristics to some of these diagnoses. You're doing a great job in such a difficult situation. Educating ourselves while our kids are young is going to make a world of difference in their futures!