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I have no experience with Lithium.  However, I do know that any medication change can cause instability in the short term until a settling out period occurs.  I also know that difficult children, no matter what their age or medications, can have meltdowns when they get little sleep.  So I guess I would advise a wait-and-see preiod before making a decision about medications.  Except in extreme cases, there is never anything wrong with waiting a bit until you know what's really going on.  You can also check in the psychiatrist by phone to see what he thinks.