Could this be bipolar?

[humbleyourheart]

I am new to this site, which someone recommended to me. I have been reading the boards for a few weeks and decided to go ahead post and get some feedback on my situation. I have an 8 year old son who has been difficult since he was a toddler. He has seen a couple of psychiatrists and one gave the diagnosis of Bipolar. This particular doctor was not on our insurance plan and everything was coming out of our pocket. So even though we really liked her we had to make the switch to someone who is on our insurance. This current doctor is not so quick to label with bipolar. He says he won’t know for sure until my son gets a little older and we see how his symptoms develop. So now I am left with a lot of questions and wondering if it could be bipolar or not. I am hoping maybe someone can share what their experience has been if they have a bipolar diagnosis.

He is currently taking Abilify which has given us some relief from his constant negative behavior. The thing that is so confusing to me is that he seems to do fine at school. At home is another story though. Prior to taking the Abilify it was a daily struggle with him. He seemed angry most of the time. A simple question asked of him would get an angry yelling response. His reactions are very intense and over dramatic to the point that he is irrational. If I tried to touch him or hug him he would flail his arms and scream to leave him alone. Disciplining him had become a nightmare. We mostly rely on timeouts, but he's gotten to the point where he won't go to the timeouts any more. He is almost too big for me to physically put in him in time out and if I try he always "gets hurt." That turns into a whole other battle with him screaming that his leg is broken, he can't walk, I hurt him, etc. Most of the time after he was in time out he would be kicking the wall and yelling very ugly things to me. Homework is a major battle. He yells and screams that he can't do it, it's too hard, he doesn't understand it. But then if you try to help him he screams that you aren't doing it right or that's not the way they do it at school. He will argue with you about EVERYTHING. He is very aggressive toward his 5 year old sister and somewhat of a bully towards any of the friends she has over. If I am disciplining him because he pushed her he will argue that it wasn't a push and then give her a shove and say “that’s a push.”. If I tell him to stop yelling he argues that he isn't yelling he's just raising his voice. Two of our neighbors have banned their girls from playing with him any longer because of his behavior with them. It is just constant attitude and anger with him. While we have seen major improvements in his overall negativity we still have blow ups over things. He will get something in his head (like maybe a certain book he wants) and have a melt down when I won’t take him to the store to get it. He will go on and on about whatever it is that he is wanting at that moment. He still has trouble sometimes getting along with his friends. If they aren’t doing things exactly as he wants or doesn’t think they are giving him enough turns he has a melt down. He has been lucky that his friends have been patient with him, but I don’t know how long that will last. He has a lot of anxiety about certain things too. Like this morning he had a complete meltdown before school because of a school program he was supposed to be in. He cried and screamed for over an hour about getting dressed, what to wear, that he was scared to get up on the stage,etc.

I have read “The Bipolar Child.” And while a lot of it does seem to fit I still have questions. His doing fine at school for one. And I don’t see clear patterns of ups and downs. It’s mostly just negative unless something really gets him excited. Like his friends coming over will make him very hyper and loud.

I have also read most of The Explosive Child. It was about 1 ½ years ago, but I didn’t do anything at the time because he didn’t seem capable of doing the talking through situations thing. There was almost no warning to his explosions and no matter how many times I tell him different ways to do things when he is calm he seems to forget those options once he is angry and frustrated.

One other thing I wanted to mention about him is his sensory issues. Ever since he was a toddler the bumps in his socks were a major issue and his clothes had to fit just right. That has been much better since the Abilify and that we let him pick his own clothes. Only a certain style of jeans (that are much looser and baggier than I would like) and short sleeve shirts even in the winter. And absolutely no collared shirts. Also since he was a toddler he would ****/chew his blanket. He still does this now at 8 and whenever he his upset or frustrated he will want his blanket.

Sorry this is so long. I am just so overwhelmed and hoping someone can offer advice. Does this sound like bipolar? I want to educate myself as much as I can and since I don’t have an official diagnosis (unless I count the one from the doctor we don't see any longer) and I am not sure where to start.

Also, he is currently on 5 mg Abilify and the doctor wants to jump him up to 10 mg. That seems like such a jump. Is 10 mg safe for an 8 year old who is on the skinny side?

Donna

 

[TerryJ2]

Hi Donna, welcome. So glad you found us.

Your son sounds a lot like mine! My son has rec'd a diagnosis of Asperger's and may also be bipolar, but my son has calmed down a lot since we have put interventions and behaviors in place, so I'm not so sure about the bipolar any more.

One thing is for sure, your son is an unhappy little guy and he has so much more to offer.

We have not used Abilify. Several people here have their kids on it so they can tell you about it.
We have our difficult child on Adderall and Clonidine (used off-label). We also use Vistaril at night (an antihistame) for sleep. It is crucial that kids get lots of sleep, especially kids who are bipolar or who are Aspies. It makes a HUGE difference.

So, sleep would be my first suggestion. (That doesn't answer the Q of bipolar--no one here can answer it--but it will help! )

My second would be to have a neuropsychologist evaluation. That means an MD who is knowlegable in neurology as well as psychiatry. Psychiatrists look at things from a biochemical point of view. Neurologists look at things from a neurological point of view. It makes a big diff.
And, of course, your son could be both, but you can only do one thing at a time.
I don't know what your ins. will cover in that regard. You have to call to find out. I do know that psychiatrists often like to treat with-medications and try them out and discard them if they don't work. I don't really like that approach.

We've used talk therapy with-a child psychologist for yrs and it has really helped. Sometimes you have to pay someone to say the same things you do, and because it's an authority figure, the kids will listen!

Does he have any ADHD symptoms?
Putting my son on Adderall was the first big leap we took, after we had cut out dairy and tried to cut out wheat. Once he was on the stimulant, he calmed down and we were better able to implement the new diet. (He would grab anything and stick it into his mouth, and take things from other people's houses. He just wouldn't stop moving).

You don't have to talk through everything to use the ideas in The Explosive Child. One thing I learned was to totally give up certain ideas I had been clinging to, like, having my son look perfect in public. It's amazing how giving up on one thing made a difference. It was once less thing to fight about. Sometimes I would let difficult child go out in his pjs and I'd bring along a change of clothes, and once he spilled something (which was inevitable) I'd say, "Oh, look, I have clean clothes for you!" so he would end up wearing what I wanted him to wear to begin with. Hey, where there's a will, there's a way.

Also, with-therapy, I learned to spot my son's triggers. As it turned out, he was not raging at just anything. There were and are definite triggers, and I can now see him escalate and stop what we're doing b4 a big blowup.
You will have to learn how to spot your son's escalation signs, such as tapping his foot, pacing, circles under his eyes, breathing patterns, etc. Then you can learn to back away. If he's got homework, if he's escalating, that is NOT the time to remind him, LOL!

I hope this gives you some ideas and tools ... trying to distinguish whether or not he is bipolar may take yrs. It helps to know if there is any history in the family because it tends to be genetic.

 

[BusynMember]

At one time I would have said, yep, sounds like bipolar. Then my own son was misdiagnosed with it. Frankly, most kids who bring their folks to our board (and welcome by the way ) have the same defiant raging behaviors and they can be caused by more than just bipolar. Aspergers or other forms of high functioning autism or maybe something else too. Rather than accepting the diagnosis without getting another opinion, I'd take him to a neuropsychologist. A neuropsychologist will sit down with him and do a lot of testing--for us it lasted ten hours over two hour appointments and we found out that our son didn't have bipolar, never did, and had never needed all the heavy duty medications he'd been put on. I always think it's good to get a fresh eye before we just accept what we hear because there are no blood tests for these disorders and bipolar medications are heavy duty--if the kids NEED them, they do. But my son was on them for three years and they weren't necessary. Plus it held him back from getting Autism Spectrum Disorders (ASD) interventions, which have helped him far more than any of the medications ever did. He's doing well now, no more of those horrible behaviors that partly brought me here. Why not tell us more about your son? How was his early development? Did he manage his milestones on time? Talk all right? Look people in the eye? Cuddle? Interact appropriately with his same-age peers? Cover his ears if he heard loud noise, refuse to eat certain textured foods, not let you put on certain clothing? Did he play with his toys appropriately or did he dismantle them instead or throw them or line them up over and over again. Does he have an amazing rote memory? Can he remember things he watched on television almost by heart?
Others will come along. Nice to meet you.

 

[Big Bad Kitty]

Welcome, fellow Illinois-an!

You have my child in a boy's body. My Tink is 8 and very much like your son. She is an angel at school ("a delight to have in the classroom", says her teacher), but the horns come out the second she walks in the door. We also deal with sensory issues (won't brush her hair, long sleeved shirts/coats cannot have elastic at the wrist, won't let me cut her nails).

My Tink is on Abilify, 5mg. She started at 2.5, then bumped up to 5 after a month or so. We bumped it again to 7.5 but she became violent, so we brought her back down to 5. It helps, but not completely. Her original diagnosis was ADHD/ODD. I think she may be bipolar or on the spectrum. I have been trying for 2 years (since I found this wonderful board!) to get her in for a neuropsychologist evaluation, but nobody around here takes our insurance (Medicaid). I don't know if you are near Chicago or not, but any of the learning universities (Loyola, DePaul, U of C) or Children's Memorial will do neuropsychologist evaluations. If they take your insurance, you are good to go.

Glad you found us, sorry you had to!

 

[smallworld]

Welcome! I'm glad you found us.

I just want to clarify that a neuropsychologist is a clinical psychologist (not an MD)with extra training in how the brain functions. Neuropsychologists do extensive testing to determine the strengths and challenges of an individual child, whether there are learning disabilities, attention issues, motor difficulties, etc. Putting all the pieces together enables the neuropsychologist to hone in on a diagnosis and then make recommendations for appropriate interventions (which can include medications, therapy, school accommodations/services, etc).

Neuropsychologists can be found at children's and university teaching hospitals. Sometimes they're covered by insurance, sometimes not, but in my personal experience, we've found the info gathered in this sort of evaluation invaluable.

Good luck.

 

[jal]

Your child sounds like mine in a lot of ways. Mine was diagnosis'd Bipolar and ADHD. Stims set him off. He was on Abilify for a while 7.5mg max - any time we tried to up it he would get violent too. I saw a lot of Bipolar traits in my child and it runs in husband's side of the family so it seemed like we were on course with-th diagnosis, but none of the medications worked. difficult child has just recently been rediagnosed with Pervasive Developmental Disorder (PDD) - Aspergers, anxiety and Sensory Integration Disorder (SID). He is in a therapeutic school and we have intensive in home therapy 2x a week. I would definately get him to a neuropsychologist for an evaluation. It sounds like he may be on the spectrum.

 

[TerryJ2]

Smallworld and all, I'm wondering if we should spell out neuropsychologist, because the neuropsychologist we went to was a psychiatrist and a neurologist.
The psychiatric who tested difficult child was a PhD in psychology and education.
The child psychiatric with whom we do therapy to is a PhD in psychology.

 

[smallworld]

Terry, I have been spelling neuropsychologist out in first reference in all of my posts (see above).

There is a specialist known as a neuropsychiatrist, but that's not what most of us refer to when we recommend a neuropsychological evaluation.

Some PhD psychologists do therapy. Some PhD psychologists do educational/psychological testing. And then there are some PhD psychologists who have extra training in how the brain functions and are neuropsychologists. Their evaluations tend to be more intensive and informative.

 

[klmno]

I thought we were using "psychiatric" to indicate psychologist.

FWIW, difficult child's psychiatrist also has extensive training in neurology, but categorizes himself as a "psychiatrist". He only lists "MD, DFAPA, and Child & Adolescent Board Certified Psychiatrist" after/below his name.

SW: If testing results/report say "Neuropsychological Testing Report" in bold letters at the type, does that neccessarily mean that the psychiatric who did them had that special training about how the brain functions?

 

[humbleyourheart]

Thanks everyone for your input.

Midwest Mom - My sons development all seemed normal. Other than the issue with his socks and frustration level when playing. He would rarely play alone, but when I played with him he would get frustrated that I wasn't doing it exactly the way he wanted and would have a tantrum and usually wreck whatever it was we were playing with (like a lego tower). His teacher in 1st grade and now again in 3rd have mentioned that he is very slow to complete his work. Outside of the normal slow. She described it as painstakingly slow. Neither of them felt that it was because of a lack of focus.
He just seems so emotionally immature.

Big Bad Kitty - I am close enough to Chicago that I could see someone there. There is a neuropysch doctor at U of C that would be on my insurance. What are everyone's thoughts on having a neuropsychologist evaluation done there as opposed to someone closer? I've read that I might get a better evaluation at a teaching hospital like U of C.

Donna

 

[klmno]

I agree- and if you can get a mde or at least a consult with a psychiatrist there and have them review testing results, you'd probably get the best shot at an accurate diagnosis and treatment recommendations.

 

[wakeupcall]

Oh my, you've been through the mill, haven't you? Been there, done that. My difficult child was a handful when he was a toddler.....I mean, he's STILL a handful. He doesn't have a diagnosis of bipolar because none of his doctor's want to go that far. I don't care what they call it. He acted exactly like your child, exactly. To this day, he does very well in school (though he's in a small social development class in the 7th grade) and it's war the minute he hits the door when the bus drops him off. (By the way, he's now 13.) We went to Texas Children's Hospital when he was in the third grade....actually didn't get much out of it if you can believe it. There's no doubt that he's ADHD and stims help that beyond belief, but there's more wrong and I don't know that I agree with the diagnosis. He's on Focalin XR, Lithium and just went off of Abilify. Abilify caused weight gain though you'll not read that as a side effect. Oddly enough right now it seems like the surge in hormones is helping him be a little more tolerable. He only has one friend and he's extremely immature. He still sits outside and plays with tech decks on the sidewalk. He's afraid of being alone and showers with the door open. He has always had tactile issues and to this day, drags around a blanket when it's just us at home. He drags it to the breakfast table every morning to wrap around him while he eats (if I can convince him to eat anything at that hour)....and we live in south Texas where it is NOT cold.

The best advice I think I would give you is to let some things just go. I rarely go off the deep end over his trashed room anymore (and I'm an impeccable housekeeper). He does no homework (and still has good grades) because it was a battle ground. Our children have to have a SAFE place and I was determined to make that home if I could. He holds it together at school all day and when school is over, he can't hold it in anymore, thus the bad behavior when he gets home. Battling over homework was getting him no where except to destroy our relationship.

These difficult child's are very, very difficult. I worry what will happen to him as an adult if he can't learn to control his impulses. He's been on medications since he was 4 and in therapy starting at 4. We quit therapy less than a year ago, for the time being. We were getting nowhere all of a sudden. My difficult child's self-esteem was beaten down terribly in elementary school and we've spent a LOT of time trying to build him back up. I wish I'd known then what I know now.

It takes strong parents to parent these children.

 

[BusynMember]

I'm glad you're going to the U. of C. and hope you do see a neuropsychologist. Bipolar and high functioning autism totally mimic each other, and are often mistaken for one another. A neuropsychologist is more apt to be able to sort out what is what than a Psychiatrist (even one with the MD). Psychiatrists are not that hot diagnosing neurological problems and tend to blame mental health issues for everything. Sometimes they are right, sometimes they aren't. I am leery of the mental health system and diagnoses given out since both me and my son have been wrongly diagnosed so much. After a while you start to not believe anyone...the U. of C. has a great rep. I used to live in the Chicago burbs. In general university hospitals tend to be more on the cutting edge of research and I love them. neuropsychologist evaluations are much more thorough then other ones, that's why I like them. Good luck.

 

[Nomad]

I think it is preferable for a doctor to hold off on a diagnosis of bipolar at such a young age. First of all, it would be hard to make a final decision so early and second of all, the diagnosis can be labeling. We tend to live up to expectations. This goes both for parent and child. On the other hand, I also believe that if we don't treat the child appropriately...with the appropriate medications/treatment, then the child will not receive the best care possible. Ironically, you may have stumbled onto a really good situation for yourself and child. You are working with a physician who has an open mind, yet the diagnosis of "Bipolar illness" is on the table. If Abilify is helpful, then I would not interfere. It is very important that your child learn good social skills at school and have healthy interaction within the home. Why does the Dr. want to increase the dosage? If your child has gained weight or has had instances of raging (or there is some other reason for this), it certainly seems like it might be a good idea. (by the way, our child takes this with good results). The Bipolar diagnosis is hard to diagnosis at such a young age. Children manifest the illness differently than adults. And, it does seem to look like other illnesses at times. To make things more confusing, it is sometimes comorbid with other disorders, like ADHD. I think it is absolutely terrific that you are reading literature about Bipolar Illness. I would ask the Dr. if other diagnosis's have crossed his mind, so you could do your research in those areas as well. If I had it to do all over today, I would push more to have my child take supplements with her medication in an effort to keep her dosages smaller. Such things like Fish Oil are said to be helpful (although she was always negative about taking it). Talk therapy...also a great idea. We have a child with- Bipolar illness (she too had issues with- her clothes bothering her at that age) and at times it really helped us to have her work things out with- her therapist. The therapist was vital during the teen years. Today, she is a young woman and she goes every other week....more if needed. Wishing you well...believe me, I understand the difficulties surrounding this sort of thing.
p.s. Loved what "wake up call" said...it takes strong parents to care for these children. Make sure you take good care of yourself. Make time when you are able for yourself and your spouse.

 

[jasz1971]

Donna, I don't have a whole lot of advice for you but I wanted to let you know that my son sounds very similiar to yours (we are having him evaluated again by a new psychologist in Feb). The Explosive Child book is really good even if you can't totally implement the program. It helps you take a good look at what is triggering the explosions and also helps the parent take a closer look as to why you are saying no to certain things. My husband and I realized that sometimes we say no just to say no and that really doesn't work with these types of kids. Good luck and I hope things get better for you soon. A.

 

[Nancy423]

Hi and welcome! I have nothing to add to all the great advice above. Just wanted to say hello. Oh, we're getting a full evaluation by a neuropsychologist in Northbrook. if you'd like his name, just PM me.