Discussion in 'General Parenting' started by ShanDiann, Oct 14, 2011.

  1. ShanDiann

    ShanDiann Guest

    Hi - I posted here a few times last year. I seriously need some support right now and hope I can help support others.

    I am starting to believe my difficult child may have some sort of mood disorder. Here is the background. My son, I will call him R. R is 8 years old and in the 3rd grade. Beginning in Kindergarten we began to see extreme fits of rage that could olast several hours. We took him to the pediatrician. and he was diagnosed ADHD. He was put on Focalin XR which seemed to help. We survived Kind. and 1st grade was wonderful thanks to a fabulous teacher who could diffuse the situations before they started. 2nd grade started as a challenge with him flying into these rages. We were reffered to a child pshyc. who has been seeing him in therapy and upped the Focalin to 15mg. Things got a bit better, never perfect he would still get angry over little stuff. 3rd grade has been a nightmare. He has tried to run away from school because he made a 96 on a math test. He has serious issues with getting things wrong and melting down over it. He has been suspended twice already this year. Things flip from good to bad quickly. Yesterday he tried climbing out of the window during his rage. Once the episode was over, my sweet loving boy was back and very apologetic. Consequences don't seem to work with him. I am a big fan of The Explosive Child,but even that dosen't seem to help. It is like he isn't even present when he is raging. Nothing I say will calm him down. I have to let it run it's course. Lately his mood swings have been up and down rapidly. This morning he was almost giddy. He was walking around the house singing and laughing at the top of his lungs for no apparent reason. I got the call from the school at 8:20 to come get him. He was screaming, throwing things, and snatching the paper out of the teacher's hands. She got hit in the process. He says he wasn't trying to hit her - He just wanted his paper back. I don't know if I believe him or not. He is currently on 20mg of Focalin XR but it doesn't seem to be helping at all.
    Thanks for reading! I appreciate any feedback I can get
  2. buddy

    buddy New Member

    I doubt he meant to hurt the teacher but he probably didn't care (as in it was off his radar) at that moment. I can totally relate to how that rage state looks, they just are not "home" during that time. 3rd grade is a huge breaking point for so many kids. Early childhood education is over. Communication demands and rule following expectations increase exponentially. All subjects have huge language increases in terms of directions and problem solving both in the books and teaching. If he is so perfectionistic he is probably stressed off the charts. So, are you planning to get any new evaluations? Is his current medication increasing his anxiety (it does with my difficult child but it is a trade off for now), does he need an "add on"/another medication or a different medication? Is his diagnosis right? Now that he is older you have more info to share and maybe a new psychiatrist with a fresh perspective can give you more insight. Does he have an IEP or 504 plan? Sounds like he needs a positive behavior plan to help build skills to deal with these issues and then he can have appropriate consequences which will help him and not just get him out of their hair. A functional behavior assessment (FBA) can/should be done at any time even if it is not time for a complete re-evaluation. It is supposed to be done for any behavior that is interfering with his or others' educational day. Go to or google FBA and and Positive Behavioral Intervention Plan (not the school-wide kind, the IEP/504 individual kind) to see what they need to do. Of course this is along with the things you are doing...checking with docs, getting an outside evaluation (neuropsychologist evaluation if you can) etc. Something else is going on here it seems (Just MHO) Poor kiddo. I am sorry you are having to struggle thru this. It is so hard.
    Glad you came here! Hugs, Buddy
  3. InsaneCdn

    InsaneCdn Well-Known Member

    I'm going to guess that you need to move beyond the psychiatrist, and get a comprehensive evaluation.

    Your mommy-gut is telling you there is something more going on... and that makes sense to me, too.

    ADHD is "normal" in our family - and what you're describing doesn't sound like "just" ADHD to me... not that the ADHD is necessarily a wrong diagnosis, but that... there's more to it.

    Not unusual for problems to appear when they start school. Its a whole different world - AND, they are expected to be in lock-step developmentally with their age-similar peers. NOT true for all kids.

    There's a raft of things that can be co-morbid with ADHD - like Developmental Coordination Disorder (DCD) (motor skills issues), LDs, executive functions. These need to be checked out.

    Lots of kids have sensory issues, too, and that can really affect how they react to the world around them. And auditory issues (hearing, language processing, noise filtering, etc.) can go completely undetected.

    And then, as you said, mood disorders can come into play...

    Probably need to consider...
    - Occupational Therapist (OT) evaluation for motor skills and sensory issues
    - Speech Language Pathologist (SLP) as a start on checking for auditory issues - even without language issues. Don't let them tell you he doesn't need Speech Language Pathologist (SLP) testing because his language is developing normally... it may be a background-noise issue that makes it almost impossible to cope with classroom yet learn well in quiet, one-on-one situations.
    - plus a comprehensive evaluation somewhere - childrens hospital, neuropsychologist, something... where they can look for everything from Autism Spectrum Disorders (ASD) to emerging mood disorders.

    Once you know what you are dealing with, it wil be easier to come up with plans of action.

    Glad to hear you already have "the book". No, it doesn't solve everything... but the perspective helps.

    Welcome. Others will be along shortly.
  4. TeDo

    TeDo Guest

    Definitely get more thorough evaluations from a neuropsychologist. You might even need to find a different psychiatrist since this one seems content with just the ADHD diagnosis. There is OBVIOUSLY something more going on. Your son may have been totally correct when he said he just wanted his paper back. That could very well be his "reality". You said you're a big fan of Explosive Child. What does your son usually say is the REASON behind each behavioral episode or does he say "I don't know"? If you are drilling for the WHY, you should be getting a clearer picture of how he thinks. Does he think like everyone else or are his explanations "different".
  5. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Hi there. Welcome to the board, but sorry you have to be here.

    I have a few questions for you that can help us support you:

    1/How was his early development?

    2/Any speech delays, even if they are resolved? Any precocious speech/early reading?

    3/Any strange quirks or obsessive interests?

    4/How does he relate to his same age peers?

    5/Any sensitivities to his clothes, loud noise, bright lights, too many people?

    6/Can he transition well from one activity to another?

    7/Are there ANY psychiatric problems, diagnosed or suspected, on either side of his genetic family tree? This includes depression/bipolar/schizophrenia/any suicides etc. Is your hub is biological father?

    8/Has he ever been evaluated by a neuropsychologist?

    Others will come along.
  6. whatamess

    whatamess New Member

    I have had similar issues. If he had a fabulous first grade year, I think it is very important to look at what supports made that possible! If those supports (including training for his current teacher on effective prevention strategies) can be given now and improves his behavior, etc, I would look at that route above ways to medicate for school not accomodating the disability. He sounds anxious definitely. Perhaps previous days that don't go well trigger more anxiety at home right before school starts.
  7. Chaosuncontained

    Chaosuncontained New Member

    First of all, BIG HUGS.

    My son was diagnosis as having ADHD when he was 4. But I "knew" something wasn't right when he was 2. He once climbed a shelf, got down the spray paint (black) and painted my washer and the middle of the night. Broke 18 eggs in his bed trying to "hatch" them. Poured an entire bottle of shampoo all over his bedroom floor. Drew all over his body with a Fushia Sharpie pen (and I mean..ALL. OVER.).

    At 4 he couldn't focus at all. Unless it was video games or a certain movie he was intrested in. Around this time he also became a short fuse. Doesn't like strangers or any adult for that matter (except for his parents). He had a very small "personal space". Hit A LOT. Screams "you hate me!" "I wish I was dead!" "I quit! I quit! I quit" (we never found out what he was supposed to ne "quitting" ;) )

    At age 8 he was still agressive at school. Hiding under his desk, chewing on his shirt, not sleeping well. Sleep walking/talking. He ran out of school (several times) but once hid behind a building on campus. Hiding from the Principal. He spent A LOT of time in OSC. A LOT. But his grades were ok. He is an avid reader. Video gamer. Cartoon watcher. He has no friends. No one WANTS to be his friend. He gets upset easily. Loses a game in Math? MELTDOWN. The book he wants to read isn't in the library? fit. He was threatened with the school calling the Police.

    Much of the same this year...refuses to do most work. Refuses to do ANY work that requires writing. Allergic to cursive too.

    We found out that he also has Severe Generalized Anxiety Disorder. And Depression. And a Mood Disorder. We asked for an IEP at school. The school is doing some testing on him. To see if there is anything else going on--and to see if he qualifies for an IEP. If he does the school will make accomodations to help him get the education that is a right to ALL kids.

    He also is to start seeing a Psycologist who is certified as a Behavior Analyst.

    He is on a few medications. And he does have good days here and there. He is a loving child. He seeks approval from EVERYONE. He loooves babies (we cant pass one in WalMart without him cooing over them).

    Even with all his needs he is a blessing to me.

    You need help, Momma. Ask his doctor what to do, talk to the doctor about IEP (if you want to). Sometimes you have to knock on a few doors--and keep knocking--until you get the answers that feel right to you. You are his #1 Advocate--maybe his only one right now. He needs you fighting for him--and I am sure you are!

    I also recommend you come here twice a day...LOL That's my prescription anyway. Big Hugs, as you can see, you are NOT alone. And there are some brilliant women on here who enjoy helping others!
  8. DammitJanet

    DammitJanet Well-Known Member Staff Member

    ShanDiann....I am also from NC. I see both you and your husband are in the educational field. This cannot be easy for either of you. Could you possibly PM me if you are anywhere near me? I live in Lumberton which is near Fayetteville.

    My boys are grown now but I have been around the block a time or three with these issues and the mental health system. Did you attempt to get your son evaluated through the Developmental Evaluation Centers? Im not sure if he is too old now or not. I dont know what their cut off age is. Both of mine went there at 6 and 4.

    I can give you some tips for getting help through the local mental health agencies. And if you are near me, I can give you the name of an excellent psychiatrist and therapist.
  9. ShanDiann

    ShanDiann Guest

    Thanks for all the quick replies. I seriously have tears in my eyes reading them. It is so nice not to feel judged. I am going to try to answers all the questions and update on today's psychiatrist appointment.

    1.husband is R's Bio - father

    2.His early development was normal and he hit all milestones on time. The first indication of a problem was around four when he melted down at daycare because someone messed up his line of toy cars.

    3.He is actually above grade level in both reading and math.

    4. He has always gone through phases where he becomes super obsessed with something. It has varied from age to age. When he is obsessing it seems to be all he can talk about. Right now the topic is rainbows...weird right.

    5. He has always been overly social. He will walk up to any random kid and start playing. He has had a few close friends but even those relationships are beginning to fail. The kids are becoming less tolerant of his differences. He participates in Boy Scouts which is wonderful for him.

    6. He has always been picky about tags in clothes and food textures. Background noise bothers him. He swears the hum of the air conditioner keeps him from concentrating on his HW

    7. My grandmother has bi-polar disorder but our psychiatrist swears it is not it. He says his moods cycle to rapidly within a day.

    8. The only evaluation we have had done was by our pediatrician and the psychiatrist. I have recently requested in writing for the school to test him for any disabilities impacting his learning.

    So at the psychiatrist appointment today. The doctor said he felt like alot of R's behaviors are anxiety driven. He prescribed 10mg of Prozac and dropped the Focalin back to 15mg. I am very nervous about this change but he said that he has had alot of success with prozac in kids. Keeping my fingers crossed. Thanks again for the words of support. You are awesome!
  10. InsaneCdn

    InsaneCdn Well-Known Member

    Ummm.... my gut reaction? You don't medicate what you don't know... psychiatrist doesn't know what's going on either, so is "trying" medications? You can do that in an absolute crisis... but this doesn't seem to be a crisis.

    Occupational Therapist (OT) evaluation sounds like its critical - definitely sensory issues. More importantly, Occupational Therapist (OT) has therapies to help.

    Background noise... may end up being an Auditory Processing Disorders (APD) (there is one where the person has normal hearing and normal language comprehension, but can't filter out the background noise) - in this case, it also leads to sensory overload, on top of trying to figure out what you're supposed to do because you didn't catch the instructions... They will NOT test for this at this age - too many other things to rule out first, and you need to have developed "concentration" skills for the tests to work. But for now... reduce background noise as much as possible, and see if there are ways to do this at preschool/daycare as well.

    On top of that? the whole obsession-with-a-topic thing and some of the other things you describe, almost sound like traits from the Autism Spectrum Disorders (ASD) spectrum... that does not mean he IS on the spectrum, but its possible to have some of the traits even if you're not. Autism Spectrum Disorders (ASD)/Aspergers will be something on your "rule out" list... definitely want evaluated.

    Sensory and auditory issues tend to generate a LOT of anxiety. So, can anxiety be a factor? Sure. But if these are at the root, you won't solve the anxiety problem with medications... you HAVE to get to the root causes.
  11. Liahona

    Liahona Guest

    Welcome! Have you read the Bipolar Child? When difficult child 1 was diagnosis with bipolar I read it and its a great book. Bipolar kids moods cycle more rapidly than adults. It is also possible to have more than one diagnosis; like Autism Spectrum Disorders (ASD) and BiPolar (BP) together. Just makes it more hard to diagnosis.

    Just my thought but you might want to one do one medication change at a time. Its not popular with my psychiatrist but it helps keep track of which side effects are do to which medication.

    I second the opinion for more testing.

    Because of your backgrounds in education you probably already know this. He doesn't have to be academically behind to get an IEP.
  12. cubsgirl

    cubsgirl Well-Known Member

    I agree with a neuropsychological evaluation that others have mentioned. Other than that ((hugs)) to get through it. I was a major difficult child as a child and third grade was one of my worst years. Like your son, I was above grade level in reading and math - my gfgness (for that year) was born out of major boredom.

    I was diagnosed much much later with a mood disorder (age26). Your son may or may not have that but I agree that comprehensive testing is in order.
  13. whatamess

    whatamess New Member

    Your second post screams "Asperger's" to me.
  14. HaoZi

    HaoZi Guest

    His changes are too rapid for bipolar? Is that what doctor is saying? Did I read that right? Please tell me I read that wrong. My kid cycles like PMS on crack in a tornado.
    Have to agree that I also see some Autism Spectrum Disorders (ASD) traits in there, it would be worth testing for. In some kids it becomes more apparent as they go through school because social situations are becoming more complex and their abilities and coping mechanisms lag, with the gap widening about this time. The rage is part of that vapor-lock you're looking to head off, because (as you well know by now) once that hits his brain is on lockdown and self-calming isn't going to happen.
  15. buddy

    buddy New Member

    WOW was that an image I can visualize clearly!
  16. susiestar

    susiestar Roll With It

    You NEED a new psychiatrist. Go and get a copy of The Bipolar Child by Papalous at the bookstore. ASAP, in my opinion. The psychiatrist is NUTS. One of the HALLMARKS of bipolar in kids is that they cycle super fast. I think it is called ultra radian and ultra ultra radian to describe how fast they cycle. Some kids can cycle in 15min or less. This is early onset bipolar. Or it sure sounds like it.

    The LAST thing that yoru child should have is an antidepressant. he needs medications for bipolar - and stimulants and antidepressants will cause him to cycle more.

    The book explains the disorder very well, esp how it presents in children. It also has an excellent section on medications - what to do and what not to, including the medication protocol approved by the board of child and adolescent psychiatrists, which calls for mood stabilizers (one or even two if one is not enough) and antipsychotics (seroquel, risperidone, abilify) to be used until the child's moods are stable. MANY children and adults with bipolar find that their adhd, anxiety, etc.... problems are gone once they are on the right medications. If the symptoms persist then SMALL amounts of stimulants, antidepressants, etc.... can be trialed to see if they help.

    To say that a child's moods cycle to rapidly to be bipolar is just. plain. nuts. Or stupid. Not sure which.

    PLEASE read the book, esp the parts about medications and what bipolar looks like in kids. Then, if the doctor won't help, get a new one. PUSH the doctor to try the medication protocol for your son. Be aware that it takes time to get mood stabilizers up to a therapeutic level in the body, and once they are at that level it takes 6 weeks to get the full effects. But if he stays on stimulants and antidepressants there isn't much hope that his moods will ever be stable. Not unless this is something terribly different, but it sounds a LOT like bipolar.
  17. buddy

    buddy New Member

    HI! With this additional information I just wanted to agree with some of the others in their observations... I hope this is helpful to you.

    These things stand out to me:
    1. lining up cars--rigid-have to play with them by his rules
    2. sensitive to sounds-but is loud himself--also sensory issues with tags/textures
    3. perfectionistic, major meltdowns over issues
    4."overly social" but not able to handle those differences
    5. high interest areas that go from one thing to another but still he is really into those things at that time
    6. anxiety
    7. rages/metldowns over different things like leaving one activity for another/transitions or change in plans....had to mention it again, it is big for lots of us, smile.

    So when he plays how does he do? Can he really play fluid/changing scenarious in pretend play where he can take on roles of other characters? Can he follow the lead of others? Does he play more side by side sharing things/parallel or associative play/do routine scripts in play? Does he talk more or better with adults than kids?

    I will leave it to others to share what they think of how the things you list apply to the areas they are more familiar with. It will really help you to sort through this, not on your own but in terms of what to ask from psychiatrist and any future evaluators you are going to hire.

    So, I will just talk about the things I am more familiar with. Of course just toss anything that does not fit since I am not/we are not there actually seeing what you see. While it could be that the individual issues like anxiety and sensory processing disorder are stand alone diagnosis for him--he sure sounds like maybe in the bigger picture it could be Asperger's ( or Pervasive Developmental Disorder (PDD)-not otherwise specified or high functioning Autism Spectrum Disorders (ASD), in the schools they only use Autism Spectrum Disorders (ASD) because it is an edcational category but in the medical community they will give kids a more specific diagnosis like autism, asperger's etc.). Many kids with Asperger's or high functioning Autism Spectrum Disorders (ASD) are misdiagnosed as ADHD, Oppositional, anxiety disorder, Obsessive Compulsive Disorder (OCD), etc. to name a few. As they get older the signs become a little more clear as the gap widens socially. Again, this just is to give you another place to go and check because if you are not with someone who is familiar with these issues they may just diagnose the symptoms, and miss the big picture.

    Maybe look online and see what you think when you read about this. Kids with Asperger's or high functioning Autism Spectrum Disorders (ASD) often are high functioning academically, many really want to be social and try very hard but just dont navigate it well-can do better with adults- when they play it is not really imaginative kind of turn is more doing things next to others or sharing a pile of something or doing the same scripts over and over. They typically develop high interests, a favorite tv show character, a sport, a musical singer, space travel, presidents, numbers, you name it...there are many. Lots of them like to collect things. Super huge issues with anxiety for most aspies. As they grow older, the gap in social skills (including unwritten class rules with teachers and peers) grows so the issues and meltdowns increase. Peers become less and less tolerant. Of course there can be the sensory issues...

    Kids can become viewed as a behavior problemespecially as they grow older, and are labeled as troubled when in reality there is a neurological basis for the issue. The great news is IF this is the problem you can get help for the other issues in a way that matches how he thinks and processes the world and it goes a little smoother than just medications alone and traditional discipline. If you can it would be worthwhile to ask for an autism specialist to be on your educational evaluation. team. Any outside evaluations you can check and request the evaluator to be someone who is well versed in the issues you think could apply (whether bi-polar or ADHD or Aspergers/Autism).

    My best to you!
  18. susiestar

    susiestar Roll With It

    i agree that there are signs of Autism Spectrum Disorders (ASD) and there are definitely signs of significant sensory issues. Sensory issues need to be evaluated by a private Occupational Therapist (OT). Often school can help with treatment, but a school evaluation just doesn't have the scope that a private evaluation has. School evaluation covers ways the problems impact his life at school and a private evaluation covers ways the problems impact his entire life. Sensory problems are often a HUGE piece of the puzzle and helping them can have a HUGE impact on the other issues. I have a lot of sensory problems and quirks myself. When the sensory problems are acting up, everything else that might go "wrong" is 10,000 times more of a problem for me. I am FAR more explosive, angry, unhappy with every single thing, and mostly I am UNABLE to pull my brain/attention/whatever you call it away from the sensory problem I am experiencing. Treating the sensory issues makes everything else far easier to handle.

    It is VERY common to have comorbid disorders (more than one diagnosis). If bipolar is even suspected, it MUST be the FIRST problem that medications address. Why? The medications for MANY other problems can CAUSE mood cycling if you are bipolar. You cannot effectively treat the other problems if the moods are not stable, and because the medications to help other problems cause moods to be more unstable, you have to treat the bipolar first or rule it out totally.

    I strongly encourage a full evaluation by a neuropsychologist. You can usually find one at a Children's hospital or major teaching hospital. Here they are always part of the neurology dept. If you cannot find one any other way, look up ALL the pediatrician neurologists in your area and call every one until you have the names of some neuropsychologists. You can ask the office staff if they know the name of a neuropsychologist - usually they will tell you.

    I still feel strongly that you need to read The Bipolar Child by Papalous asap. Then you need to discuss it with the psychiatrist and push him to try mood stabilizers. R can still have Autism Spectrum Disorders (ASD), but all the interventions/supports in the world won't help until his moods are stable.
  19. keista

    keista New Member

    I saw Asperger's in your second post as well.

    As far as the doctor's opinion of bipolar? Yeah, OK. Well look at cyclothymia then. It's got all the classic bipolar symptoms without the time restrictions for manic cycles as spelled out in the DSM. It's treated similarly to bipolar, and can become full blown bipolar.

    Please, please, please be careful with that prozac. I know it is a godsend for some ppl, but for others it's a nightmare, and if you suspect bipolar (or cyclothymia) it can be an even BIGGER nightmare.

  20. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Ditto, ditto and ditto!!!! Get thee to a neuropsychologist.

    Actually, it screams to me of autistic spectrum disorder, high functioning, which could be Aseprgers.

    My son, who is on the spectrum, was misdiagnosed with bipolar and put on heavy duty medications. Be VERY careful before accepting a BiPolar (BP) diagnosis in a young kid. You mentioned he was lining up cars at daycare. Does he do this often? That plus obsessions plus meltdowns and moodswings is also classic Autism Spectrum Disorders (ASD).

    See somebody you really trust! Keep us posted.