I am at my wits end.

Discussion in 'Special Ed 101' started by TerriH, Oct 26, 2009.

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  1. TerriH

    TerriH Member

    My daughter, who is highly intelligent, can no longer attend class without collapsing in tears in the counselors office and I have tried EVERYTHING!!!!!!

    My daughter is 16. She is bipolar but she also hallucinates when she is very ill. I suspect that he bio-mom was using drugs as he bio mom was living on the streets at the time. My daughter was taken at birth by SRS and put up for adoption: we have had her since she was 16 months.

    She was hospitalized for 10 days this fall, at her request. It is her third hospitalization in 4 years, each time in the Fall.

    She is having a horrible time getting back into school, and we have tried everything that we can think of.

    She has a 504, and the school is telling us that we have had about everything that the school district is able to offer. She had homebound for 2 weeks when she got out of the hospital. She has extended time to get her work done. They cut her class load back to half days. She has a quiet place to go if she feels stressed.

    She still cannot attend class. She tries, and 20 minutes later she is crying in the counselors office (her usual quiet place)

    We have talked to her docs, and medications have been changed. She is currently on lamictal 200 mg, seroquel XR 300 mg, and abilify 45 mg. They change the medications, but it does little good.

    We have talked to her counselor, repeatedly, on this subject as well as others.

    To make things even MORE difficult, she is not always honest. Mind, she is not DISHONEST, but many teenagers will lie JUST a bit and she is one of them.

    She went to a college last weekend to look around, and she came back starry-eyed and eager to go. She is gifted. And, she KNOWS that she must get through high school before she can attend college! But nothing helps.

    I take her to school, she goes to the councellors office where she cries, complains of hallucinations and suicidal thoughts, and then home. Often she does not get as far as school.

    There are things that she would like to do, but we refuse because we do not consider her to be well enough.

    She says that her mood is more stable, and she ACTS like her mood is more stable. Usually the hallucinations are linked to a worstening mood, but this time they are not.

    At home she reports the same symptoms, only not as serious and she can funcion very well, though she is not very focused.

    And we are stumped.
    Last edited: Oct 26, 2009
  2. smallworld

    smallworld Moderator

    Why doesn't she have an IEP? A 504 will not offer enough services to a girl with as many emotional challenges as your daughter has. An IEP will.

    You need to write a letter to the school requesting a full evaluation for the purposes of special education and related services. Have you thought about bringing in an educational advocate to make sure your daughter's rights are being protected?
  3. rlsnights

    rlsnights New Member

    Preface - this is a long response but I hope you find it helpful. :chatty:

    1. I agree with-smallworld - why doesn't she have an IEP? She is potentially eligible for services through age 21 so I would request assessment for Special Education right away. And it certainly sounds like she needs an individualized program developed and implemented on an emergency basis.

    Based on your description there is substantial evidence that she meets IDEA 2004's definition of a child with a suspected disability and therefore the SD should be asking to assess her immediately (this is called Child Find in IDEA 2004). She does not have to be failing her classes to need services - and don't let them tell you otherwise. If the stress of showing up for school is aggravating her psychiatric symptoms to the point she cannot attend or stay in class once she gets there then by definition she is not able to access the regular curriculum without an individualized educational plan with modifications to allow her to get a Free and Appropriate Public Education (better known as FAPE in IEP-speak).

    If they assessed her and found her ineligible and told you she only qualified for a 504 plan then I think you need an attorney or at least a professional advocate. Cause you should probably sue their pants off. If they refuse to assess her now - same deal.

    2. The SD is trying to sell you a load of smelly socks if they are saying that a partial day program at a regular high school is the best they have to offer to a child with these challenges. If you live in an extremely rural area it may be true that access to more appropriate educational settings is geographically limited. But that is not the same as saying they have nothing more to offer. It may be that she needs a residential treatment placement or a non-public school some distance away. I don't know. But an IEP team should be deciding on her placement based on her NEEDS not on what happens to be conveniently available.

    3. If I understand you, it appears that the stress of attending school at all seems to be causing her symptoms to get worse? How did she do on homebound? If she did well, then I would be asking her doctors for a letter recommending homebound until she is stabilized and you can get her assessed for Special Education. Depending on your SD's policies they may only be able to do this through Special Education services or they may be able to do it through the usual health-related homebound program.

    4. What does the psychiatrist say about her difficulties? Do you feel like she is getting good care or do you think you need to get a 2nd opinion?

    5. Just a thought and something to ask the psychiatrist about - could her medications (or this combo of medications) be causing the suicidal thoughts and hallucinations since she does NOT seem to be having a mood swing problem? It is possible to get suicidal thoughts and hallucinations as a side effect of Seroquel (or any psychiatric medication actually). I know because one dose of Seroquel made me actively suicidal and we now list it as a life-threatening allergy on my medical chart.

    6. That is kind of a high dose of Abilify. According to the PI sheet, Abilify target dose is typically 10 to 15 mg / day with doses up to 30 mg if clinical response warrants. But clinical trials have generally shown no significant improvement at doses above 15 mg. Just a laymom here and not a doctor but I'm just wondering if you saw an improvement with the increased dosage that warrants the high dose.

    6. Could her worsening fall symptoms be related to changes in the day/night cycle? If you suspect this might be part of her problem I suggest you read information on Dr. Phelps' website about the importance of light and dark and specific kinds of light in the management of bipolar


    7. She sounds like she also has a very high level of anxiety. Has this been diagnosed by the psychiatrist or are her difficulties at school attributed solely to BPII? Seroquel is supposed to be good for anxiety but perhaps an additional medication tweak aimed specifically at anxiety should be considered?

    8. When you say you have talked to her counselor - do you mean the school counselor or do you mean a private therapist?

    9. I would see if you can find a therapist or program in your area that offers DBT (Dialectical Behavioral Therapy). This kind of treatment might be very helpful to your daughter. To vastly simplify it, DBT teaches the use of mindfulness and some specific cognitive techniques to manage dramatic shifts of mood, emotional reactivity, and suicidal ideation and/or unwanted thoughts. It has been shown successful in actual clinical trials. If her current therapist isn't trying to teach her these techniques, I would strongly consider finding her a new therapist who is familiar with the techniques or a structured program to supplement her regular therapy.

    Hope tomorrow is a better day for you and your daughter.
  4. Sheila

    Sheila Moderator

    Can't add much.

    Frankly, I'm shocked that the sd has done so much under a 504. Technically, a 504 can give a child everything s/he needs, however, it rarely happens that even adequate accommodations are tendered.

    There are sample letters for parent referral for evaluations in the Sp Ed 101 Archives.

    The sd is responsible for educating your child. If they can't, they need to contract with an entity that can. (This may mean a theraputic day school, Residential Treatment Center (RTC), etc.)

    We are fortunate in that we haven't had to deal with bipolar or hallucinations. But I can tell you that of all difficult child's problems, his school related anxiety is THE MOST DIFFICULT to manage.

    I don't recall whether you mentioned if an adolescent psychiatrist is managing your difficult child's medications. But if not, it's something you may need to check into.
  5. svengandhi

    svengandhi Well-Known Member

    Is there a smaller alternative HS she can attend? My Aspie son went to one of those and he had several classmates who were bipolar and on medications. The smaller environment and the fact that the teachers were more aware of kids' issues and needs helped them. One of them is still a good friend of my son's and is at community college.

    You might also want to look into seasonal depression since you say it happens mostly in the fall. Maybe a light box or a vitamin D supplement might assist.
  6. TerriH

    TerriH Member

    Rlsnights, if would appear that you are correct about the abilify. Yesterday the psychiatrist increased the dose yet again, and her hallucinations promptly got worse.

    Over the next 6 days she is to be tapered down to a dose of 7.5 milligrams, or tapered until the hallucinations stop, whichever comes first.

    Tomorrow I will make up a rough draft and look at sample letters: today has been both busy and draining (one on one with a hallucinating bi-polar) and she now reports that she is feeling considerably better. She has also spent the last 2 hours on the phone with friends, and she sounds happy again and optimistic that she will feel even better tomorrow.:D

    I think I am done for the night: DS is working on homework, We might have enough leftovers for dinner, and I wonder how late the library is open? It would be sweet if I left the house for a bit.......

    Thank you for the advice: I shared it with husband but I will think about it myself tomorrow...... :faint:

    I did go ahead and email her counselor and asked him to get together the work that she has missed over the last few days.
  7. rlsnights

    rlsnights New Member

    That's a really fast wean from 45 mgs. Hope it goes OK.

    Abilify has a half-life of about 75 hours. That means it takes that long for half of it to be out of your system. So if the Abilify is to blame, it may take a while before you see a big improvement. Once she's down to 7.5 mg it may take around two weeks for her to really get down to that level depending on how fast she metabolizes it.
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