In BiPolar (BP) diagnosis, do you have to have sleep issues?

Discussion in 'General Parenting' started by whatamess, Nov 19, 2009.

  1. whatamess

    whatamess New Member

    My difficult child is on the autism spectrum. This is making it difficult to get psychiatrists to look at the possibility of bipolar. This week and a portion of last he was pretty much non-functional at school (very out of control/giddy/hyper). Normally he requires frequent breaks, sensory accomodations and most often 1:1 help to get through a day. Over this last week none of those things made a difference-it has been survival mode at school. At home the only way he can maintain is to play computer games, as soon as his time is up, his behaviors/giddiness emerge-he simply cannot focus on anything even sitting down to eat. I have noted this 'cycle' of extreme giddiness/mania since the beginning of July and he had two good months in summer and since then it is 3-4 weeks between 'cycle's that last 4-8 days. But the psychiatrist always asks "how is his sleep?". With the exception of a little harder time falling asleep and maybe a night waking or two, his sleep is seems the 2 psychiatrists do not want to diagnosis bipolar based on the fact that he does not have sleep problems.
  2. crazymama30

    crazymama30 Active Member

    I am not up on the Pervasive Developmental Disorder (PDD)-not otherwise specified stuff, but ADHD and BiPolar (BP) can both cause sleep disturbances. My husband is BiPolar (BP), and has mega mega sleep issues. My difficult child who is most likely BiPolar (BP)--nope no sleep issues at all. He mostly puts himself to bed at 8pm and is alseep by 8:30 or 9.

    With husband, if he does not sleep it will trigger a manic episode, so his doctor is always worried about his sleep.

    I don't think you HAVE to have sleep issues to have BiPolar (BP), but they are very very common.
  3. CrazyinVA

    CrazyinVA Well-Known Member Staff Member

    My Youngest slept like a log ... sleep was not an issue with her. So, it's not necessarily present in all bipolar diagnoses.
  4. gcvmom

    gcvmom Here we go again!

    Just because he's not staying up all night doesn't mean the bipolar could not be emerging. You can by hypomanic and sleep fine, or within normal ranges. Keep track of his sleep habits so you have the data to support your suspicions in time.

    My difficult child 2 has always needed more sleep than most kids. A LOT more. However, he has had episodes where he's missed a few doses of medication and ended up staying up all night, or had a very, very hard time falling asleep even though medications were not missed.

    If you still feel your psychiatrist is not hearing you, it may be time for a new one!
  5. Christy

    Christy New Member

    My son is both Pervasive Developmental Disorder (PDD)-not otherwise specified and bipolar. He has issues with waking up very early (middle of the night) at times when he is heading towards mania but has never had an issue falling asleep. Does he currently take any medication? Sometimes if the medications make him drowsy you will not see the sleep issues.
  6. Nomad

    Nomad Guest

    Have not checked the DSM, but it seems like sleep issues are often present with bipolar illness.
  7. miles2go

    miles2go Member

    My BiPolar (BP) difficult child -- no sleep issues other than needing about 11 hours of it a day. His BiPolar (BP) mom no sleep issues either. However if either of them miss sleep, makes hypomania startup much more likely.
    Here's the diff between adhd type hyper and BiPolar (BP) type mania afaik:
    Adhd hyper is more on a physical level, likes running fingers over textured surfaces, bouncy, buzz whatever. BiPolar (BP) mania has more of a mental aspect where the kid feels no reluctance to go against authority figures, risk-taking with life and limb, no inhibitions, laugh, rage, etc. Adhd has impulsivity but BiPolar (BP) manic kid feels that he is authority is on par with adults and gets very frustrated when the world doesn't cooperate. People, correct or add, this is how I see it. Video game addiction is strong in both I think.
    So if your psychiatrist is too focused on sleep disturbance for BiPolar (BP) diagnosis that may be misplaced but your difficult child may still not be BiPolar (BP). Any of that in family history -- alcohol/drug abuse, suicide, spouse/child abuse (yelling or physical), promiscuity, criminality? Often is how BiPolar (BP) shows up, I think.
  8. smallworld

    smallworld Moderator

    Here's a link to a helpful article discussing the symptoms of pediatric bipolar disorder, which was written by researchers at NIMH in Bethesda, Maryland:

    FWIW, I do think children on the autism spectrum can have mood dysregulation and benefit from mood-stabilizing medication without having full-blown bipolar disorder. My two daughters do not have bipolar disorder -- they do have mood disorders -- but still benefit greatly from taking the mood stabilizer Lamictal. Is your difficult child taking any medication?
  9. TerryJ2

    TerryJ2 Well-Known Member

    There are always exceptions, but more often than not, there are sleep issues. It's a red flag for bipolar.
    Having said that, your difficult child is still only 11, and you won't really know for sure until more symptoms become more obvoius after puberty. I can see why the docs ask. on the other hand, they are looking for easy answers, "red flags." There are no easy answers. Sorry!
    Why isn't he on any medications? (Just wondering.)
  10. rlsnights

    rlsnights New Member

    You need to get your hands on the book Survival Strategies for Parenting Children with Bipolar Disorder by George Lynn. You can order through the CD website (see bookstore) which links to Amazon. Or see if it's at your library.

    He thoroughly discusses what it looks like (in his experience) when a child has stand-alone BiPolar (BP), BiPolar (BP) with Autism Spectrum Disorders (ASD) and BiPolar (BP) with Tourettes.

    After you've read this you will be much clearer about whether your kiddo is experiencing anxiety related to the Autism Spectrum Disorders (ASD) or the added issues of BiPolar (BP). There is a high percentage of dual diagnosis of Autism Spectrum Disorders (ASD) and BiPolar (BP) so you may be right about your child's mood swings.

    I would also strongly suggest that you start a mood chart/diary. I have my own Excel chart tailored to the things that are issues with my son. You could do the same or you can find lots of them online. If your son does stimming or has rituals, etc you could put them in instead of suicidal behavior/speech for example. If you do your own chart it's a good idea to keep everything either Y/N or on the same scale. I picked 6 just because it felt right to me. Gave me enough room to show differences in mood without giving to wide a range from top to bottom.

    I chart the following things daily:
    Upper mood limit (on a 6 pt plus scale)
    Lower mood limit (on a 6 pt minus scale)
    irritability (6 pt scale)
    anxiety (6 pt scale)
    impulsivity (6 pt scale)
    # hours sleep per night
    suicidal thoughts or actions (Y/N)
    # hours sleep during day
    attended school (Y/N)
    Sick (Y/N)
    medications - I list each medication he usually takes and the dose plus Benadryl which we sometimes use to help him sleep. I code each day's medications as X if he took it, R if he refused, and X2 if he took 2 doses in one day because he was catching up after refusing the day before. If the dose changes I put the new dose in the cell so that I know the date that we changed the dose. I add new medications as they come along.

    I chart both up and down moods daily since my son often has mixed moods with both the activation of hypomania and the agitation of hopeless depression together.

    I also keep a narrative diary with special emphasis on changes in behavior and unusual stuff like illnesses, stressors like deaths or health problems in friends/family, big changes to his routine. When he is having a bad streak with big rages, etc. I make very detailed notes if I have the time. You can make it really short too and you don't have to write every day as long as you at least do the numbers and note the medications.

    For my purposes, the numbers on the mood scale represent:

    +6 Activated severe; unable to work; hospitalized
    +5 Act mod/severe impairment
    +4 Act Mod sig impairment/able to work
    +3 Act mild/mod impairment
    +2 Act mild no sig impairment
    +1 Upper normal
    0 Normal
    -1 Low normal
    -2 Dep mild no sig impairment
    -3 Dep mild/mod impairment
    -4 Dep mod sig impairment
    -5 Dep mod/severe impairment
    -6 Depressed severe; unable to work; hospitalized

    My son rarely shows "traditional" signs of mania. Instead he gets what I call activated - intense, hyperfocused (mission mode), agitated, angry, anxious.

    I will tell you that difficult child 2's therapist, psychiatrist and I have all really found this helpful. It keeps the professionals up to date quickly and easily since I can send them the info electronically. They can print it out for his records if they want it. I can take the data and put it into a graph and show his mood shifts over the course of weeks and months if I want to.

    My difficult child 2 almost always sleeps easily and hard except for talking in his sleep a lot. I didn't think there was any real variation in his sleep patterns until I started religiously charting his sleep. Now I know that when he's trending manic he only sleeps 8 to 9 hours a night. When he's trending depressed he sleeps 11 to 12 hours (if his school schedule permits). That amounts to a change of up to 4 hours a day in the amount of sleep. It's not the same as in adults where there can be a very big reduction in sleep but it's still a significant difference from the psychiatrist's perspective.

    That's one of the things that a really experienced child psychiatrist knows - early onset BiPolar (BP) does NOT look like adult onset BiPolar (BP). Getting yourself more familiar with the features of early onset BiPolar (BP) will help you get a handle on whether your child is showing signs of BiPolar (BP) or not.

    If you get the book I suggested it will give you a good start on getting the info you need about BiPolar (BP). There are many other good ones but I would start with this one if it were me.
    Last edited: Nov 19, 2009
  11. whatamess

    whatamess New Member

    He is on Strattera (our 3rd attempt with this medication). Today I was called into school, he was a complete mess from giddy to angry to mournful crying and back around the same cycle multiple times in two hours. He was completely non-functional. He admitted he hid his pill last night and we have experienced the immediate effects of him not taking strattera, however he was like this on tues and wed as well and he did take it then. This is definitely a deviation from his 'normal'-his teacher completely agrees. We're supposed to have an IEP tomorrow to move him to full days (and the principal (who was in the room today) just about fainted and said "and we're moving him to full days?"). He has gotten 3 'emergency' doses of risperdal over the last week(first time trying this medication), not sure it's had any effect and I want to make sure the Strattera isn't working or if this is just another cycle that Strattera can't touch.
  12. smallworld

    smallworld Moderator

    You may be aware that Strattera is an SNRI antidepressant that can cause anger and irritability as side effects, even in kids who don't have mood disorders. And according to clinical trials, it's only effective in about 40 percent of the time for ADHD symptoms.
  13. whatamess

    whatamess New Member

    He is definitely more irritable on Strattera, but for the last 3 months on it he has seemed more able to function at school.
  14. smallworld

    smallworld Moderator

    It's always a cost-benefit analysis with medications. However, irritability is high on my list of an unacceptable side effect.
  15. Marguerite

    Marguerite Active Member

    Strattera was a disaster for difficult child 3, the behaviour problems it triggered appearedd very much like bipolar. Or worse. He became irritable, aggressive, more obsessive, manic, finally dangerously aggressive and violent.

    What you describe could still be explained within the Pervasive Developmental Disorder (PDD) profile.

    The problems our kids have can be very complex. I'm not saying he's not also dealing with BiPolar (BP), but simply having Pervasive Developmental Disorder (PDD) is going to cause some other problems. Depression, for example, is understwandable especially as they get older and begin to really resent the limitations that Pervasive Developmental Disorder (PDD) brings to their lives. If the child is feelnig increasingly an outcase, is being bullied or disciplined harshly, you can get a lot of psychological overlay purely because of the Pervasive Developmental Disorder (PDD) and its effects. These things won't respond well to medications but will respond to environmental changes and supports. For example, playground supervision and increas in aide time at school (plus ising the aides more effectively) can greatly reduce a child's stress which can increase their self-esteem as well as their ability to adapt to what is required of them.

    We did go down the path of throwing more medications at the problems, especiallywhen he became increasingly out of control at school mostly, but also at home. Any benefit was marginal. We got the best benefit when we changed how we handle him.

    I was talking to mother in law today at length (long drive in the car) and she was insisting that Pervasive Developmental Disorder (PDD) kids need early intervention to help them learn social skills - according Occupational Therapist (OT) her, Pervasive Developmental Disorder (PDD) kids need social skills instruction as a matter of urgency. I agree with this. But she went on to say that Pervasive Developmental Disorder (PDD) kids AND "normal" kids need exactly the same approach, what you do for normal kids is all a Pervasive Developmental Disorder (PDD) kid needs.
    I had to explain (and I don't think she got it) that Pervasive Developmental Disorder (PDD) kids' brains are wired so differently, pluys they lack certian functional ability in the areas of social skills, tat instruction re social skills needs to be more intense, ongoing and presented very differently. And it's different for different kids, it's a matter of searching to find what works with each kid.
    difficult child 3 did well with social stories, providing they weren't "preachy". The school would give him a social story following a misbehaviour episode which only ended up turning him off social stories, because they would word the social story along the lines of, "difficult child 3 must not hit other children, because it hurts them. If he hits other children he will be punished." Very negative, expressed in "no" terms and not in a positive way. also there was no consideration of why the hitting was taking place; in fact difficult child 3 was hitting back, after being attacked physically by other kids, and the social story said nothing about what he should do to keep himself safe from being attacked by others.
    Froom difficult child 3's point of view, he desperately wanted to learn how to behave, how to fit in. But anything presented to him that seemed pointless or futile, he would reject. And I know how I would have felt if I'd had his problems and been handed such a social story - I would have rejected it too.

    He can't properly tell you what is wrong. If you could completely involve him in your concerns about what else could be his diagnosis, he still wouldn't be able to give you any clues.

    Example: today difficult child 3 had a Speech Pathology session and the therapist was discussing with him, the problems he is having. He said to her that a lot of his speech problems are attention-related (his ADHD) and also his language delay issues due to his autism. She said to him, "Yes, they are factors. But don't forget - you are a teenager, and the teen brain is going through a great deal of devleopment. Teenagers can be very annoying, it's normal. You're blaming a lot of problems on your autism, when in fact it could simply be the teen stuff. Your brain is maturing, the same as any other teenager. Don't blame your autism for everything."

    He was surprised by this and I think relieved. He does realise his speech dysfluency is getting worse and I think was worrying that his autism was getting worse. Now he feels more encouraged and confident.

    medications can help but only to a point. Even if there is an acute physical illness, medications are only part of the story. Doctors also rely on a person's own body to pull its weight in the healing stakes. In the same way, we use medications as a tool but they aren't the only tools we have. we need to use everything we have, to help our children.

    I hope that can rule out BiPolar (BP) - frankly it's the last thing difficult child needs, to have a double whammy. He's at a difficult age anyway, the Pervasive Developmental Disorder (PDD) just adds to the problems.

    I suggest with your son, that you keep a diary. Note down all factors plus his activity level. Note down dates, any other events and over time see if you can see a pattern. There can be so many possible factors - a particular friend over to play may be a trigger for later manic behaviour. Or perhaps a visit to a friend's house may expose him to some types of snacks which could have food additives which could be setting him off. easy child used to get angry and aggressive with tartrazine, a yellow food colour. Both my boys would get manic and aggressive if they had a glass of cola, or a chocolate bat with guarana (caffeine in another form). difficult child 1 also rected the same way to oranges and orange juice.

    With both boys, if they got angry, really angry, then could then come down with a thump and be really depressed for some hours afterwards. I remember the same ting in my teens. My depression was a raction to me earlier anger and often what I had done while angry. Or perhaps why I had been enraged in the first place (a "best friend" betraying me, for example).

    Kids feel things intensely, especially Pervasive Developmental Disorder (PDD) kids. We often don't recognise how deeply they feel because they don't show it in any way we recognise.

    Kids generally are a complex package. Never underestimate the problems caused simply by trying to get along in the world.

  16. whatamess

    whatamess New Member

    Yesterday was the worst day at school-absolutely was excellent-difficult child was fully functional, participatory,well-behaved, empathetic, conversational. Not knowing what causes the difference is disturbing as we would try to replicate today any way we could think.
  17. Marguerite

    Marguerite Active Member

    There can be so many reasons for this. We still get this now, with difficult child 3 working at home. When he was at school he was out of my sight and so I was unable to make my own observations. It is very easy for the school to emphasise this and play down that; it is natural for people to have their own ideas and for those ideas to influence what they tell you.

    From my observations of difficult child 3 working at home, some days are a write-off and some days he's brilliant.

    Reasons for a day being a write-off (both when he was in mainstream and now at home) -

    1) A change in the environment, as in other people in the house (even if they're not doing anything or making any noise). Or someone who should be in the house but isn't.

    2) A break in routine, even if that disturbance in routine is over and normal routine appears to have been restored. Example - teacher arriving late, student arriving late, arrival of hall monitor, a change in teacher, a change in aide. Teacher decides to swap two subjects around, does something different such as ignoring the class weather calendar or similar.

    3) Bullying or teasing incidents would upset difficult child 3 for the entire day, but the teacher noticed he was always more disruptive and unsettled when coming in from a break (as in from lunch or recess). This eased when we had playground supervision. Teachers were often unaware of bullying incidents, or played them down as not being sufficiently significant to be a problem. One "darlnig" boy used to stick pins or anything else sharp into difficult child 3, maybe just a sahrpened pencil, maybe a set of compasses. He would do this in class with the teacher present. The teacher NEVER reported this to me, difficult child 3 reported feeling something sharp or "he's sticking pins in me" over several YEARS. Their Scripture teacher (a voluntary position for a once a week optional religious instruction and morals lesson in Australian government schools) was a friend of mine from our church who came to me and told me about this and said she was convinced the class teacher knew but was choosing to not do anything about it. From what I know of difficult child 3, a couple of incidents of this in the morning would blow out difficult child 3's entire school day and probably end with him being given detention for misbehaviour and attacking this other student.

    4) difficult child 3 feeling slightly unwell, even if he was only beginning to come down with something. We noticed that three days before symptoms showed up, he would be difficult, disruptive or at the very least, unproductive. The day he actually developed a fever or signs of a cold, was paradoxically often a day when he worked well. We thougt that perhaps as he was coming down with something, his body was making too many changes and constantly distracting him. But when actually unwell, despite being not well things at least seemed more stable for him.

    5) He's asked to do a subject that is disturbing him in some way. For example, difficult child 3 wouldgenerally work well in Maths or Science, but if te topic were a bit "waffly", he would take much longer to settle to work (task-changing problems) and by the time he began work the rest of the class would be finished and ready to moe on. difficult child 3 would then spend the entire day playing academic catch-up, and always be behind. After a while he would simply get obstinate and refuse to work.

    The kid who was sticking pins in him - that was a long-term problem and that kid was a known problem, known to other parents and kids. But because difficult child 3 was "the weird kid" he was generally scapegoated. When this other student, some years later, attacked difficult child 3 in the street (which was observed independently to be an unprovoked attack on difficult child 3) I went round to talk to this kid and his mother, who told me that the teachers had told her that difficult child 3 was always the aggressor and she should go to the police and have charges laid against difficult child 3. She said she had chosen not to do that. I pointed out that whatever was in the past was in the past (although I was shocked, it did not match with what I had been told nor with what I knew to be difficult child 3's nature) and that we would from here on have a clean slate between the boys. I told her son to not hit difficult child 3 if he attacked him but to come and tell me and let me deal with it. I said I would be tellnig difficult child 3 the same thing - to not retaliate physically (something I have always insisted on anyway).

    I was horrified to be told that his class teacher, who I would have thought would have seen the pins sticking incidents and who I know difficult child 3 had told about it, had instead chosen to advise another parent to lay charges on difficult child 3, when it was her son who was the constant aggressor.

    But after we had our talk, I made a point of praising that other kid when I saw him do something good. He was good at sports and there was an after-school ball game that most of the kids were involved in. At one point this boy's team was playing against difficult child 3's team and I felt some of the boys were being a bit rough, but I did my best to calm difficult child 3 down and say that sometimes in the heat of the game, kids get a bit enthusiastic. But I saw this boy make a really good play in the game and afterwards I went up to him and told him I thought he was a good payer and a generous player, for the way he had played the game. I think he thought I was going to say something mean, but I carefully didn't. Next time I saw him with his parents, I said the same sort of thing - "I saw your son play the other day, he's really good, his team must be so proud of him."

    It turned everything around. When difficult child 3 was getting attacked by a group of younger kids two years ago, it was this boy and another who had also been problems for difficult child 3 in the past, who broke up the fight and rescued difficult child 3. They've done this again since that time, when a fight was just beginning. difficult child 3 told me that it was those boys who rescued him and I made a point of thanking them.

    The thing is - a lot of stuff goes on at school and you won't be getting told about it. A lot of what can affect a Pervasive Developmental Disorder (PDD) child can be very subtle - difficult child 3 was very unsettled doing an important exam last week because of three things:

    1) the ceiling fan was making the papers move on his desk.

    2) way outside a dog was barking, then someone started up a leaf blower.

    3) he was a little bit hungry and had not been permitted to finish his lunch.

    That combination meant he was so off-task, he barely completed half the paper, in one of his best subjects.

    The next day, with an exam in an even more difficult subject for him, he was focussed and on-task. The ceiling fan was still on but not on such a high level. The outside noises were still happening. But he had now adapted a little more to the exam environment and coped better. The following day, his best subject, the environment changed again. But he was in the swing of exams ow and took it all in his stride. he believes he did very well and finished the entire paper with 20 minutes to spare. The exam supervisors said he was on task and working well the whole time.

    Human beings are complex creatures. Those with Pervasive Developmental Disorder (PDD) are much more unsettled very easily by things which the rest of us can tune out. They also get mood swings as part of their response to these problems. How would you feel if, in an exam, your papers were blowing around so much that you couldn't concentrate? Or the sounds outside drowned out all your thoughts? Or the sound of other pencils in the room were just too distracting? difficult child 3 handled it by picking at the skin on his arms for three hours. BUt how would you feel about how you had done in your exam, if this happened? And how would you feel about yourself? It would be very natural for a kid to feel depressed. But ten - a Pervasive Developmental Disorder (PDD) kid can be very immediate, too. He might walk outside and see the wonderful lime-green leaves of the poplar trees and the purple of the flowering jararandahs raining their mauve trumpet flowers onto the cobblestones, and feel happy. He could lose himself in that purple cascade and just stand there and turn around in it, hands outstretched and eyes to the flicker of sunlight through the leaves. There is a joy in autism too, that can be hard for us to recognise. The despair can be just as intense.

    But it's not necessarily BiPolar (BP).

    It is possible to have both, I'm not saying it isn't. But remember - the doctors doing the diagnosing are thinking with "normal" brains. It is important to think deeply about the Pervasive Developmental Disorder (PDD) component on its own and just how much it could be responsible for, before you begin to think - what else is there that even this part of the Pervasive Developmental Disorder (PDD) can't explain?

    With BiPolar (BP) and with any serious depressive illness, you can't really find a reason for the mood itself. It "feels" different, thna a mood for a reason. If your dog dies, you will be very sad. If your dog isn't dead after all but was a case of mistaken identity, you will be happy. But if you have those intense feelings and you can't find a reason, then you need to consider you may have a problem, especially if those feelings keep happening without an identifiable conneciton to an event.

    In Pervasive Developmental Disorder (PDD), those events are much more subtle and sometimes the reasons are hidden from us as parents. The child can't always explain because to them, they think it's all normal. They also often think that we can feel their thoughts too, that we are also inside their heads. This is why they get so frustrated with us - why can't we understand, surely we can see it too?

    Again, some more old-fashioned specialsits see this belief as unbalanced. For these kids, it is not. It is how they cope. Medication won't help. Constant explanations and discussion has a much beter chance of them eventually getting the message.

    Some specialsits, even the younger ones, have their own pre-conceived ideas and pet theories and spend their time making the world (and their patients) fit that model.
    Example: we spent a lot of time and energy trying to get answers about our kids. I had dragged form from doctor to doctor, I had rung around talking to doctors before we even went to see tem, often travellnig across the city and further afield oonly to discover the bloke who had promised so much understanding didn't really have a clue and when it came to it, couldn't help us. Finally we saw the doctor we stayed with - the very first appointment was a very long one but we had a lot of reports by this stage which helped him make his diagnosis - difficult child 1 had Asperger's, difficult child 3 had autism and easy child 2/difficult child 2 was on the edge of Asperger's.
    We were in shock as we leeft. But before we had even turned the corner of the street, my phone rang. It was one of my specialists, I was booked to go into hospital that day and needed to go straight there. I was to be there for several weeks. So at a time when as a family we were needing to get our heads around the shock of this diagnosis of our perfect children, husband & I were separated. I was separated from my kids and I was very upset. A psychiatrist who came to see me ran the tests (tick the box type of thing) the day after I was admitted. he then told me, "You have dysthymia. It means your mood is flattened, you are unable to really experience joy in the simple pleasures such as watching a beatufiul sunset, you probably would benefit from a course of antidepressants."
    I told him that he perhaps hadn't considered the timing of his testing, that I had some very real reasons to be feeling sad right then. But he wouldn't consider it; his piece of paper had given me a score and that was that. Idiot.

    I contemplated the man's idiocy while from my hospital room balcony I watched each sunset for three weeks, every single one beautiful. I loved those sunsets but was still sad about my kids being diagnosed as autistic. And despite his belief that I needed his help, that psychiatrist never came near me for the rest of the time I was there.

  18. whatamess

    whatamess New Member

    His teacher is wonderful, the first time for difficult child in 8 years! She is very intuitive with him and makes accomodations that I have never experienced before~and after I was called in yesterday I stayed the rest of the day to observe, so I know everything that was done to try to help difficult child cope...he was so severe there was nothing that could be done except to comfort him and keep him (and others) safe. He looked and acted very 'ill' yesterday. It reminds me of the movie Awakenings.