Mood Charts - Need help

[TiredSoul]

psychiatrist asked me to chart difficult child's moods. The form he gave me is called NIMH Child Life Chart Method. It feels too clinical to me. I can't seem to figure out how to chart his moods because they seem all over the place to me. I don't like charts like this because they are subjective. I am much better at just listing what I see as I see it.

For example how would I chart this??? (this is hypothetical)
difficult child woke up super hyper, then he calmed down and ate breakfast and watched cartoons, then he wanted to get on the computer and when told 'not yet' he got agitated for awhile, then he calmed down and watched tv some more, then later when his friend wanted to leave, he got agitated and started hitting him, then when friend left got explosive and had to be restrained for an hour - then started hitting himself and saying he was stupid and wants to die, then he was calm and started working on a project so much that he seemed obsessed with it and started demanding we buy him supplies and help him with it, then when we said no he blew up, then he gave up and started poking his brother and running around irritating everyone, etc, etc, etc.

I cannot possibly rate that with these categories:
ACTIVATED:
Severe
High Moderate
Low Moderate
Mild

NORMAL:

WITHDRAWN:
Mild
Low Moderate
High Moderate
Severe

Any suggestions?

 

[gcvmom]

Well, everything you've described sounds like he's "activated" and it's simply a matter of you deciding to what degree. Withdrawn would be more like a depressed state. He would be quiet, not wanting to interact with others, hanging out alone in his room doing something quiet or nothing at all, or curled up in bed crying or suicidal (that would be severe, I think). Sometimes if someone is having a full-blown bipolar episdoe they can be BOTH activated and withdrawn (think of someone who would be manic AND suicidal at the same time -- and likely bordering on psychotic).

I'd go ahead and take notes the way you are most comfortable, and then after you write it down, see if you can apply what you've written to the chart. The main thing is to get your observations down as clearly as possible.

 

[DammitJanet]

There are childhood mood charts online that break down the day into 4 or 5...maybe 6 segments. You can draw or buy stickers with several different faces on them I dont know...maybe use something like those. Breakdown the day by half hours before and after school during the school days and then weekends on Excel if you have it.

 

[remclick]

I often have the same problem. I do write down a lot of examples of how he responds to things and report that to the psychiatrist. Your hypothetical day sounds a whole lot like our days too. There is a lot of that alternating between - he's fine, he's mad, he's fine, he's really mad, he's demanding, he's agitating, he's fine, etc. It just goes on all day, everyday.

 

[TiredSoul]

Thank you all. I decided to print out a daily calendar with the hour blocks on it from Outlook. All heck started yesterday at 11 am. I practically filled the entire 8.5x11 page front and back. I then made a spreadsheet on excel that lists the dates across the top and the activated symptoms and withdrawn symptoms in order along the left side. What I am going to do is highlight the symptoms he displays during the day, then at the end of the day, I will assign a value ranging from 4 to -4 depending on severity. If I was really smart, I could figure out how to graph it. But at least for now, the psychiatrist will be able to see all of the symptoms he displays each day. Yesterday for example he displayed these:

ACTIVATED:
Irritability
Temper tantrums
Increased aggression
Disregard for authority (mine)

WITHDRAWN:
Sadness
Low self esteem
Cries more
Anxious/tense/worry
Change in appetite (hungry)
Physical complaints
Night terrors

gvcmom,
I was thinking the same thing that his behaviors are most all the activated type, but when I looked at this closer, he was crying a lot, seemed sad (after he was mad), says things like I hate myself, I want to die, I want a new family, you're being mean to me (when all I am doing is talking to him), etc. Sometimes I think he is delusional because he really believes I am being mean to him or trying to hurt him. Also, he had a bad dream that his dad was flying a plane and his little brother fell over a cliff. Would a bad dream be considered 'night terrors'? I know what night terrors really are because he had them from age 1 -3. But should I list the bad dreams in that category? Also, the screaming I want to die - would you indicate that under suicidal thinking, or is it really an activated behavior because he is yelling it - maybe to get a reaction from me, but maybe not?

Is it Wed. yet?

 

[smallworld]

Jules, I don't like when doctors ask us to categorize the behaviors because that's like asking us as parents to diagnose and I think the doctors should do the diagnosing. I was much better at describing the behaviors in non-judgmental words and letting the doctors decide what the diagnosis was.

Just my humble opinion.

 

[TiredSoul]

Jules, I don't like when doctors ask us to categorize the behaviors because that's like asking us as parents to diagnose and I think the doctors should do the diagnosing. I was much better at describing the behaviors in non-judgmental words and letting the doctors decide what the diagnosis was.

Just my humble opinion.

I agree with you there - like I said the format he wants me to use seems too clinical. My revised spreadsheet has the exact same wording as the form he gave me to fill out - but I just want to note what I see and sometimes that is hard because for example, I don't know if he is feeling a lack or remorse or excessive guilt. I am not in his head, Know what I mean?? I don't know if he really has poor self esteem or if he just wants my reaction. It is hard to chart all of this. It might be much easier if I were charting my own behaviors/thoughts, but to do so for my difficult child - it's hard. I'm sure he wants a quick and easy way to look at the data to make his determinations, but none of this is quick and easy. It is complex and if I fill out his chart, it really will not be accurate.

 

[Josie]

I keep a log of my daughter's physical symptoms. I find it works better to write a description of her day rather than try to rate the severity of her symptoms.

For me, it is too hard to assign a number. We get used to a certain symptom and that becomes the new norm. It's hard to say what number to give it, because we might change our mind if it gets better or worse. If we think it is a 4 on a scale of 1 - 5, then it gets worse, then even worse, where does that leave us?

I just write "seems worse" or "seems better" along with the reasons why I think that and a simple description of her day.

I think getting started a more detailed description is better.

 

[smallworld]

The kinds of things I noted for our psychiatrists were descriptions of meltdowns, apparent triggers and time of day. I also noted time of sleep, time of waking, any middle of the night wakings, any physical complaints and any unusual eating patterns. This type of charting was in the end helpful for the diagnostic process.

 

[TiredSoul]

Hope, I know what you mean about assigning a number. I am a pretty black and white person and it is always hard for me to assign #'s to things. It either is or isn't - or it's better or worse than usual.

SW, I gave the psychiatrist a list of his triggers. Those triggers will almost always result in either defiance and/or verbal/physical aggression. If we avoid those triggers and any disappointment or boredom in his day - most likely his day will be fine. I can note the # hours of sleep, night wakings, if his appetite changed, and physical symptoms (stomach ache, headache, etc.) - but the "mood" part of mood charting is hard for me. For one, because I am not in his head and don't know what he is feeling and two, because my perceptions may not be the case. If he is fighting or stealing, I can check that. If he has racing thoughts, how do I know?

 

[gcvmom]

Would a bad dream be considered 'night terrors'? I know what night terrors really are because he had them from age 1 -3. But should I list the bad dreams in that category? Also, the screaming I want to die - would you indicate that under suicidal thinking, or is it really an activated behavior because he is yelling it - maybe to get a reaction from me, but maybe not?

I wouldn't class the bad dream the same as a night terror, but I would still document it, especially if he is sharing any details. A lot of bipolar kids will have very graphic nightmares. I wouldn't try to analyze it, just note it for the psychiatrist to assess.

The "I want to die" screaming could just be his way of expressing his distress with everything he's feeling. Again, I'd just note it for the psychiatrist so it can be evaluated with the rest of the big picture.

 

[Jena]

hi

i;m playing catch up was so self evolved for days. sorry i'm late. yet everyone gave great insight. me, what i did for years was broke it up a.m. lunch afternoon p.m. i would state calm in a.m. focused for the t.v. watching, irritable yet easily redirected the first time, than when he had to be restrained i'd write just that.

it's all what you see. and i'd take that to the doctor with the chart that you have and say ok tell me what goes where? their perception of those behaviors can be different than us as mom's because as i can see from the chart their soo clinical. we're smart but hey we're mom's.

it's kinda like id' write on certain days. difficult child ****** me off - threw temper tantrum; wouldnt' self sooth or de escalate with-o prompting or assitance. that sort of stuff.

ahhh the joys of motherhood youll get the hang of it. wish i had more help to offer.