Panic/anxiety in BiPolar (BP) child

[teacherma]

First, I have to say that I have found so much information and support in the last month, just from reading the forum. I am thankful to have one more resource in helping my child.

Long story short, my son is 8 and was diagnosed early-onset bipolar disorder at age 5. He fit every symptom (except hypersexuality and psychosis--thank goodness), and school has always been a huge anxiety inducer for him. Separation anxiety has been a problem since he was a baby, and leaving him in the mornings can sometimes require restraint on the part of school personnel.

This year we have had 4 days where, when I left, he had a panic attack/rage/meltdown and had to be restrained by the asst. principal and counselor--neither of whom seem to have a clue how to deal with a panicked child. They don't quite get the whole 'fight-or-flight response', and I believe that their reaction to the situation is causing it to be worse. We have a 504 meeting scheduled for this week, and I've requested IEP testing. Ironically, other than the panic attacks, he is a model student--straight As, never a behavior problem, listens, follows rules, etc. I try and remind myself how lucky we are in that respect, but it pains me that we can't seem to figure out how to get through this school refusal. On the medication front, he's on Trileptal, Atarax, Melatonin, and we added Buspar at the beginning of the year, which helped the anxiety tremendously.

Has anyone had experience in this and can give some advice as to what might work? The school has been trying to treat it as a behavior issue--threatening consequences, even calling me at one point to pick him up. I've told the asst. principal that The Boy has no trust in them and is scared of them because all he knows is that when he's trying to get to his mom, they are holding him down. I don't know how to make them see this for the anxiety issue that it is.

I appreciate any advice or input you all could give

 

[TeDo]

Welcome to our "family". This board had been a godsend for me, too. I can't really offer any suggestions since my 13 year old is going through the same thing and our school(s) handle it the same way. I was even told last week at an IEP meeting that they "don't have time in the school year to get him to trust them" which is very disheartening to hear educators say. I am assuming your son sees a child psychiatrist. Is there any chance the psychiatrist would write something up describing your sons panic attacks and what HE/SHE suggests your son needs to overcome this barrier. All I CAN offer you is many gentle, supportive {{{{(((HUGS)))}}}}.

 

[teacherma]

Thank you for your response.

The principal now was the asst. principal for the last 3 years, and he trusts her implicitly. She was able to get him calm enough the first 2 days of school so that he could go on to class around 9am. The meltdown still took about an hour, but he was able to get over it. Since she has other duties (which, as a teacher myself, I totally understand), his care has fallen to a new asst. principal who was overheard on the 2nd day of school stating that my son was just being defiant, and the counselor--neither of whom does The Boy trust at this point. It has been in their 'care' that the meltdowns have lasted for 4 hours, and he never did make it to class those 2 days. The fix may be as simple as having other people work with him, but so far they have been unwilling to really give that a lot of thought. And, since this has happened only 1 more time since the beginning of school in August (along with the first 4 days), I was passive enough to let it go.

On top of all that, I really want to get down to why the meltdowns are occurring with more frequency and intensity and fix the problem from that end, so I'm hoping the psychiatrist has suggestions when we see her next week. We are on a modified year-round schedule, so after this coming week, we're off a week, and we're hoping to do a medication add-on then.

 

[Liahona]

My difficult child 1 can have anxiety over school. He ran out of the building a few times last year trying to go home. The way his schools have handled it has been to have one person (you need a new person) that he trusts to gently hold him back. They didn't even use any holds, just an arm around his shoulders. Sometimes all it takes is them getting between him and the door so they don't have to hold him at all. They also schedule something fun (computer time) right after school starts. Plus, he has a safe spot he can go to with his person. So, instead of running to home he can go to a safe spot. I've also made a card that he can carry in his pocket that has all the steps he is going to do right after he gets to school. We can repeat those steps over and over as we go to school. The aide also knows all the steps and has a copy of the card so she takes over reminding him of the steps as soon as we get there. It also helps to have someone besides me bring him to school.

Good luck and welcome!

 

[HaoZi]

What medications is he currently on? Topamax was added in to Kiddo's mix for anxiety issues, I'm hoping it holds her just as well when state testing time comes, that's one of her major panic triggers.

ETA: Someone here recommended 1/2 of a chlor-tab (an OTC allergy medication) as a PRN for anxiety attacks, we've found it works well for us and doesn't clash with our medications, but you'd have to check it against what he's on if you're wanting to try it.

 

[Wiped Out]

I'm glad you are requesting and IEP. This should not be treated strictly as a behavior issue with consequences. I've had students in the past in my room that have had similar issues. Usually the spec. ed aide or teacher would meet with the child and get him/her engaged with an activity outside of the room. Then they would work on transitioning into the classroom and usually with-in the hour the student is completely engaged in the classroom. Hugs to you and your son.

 

[teacherma]

My difficult child 1 can have anxiety over school. He ran out of the building a few times last year trying to go home. The way his schools have handled it has been to have one person (you need a new person) that he trusts to gently hold him back. They didn't even use any holds, just an arm around his shoulders. Sometimes all it takes is them getting between him and the door so they don't have to hold him at all. They also schedule something fun (computer time) right after school starts. Plus, he has a safe spot he can go to with his person. So, instead of running to home he can go to a safe spot. I've also made a card that he can carry in his pocket that has all the steps he is going to do right after he gets to school. We can repeat those steps over and over as we go to school. The aide also knows all the steps and has a copy of the card so she takes over reminding him of the steps as soon as we get there. It also helps to have someone besides me bring him to school.

Good luck and welcome!

I think the problem is that they aren't thinking past the initial restraint needed so that I can get out the door. Since this doesn't happen everyday, and we don't know it's going to happen until it's on us, they don't really have a go-to person other than the two that he doesn't trust. If I can get them to see that, and to assign the task of restraint to someone other than them, I think that could make the difference in how long it takes him to calm down. What they don't seem to understand is that he WANTS to be at school. He loves his class, has lots of friends and positive social interactions, and his teacher is awesome. It's just the dropping off and getting in the door that becomes the problem when he has these panic attacks.

Maybe that is why they are wanting to treat it as a behavior issue, since it only happens in that one setting/situation.

 

[teacherma]

He's currently on Trileptal (1050mg), Atarax (which is basically souped-up Benadryl) PRN 10mg in morning, 25 mg at night, Buspar 10 mg, and Melatonin 1.5 mg.

We are looking at the possibility that the Atarax at night is causing him to have trouble getting up and going in the mornings, thus causing the meltdowns. I've scaled that dose back to 12.5 mg, so I'm hoping that helps.

 

[teacherma]

Thanks Sharon

My hope is that we can create an IEP that creates a plan of action involving teachers and ESEP aides, as opposed to administrators. For a kid that has never been in trouble at school, the intimidation of having the asst. principal tell you that you're going to ISS if you can't calm down---well, that created mountains of anxiety on top of what we were already experiencing.

 

[keista]

Hi and Welcome to the board.

I don't have direct experience with this, but if you can get a "go to" person like Liahona suggested (most sped kids have this in one way shape or form) you can maybe create a transition routine where you and your son meet this third person, spend about 5 minutes of goodbyes, and then he's alone with the "go to" and then the "go to" transitions him to the class. That way if there is a meltdown, he's alone with "go to", and he can calm down there.

How to convince administration that this is NOT a behavior issue? I promise if I ever figure it out, I'll let you know. Letters from psychiatrist might help. I hope they do. I just don't understand how ppl can think that behavior that is so over the top is "just" a behavior issue.

 

[teacherma]

Exactly! Why can't they wrap their heads around the fact that a child who loves school doesn't just suddenly decide to have a 4 hour panic attack simply to be defiant and inconvenience them.

 

[TeDo]

I am beginning to think that school personnel feel anxiety/panic aren't real and are really only behaviors kids use to avoid something they don't WANT to do. That is what the 2 schools I've been dealing with seem to think. Punishing (restraining) for anxiety is supposed to stop the anxiety? On what planet???

 

[InsaneCdn]

I think there are two separate issues here, and we should be brainstorming on both of them.

1) What to do when the anxiety attack hits - this one is being discussed...

2) How to avoid getting there in the first place. Now, I'm not saying this is an easy question to answer, but... if you can find an answer, then the other problem "goes away" - or at least, for the most part. I'm seeing this as a "transitioning" problem - the whole "shift" skill from the executive functions. Kids with other dxes - like Autism Spectrum Disorders (ASD) - also have major transitioning problems. How can the start of his day be set up so that he is comfortable with the transition?

 

[HaoZi]

Was there anything specific happening on those four days that he was anxious about? Is he being bullied in any way by other kids?

 

[teacherma]

I think there are two separate issues here, and we should be brainstorming on both of them.1) What to do when the anxiety attack hits - this one is being discussed...2) How to avoid getting there in the first place. Now, I'm not saying this is an easy question to answer, but... if you can find an answer, then the other problem "goes away" - or at least, for the most part. I'm seeing this as a "transitioning" problem - the whole "shift" skill from the executive functions. Kids with other dxes - like Autism Spectrum Disorders (ASD) -also have major transitioning problems. How can the start of his day be set up so that he is comfortable with the transition?

#2 is the million dollar question. The only link we see in the panic attacks is that each morning he's had them, he has trouble waking up and getting out the door. From all accounts, there is nothing at school he's scared/worried about. Rather, it's the separation between us and leaving home that seems to be the biggest issue.