Something's missing - mood/cognitive issues

Discussion in 'General Parenting' started by fishingdad, May 19, 2007.

  1. fishingdad

    fishingdad New Member

    Well, we're stumped. Our difficult child, who has morphed from an ADHD diagnosis to a "mood disorder" diagnosis (doctor still won't call it bipolar), still has a <u>missing link</u>that we can't figure out.
    Despite being a bright younger child, her cognitive function continues to wane. Each year, she seems to fall further behind her peers. In recent years, the "fog" she's been in academically was attributed to ADHD or lack of focus. Now, we and the teachers agree that it's a processing problem - her short term memory seems to get worse every year.
    Further, her mood hasn't stabilized much while on the Abilify. It's still very unstable. I've heard that Lamictal is often used with Abilify as a stabilizer - anyone had success with these two?
    Back on the cognitive issues. We've done one EEG and it was normal. We have another 24 hour EEG scheduled, and hope to find something - anything.
    I'm hoping that someone out there has had experience with cognitive challenges and will help channel us in the right direction. We feel that this is our "missing link" and if we can figure this out, we'll have a real breakthrough, as difficult child is frustrated and tired of not being able to perform academically. Thanks in advance!
  2. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    This happened to my son. He was actually misdiagnosed twice--once with ADHD/ODD and once with bipolar. He has Pervasive Developmental Disorder (PDD)-not otherwise specified or high functioning autism. The more independent the kids had to be in school along with the harder work load and organization, the further behind he fell. He is doing really well now, and has had lots of supports. I'd take her to a neuropsychologist for an evaluation. They do a great job of nailing down the problem areas and why they are problem areas. It's not, in our case, that cognitive abilities went down. It's that independent work and multi-tasking went up. My son needed help with that and had an aide for several years. He rarely uses her anymore, but still goes to Special Education one period every day. He is now in seventh grade and always makes the honor roll. He still has some life skill/social skill deficits that I expect will continue, but he's also much better with those too than he used to be.
  3. SRL

    SRL Active Member

    Hi fishingdad and welcome aboard. Has a complete workup by a pediatric neurologist been done, an including MRI? If you're seeing increased mood issues in conjunction with decreased cognitive function that should be a must.

    What types of doctors has she seen?
  4. flutterbee

    flutterbee Guest

    Often times NonVerbal Learning Disorder (NVLD) or Pervasive Developmental Disorder (PDD) and Aspergers don't stand out with kids until around this age. More is expected, especially in school, at this age and while they could maintain before, it becomes harder to do so with the increased expectations.

    Just a thought. I would certainly cover all bases with the doctors.
  5. fishingdad

    fishingdad New Member

    She's seen all the docs. We had a very poor neurologist, who early on labeled her as a "textbook ADHD" case. When things started to change, she didn't. We've had two psychologists, and have a very strong psychiatrist today. We haven't been to a neurologist in a while - maybe it's time to find a new one? Are we missing any docs?
  6. SRL

    SRL Active Member

    A good neurologist along with seeing a pediatric neuropsychologist would cover a lot of ground diagnostically. Make sure that it's a neuropsychologist and not a regular psychologist.
  7. Wiped Out

    Wiped Out Well-Known Member Staff Member

    My difficult child has struggled academically although when youger seemed very bright-even scored superior in some areas in 1st grade. He is still reading at a kindergarten level in 4th grade. We had a very good child neurophychologist who diagnosis him with severe dyslexia and cognitive disorder not otherwise specified. A lot of this is due to executive function problems as long as memory issues. I would look for a good nueropsychologist to see what he finds.
  8. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    For this type of testing, you can see a neurologist first, but I'd see a neuropsychologist rather than just a Neurologist or just a regular Psychologist. And if he is starting to slide in school, it is likely a learning disability issue, which is a neuropsychologist issue, not a Psychiatric one. Neurologists are way different in how they test kids than NeuroPsychs. Neurologists look for concrete stuff, like epilepsy that shows up. NeuroPsychs do intensive evaluation tests that can take up to twelve hours, and tend to find the problem areas and are pretty good at nailing the causes.Agree that NonVerbal Learning Disorder (NVLD), Aspergers, and other high forms of Autistic Spectrum don't often show up until the kids are older. They look like other things when the kids are younger, and many professionals don't know how to spot it or assume it's a psychiatric problem or just plain ADHD. These kids have average to superior IQ's, but don't seem to "get it" and have clueless social skills. They may be friendly, but they don't "get" social cues and often really annoy their peers and have no friends. Another clues is obsessing, especially over computer and videogames, not the normal kid way, but to the exclusion of wanting to do much else. My son thinks about videogames even when he's playing And he'd rather not play it, but he's good at it and we need to force him out of the house :smile: Good luck.
  9. smallworld

    smallworld Moderator

    I agree with the need for neuropsychological testing. It will help you figure out what's going on.

    You may actually not be missing any links at all. Working memory deficits can strongly correlate with mood issues -- anxiety and depression -- as well as ADHD (according to both my difficult children's neuropsychologists). If your difficult child's moods are not stable, that could account for the "fog." My difficult child 1, who also is very bright but is currently close to failing school, first received an ADHD diagnosis at age 9. Like your difficult child, his diagnosis morphed into a mood disorder that we are now treating as if he has bipolar disorder. He has done well on Lamictal, but the "fog" is still there, largely from depression. We have added a low dose of an AD (Lexapro) and plan to increase it once school lets out in the event it sends him into mania (he has a bad track record with ADs). We strongly believe his working memory deficits will improve once his mood is stabilized.

    In your difficult child's case, Abilify is unlikely to do much on its own. Once you get the testing done and know what is what, it may be time to consider a true mood stabilizer (Lamictal, Lithium, Depakote, Tegretol and Trileptal). That may help more than any ADHD medication out there.
  10. SRL

    SRL Active Member

    The neurologist should also order a complete blood workup. Some diseases such as Lyme Disease have possible symptoms that include loss of cognitive function, memory loss, and brain fog. I wouldn't for a moment suggest that particular disease in your daughter's case but use it as an example that you may need to sweep wider to get to the bottom of this.
  11. flutterbee

    flutterbee Guest

    With my daughter, I often wonder which came first: the anxiety from the cognitive issues or the cognitive issues from the anxiety (her anxiety is severe). Or a bit of both. There are so many variables with our kids, it's hard to tell.

    by the way, fishingdad - there are threads in the archive re: ADHD and executive function that you might find insightful. I'm not implying this is the case with your child, but it can't hurt to to take a read.