We met with the social worker at the psychiatric hospital

Discussion in 'General Parenting' started by TerryJ2, Aug 31, 2008.

  1. TerryJ2

    TerryJ2 Well-Known Member

    We met with-the social wkr today. They don't have all the tests back, but, no surprise, difficult child has a "little bit of this and a little bit of that." incl. possible bipolar.

    Sh*t. I had no idea that Asperger's and bipolar had so much in common. I mean I knew it, but I didn't realize HOW nearly IDENTICAL they could be until today.
    It's nearly impossible to tell the diff at this point. There is an aspect of bipolar in kids where they don't learn from consequences and think the rules don't apply to them. Just like some Aspies.
    Aaarrgh. :sad-very:

    After the mtng, husband and I went to B&N to kill time, because our visit with-difficult child was 1-1/2 hrs later and there wasn't enough time to go home. I found a book on bipolar in kids. One paragraph in it described a know-it-all, argumentative personality that was difficult child's bio grandmother to a T. :anxious:

    The soc wkr said we were in it for the long haul, no matter what the diagnosis is, but of course, difficult child is too young and we just have to wait and see. He said to expect to see more of the acting out and anger issues and to be strong and consistent. :faint:

    We have to make sure difficult child gets a lot of sleep, because lack of sleep sets him off. No easy feat when he gets up in the middle of the night to play on the computer or watch TV or read. husband has been setting his watch for 20-min increments and doing bed-checks to make sure difficult child stays in bed. And this was before the problems that escalated into his going to the psychiatric hospital.
    And we have to get him to practice coping skills and anger mgmt. No-brainer there. :D
    We'll know more on Thurs, which is his expected release date.
    The good news is that the soc wkr said he was much better than most of the pts they get in there (like that's supposed to make us feel better?) and that they were not concerned about any sexual identity issues, just impulse control. :angel3:

    Crystal ball ... I foresee a future with-a defiant teen who gets his 17-yr-old girlfriend pregnant, history repeating himself just like his bmom ...

    difficult child was happy to see us at the regular visit between 6-7. We played Clue and chatted a bit. We'll visit at lunchtime Mon.
  2. Andy

    Andy Active Member

    I had that same crystal ball last Winter/Spring! Caused me lots of tears. Haven't seen it lately - it must have rolled your way.

    Remember crystal balls are not real - no one can tell the future. If we dwell on the negative, it is more likely to happen because we are looking for it. We usually can find what we are looking for so start looking for your difficult child's determination to work through this.

    Shatter the crystal ball, have strong deep conversations with difficult child, and follow your heart. No matter what the signs are saying, your heart will be the one to steer you in the right direction. If your heart feels the good in difficult child, it is then still there and can grow.

    I think with my difficult child that this was a good age for something to pop up. He was also scared about what was going on and that fear made him determined to follow the directions of his doctors. I talked to him about the kind of person he wants to be and if he kept making the choices he was making, he would not become that person. Younger kids have a harder time understanding and older kids get even more stubborn and non-cooperative with medications and treatment plans.

    Have you discussed with psychiatric hospital about him getting up in the middle of the night? Has he done so there also? That is definately an issue to address - lack of sleep sure does escalate symptoms.

    The neighbor boy complained to difficult child that his 7:00 school night and 8:00 non-school night friends-go-home rule is stupid. difficult child replied, "I want to get my 11 hours of sleep in." So, we are not reaching the goal but difficult child is sure trying. (goal of being asleep by 8:00 school nights and 9:00 non school nights)

    I do have a good feeling that with you as his parent, your difficult child has a great chance of controlling this. If he doesn't, it will not be for lack of tools.
  3. TerryJ2

    TerryJ2 Well-Known Member

    Thank you, Andy.
    I do NOT want that crystal ball rolling my way! (But I'm not mean enough to send it anywhere else ... what do I do with-it?)

    I agree, we have to work on the good in difficult child and have him work on it, too. Today he did start the manipulation a bit while we were visiting ... asking for something from Toys-R-Us, like a coming home gift, etc. I will see him alone on Tue. and make sure he understands that's not going to happen.

    Speaking of sleep, I really need to get some ...
  4. amazeofgrace

    amazeofgrace New Member

    Crystal ball ... I foresee a future with-a defiant teen who gets his 17-yr-old girlfriend pregnant, history repeating himself just like his bmom ...

    I had to smash my crystal ball, or I would cry every time I looked into it
  5. gcvmom

    gcvmom Here we go again!

    I disagree with your crystal ball -- because he has YOU for parents, which is one thing his biomom did not have. That alone gives him higher odds for a better outcome, in my humble opinion.

    You are doing a great job and it sounds like this stay was a very good move for him.

    I've seen the whole "rules-don't-apply-to-me" business with my difficult child 2 when he is unstable. When medications are working, he has a very strong sense of justice/fairness, whatever you want to call it and works very well within normal frameworks. I don't know if it were an Aspie diagnosis that medications would help that or not. Maybe others here can comment on that aspect.
  6. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Bipolar and Aspergers are often mistaken for one another, but they are NOT virtually identical. THere are huge differences. It's just that psychiatrists often don't know this (Aspergers was not really "discovered" until ten years ago, so many psychs are just not "up" on it). Here are some of the differences.

    1/Aspies often don't have moodswings or major moodswings. They shouldn't have serious sleep issues or get manic. Some tend to get a little depressed. Rage triggers, IF there are rages with Aspies, are normally due to serious anxiety over changes in routine or even room changes and high frustration with not "getting" people or life in general. Sensory issues can start rages in younger Aspies--having to wear socks that "feel funny" or eat textures of foods they can't tolerate (they may even vomit). Noises that don't seem loud to us may drive Aspies nuts; they may think they are too loud and claim headaches and start crying. Mine did that. They also have serious social issues. Bipolar kids are often very friendly and outgoing, although they antagonize other kids if they are manic or depressed. They are far moodier and their rages are often unpredictable (I have bipolar and had it as a kid). They say "no" just to be contrary, but the real reason behind that is that they are so unhappy and confused that the thrill of a confrontation with Mom can actually let off a lot of steam. But most hate themselves after a rage and feel crazy and remorseful. Aspies do not rage for the same reasons--they don't enjoy the "High" of high stimuli. In fact it is very uncomfortable for him.

    2/Bipolar kids repeat mistakes because of their out-of-control moodswings and impulse control issues, especially when manic. Their minds race 100 miles a minute. Aspies often need to be taught rules in different ways and it HAS to make sense to the Aspie for the Aspie to decide it's worth following the rule. "Because I said so" is useless to an Aspie. "If you steal, you will go to jail" and showing them jail would probably work well with an Aspie. They are NOT driven by their moodswings, but by their "different" thinking. in my opinion they are far easier than mood disordered kids (as one who was a mood-disordered kid).

    3/Aspies who get good interventions don't always need medications. 50% don't take any. My son doesn't. If an Aspie needs serious medications it often means there is a co-diagnosis. Or else the Aspie isn't getting interventions that help him understand people and life, and those are major stressors for an Aspie. Or the parent doesn't "get" HIM and tries convetional discipline. Won't work for an Aspie because they think differently. Won't work for a bipolar kid either if he is not stable on medications because he or she can not control her moods and will easily lose control. Different reasons here.

    I lost count so I'm not putting a number down...lol.
    Aspies have a really good prognosis of improvement IF they get a lot of interventions and the earlier the better.
    Bipolar is tougher. IT tends to get worse, especially with the wrong medication and increased cycling. I noticed an increase at around 13 and it was NOT fun for me (or my parents who had to deal with my acting out). Bipolar kids do not improve just with interventions. They need medication. As soon as I got on the right medications, I didn't even seem to need much therapy...but without the right medications even knowing the triggers or understanding myself a lot didn't help...my moods controlled me.
    It is important to know if you have Aspergers or bipolar. They are two completely different diagnosis. that often get mistaken for one another. And what works for an Aspie doesn't work for a bipolar (or a mood-disordered child) and vice versa.

    What they have in common: Anxiety (with bipolar kids it is often phobias however--with Aspies it is CHANGE a lot); they can both seem moody. With Aspies it makes more sense when they are moody. With bipolar "Moody" just happens. Bipolar kids can be suicidal. Aspie kids can too, but their suicide rate is a lot lower and they don't get into illegal drugs as much as bipolars (80% folks--I didn't though!). Aspies are often dogmatic rule followers and non-rebellious. I don't have to tell anyone with bipolar or who has a bipolar kid then, um, they tend to rebel.
    I hope this blathering made a LITTLE sense...lol. Nothing is set in stone, but these are two very different conditions. Ten yeras ago, when my son was five, nobody knew about Aspergers. That's why I believe he was so grossly diagnosed. It's still new.
    Do a lot of reading yourself so you have an idea what seems to "click." I believe in "Mom Gut" :) Take care.
    Last edited: Aug 31, 2008
  7. susiestar

    susiestar Roll With It


    I strongly recommend you read The Bipolar Child by Dmitri Papalous and his wife. It is an excellent book. I don't know if Dr. Pavuluri has a book out - Totoro is using her methods (I think the Dr. is a her), so she might know. Anyway, the Bipolar Child book is an excellent resource.

    I disagree with MWM on some things. Aspies DO have mood swings. My Aspie is NOT bipolar - and every doctor he has seen has said this. It was tossed around by a few but always ruled out.

    Aspies also have sleep issues. I have been to many aspie support groups and that is a problem many of the parents mentioned. It seems the aspie has too much to ponder or play with (even if there is nothing to play with in the room). Aspies also often become fixated or obsessed with something (first it was dinosaurs, then pokemon, now Magic the Gathering and Dungeons and Dragons) and wake up thinking about it in the middle of the night. Wiz takes a tricyclic antidepressant to help with this. Melatonin just didn't help much.

    Aspies also have mood swings. They are NOT the same as bipolar kids go through but they do happen. Aspies are also VERY hard on themselves.

    No matter what the docs/hospital/sw say - I strongly strongly do NOT recommend using a chip or point system that ties chores or behaviors to a reward. There have been several cases where an aspie will then want a reward for EVERYTHING. We went through it with Wiz and I also read a book about Aspies that an Aspie child in Ireland wrote. I am pretty sure it was Ireland - might have been England, it has been a number of years. Anyway, this child at age 16 refused to do anything with-o a reward. And the reward had to be BIG. He wouldn't even get out of bed with-o a reward. He was touted as a genius who would give the rest of the world instructions on dealing with aspies when he wrote the book (at a very early age). Several years later he was impossible to motivate - largely because he had learned that people would reward him if he finally gave in. and if he refused long enough he would get a bigger reward. Ia m not talking about candy bars as a reward, or even a book. He was insisting on a new video game to get out of bed one day - his mom said this on an interview.

    While many aspies don't use medications, jsut being aspie is nto a reason to stop medications that are helping. Wiz does very will on strattera, he also did well on concerta. And he really NEEDS something to help with the ADHD aspect of Aspbergers.

    If they think maybe bipolar, do they want to start medications? If they do - and bipolar is in question - then it is very wise to start with a mood stabilizer. Many other medications would keep mood stabilizers from working properly. The recommendation from the academy of psychiatrists is to first stabilize moods with one or two first line mood stabilizers. AFTER stabilization then other things can be addressed if needed. Often other problems disappear if the child is stable. Antipsychotics are usually next to handle rages and violence. Then medications forADHD and other things are added. I reallly DO wish we had known about this when we started Wiz on medications. But he was suicidal, so we needed the antidepressants on board bigtime. While he is not BiPolar (BP), it was in question for quite a while. With the mood stabilizers first we would have ruled out BiPolar (BP) much faster.

    Anyway, I am glad you have had this break and that difficult child is getting some more help and testing. I am glad you are having good visits with him, and that husband is more on board than he used to be.

    Sending hugs,
  8. Wiped Out

    Wiped Out Well-Known Member Staff Member

    It is interesting that they are so similar. My difficult child is definitely a Bipolar kiddo and not an Aspie but there are many similarities. I'm glad you had a nice visit-and get rid of that crystal ball!
  9. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I actually mostly agree with you, Susie, except for the wild, crazy moodswings. I know many Aspies that are pretty even keel and we're in a group just for high functioning autism of 150 kids. Aside from that, I agree with you. THey are VERY hard on themselves and hate to make mistakes and overreact to that and the other stuff you said. But it is not bipolar. I have bipolar. My problems are different than my son's and my moodswings are far more debilitating and last a lot longer and defintely respond only to medication. Of course, all Aspies are different...just as everyone with bipolar...and everyone with NOTHING is different :) But I think you brought up some excellent points. However, only 50% of those on the autism spectrum need medication. The most common medications, when they are used, are stimulants and Risperdal.
  10. klmno

    klmno Active Member

    Hi, Terry! You've gotten some good pointers and info here so I just wanted to send HUGS! I read your post on the other thread, too. I know what you mean about feeling like you just woke up from a nightmare, then having the devastating feeling when you realize all over again that it wasn't a nightmare. I have felt that several times over the past 2 years.

    My difficult child has a mood disorder- probably BiPolar (BP). He has Obsessive Compulsive Disorder (OCD) tendencies, can't quit talking sometimes, and craves certain foods at times. I find myself wondering why he seems so defiant periodically after being so well-behaved and seemingly responsible and sweet for long periods. He goes thru clear "phases" of being interested in porn (which I have to stay one step ahead of to prevent/stop), stealing/sneaking, lieing, inability to sleep, acting impulsively, having compulsions- in contrast to periods of helping me out on his own initiative, being completely typical, a reprimand deterring him pushing boundaries, agreeable, level-headed, ambitious, etc.

    I am not sure if Aspies have those compulsive periods or periods where they look ADHD. I'm not sure if Aspies have that same type of cycling either. (I don't know anything about Aspie to tell you the truth.) It wasn't clear at first that this is what was going on with my son-it became clearer after I saw that several of the manic/hypomanic signs happened concurrently when the "stable" behavior went away, and conversely, when the hypomanic/manic behavior stops, he's suddenly a good kid again. It's kind of like flipping a switch between having a great kid with no issues outside of typical teen issues (he'll never be perfect LOL!), and having a kid who has ADHD/ODD. Of course, true ADHD/ODD doesn't come and go (start and stop) like that. Teachers and administrators at school told me he got punished the way he did in 6th grade because he was acting like a kid who had ADHD but since they knew he didn't have it because he had gone months without acting that way, then it must be defiant behavior so he was getting punished to the max.

    I'm curious- is it safer to start a difficult child out on mood stabilizers as a trial if he possibly is Aspie or is it safer to start out trying treatment for Aspie if he's possibly BiPolar (BP)/mood disorder? I hope they are either giving difficult child a break from all medications at the psychiatric hospital so they can see what specifically he is exhibiting without any medications; or checking out how he is without the stims he's been on and maybe trying a mood stabilizer. My difficult child came off his first medication (prozac) for about 6-8 weeks last summer so psychiatrist could see difficult child's "baseline". This is when things started coming out in an obvious way, but I would have much preferred that it had happened while in a psychiatric hospital, for several reasons.
    Last edited: Sep 1, 2008
  11. klmno

    klmno Active Member

    MWM- what differences might there be on neuropsychologist testing results between a kid with BiPolar (BP)/mood disorder and one who's Aspie?
  12. susiestar

    susiestar Roll With It


    klmno had a good question about the medications. I really wish we had started with a mood stabilizer and then gone with the stims and antipsychotics. Wiz is SO suicidal when off medications that it just isn't something we could/can do.

    There is a protocol for kids who are suspected of having mood disorders. I think it is from the bipolar Child book, but I have also seen it for psychiatrists from the academy or board that certifies them. It says to start with a first-line mood stabil. then to add a 2nd if needed. Once youa re at the therapeautic level it takes 6-8 weeks to see if it is working. If it is, you problem have bipolar or other mood problem.

    After that 6-8 weeks, you address any other problems. You try to deal with ADHD, or rage/violence/anger, etc... You ahve to be careful - stims can send people with BiPolar (BP) cycling. SSRIs and other ADs can also cause cycling. There is actually a form of BiPolar (BP) that is CAUSED by SSRI/SNRI medications. Effects from the ADs can last a LONG time after the medication is stopped, so it is important to be careful when using these medications.

    With ANY medication it is important to start low and go slow - start at the lowest dose and increase slowly. medications have to be at the therapeautic level before you know if they will work. Sometimes it takes weeks or months to know if they are working.

    Also good to remember is to make ONE medication change at a time. Let the medication change have time to work before you add/change another medication. It can seem to take forever, but if you change more than one medication you don't know what each one is doing.

    I hope this was a bit clearer than mud - Sara PA is a really good medication resource. She has really educated herself about them.
  13. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    klmo, there are more issues with early development, black/white thinking, lack of appropriate play with toys and eye contact, uneven IQ testing, more social issues, demeanor, speech patterns, gait, the way the child relates to the examiner, stims that only a practiced eye can catch, lots more that I don't know. They are two completely different disorders. One is psychiatric (brain disorder) one is a neurological difference. Another issue can be how hard it is for an Autism Spectrum Disorders (ASD) child to transition from one activity to another. It may not just be hard for him, it may seriously confuse him. YOu need an evaluator who is famililar with Autism Spectrum Disorders (ASD) otherwise he may be way behind the times. That's why so many ASDers are misdiagnosed, especially as ADHD and/or bipolar.
  14. TerryJ2

    TerryJ2 Well-Known Member

    Whew. So many things to think about.
    My difficult child seems to be both, reading your notes.
    Gotta go--we're visiting again.
  15. smallworld

    smallworld Moderator

  16. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I think this is probably more true of bipolar people...well maybe not even bipolar people but ODD, CD and later on ASPD.

    That statement couldnt describe Cory more if you put his name in the place where it states "Bipolare in kids". Rules never apply to him and he has never learned from consequences. We used to describe him as the kid that if we told him the stove was hot he would go back 100 times to test that theory...and if just once...he found it wasnt hot...he had to start all over again to test that theory out again. So in essence...if he ever got away with something...he would keep doing it because the probability was he could get away with it at least part of the time. No one could catch him all of the time.

    I am bipolar and I think just the opposite. I dont want to get in trouble so I try my hardest not to do things wrong. It bothers me to get in trouble. Of course, I also have borderline and that may play a roll in that.
  17. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    If a child is Autism Spectrum Disorders (ASD), he shouldn't be on a mood stabilizer unless he also has co-morbid bipolar...and be careful. Autism Spectrum Disorders (ASD) moodiness is not the same as uncontrollable bipolar moodswings (I am sure my son is much happier than I was a kid--I was swinging from high to low, out of control, rebelling because I was so miserable PLUS the chaos excited me WHEN I was both hypomanic and very depressed). I was sure I was crazy.
    My son does not act out--if anything he has a flat affect, which is more an Autism Spectrum Disorders (ASD) trait than bipolar. However, my son CAN become quite animated with people he is comfortable with.
    It's a very narrow, scary path we walk. We want what is best for our kids and we turn to so-called experts, but often THEY don't even know what is wrong with the child. For kids with speech delays, obsessions, stims...that points to Autism Spectrum Disorders (ASD). Bipolar kids/mood disordered kids (of which I was one) are plain ole miserable and can't keep it inside (at least not at home). Also, bipolar kids are drama queens/kings. Autism Spectrum Disorders (ASD) kids get involved in dramas due to their cluelessness, but they don't like Center Stage and lament that they got themselves into still another mess that they can't understand.
    Anxiety is big with both, however bipolars tend to have phobias whereas ASDers tend to fear new places, new changes, transitions, new people, new anything.
    It can get very confusing, but it is not good for an ASDer to get bipolar supports nor will it help a bipolar to get Autism Spectrum Disorders (ASD) supports.
    I wish I had answers. God bless our neuropsychologist, who finally "got" my son or maybe he'd be a mess too :<
  18. TerryJ2

    TerryJ2 Well-Known Member

    Thank you all. And gcv mom, for the "atta boy." :)

    I re-read the notes and truly, difficult child seems to have both.
    In reg to difficult child transitioning, I can see where it could be Autism Spectrum Disorders (ASD) and/or bipolar. He used to totally melt down when he was little, but now he either gets angry and just yells, "WAIT!" until he finishes what he's doing (which may take a half hr) or he rifles me with-a zillion questions. Anxiety.

    He's got lots of control issues. For ex., we have to buy a guitar for a class at school, and husband has Tue off. So he and I plan to buy one Tues. But difficult child wants to be there, and he can't. He doesn't get out of the psychiatric hospital until Thur. So now he's all upset about it and insists we wait until Thurs. He just harps on stuff until he either gets his way, or it's taken out of our hands, (such as a baseball game cancellation by rain).

    The psychiatric hospital has not had us sign any more medication releases so I think he's still on the Adderal and the Klonipine.

    We're still in the diagnosis part, and haven't gotten back any blood tests, (I think the dr's day is Tue because they do not allow visitors). To recap, the soc wkr did not sound hopeful about anything definitive, just not to rule out anything. Not even schizophrenia. That would give me a meltdown. There is so little you can do for it.

    Today when we saw difficult child, he was more down, and had circles under his eyes. They had a Labor Day family visit day and we all ate cafeteria food. difficult child chose a cookie (wheat) and hamburger with-half a bun. :( Also, drank red juice. :( :(
    He wasn't very hungry ... just took a few bites. You can tell he's still on the stims. He gets hungry at night when they wear off, but the night treat is usually ice cream, which they will not serve him. He's going to eat up a storm when he gets home!

    One thing I want to do when he gets home is to keep his room stripped and clean. The lack of clutter is a calming force. That's true with-anyone, but with-difficult child's, more so.
    The first time I stripped his rm, last yr, he was so calm, I was shocked by his reaction. He actually liked it that way.
    Problem is, the last meltdown caused more broken dresser handles, more gouges in the door, more torn paper, more sticky stuff on the floor, so some of that doesn't always go away. I pulled a muscle in my thigh, way high up by my hip, so it's really cut into my activities, incl painting (can't sit too long), cleaning, gardening, etc. I've got to get it clean b4 he comes home Thurs.

    by the way, you can tell the diff between the pts and visitors by who is wearing shoes, and who is wearing socks. Pts are not allowed shoes. :) Frankly, it's pretty obvious by the people's demeanor, too. The kids are either really depressed or really, really hyper.
    Today difficult child seemed depressed. He is very homesick.

    Don't know if I mentioned that the soc wkr is Chinese, and has a very heavy accent. I understand every 6th word. The psychiatrist was Indian or something. What's with-that, with-hospitals? They must be interns. I can't wait to get things in writing. :)
  19. TerryJ2

    TerryJ2 Well-Known Member

    One Q for you all: if you had to choose, which would show a lack of boundary comprehension more, bipolar or Asperger's? That's one of difficult child's biggies. That, and anger issues.
  20. susiestar

    susiestar Roll With It

    I don't know on the boundary issues. Boundaries only meant anything to Wiz if they were HIS boundaries. As in - no one could come into HIS room but he could go into anyones room. Not sure how someone with bipolar sees it.

    I tihnk it goes with many many disorders.

    Can you get an Occupational Therapist (OT) to teach you brushing therapy? It made a huge difference in thank you, and after I learned it I tried it on Jess and Wiz. The Occupational Therapist (OT) said as long as I followed the protocol it wouldn't HURT, so it was worth a shot. It really really calmed Wiz down. Esp when he was up late and couldn't sleep. I know, you really need 1 more thing, but this is non-medication, non-invasive (can be done on bare skin or over clothes), and can be SO helpful. It is for sensory integration problems, but most of our kids are sensitive to things anyway. So with-o the full fledged diagnosis of Sensory Integration Disorder (SID) it could still be helpful.

    Sorry about the hard to talk to sw. Can you ask for someone to be in the session with you to help you understand? You are paying an awful lot to have this person work with you. Seems counter-productive to have a sw you can't understand. You have a responsiblity to understand what this person says. If you don't, they can't help you or difficult child. And heaven knows if you are giving the answers you mean to give if you can't fully understand the questions. At the very least take a voice recorder into the session so you can listen to it at home and hopefully understand more of it.

    I am sorry he is depressed. Can they give him a different night time snack? Can the docs order it if you have something from his doctor saying he needs to be wheat free? I would have thought that this would be available, given how many kdis are helped by the girlfriend/CF diet. I just hate to think of him being hungry all night. If nothing else could you make some homemade granola? I know the sugar is high, but he may need that. I can send you my recipe - you can adjust it to whatever works for his diet. It is easy to make and quite inexpensive. It just hit me - is oatmeal gluten free? I think it is. Anyway, I add protein powder to it, so that would also help if you have a soy protein powder.