what does mania look like?

[pepperidge]

I was looking for an article I had found on Fetal Alcohol Effects (FAE) that described the more charming parts of my Fetal Alcohol Effects (FAE) child. Did't find it, but found what is below instead. It does a pretty good job.


I also wanted to emphasize that at some point I think my child might have been diagnosed as BiPolar (BP). But as he grows older it really doesn't fit as a diagnosis. I would worry less about the diagnosis and more about seeing if there is any medications that help, whatever the diagnosis. I think that FA may complicate all the attempts at diagnosis. I was glad to have found a psychiatrist who believed that things like Tenex could have paradoxical reactions and trusted our observations about medications. Focus on the specific behaviors that you are trying to deal with, and don't worry about trying to find the correct diagnostic box to fit them in--or at least in any detail. He probably does have some aspects of ADHD. He probably does have difficulties with emotional regulation which look like mood disorders. He may have anxiety. He may have BiPolar (BP), but he may have lots of issues that look like BiPolar (BP) but have more to do with FA, his earliest years, and other things.

Good luck talking to your docs.

Here's what I found below on the web:



I was talking with a friend today and we were discussing what it is like to live with a child who has Fetal Alcohol Syndrome or Fetal Alcohol Effects. It is not easy.

There are several behavioral issues that are directly associated with fetal alcohol that drive most parents crazy. Even when you understand where these behaviors come from, they are still maddening.

Lack of impulse control – Children with fetal alcohol have poor impulse control. If they see something they want, they take it. Before or after the “event” they can tell you what people don’t take things that don’t belong to them and they probably can tell you what the consequences are after the event but in that moment, they cannot control their impulses.

Lack of cause and effect thinking – Fetal alcohol damages portions of the brain and one of them is the cause and effect center. These children do not understand that if you do A, the result will be B. This also manifests itself in different learning disabilities. Math is a cause and effect subject. If I add 6 to 3, the result will always be 9. There is no way around that. For kids with fetal alcohol issues, these concepts are difficult to understand. Even with consistent parenting, they will not remember what the consequence is for stealing, not doing homework, or the various other things that you normally assign consequences for.

Lack of empathy – I don’t know why this is so prevalent in kids with fetal alcohol issues. Maybe it goes along with attachment disorder and abuse that kids suffer, or maybe there is a different neurological explanation, but it is hard to live with either way. When your child hurts someone and does not feel badly about it, you wonder and worry.

I don’t know – You ask your child why a certain behavior happened and your child answers with “I don’t know” and you want to scream. The truth is, your child doesn’t know. They don’t know why they took the $20 from your purse. The answer you may get is “I wanted it” which goes along with the lack of impulse control. Our kids don’t understand why they do what they do and our inability to understand is just as frustrating.

Disrespect – Disrespect stems from the lack of impulse control mentioned above. The children feel like doing something, so they do it. They feel like cursing at you, so they do. They feel like hitting one of your children, so they do.

These are difficult things to live with every day. I fully understand that. I lived with it for years. Of all of my son’s mental health issues, I think this is the most difficult one to handle.

 

[gcvmom]

FWIW, my difficult child 2 behaved EXACTLY as you are describing your difficult child's behavior when we tried Tenex AND he was also on a stimulant at the time. I got the "that's not supposed to happen" response from the psychiatrist but in the same breath he said he thought that we weren't dealing with ADHD anymore (based on this response and five years of history with our difficult child).

Like Smallworld said earlier, I'd seriously consider stopping either the stimulant he's on now or the tenex-based medication... or like we did, a complete medication wash. Then we started him slowly on a mood stabilizer, but then we had the luxury of summer vacation coming and could do that.

I hope you can get him settled back down soon. I know my difficult child did not like feeling that way, and I can imagine it's a bit unsettling for yours to a certain extent, too.

 

[agee]

Pepperidge - you'd right - it's not the diagnosis we realy need, it's the behaviors we need treating.
The description you have of the Fetal Alcohol Effects (FAE) kid is my son.
No impulse control.
No empathy. He'll say sorry but it is never genuine. He knows that's what he's supposed to say.
So far no problems with math, but he's only in 1st grade so time will tell. He is actually very bright, which is one reason why it would be hard to diagnosis him Fetal Alcohol Effects (FAE).
And oh MAN does he have the disrespect, and yes, I can tell it's from the impulse control. The words come out of his mouth without him thinking at all. Anything I say no to - and that happens a lot, since he also wants to do everything and anything inappropriate - I get called names. But at least he asks! That's a step in the right direction.
~~~~~~~~~~~
He went to sleep. I gave him melatonin, which will usually turn the switch. I will call his dr. this a.m. to see what he says about dropping the Intuniv totally (you have to amp it up, and he's on week 2).
I'm thinking that I'll see if we can work with the medications I know do work - the imipramine and the Risperdal. Perhaps he can go up in dose. And next weekend we'll try a couple days with-o the Vyvanse, which I don't think is working any more. Then maybe over xmas break we'll look into Abilify.
Or maybe we should take him off everything and see what happens then? I wonder it would be better if he were "clean" for his neuropsychologist appointment?
A

 

[pepperidge]

This is just my opinion, but the neuropsychologist may want to see him without the Vyvanse possibly. If the other medications are positive you may want to continue them until you switch to something else--unless you are at high doses they probably don't affect cognitive functioning. Personally, if I am switching to a new medication, I like to get a baseline unless I am pretty sure what they are on is actually working.

FWIW, my son, while not bright is quite normal as far as schoolwork goes, though does have some trouble with higher order thinking. Fortunately he has escaped damage that way. Executive functioning though, boy that's a whole 'nother ballgame....

good luck, let us know what the psychiatrist says.

 

[DammitJanet]

My son was dxd with BiPolar (BP) at 13 but was on ritilan or adderal until age 11. They didnt send him into mania when he was younger though they didnt really stop the impulsive or negative behaviors. They did help with his hyperactivity and his handwriting were much better on the stims. Now after puberty, the stims were bad.

 

[jannie]

In regards to your observation of intuniv...my difficult child has just started his third week of intuniv and is currently taking 3 mg. I haven't seen any improvements and possibly things have been a bit worse. He seems to be a bit more frustrated, (screaming at us and or throwing remotes etc) however, he is getting past these moments much quicker and seems to be apologizing without prompting....so who knows. I was really hoping this would be a really good medication...

 

[BusynMember]

I have a son who has been adopted. He was exposed to drugs and alcohol. Some things you can look for regarding Fetal Alcohol Effects (FAE) are "swiss-cheese thinking" as in he remembers something one day, but forgets it the next. He can seem to lack a conscience. He doesn't learn right from wrong. He is hyperactive and emotionally liable and it doesn't respond to medication. We took my son to a very good place for Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE) in Chicago. It is known throughout the country.

My son dodged a bullet. He doesn't have Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE), but his birthmother's drug use undoubtably contributed to his diagnosis...he is on the high functioning autism spectrum. This is another common diagnosis for kids who are exposed to drugs in utero. Thankfully, L. doesn't "forget" and well understands right from wrong (and is very well behaved), but he did have a difficult time in his toddlerhood and early childhood and needed interventions.j

The neuropsychologist should be able to point you in the right direction. Often our adopted, drug exposed children require a new evaluation by a neuropsychologist every two years to see if any new stuff pops up and can be helped. Do you have any history on his birthparents? That helps too. Sadly, most of the time we have minimal history.

I don't want you to feel hopeless. My son is a great kid and I can't imagine life without him. He is just wired differently. He had two misdiagnoses...ADHD/ODD was the first wrong diagnosis (stims made him aggressive and mean). Bipolar was the next wrong diagnosis. He got this wrong diagnosis because he got manic on Prozac. He doesn't have bipolar at all, but was on bipolar medications for three years, causing side effects and obesity. He is still quite overweight although he has been off medications for five years. Sometimes I think it changed his metabolism forever because he was think before those medications, and his birthmother was listed as "medium" in build, but we don't know anything about his birthfather. I have been trying to work with doctors on the weight issue since then because L. isn't motivated to lose weight, but nothing has been found in him that would cause him to still be so hungry.

I wish you luck. These particular kids are harder to diagnose and in my opinion a psychiatrist doesn't know that much about the effects of drugs on our children. I'm glad you're seeing a neuropsychologist. Keep on checking back with us. I'm not the only one here with adopted, drug-exposed children. One last t hing, how old was he when you adopted him? Was he ever abused?

 

[agee]

So - get this - my little guy had a great day yesterday. No sign of what I'd seen before...and we had given him his next dose of Intuniv.
????
So weird.
I called his dr. and we decided to stick with it a little while just to see if he responds. He's not up to the effective dose yet. I guess it'll just be wait and see at this point.

I haven't seen any improvements and possibly things have been a bit worse. He seems to be a bit more frustrated, (screaming at us and or throwing remotes etc) however, he is getting past these moments much quicker and seems to be apologizing without prompting....so who knows. I was really hoping this would be a really good medication

Oddly enough, this is the one thing I've noticed so far (besides the speediness on Sunday). He is still calling names, being rude as h*ll, and overreacting, but he immediately says sorry. It's like he's only half a beat behind how he knows he should ask instead of a full beat. He's only at 2 mg, though, so any changes should come next week. My guy isn't *more* frustrated, really, but perhaps a little more hair-trigger to have BIG reactions like throwing stuff across the room.

I also had high hopes for this medication. Maybe I still do.
A

 

[agee]

The neuropsychologist should be able to point you in the right direction. Often our adopted, drug exposed children require a new evaluation by a neuropsychologist every two years to see if any new stuff pops up and can be helped. Do you have any history on his birthparents? That helps too. Sadly, most of the time we have minimal history.

I cannot wait until our neuropsychologist appointment. I am hoping we'll get real answers from him. We've been to so many doctors and gotten so little that is really helpful...
I don't have "proof" that his birthparents were alcoholic. I have information given to me verbally at the time of his adoption and also the fact that he was adopted from Russia. Not all kids adopted from EE were exposed to alcohol in utero, but a huge number of them were.
He actually as a very good memory. This, plus no facial features and an above average intelligence makes me think it'll be hard to get a FAC diagnosis. But one step at a time, right?
Thanks for all of your help -
A

 

[mstang67chic]

There are several behavioral issues that are directly associated with fetal alcohol that drive most parents crazy. Even when you understand where these behaviors come from, they are still maddening.

Lack of impulse control – Children with fetal alcohol have poor impulse control. If they see something they want, they take it. Before or after the “event” they can tell you what people don’t take things that don’t belong to them and they probably can tell you what the consequences are after the event but in that moment, they cannot control their impulses.

Lack of cause and effect thinking – Fetal alcohol damages portions of the brain and one of them is the cause and effect center. These children do not understand that if you do A, the result will be B. This also manifests itself in different learning disabilities. Math is a cause and effect subject. If I add 6 to 3, the result will always be 9. There is no way around that. For kids with fetal alcohol issues, these concepts are difficult to understand. Even with consistent parenting, they will not remember what the consequence is for stealing, not doing homework, or the various other things that you normally assign consequences for.

Lack of empathy – I don’t know why this is so prevalent in kids with fetal alcohol issues. Maybe it goes along with attachment disorder and abuse that kids suffer, or maybe there is a different neurological explanation, but it is hard to live with either way. When your child hurts someone and does not feel badly about it, you wonder and worry.

I don’t know – You ask your child why a certain behavior happened and your child answers with “I don’t know” and you want to scream. The truth is, your child doesn’t know. They don’t know why they took the $20 from your purse. The answer you may get is “I wanted it” which goes along with the lack of impulse control. Our kids don’t understand why they do what they do and our inability to understand is just as frustrating.

Disrespect – Disrespect stems from the lack of impulse control mentioned above. The children feel like doing something, so they do it. They feel like cursing at you, so they do. They feel like hitting one of your children, so they do.

These are difficult things to live with every day. I fully understand that. I lived with it for years. Of all of my son’s mental health issues, I think this is the most difficult one to handle.

That is my difficult child to a T. Supposedly though, biomom quit drinking when she found out she was pregnant but still smoked the pot. Maybe she didn't stop the booze soon enough? Although I know he was born "clean" as she had been in the hospital for a couple of weeks prior to his birth because of complications. He has a diagnosis of BiPolar (BP) which I don't really question....I've seen him cycle...but it does make me wonder about the drugs.

 

[pepperidge]

What I have read about FA is that the first trimester and indeed the first three weeks has the biggest potential for damage. There is some research that links drinking on specific days in pregnancy to specific types of damage. Unfotunately the reality is that even if some of the biomoms made an effort to clean up their act at some point in their pregnancies, the damage may have already been done.

Many ofthe symptoms of Fetal Alcohol Effects (FAE) are overlap with a number of the diagnosis's our children have because they all involve compromised executive functioning . Probably some of it can be helped by medications, some not.

We all struggle so hard with how to help our children gain control over their impulses. I wish I knew the answers!